
Medical Claims Specialist
1 day ago
About the Role
We are seeking a highly skilled professional to assess and interpret customer needs, requirements, and medical records in our Utilization Management team.
Key Responsibilities:
- Review medical claims for medical necessity
- Analyze customer needs and determine the best course of action
- Collaborate with cross-functional teams for seamless execution of UM processes
- Maintain up-to-date knowledge of relevant laws, regulations, and industry standards
Required Skills:
- Active PHRN and USRN Mainland License
- 1 year Bedside experience, preferably with UR/UM experience
About Us:
As a leading provider of innovative solutions in the healthcare industry, we deliver exceptional results and build long-lasting relationships with clients through dedication and expertise.
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