Provider Specialist
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Job Description
Position Responsibilities: Β
Reviews and processes requests from external customers to initiate long-term care claims, ensuring forms are complete and in good order to avoid delays.
Exercises sound judgment, supported by system tools, to determine claim readiness and eligibility for initiation.
Contacts policyholders (via call or system-generated letter) when submissions are incomplete, selecting the most appropriate follow-up approach.
Handles urgent vendor requests promptly to support timely claim progression.
Manages escalations related to claim initiation, requirements, or follow-ups, ensuring thorough and accurate resolution.
Utilizes multiple claims systems effectively, maintaining a strong working knowledge of each.
Performs additional tasks and responsibilities as assigned.
Required Qualifications: Β
At least 3 years of admini...