Roles and Responsibilities:

Process Adjudication claims and resolve for payment and Denials
Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process
Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
Ensuring accurate and timely completion of transactions to meet or exceed client SLAs
Organizing and completing tasks according to assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines