Teams at Independent Living Systems, LLC

Test and validate claim adjudication system configurations, review and analyze claims and adjustments for correct pricing, identify root causes and trends, recommend policy/procedure improvements, and provide staff training and guidance on coding and policy application.

Process and review prior authorization requests for completeness and necessity, determine authorization needs, perform eligibility verification and non-medical research, route appropriate cases to Clinical Care Specialists, and communicate with providers and internal teams to facilitate timely access to care.

Serve as a clinical expert to evaluate provider performance, lead quality improvement initiatives, ensure regulatory compliance, analyze clinical data, deliver provider education, and support coordinated, patient-centered care across the health plan.