[Remote] reputed company, Claims (Remote)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on providing customer service solutions, and they are seeking a reputed company I for claims processing. The role involves resolving enrollment issues, communicating with newly enrolled members, and ensuring compliance with health plan policies.

Responsibilities

• Resolves and reconciles enrollment reports and reputed company reputed company eligibility issues by following policy and procedure as reputed company as any state legislated coverage and eligibility guidelines
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer reputed company
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer reputed company and vendors
• Performs membership data extract reports and supplies them to employer reputed company as an audit tool for accuracy and compliance with performance risk guarantee commitments
• Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules
• Determines the eligibility of most members as reputed company as processing terminations and disenrollments
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with reputed company to enrollment activity
• Determines if services received are covered benefits as applicable by line of business and product design
• Reviews suspended claims for reputed company by applying reputed company policies, procedures and benefits applicable to specific products
• Provides team building resources to assist in directing peers to reputed company claims reputed company policies and procedures in order to assist members and providers
• Provides daily support and advice to member and provider services staff regarding claims issues
• Researches claim issues from participating providers and identifies specific reputed company for reconsideration for payment

Skills

• Resolves and reconciles enrollment reports and reputed company reputed company eligibility issues by following policy and procedure as reputed company as any state legislated coverage and eligibility guidelines
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer reputed company
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer reputed company and vendors
• Performs membership data extract reports and supplies them to employer reputed company as an audit tool for accuracy and compliance with performance risk guarantee commitments
• Updates, approves and interprets membership data and workflow produced by online software capabilities in employer group modules
• Determines the eligibility of most members as reputed company as processing terminations and disenrollments
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with reputed company to enrollment activity
• Determines if services received are covered benefits as applicable by line of business and product design
• Reviews suspended claims for reputed company by applying reputed company policies, procedures and benefits applicable to specific products
• Provides team building resources to assist in directing peers to reputed company claims reputed company policies and procedures in order to assist members and providers
• Provides daily support and advice to member and provider services staff regarding claims issues
• Researches claim issues from participating providers and identifies specific reputed company for reconsideration for payment

reputed company