The Claims Examiner is responsible for processing and adjudicating medical, dental, vision, and mental health claims while ensuring compliance with policy guidelines. They also conduct claims research, manage overpayment recovery, and resolve appeals to maintain accurate financial records.
The Claims Examiner is responsible for processing and adjudicating medical, dental, vision, and mental health claims while ensuring compliance with policy guidelines. They also conduct claims investigations, manage overpayment recoveries, and resolve appeals while maintaining professional rapport with providers and clients.
The role involves providing legal counsel and transactional support for procurement, healthcare operations, and technology-enabled business initiatives. Responsibilities include drafting and negotiating complex commercial agreements while collaborating with cross-functional teams to mitigate legal and operational risks.
The RN Case Manager is responsible for creating, implementing, and monitoring treatment plans to help members achieve their healthcare goals. They will coordinate care, assess clinical status, and identify cost-effective resources while maintaining compliance with medical necessity guidelines.
Provide comprehensive legal counsel on healthcare regulatory matters and serve as a primary advisor to business units on federal and state requirements. Monitor regulatory trends, conduct risk assessments, and develop compliance policies to mitigate organizational risk.
