Job Description
* Analyzes and adjudicates routine claims, determining approval on file, eligibility, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.

* Responds to routine phone inquiries and written correspondence related to claim processing issues and/or needs.

* Screens and routes complex claims to claim manager.

* Proofs claim, review, and apply appropriate guideline, coding, member identification, and processes in appropriate turn-around-time.

* Facilitates training in accordance with operational guidelines and manages claims assignment

* Navigates multiple systems to obtain necessary data to adjudicate claims appropriately.

* Ensure payments and/or denials are made in accordance with company practices and procedures.

* Collaborates with customer service team requesting and/or providing feedback and follow up to assist in treatment as well as claims au...