Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses/planning and reporting. Includes claims-related business and systems analysis. Ensures data integrity, data security and process optimization.
Answering questions/emails regarding Coordination of Benefits in a high volume/fast paced environment
Assisting with research as needed
Participating in projects as an SME
Working with the electronic provider COB
Providing research and testing for system deployment
Ensuring accurate coding
Identifying and defects and root causes
Analyzes and investigates.
Provides explanations and interpretations within area of expertise.
Uses pertinent data and facts to identify and solve a range of problems within area of expertise.
Investigates non-standard requests and problems, with some assistance from others.
Works exclusively within a specific knowledge area .
Prioritizes and organizes own work to meet deadlines.
Provides explanations and information to others on topics within area of expertise.
Strong knowledge of the Unet claim application, claim processing/rules.
Fundamental/detailed knowledge of COB & Medicare guidelines
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