Claims Reconciliation Analyst

Ensures complete resolution and payment of all claims that are identified during reconciliation that requires processing within the agreed turnaround time and settlement.

Reconciles the claims records between Maxicare and providers including clinics, physicians and dentists.

Ensures updated information on the centralized monitoring report of all received requests for reconciliation.

Coordinates with other units to resolve the payment issues and concerns.

Escalates issues encountered or reported by the provider to the concerned unit or department for their handling or recommendation or approval.

Requests and secures Clearance Certificate from providers.

Analyze trends in claims data to identify root causes of discrepancies and recommend solutions to prevent future errors.

Develop and maintain strong relationships with providers to facilitate open communication and timely resolution of reconciliation issues.

Prepare reports and presentations on reconciliation performance metrics and findings for management review.

Serve as a subject matter expert on claims reconciliation processes and procedures, providing guidance and support to colleagues as needed.