Medical Claim Relations Associate

Job description

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together. **This position is eligible to work from home anywhere in the United States** Essential Functions: Operates as a main point of contact for the Medical Claims Review team for all inquiries, through both the customer service phone line, fax, and email Resolves escalated customer service calls from the bill review partner service center Resolves questions from medical providers and claims adjusters by researching claims and bills in both internal (File Handler, CLMS, Claims Center) and external (SmartAdvisor, Mitchell CEP) systems Provides information on payment status and explains bill review decisions by referencing explanation of review codes and other relevant data in the bill review system Assists customers in obtaining information regarding PPO networks and vendors used Communicates next steps for appeals to providers and claims adjusters, creates medical b...