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, Strong verbal and written communication skills.
Key responsabilities:
- Review and resolve member and provider complaints
- Research claims appeals and grievances
- Request and review medical records as needed
- Prepare summary correspondence and document findings
- Resolve and draft responses to claims requests