Adjudicator, Provider Claims (must reside in Kentucky)

Job Title

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. This position requires substantial time on the phone as the candidate will be responding to incoming calls from providers regarding claims inquiries and adjusting claims as needed while on the phone with the provider. The ideal candidate should provide excellent customer service, support and issue resolution.

Candidate will be supporting the Kentucky Health Plan and will need to work the 9:30am ET through 6:00pm ET shift.

Essential Job Duties

• Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. • Collaborates with the member enrollment, provider information management, benefits configuration ...