Job Description Essential Duties and Responsibilities: Under supervision, investigates and analyzes medical claims and issues related to eligibility, benefit coverages, network, and pricing. Processes medical claims. Determines when to pay or deny claims and issues benefits while achieving the quality and daily production requirements. Answers incoming calls, emails, faxes, and written correspondence regarding customer inquiries or complaints with benefit correction requests. Analyzes and responds to requests for information and claim reconsideration reviews. Makes outbound calls to members or service providers as necessary. Models Service Excellence in all activities and interacti
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