Claims Processor Sr Assoc - (Nashville, TN)

It's fun to work in a company where people truly BELIEVE in what they are doing We're committed to bringing passion and customer focus to the business. GENERAL PURPOSE: Incumbent will be a member of the Business Service Operations Medicare claims processing team; responsible for manual review and coding of direct member reimbursement claims. Maintain appropriate turnaround for claims in accordance with contract provisions to ensure timely payment to members. Responsible for mailing documents to members as needed in addition to outreach phone calls to providers and members for additional info. RESPONSIBILITIES: Manual review of Direct Member reimbursement claims, mailing of any member letters for AORs, dismissals, and approvals. Some data entry of claims to ensure claim is coded correctly in QNXT Manual pricing/handling of claims for direct member reimbursement requests.