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The Senior Claim Benefit Specialist (OPS) reviews, researches and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines. May be required to learn multiple Medicaid plans. Medical claims processing experience is a basic requirement. This role involves working to research and resolve encounter errors, ensuring all compliance requirements are met, and identifying and reporting possible claim overpayments, underpayments, scanning issues and any other irregularities.
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