14h • General discussion
CLAIMS❕
Senior Medical Claims Resolution Specialist
1. Foster and maintain provider relationship to facilitate current and future negotiations by
* Performing claim research and analysis to provide support for desired savings.
* Generating agreement by communicating with provider by written and verbal communication throughout the negotiation process; and
* Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.
2. Meet and maintain established departmental performance metrics. Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
3. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
4. Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals.
5. Identify and seek opportunities to achieve savings with previously challenging/unsuccessful providers.
6. Participate in projects and initiatives, as necessary.
7. Collaborate, coordinate, and communicate across disciplines and departments.
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CLAIMS❕
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