Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. Responsibilities may also include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data, investigate and pursue recoveries and payables on subrogation claims and file management, process recovery on claims, ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance, conduct contestable investigations to review medical history, and monitor large claims including transplant cases.Primary Responsibilities:Open, sort, date stamp, count, scan and document in case management system the receipt of file correspondence, including revenue checksDistribute correspondence to staff accordinglyAnswer incoming phone calls in a polite and professional mannerFacilitate the handling of callers' request for informationRoute calls to other staff members; take and deliver accurate and complete messages as appropriateScreen calls and initiate resolution of questions/issues without consultation with othersAssist staff and/or the management team with case investigation, research or development as neededFile Maintenance/ArchivingOther Administrative duties as assigned by managerSome work is completed without established proceduresBasic tasks are completed without review by othersSupervision/guidance is required for higher level tasks
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.