DSNP Claims Resolution Coordinator

The DSNP Claims Resolution Coordinator reviews, researches, and resolves Dual Eligible Special Needs Plan claim inquiries and escalations using internal systems. This role applies Medicare and Medicaid guidelines to determine claim actions, validates benefits and eligibility, and collaborates with cross-functional teams to ensure accurate and timely processing. The position requires strong analytical skills and attention to detail to support member and provider satisfaction while maintaining compliance with regulatory expectations.