Requirements
• High school diploma or GED.
• 3 years of related work experience in managed care and direct customer service or equivalent combination of transferrable experience and education.
• Strong computer skills to include Microsoft Office products (Word, Excel, PowerPoint and Outlook) and Internet research skills.
• Strong administrative skills to include: member and provider calls, faxing, ability to request records, communicate clearly, documentation.

Preferred
• Bachelor’s degree or equivalent work experience.
• Experience in or working knowledge of Quality Improvement Initiatives, HEDIS, Medicare STARS and Quality Rating Systems.
• Deep understanding of health insurance industry, health care systems, and provider issues.
• Advanced understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes.

Job Description
• Perform clerical functions to include; medical record request, faxing and calls to members and providers as needed.
• Maintain organized, updated reporting of activities with clear documentation.
• Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.
• Provide support to assess and analyze available information from internal and external data, and other sources as needed.