- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …claims processing and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written and oral communication, ... notice. Primary Responsibilities + Research and document pertinent information on claims requiring adjudication . Apply medical policy, contractual provisions,… more
- Sedgwick (Columbus, OH)
- …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 (Oklahoma City, OK)
- …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 (Phoenix, AZ)
- …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 (Pittsburgh, PA)
- …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
- Sedgwick (San Diego, 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
- The Cigna Group (Bloomfield, CT)
- …with AS400, MC400, McNet and RC3 systems required + 3+ years of experience with claims adjudication , claims data types and editing rules (ICD, CPT/HCPC, ... a division of the Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. For this...SI testing, end to end testing and continuously improve adjudication automation and accuracy. + Partner with technology and… more
- Kelsey-Seybold Clinic (Houston, TX)
- …Microsoft products (word and excel.) **Experience** Required: 3 years of Facility Claims Adjudication experience in a HMO,PPO, or TPA environment. Preferred: ... **Responsibilities** Responsible for the adjudication of complex facility claims including hospital, durable medical equipment, home health services, skilled… more
- The Cigna Group (Bloomfield, CT)
- …experience with MC400, McNet and RC3 systems Preferred + 3+ years of experience with claims adjudication , claims data types and editing rules (ICD, CPT/HCPC, ... a division of the Cigna Group is hiring a Claims System Configuration Senior Analyst. This highly technical systems...SI testing, end to end testing and continuously improve adjudication automation and accuracy. + Partner with technology and… more
- Apex Health Solutions (Houston, TX)
- Summary: Position is responsible for oversight of claims adjudication and regulatory reporting functions including all associated processes, reporting of key ... standards, practices, and processes focused on timely and accurate adjudication of claims Demonstrate expertise and serve as SME on data elements/language… more
- Humana (Columbus, OH)
- …Senior Pharmacy Claims Professional analyzes, monitors and enhances processes and claims adjudication logic as it pertains to pharmacy transition point of ... community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and process pharmacy claims for payment. The… more
- Sedgwick (Long Beach, CA)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead, Professional Liability (Hybrid) ) **PRIMARY PURPOSE** **:** To… more
- CommonSpirit Health (Erlanger, KY)
- …needed to succeed. + Provide technical expertise and direction to team members on claims adjudication for STD. + Facilitate the transition from STD to Long ... is to manage and monitor the Short Term Disability and/or Statutory Disability claims processes to ensure timely and accurate claim decisions are made and… more
- Kelly Services (Columbia, SC)
- …and collaborative team environment. - Chance to develop and refine your skills in claims adjudication . - Potential for career growth and advancement within the ... Job Title: Claims Adjudicator Job Summary: We are seeking a skilled Claims Adjudicator to join our team. As a Claims Adjudicator, you will be responsible for… more
- Academy Sports + Outdoors (Katy, TX)
- …reports to ensure that adequate resources and technical skills exist to facilitate claims adjudication in accordance with Company claim quality and service ... other relevant field of study Work Experiences: + Eight (8) + years of claims -related work experience required + Experience leading a team of direct reports is… 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, ... the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr....TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
- System One (Fairfax, VA)
- …systems. Pay rate $22.50/HR 100% Remote Contract to hire ESSENTIAL FUNCTIONS + Performs claims adjudication for complex medical claims . + Performs regular ... IT Services is staffing a contract to hire opportunity for a Healthcare Claims Processor to support a leading health insurance customer. The individual will review… more
- Carle (Urbana, IL)
- …LICENSURE REQUIREMENTS None Specified EXPERIENCE REQUIREMENTS One (1) year medical claims adjudication , healthcare billing or healthcare customer service ... Claims Analyst Team A + Department: HA - Claims + Entity: Health Alliance + Job Category: Clerical/Admin + Employment Type: Full - Time + Job ID: 45246 +… more
- Percepta (Melbourne, FL)
- …and independent repair facilities regarding extended service contract coverage and provides claims adjudication per contract terms and contact handling processes ... **Description** **_Automotive Claims Representative_** At Percepta, we bring first-class service...web based technical service information to complete the claim adjudication process * Excellent negotiation skills and consultative approach… more
- BrightSpring Health Services (Oklahoma City, OK)
- …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