JOB PROFILE:
Team Handling and Provide Training to new Batches in complex adjustment (rework) on UNET platform.
Auditing High Dollar claims.
Processed provider claims for payment: analyzed claims for correct billing; researched hold
codes that blocked processing; returned ineligible claims to providers; and generated member and provider correspondence when necessary.
Selected to process more complex hospital claims and Medicare ancillary claims which required higher level authorizations.
Maintained 99% accuracy record.
One of the first people to be released from training class into full production.