Senior Claim Data Specialist, Provider Claims

Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries. Determine whether any claim payment or denial issues are present, particularly those that may affect utilization management, enrollment, claims, configuration, network, contracting and/or provider data. Submit the necessary documents (if issues are identified) to specific areas, in an effort to ensure all is updated and corrected. Submit all projects and/or claims to be reprocessed, in order to ensure provider contracts are implemented effectively, as well as to avoid any further ongoing issues. Perform education for providers, both internal and external, when required. Attend provider group meetings, as well as individual meetings, both internally and externally. Submit projects within Microsoft Excel as assigned. Perform other duties as needed.