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Claims Adjustment Anlst
JOB SUMMARYThe Claims Adjustment Analyst performs extensive reviews on member or provider claim issues to calculate root cause research. Researches and investigates previously paid or denied claims to correctly apply benefit determination and pricing in accordance with claims processing guidelines.ESSENTIAL FUNCTIONS OF THE ROLEPerforms extensive reviews on member or provider claim issues to learn root cause research. Documents, tracks, resolves and reports findings. Provides professional assistance to other staff, members and providers by researching and resolving claims payment issues resulting from configuration or processing errors. Follows up with appropriate department to resolve front
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