Claims Liaison Coordinator

Job description

#LI-Hybrid - Claims Resolution & Support - Serve as the primary liaison for complex escalated claim inquiries from providers, members, account management, and internal departments. - Research and resolve complex claim discrepancies, denials, adjustments, and payment issues within established service-level agreements (SLAs). - Coordinate with claims examiners, configuration, and payment integrity teams to ensure accurate claim adjudication. - Document and maintain claim processing instructions and workflows to ensure accurate and efficient processing. - Provide guidance and mentoring to Claims Liaison Specialists. - Analysis & Reporting - Perform root-cause analysis of claim errors, payment delays, and provider/member complaints. - Compile and present findings to leadership with recommended solutions. - Track claim trends and prepare reports on recurring issues, financial impact, and compliance risks. - Stakeholder Communication - Provide clear and timely communication of claim resolutions to providers, members, and internal stakeholders. - Develop strong working relationships with provider relations, customer service, utilization management, and network management teams. - Function...