The representative will handle inbound calls from providers and members to resolve questions regarding benefits, claims, and eligibility. They are also responsible for documenting call details and adhering to specific customer service performance metrics.
The Care Coordinator supports clinicians and case managers by managing non-clinical tasks, facilitating communication between patients and providers, and assisting with patient care goals. They are responsible for telephonic follow-ups, maintaining accurate records, and directing patients to appropriate community resources.
The Claims Examiner is responsible for processing and adjudicating medical, dental, vision, and mental health claims according to policy guidelines. They also conduct claims investigations, manage overpayment recoveries, and resolve appeals while maintaining production standards.
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.
