Claim Adjudication

• Conduct expert individual claim adjudication within internal quality standards, delegated authority limits, and client response timelines.
• Identify coverage and payment discrepancies, address and resolve coverage anomalies.
• Proactively identify, assess, manage and resolve claim evidence inconsistencies with clients.
• Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
• Archive all claim documentation in an appropriate and orderly manner, perform required claim file follow‑ups.
• Utilize data management and claim system software and tools effectively to adjudicate and monitor claim risks.

Client Management

• Establish strongly positive, beneficial long‑term client relationships through professional, timely, and knowledgeable communication.
• Monitor client claim results and provide accurate client information on a ...