Assist in the on-going evaluation of pricing and configuration for new and existing claims business rules including member benefits, claims editing, reference data and system functionality within the claims processing system
• Analyze explanation of coverage documents to assist with determining best approach for configuring benefits offered including member cost shares, deductibles and out-of...
Responsible for researching and resolving provider file claims edits. Analyze reports for any data corrections and processes for the Association. Responsible for the review of the provider files for Quality Control.