Offer summary
Qualifications:
High School Diploma or equivalent, Minimum 2 years operational managed care experience, Health claims processing background, Familiarity with Medicaid and Medicare claims, Knowledge of regulatory guidelines for appeals.
Key responsabilities:
- Review and resolve member and provider complaints
- Research claims appeals using support systems
- Request and review medical records as needed
- Prepare appeal summaries and document findings
- Compose correspondence per regulatory requirements