You will analyze & process claims by investigating information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
You will analyze and interpret complex coverage contracts to determine if eligibility is met.
You will liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues.
You will rovide customers with explanations of policy details and claim determination.
You will effectively utilize and implement policies & procedures regarding overall claims workflow.
You will propose and develop practices & processes to improve performance and the customer experience.
You will work as an individual and part of a team to ensure all new appeal assignments are acted on within department t...
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