Job Details

The Claims / Encounter Administrator roles and responsibilities include: Services as Subject Matter Expert on state performance and regulatory reports regarding claims and encounter submissions Partners with Provider Education & Outreach Representatives to ensure prompt resolution of provider inquiries related to claims Partners with encounter SMEs to analyze and resolve encounter rejections according to regulatory requirements Monitors claims trends for quality improvement opportunities and communicates with leadership on findings Generates reports and provides health plan leadership insight into claims related trends, patterns, and causes Implements claim payment processes and encounter submission requirements to ensure compliance with regulatory requirement Implement Claim ops solutions to meet regulatory requirements Remediate gaps in existing production processes that do not meet regulatory requirements Develops recommendations for innovative approaches Youll be rewarded and recog...Claims, Administrator, Counter, Remote, Health, Processing, Technology, Healthcare