Remote worker with 4+ years of experience - Last seen 2 years ago

Health Insurance SME with 25 years of experience in claims auditing of regional and national payors claims administration and reimbursement methodologies for employer-sponsored health plans due diligence and performance guarantee. Audit findings and recommendations for improvement are included in client deliverables and discussed during the exit interview with payor audit management and client C-Suite executives.

Root cause analysis of confirmed and potential errors identified in the audit.

Research and resolution of appeals and grievances.

Provider Relations Representative managing the daily service delivery to 250+ medical providers (professional, facility, ancillary). Conducting onboarding and resolving provider reimbursement concerns.

Create training for the claims team based on audit findings.

🛂 Nationality	🇺🇸 United States
🏡 Residency	🇺🇸 United States
📍 Location	🇺🇸 United States
Remote OK	rok.co/@wendy_r
LinkedIn	sdfljasfjkhsdfajsf ⭐️ Upgrade to Premium to contact
Skilled in	auditor claims appeals grievances contract interpretation plan documents stop loss fee schedule claims policy procedure trainer employee benefits customer success manager psychology
Fluent in	english
Preferred timezone	0,+1 +2,+3
Preferred annual pay (min)	$80,000/year
Preferred hourly pay (min)	$40/hour
Last seen	2 years ago
Signed up	2 years ago
Badges	👩‍💻 Remote worker 🎖 Early adopter