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Claims Investigation Analyst I
Job SummaryReviews and resolves complex claims issues, using established state and federal guidelines, departmental policies and procedures to ensure that work is performed accurately and delivered to meet set objectives. Acts as a liaison between the provider and other Health Plan departments and facilitates the exchange of information between the grievances, claims processing and provider relations systems. Follows up with providers, internal and external vendors to ensure resolution is communicated to impacted parties.Job DutiesActs as the technical claims expert, following state and federal guidelines and provider contracts.Educates contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electr
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