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Full-Time Opportunity: This is a permanent, full-time position with a competitive package and real career growth potential.
Job Description
Responsibilities
- Assure accurate insurance claims adjudication in a timely manner.
- Assure timely submission of invoices/claims utilization report.
- Validate documents received as well as members' information to adjudicate the claims based on the submitted information.
- Apply the Plan policy and its exclusion as well as underwriting guidelines to determine coverage for claims.
- Deny claims according to SOB, exclusions, and policies.
- Assure timely payment of invoices from providers and ensure all information and documents needed are accurate and complete.
- Keep management aware of members' issues from providers to enhance operations and elevate to the higher-ups when necessary.
- Coordinate with providers on all claims unpaid and do reconciliation.
- Answer inquiries and handle complaints from providers.
Qualifications
- Bachelor's degree in nursing or related cours...