within ERISA standards through the claim review and investigation process Respond to all inquiries generated relative to Life... in reviewing, researching, investigating, negotiating, processing and adjudicating Life claims. Authorizes the appropriate payment...
and root cause analysis for claim quality remediation Uses pertinent data and facts to identify and solve a range of problems... Resolution, Claims, and / OR Provider and Network Service Operations (i.e., claim payments / adjustments, appeals, SOP adherence...
Analyst will play a critical role by partnering with clients and Optum RX stakeholders to assess, define, and perform pharmacy... benefit requirements and performance guarantees. Assets needed for an Associate Benefits Analyst including, but not limited...
and claim testing to ensure accurate adjudication Perform peer review as assigned Research and respond to all claims... Qualifications: Certified Pharmacy Technician (CPhT) RxCLAIM or other claim adjudication experience Retails pharmacy or PBM...
of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components Align... design and configuration Partner with claim processors, member service and provider service to identify and resolve issues...