Job description
Summary
The Claims Resolution & Adjustment Representative: processes complex MS Medicaid Provider claims, performs claims research and evaluates claims operational reporting for contact compliance.
Your role in our mission
- Conducts reviews of MS Medicaid claims submitted via paper, web portal or EDI data interchange.
- Understands adjudication logic, policy and procedures associated with claims processing
- Evaluates and resolves claims in a suspense status based on information maintained in the operating system
- Ensure correct decisioning of claims based on approved procedures and methods of correction
- Processes adjustment and void requests
What we're looking for
- High school diploma or G.E.D.
- Experience 2 years: working with healthcare insurance and/or medical claims
- Experience 2 years: working with insurance and/or medical terminology
- Proficient in MS Office Suite including Word, Excel, Outlook and PowerPoint)
- Proficient data entry skills
What you should expect in this role
- Opportunities to travel through your work (0-10%)
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