- Conduent (El Paso, TX)
- …Claims Processor** **$15.00 per hour & Great Benefits!** **Job Details:** + You will receive Dental Claims to review and process according to a set of ... the instructions. + Working with multiple windows to process claims within the established claims per hour...of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a… more
- Centene Corporation (Atlanta, GA)
- …policies and standards **Education/Experience:** DDS/DMD degree required. 5 years of experience in dental claims and knowledge of dental or orthodontic care ... Clinical Director provides professional judgment to adjudicate prior authorization, claims , and appeals submissions to help Envolve Dental appropriately… more
- Point32Health (MA)
- …performing clinical reviews of provider claims payment disputes, perform retrospective claims audits of medical records, and review potential quality of care ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment… more
- CareFirst (Baltimore, MD)
- …policy, quality improvement, disease management, utilization review , and dental /medical claims review , network recruitment, credentialing, provider ... **PURPOSE:** Responsible for clinical and provider network management for dental organization. Directs daily departmental activities that generally include care… more
- Elevance Health (Las Vegas, NV)
- …internal business processes, and internal local technology is highly preferred. + Dental claims experience preferred. For candidates working in person or ... with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable… more
- Elevance Health (Columbus, GA)
- …internal business processes, and internal local technology is highly preferred. + Dental claims experience preferred. Please be advised that Elevance Health ... with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable… more
- CareOregon (Portland, OR)
- …Skilled in at least one healthcare data domain (eg, medical claims , pharmacy claims , dental claims , clinical data, etc.) + Skills with Business ... data structures and data products to facilitate production of insights from healthcare claims , enrollment, and other related data. The core function of this position… more
- CareOregon (Portland, OR)
- …Experience with at least one healthcare data domain (eg, medical claims , pharmacy claims , dental claims , clinical data, etc.) + Experience in the ... data structures and data products to facilitate production of insights from healthcare claims , enrollment, and other related data. The core function of this position… more
- The Cigna Group (Bloomfield, CT)
- …and Change Lives? EviCore, a division of the Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. For this highly technical role, ... you'll review our claims system to ensure all...you'll be offered several health-related benefits including medical, vision, dental , and well-being and behavioral health programs. We also… more
- Robert Half Accountemps (Los Angeles, CA)
- …We are offering a contract to permanent employment opportunity for a Medical Claims Review Coordinator in Los Angeles, California. The individual will be ... * Develop guidelines for examiners to use in evaluating whether certain types of claims may require review . * Work collaboratively with legal counsel on cases… more
- Equitable (Charlotte, NC)
- …and network development, compliance and management + In-depth knowledge of group dental and vision products, claims , contracts, underwriting, risk management and ... Director of Dental & Vision Product Management ( 240000H5 )...KPI's,) to assess and improve product development practices + Review existing product development lifecycle methodology and practices and… more
- TEKsystems (St. Louis, MO)
- …code, procedure analysis, X-ray, Hygiene, Clinical research, Customer service, Clinical trial, Dental claims , excel analysis, excel data entry, google sheets, ... project coordination, microsoft office, microsoft excel Top Skills Details: dental imaging software,multi tasking,data analysis,project planning,project scheduling,documentation review… more
- Delta Dental of Iowa (Johnston, IA)
- …guarantees and develop and implement corrective actions as necessary. + Participate in the claims policy processing matrix and CDT annual review . + Establish and ... Claims Supervisor - System Configuration Johnston, IA (http://maps.google.com/maps?q=9000+Northpark+Drive+Johnston+IA+USA+50131)...Us! Are you ready to lead with purpose? Delta Dental of Iowa is seeking aClaims Supervisor - System… more
- HUB International (Columbia, SC)
- … advocate and facilitator on behalf of the client + Consultation with clients on claims issues + Review and recommend solutions to coverage, quantum and claim ... programs. + Review and comment on policy wording for account teams + Review of claims with clients/insurers/loss adjusters regularly + Work with clients to… more
- Providence (NM)
- …other Liability Claims under the PSJH Insurance Program** **:** + Review and analyze medical records, interview witnesses, assist with the discovery process and ... them._** **Providence Health Plan is calling a General Liability Claims Manager, Healthcare who will:** + Be responsible for...of exposure + Select appropriate medical experts for case review + Develop a plan of action for assigned… more
- Providence (WA)
- …empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, Evaluate, and Manage Professional, General and ... other Liability Claims under the PSJH Insurance Program:** + Communicate with...+ Communicate with patients, claimants, caregivers, providers, leadership + Review and analyze medical records, interview witnesses, assist with… more
- Metropolitan Council (St. Paul, MN)
- …leave. + Investigate and pursue subrogation, as appropriate. + Participate in bi-annual claims meetings with internal departments. + Review medical, legal, and ... Workers' Compensation Claims Representative II - REPOST Print (https://www.governmentjobs.com/careers/metrocouncil/jobs/newprint/4511198) Apply...Benefits + Questions WHO WE ARE We will NOT review resumes or cover letters for this position, so… more
- LA Care Health Plan (Los Angeles, CA)
- …performed within the department. The Claims Quality Auditor researches on complex claims problems. Duties Performs high quality review of payable and post ... in a rapidly changing work environment. Perform random review of claims audited by the Quality...(PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision + Wellness Program + Volunteer Time… more
- Kelsey-Seybold Clinic (Houston, TX)
- …Position will work closely with Supervisor and Claim Services to complete request for claims adjustments via CRM Module. Review and interpret provider issues and ... guidelines (ie TDI, CMS, HIPAA, etc.) Strong knowledge of Claims Services and Claim Review Processes. Preferred:...health cares. **Why Kelsey-Seybold Clinic?** + Medical, Vision, and Dental + Tuition Reimbursement + Company Matching 401K +… more
- GAF (Parsippany, NJ)
- …and corrective action. + Manage detailed development and maintenance of standardized claims evaluation protocols. Coordinate review with Plant Quality personnel ... site safety programs and training. + Establish and report claims evaluation turnaround metrics to ensure claim review...wide range of health insurance options that include medical, dental and vision for you and your family. +… more