Research and resolve claims disputes coming from Participating providers.
Responsibilities:
Research and resolve claim disputes by navigating company’s claims system and multiple platforms Ensure timely, efficient, accurate and compliant resolution of claim disputes Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes Identify opportunities to improve claims processing, and reduce risk and inefficiency Review claim dispute reports for data integrity and perform necessary updates Perform data entry of claims disputes Handle provider telephone calls and e-mails regarding the status of claim disputes Work with the Provider Relations team and support claim dispute escalations Communicate with internal departments as required Meet performance metrics and goals established for the pos...