Claims Resolution Analyst
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Job Description
Claims Resolution Analyst responsible for processing suspended claims and ensuring adherence to DVHA guidelines. Contributing to claims team success through efficient claims resolution and coordination across departments.
Responsibilities:
- Review and research suspended claims per DVHA guidelines.
- Refer claims to the appropriate department for further review when necessary.
- Process claim adjustments and corrections as needed.
- Prepare and issue Return to Provider (RTP) notices for incomplete or incorrect claims.
- Maintain and update claims resolution procedure documentation.
- Train backup or replacement staff as needed.
- Perform other duties as assigned.
Requirements:
- Strong attention to detail and accuracy in claims processing.
- Strong reading comprehension skills with the ability to interpret guidelines, policies, and procedures.
- Proficiency in Microsoft Excel and Outlook.
- Ability to adapt to changing priorities.
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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