- DXC Technology (Nashville, TN)
- …service delivery. **Essential Job Functions:** + Execute health and disability claims adjudication and processing , learning from experienced team members ... year in a similar role. + Proven experience in health and disability claims adjudication ... adjudication or related work. + Proficiency in claims processing , adjudication , and process… more
- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… more
- AssistRx (Phoenix, AZ)
- …reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim rejections, ... teams on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data… more
- MVP Health Care (Schenectady, NY)
- …+ Meets or exceeds department quality and work management standards for claims adjudication . + Successfully completes a course of comprehensive formal ... At MVP Health Care, we're on a mission to create...information. + Is responsible for the timely and accurate adjudication of claims that are suspended to… more
- East Boston Neighborhood Health Center (Revere, MA)
- …of the Manager of PACE Claims , is responsible for the overall claims adjudication and insurance validation process. This includes: Claims Department: ... * Coordinating with IT to enhance and refine the claims adjudication process. * Coordinating with the...liaison with IT, specifically regarding Tapestry (fee schedule development, claims processing , referrals) and reports and workflows… more
- NTT America, Inc. (Little Rock, AR)
- …principles * Minimum of 9 years of experience in Medicaid Claims Adjudication , including understanding of claims processing workflows, adjudication ... expertise in Medicaid systems, particularly in all facets of claims adjudication and demonstrate a strong ability...Minimum 10 years of experience in supporting or developing Health Care systems * Minimum 9 years of experience… more
- Highmark Health (Harrisburg, PA)
- …the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special ... benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of...field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. +… more
- Elevance Health (Boston, MA)
- …I :** Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide ... I** is responsible for pre and post payment and adjudication audits of high dollar claims for...or GED and a minimum of 5 years of claims processing experience including a minimum of… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- CVS Health (Hartford, CT)
- …and leading modernization efforts. + Strong understanding of regulatory compliance in claims processing . ** ** **Preferred Experience** + Excellent communication ... At CVS Health , we're building a world of health...modernization of legacy systems-primarily IBM Mainframe platforms-used for commercial claims routing, adjudication , and operational reporting. This… more
- PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
- …must + Health care or pharmaceutical experience, particularly in a medical claims processing , billing provider, or insurance environment + Knowledge of EOB ... EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid...a high-volume processing setting (ie, doctor's office, claims processing department, etc.) a plus. +… more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Claims Analyst is responsible for claims processing , research and adjudication to correctly apply benefit determination and pricing ... claims (CMS 1500 and UB04), in accordance with claims processing guidelines. **ESSENTIAL FUNCTIONS OF THE...benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with… more
- CVS Health (Annapolis, MD)
- …quality assurance, and compliance monitoring. This role ensures timely and accurate processing of Medicaid claims in accordance with state and federal ... At CVS Health , we're building a world of health...each and every day. **Position Summary** The Manager of Claims Management is responsible for overseeing Medicaid claims… more
- Dignity Health (Bakersfield, CA)
- …role responsible for the detailed and accurate processing , review, and adjudication of complex healthcare claims . This position requires expert knowledge of ... claims processing , coding, and regulatory compliance. The Claims ...Coder (CPC) **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO)… more
- Molina Healthcare (Albany, NY)
- …claims processing errors. **Essential Job Duties** + Audits the adjudication of claims using standard principles, and state-specific regulations to ... leadership for improvements based on audit results. + Reviews timeliness of claims processing to ensure compliance with contractual and state/federal… 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, ... Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills &...(must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs… more
- Sedgwick (Austin, TX)
- …of Absences. Special project work when floating not needed** + Analyzing and processing claims through well-developed action plans to an appropriate and timely ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Brea, CA)
- … and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzing and processing claims through well-developed action plans to an appropriate ... exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and… more
- Sedgwick (Columbia, SC)
- …growth, and inclusion. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Columbia, SC)
- …distance to office** **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more