Claims Liaison I

Details: Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check 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 all plan providers’ claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related 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 forward 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
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