Insurance Healthcare Representative
- Janesville, WI
What you'll be doing
- Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs. Participates productively as a member of a team. Completes tasks beyond general support level. Accepts instruction and direction from leadership. Identifies, prioritizes and resolves some issues independently, and escalates more complex questions or issues appropriately. Complies with contract requirements, business unit rules and related and legal regulations.
What your background should be
- Prior office or clerical experience is required. Ability to follow written policies and procedures. Ability to access and retrieve information using a PC and basic understanding of Microsoft Office products. Ability to follow procedural guidelines. Good written and verbal communication skills, including professional telephone skills.
Required Schooling / Training
- High school diploma or equivalent.
Who is the client company
- This is the American global information technology company.
- If you are interested in this position, send your resume to email@example.com