SUMMARY: Work as a member of the Data Architecture Team to design/build/maintain Enterprise Warehouse solution based on data needs from
SUMMARY: Under direct supervision, this position performs the activities involved in handling the process of moderate to complex claims, including
GENERAL PURPOSE OF JOB: Respond to members and providers over the telephone, by fax or web portal with issues related
ESSENTIAL DUTIES and RESPONSIBILITIES: - Implements population based strategies in coordination with Medical Management leadership, health system and community representatives.
SUMMARY: Perform quality assurance functions as they pertain to claims transactions audits by means of identifying, documenting, and communicating information.