JOB SUMMARYThe Claims Adjustment Analyst performs extensive reviews on member or provider claim issues to determine root cause analysis. 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 determine root cause analysis. Documents, tracks, resolves and reports findings. Provides expert 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
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