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Claims Analyst Job in Spring Hill, AA

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Job Title: Claims Analyst

Employer:Ultimate Health Plans Inc
Job Location:Other
Required Experience:5 to 7 years
Preferred Experience:5 to 7 years
Location:1244 Mariner Blvd Spring Hill 34608, AA, US
Date Posted:8/19/2021

Position Summary

 Responsible for supporting the daily administrative functions of the claims department.  Researches institutional and professional claims and acts as a resource to resolve escalated claims issues.  


Essential Duties and Responsibilities include the following. Other duties may be assigned.

·       Researches complex claims issues and works with all internal and external departments and providers on claims related content.

·       Work projects and provider inquires submitted from Provider Network team and/or Grievances and Appeals team.

·       Identifies root-cause issues to ensure enterprise solutions and communicate findings as needed.

·       Respond to customer service/MAT team inquiries via call routes, and manage the claims call routes within Facets

·       Manages the DMR (Direct Member Reimbursement) process and coordinates with the appropriate department to obtain any additional documentation needed to complete the processing of the request.

·       Responsible for reviewing and processing the refund checks received by providers.

·       Manages the return check process initiated by the Finance Department and coordinates with the credentialing department to obtain updated W9 for providers.

·       Conducts outreach to the providers to research outstanding checks reported by the finance department. 

·       Ability to run and analyze ad-hoc reports/projects and review provider contracts to confirm whether or not a claim is overpaid to allocate refund checks

·       Interfaces with Providers by telephone and/or written correspondence to respond to inquiries and resolve concerns.

·       Other duties may be assigned.


Please send resume to jblue@ulthp.com.

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