Our Client, a Leading Provider of Healthcare Delivery Systems and Solutions company, is looking for a Claims Resolution Representative for their Remote location. Responsibilities:

+ Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments.

+ Determine when to use a Forcible disposition to override the edit and process the claim based on operational claims adjudication procedure.

+ Review and analyze claims and follow up on the status of claims and reimbursement.

+ Interpret and apply policy and reimbursement rules to support provider inquiries.

+ Ensure accuracy and consistency in claims processing.

+ Research and review submitted claims (electronic) and process them according to policies and procedures.

+ Possess an unwavering commitment to customer service and operational excellence.

+ Perform manual pricing and audit checks...