- CVS Health (Richardson, TX)
- …personal, convenient and affordable. **Position Summary** As part of the Rx Claim Adjudication team, you will be expected to be proficient in all critical functions ... of the application development and will champion SDLC methodologies with a deep understanding of best practices to ensure that quality standards are met. We believe for success you should have flexibility, possess a positive outlook, discernment, and inspire… more
- CVS Health (Woonsocket, RI)
- …insights and actions **Required Qualifications** + 2+ years of experience with pharmacy claims adjudication and NCPDP standards + 3+ years of analytical ... be responsible for facilitating effective solutions related to the adjudication and processing of pharmacy claims and...to the adjudication and processing of pharmacy claims and newly expanded healthcare services. Create and ensure… more
- BrightSpring Health Services (Englewood, CO)
- …Adjudication Specialistwill be responsible for all aspects of pharmacy and medical claims adjudication , accuracy of pharmacy and medical claims , ... Paid Time Off & Holidays Responsibilities + Processes pharmacy and medical claims accurately and efficiently, ensuring compliance with payer policies and guidelines.… more
- AON (NY)
- Aon is looking for a Claims Specialist II Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your ... through verbal and written communication. Skills that lead to success: + Claims adjudication experience. + Excellent writing and verbal communication skills . +… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** Responsible for the supervision of Commercial claims adjudication . Essential job functions include ensure that quality and productivity ... develop training and in-service initiatives. Oversee all quality improvement initiatives for Claims unit. Oversee the Provider Service Unit to ensure that service… more
- State of Massachusetts (Boston, MA)
- …counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication , claims settlement, claims ... *Lead Claims Examiner/Job Service Representative II| Department of Family...completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process… more
- Kelsey-Seybold Clinic (TX)
- …to foster and sustain training program associated with Commercial and Medicare Advantage claims adjudication procedures, address the training needs for Claims ... experience in Healthcare Claims Operation Experience with Facility and Professional Claims Adjudication Knowledge of Medicare Claims Processing Previous… more
- Sedgwick (San Antonio, TX)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (West Des Moines, IA)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Brea, CA)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Honolulu, HI)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- UCLA Health (Los Angeles, CA)
- …compliance. You will be responsible for implementing and maintaining efficient claims adjudication processes that utilize technology to automate workflows ... Coding Initiative (NCCI) edits and their relation to clinical logic in claims adjudication + Experience with Microsoft Office Suite (Excel, Word, and PowerPoint)… more
- University of Utah Health (Murray, UT)
- …team environment. + Performs routine and complex audits on phone calls and claims adjudication . + Researches claim processing problems and errors to determine ... mission. EO/AA_ + This position is responsible for auditing claims and customer service calls for UUHP. + The...those findings in reports for management. + Ensures proper adjudication policies and procedures were followed as well as… more
- Sedgwick (Albany, NY)
- …for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workers Compensation Claims Team Lead | NY Licensing Required We are...ideal candidate will have at least 5 years of claims handling experience, with a strong background in New… more
- Healthfirst (CO)
- … configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate claims payment. + Aid in ... + Assist in the on-going evaluation of configuration for new and existing claims business rules including member benefits, claims editing, reference data and… more
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... 011250 CCA- Claims **Position Summary:** Working under the direction of...the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr.… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements of LA Care. Track and trend the metrics associated with the claims adjudication . Prepare and present written and verbal reports. Research complex ... Supervisor, Claims Job Category: Claims Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11739… more
- Sedgwick (New York, NY)
- …for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workers Compensation Claims Team Lead | New York Jurisdiction | Dedicated Client We are… more
- Independent Health (Buffalo, NY)
- …relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication . + Analyze, identify and research, as needed, edits ... first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Claims Adjudicator shall be responsible for adjudicating claims against… more
- Banner Health (Tucson, AZ)
- …IT to implement claims systems edits to reduce overpayments and increase claims auto adjudication . Lastly, this position provides support as a clinical ... innovative employment options by offering remote and hybrid work settings. As a Director, Claims Recovery Unit, you will lead a small team and support three vendors.… more