Nevada Claims Liaison

Job Summary

A company is looking for a Claims Liaison I to serve as a liaison between the plan, claims, providers, and various departments to effectively identify and resolve claims issues.

Key Responsibilities

• Audit check runs and send claims to the claims department for corrections
• Collaborate with various business units to resolve claims issues and ensure prompt and accurate claims adjudication
• Analyze trends in claims processing issues and assist in identifying and quantifying issues

Required Qualifications

• High school diploma or equivalent
• 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment
• Proficient in Excel
• CPC certification preferred
• Knowledge of provider contracts/reimbursement interpretation preferred