Operations Support Specialist - 39569SY - (US-OH-Mason - 45040)

Minimum Education: Tech School
Job Type: Full Time
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Responsible for researching and resolving pended claims. Essential duties to include, but are not limited to: Reviews and investigates pended claims to determine reason for pend. Responds to inquires from other departments regarding status of claim. Researches a variety of things to resolve claim pend, to include eligibility, provider network and other issues. May contact providers or members for additional information to resolve claim pend. Researches and resolves interface issues. Performs other duties as assigned.

Skills:
HS diploma or equivalent and 3 years experience, preferably in claims, customer service or utilization management. Utilization management experience strongly preferred. Must have working knowledge of claims payment system. Good oral and written communication skills needed. Organizational skills, along with keyboard and PC proficiency also required. Knowledge of Facets, Ultera, AMMS, WMDS, and/or Medicare Advantage required. Experience resolving Interface Issues.

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