JOB DESCRIPTION Job Summary

Must reside in Florida.

Provides senior level analyst support for claims research activities. Ensures timely and accurate resolution of provider submitted claims issues/inquiries. Leverages deep understanding of medical claims processing, analytical skills, root-cause analysis, and regulatory interpretation to effectively triage issues to facilitate complex/high priority claims investigation or correction. Develops remediation strategies, ensures timely and accurate claims project execution, and drives continuous improvement in claims performance and compliance.

**Essential Job Duties**

• Leverages claims subject matter expertise and advanced analytical skills to conduct research and analysis for provider claims issues, requests, and inquiries, and provide recommendation for remediation and resolution.
• Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims...