Position Purpose. The. Claims Examiner. is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims and other duties as necessary. Key Responsibilities. Review, research, analyze and process professional claims by navigating multiple applications and platforms accurately. Ensure that the proper benefits are applied to the claim using the appropriate tools (e.g. CMS guideli...
To support the Director of Member Services in providing a single point of contact for questions, problem solving, and access to care, for all involved in members’ care. To provide accurate, prompt, and courteous service in response to written and telephonic inquiries, from Members, Members’ Care-Givers, Primary or Interdisciplinary Care Team Members, Pharmacies, and Vendors. To facilitate quality member care and service delivery by responding to...
