As the Claims Specialist you will coordinate activities critical to the successful completion of clinical reviews projects. You will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking deliverables and deadlines, and develop project frameworks to support interdisciplinary and interagency communications. Duties include by are not limited to:
Monitor appeal/dispute status and communication received on client portals.Conduct initial eligibility reviews and recommend course of action to internal team and department management.Track and assign cases using commercial off-the-shelf and custom software applications.Monitor and measure key performance indicators.Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
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