Provider Claims Analyst
Current- Multilingual handling of technical documentation (medical, financial, etc.) to ensure that payments to providers are appropriate and within policy.- Processing of payments to guarantee procedural and financial accuracy in line with both member and provider contractual stipulations.- Usage of historical and statistical data to track payments, anticipate future expenses and apply cuts according to the reasonable and customary in each area. - Prompting interdepartmental action for transversal cases (recoveries, rectifications, urgent payments, fraud prevention, etc).- Continuous control of workflow, prioritizing and agile handling of huge amounts of payments to comply with agreed TAT, benefit from prompt payment discounts and prevent late payment penalties.
