Claims Resolution Analyst

The Claims Internal Resolution Analyst is responsible for coordinating the resolution of claims issues locally at the health plan by actively researching and analyzing systems and processes that span across multiple operational areas.

+ Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.

+ Identifies the interdependencies of the resolution of claims errors on other activities within operations.

+ Assists in the reviews of state or federal complaints related to claims.

+ Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.

+ Interacts with network providers and health plans regularly to manage customer expectati...