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Lead Network Support Representative
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- Provides direction on corrective actions needed including but not limited to processed claims, using enrollment, benefit and historical claim processing information.
- This role will work across the enterprise to partner with key functions, including Health Plan Operations (HPO), provider contracting, provider audit, and other key implementation stakeholders, and may support multiple health plan clients.
- Respond to and resolve help desk/received customer inquiries via written, telephonic and/or various platform-type communication systems in a timely and accurate manner in compliance with organizational KPI/SLAs; provide guidance regarding complex and/or escalated inquiries.
- Provide processing instruction to claims adjudicator(s) and review payment levels to arrive at final payment determination.
- Work with provider network to solve claim inquiries and escalates issues to next level of supervision as appropriate.
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