To provide technical support and act as a contact point for the Medical Claims Unit/Assigned Claims Unit resulting in proper disposition of claims, develop, implement and manage proper processes and procedures.

Advanced knowledge of computer systems, keying functions including but not limited to letter composition, log entry, time entry, and diary entry.

Review medical bills for validity including processing through the fee schedule as applicable and issue payments as warranted. Coordinate use of outside investigators and medical examinations as directed.

Enhanced ability to review, develop, and maintain medical claims processes including provider line inquiries.

Required:

• Bachelor’s degree required or equivalent experience.
• Minimum three to five years’ experience required. Successful track record in building relationships.
• Proven successful track record in building positive relationships required. Willingness to pursue continuing job-related training and education required.

PM19