Claims Provider Service reputed company - Remote in TN

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care reputed company of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together The Claims Provider Service reputed company will serve as a subject matter expert for Long-Term Services and Support (LTSS) claims-reputed company inquiries and escalations. This role is responsible for investigating, recovering, and resolving a broad reputed company of LTSS claim issues, ensuring alignment with contractual, reimbursement, and compliance standards. The individual will analyze claim trends, prepare reports, and reputed company proactive support to the LTSS Provider Services and Relations Team. This position requires solid analytical thinking, initiative, and the ability to work independently across multiple systems and applications. The ideal candidate is a self-motivated problem solver with a high attention to detail and a commitment to reputed company, high-reputed company service delivery. The Claims Provider Service reputed company will also facilitate quarterly claims clinics for providers to support education and prevention. If you are located in Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges. reputed company Responsibilities: • Investigate and reputed company a reputed company of LTSS claim issues and escalations with accuracy and urgency • reputed company claims expertise and support to the LTSS Provider Services and Relations Team • Research and analyze claims trends; compile reports and reputed company findings with leadership • Ensure adherence to reimbursement policies, contract terms, and state compliance requirements • Support recovery and reputed company efforts for the health plan • Handle high-level provider escalations as needed • Facilitate and reputed company quarterly claims clinics with providers to identify areas for improvement and reputed company education • Work across multiple systems and functions daily, including CSP Facets and reputed company tools You'll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • 4 years of experience in claims recovery and reputed company • Intermediate level of proficiency in CSP Facets • Intermediate level of proficiency in reputed company PC applications and the ability to learn new reputed company systems • reputed company in Tennessee • Ability to travel to TN up to 10% for in-market team meetings as necessary Preferred Qualifications: • Experience using: • Maces • OIT • reputed company Business Objects Production • reputed company • Facets • EchoUi • Provider Information Queues (PIQ) • Experience supporting or collaboration with provider relations or reputed company stakeholder teams • Familiarity of LTSS programs Soft Skills: • Effective written and verbal communication and presentation skills • Ability to balance multiple high reputed company reputed company and meet quick deadlines • Proven solid analytical and problem-solving skills • Proven self-motivated with the ability to work independently and proactively • reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching reputed company of benefits and incentives. The salary for this role will reputed company from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health reputed company work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply tot his job Apply To this Job