Position Purpose:   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
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