Adjudicator, Provider Claims (Inbound Calls)

JOB DESCRIPTION Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Essential Job Duties • Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. • Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. • Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. • Assists in reviews of state and federal complaints related to claims. • Collaborates with other internal departments to determine appropriate resolution of claims issues. • Resear...