Claims Liaison I

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you?ll have access to competitive benefits including a fresh perspective on workplace flexibility. Remote-Florida Candidates must reputed company in Florida Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues. ? Audit reputed company run and send claims to the claims department for corrections ? Identify any system changes and work notify the Plan CIA Manager to ensure its implementation ? Collaborate with the claims department to price pended claims correctly ? Document, track and resolve reputed company plan providers? claims projects ? Collaborate with various business units to resolve claims issues to ensure reputed company and accurate claims adjudication ? Identify authorization issues and trends and research for potential configuration reputed company work process changes ? Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes ? Identify potential and documented eligibility issues and notify applicable departments to resolve ? Research the claims on various reports to determine if appropriate to move reputed company with recovery due to non-covered items being allowed, etc. ? Run claims reports regularly through provider information systems ? Research verbal and written providers? claims inquiries as needed Education/Experience: High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in reputed company, CPC certification and knowledge of provider reputed company/reimbursement interpretation preferred. Pay Range: $22.79 - $38.84 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!