Read, review, and analyze claims for complete information.
Conduct a thorough investigation of disclosure information and
Monitor, track, review, analyze, adjudicate, and compile results
of completed BIs
Determine appropriate copay, coinsurance, and deductible
information according to plan documents.
Adjudicate claims appropriately using departmental procedures
and guidelines as applicable.
Send appropriate correspondence to providers/members requesting
additional information as needed.
Meet or exceed productivity and quality requirements.
All other duties as assigned. This list is not intended to be an
all-inclusive representation of the responsibilities of this
position but instead, is intended to present a summary of its major
functions. Specific assignments may be changed at the discretion of
Excellent written and verbal communication skills.
Excellent analytical skills.
Ability to identify and investigate insurance disclosures and
Excellent organizational skills.
Ability to work independently.
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