MotivHealth

Claims Specialist

• Load, review and adjudicate complex claims submitted by providers and members electronically and by paper
• Manage and perform adjustments, reconsiderations and other advanced claim processes
• Consistently exceed processing accuracy and volume standards where appropriate
• Research and resolve complicated claims, quality concerns, and other member or provider issues
• Participation with external parties regarding Subrogation, Other Payer Liability, High Dollar Claims, Stop Loss and the like
• Serve as the point of contact for Claim Processors and Personal Health Assistants claim questions and issues
• Identify and explore trends, patterns and issues that require tool or process changes
• Maintain compliance, privacy and confidentiality in all documentation, communications and correspondence
• Contribute to team wide goals to improve claims processes and integrate additional functions into our operations