ESSENTIAL JOB FUNCTIONS:Adjudicates complex professional and institutional claims.Responsible for meeting performance measurement standards for productivity and accuracy.Adjudication of claims adjustment.Follow all appropriate Federal and State regulatory requ…

JOB TITLE: Appeals and Grievance Coordinator FLSA STATUS: Non-ExemptDEPARTMENT: Appeals and Grievances REPORTS TO: Supervisor, Appeals & Grievances JOB SUMMARY: Responsible for reviewing and resolving member complaints and appeals and communicating resolution …

JOB SUMMARY: Is responsible for adjudicating complex claims which include high dollar claims. Responsible for accurate manual/auto pricing of claims. Identify provider billing issues that impact claims processing. Works closely with the Supervisor to identify …