- UCLA Health (Los Angeles, CA)
- … payment experience in an HMO setting + Expertise in industry standard claims adjudication policies, procedures, and processes + In-depth knowledge of fee ... proficiency with Microsoft Office and data visualization tools + Knowledge of claims adjudication systems (eg, EPIC-Tapestry, EZ Cap, QNXT, IDX) + Willingness to… more
- Sedgwick (Roseville, 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 (Bartlesville, 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 (Plano, 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 (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
- Defense Legal Services Agency (Arlington, VA)
- …in special projects and responds to outside inquiries regarding the claims adjudication process and waivers application process. Requirements Conditions ... Summary The position of Program Support Specialist ( Claims ) is located in the Claims ...for the purpose of discussing changes or explaining the adjudication process. Provides specific instructions and assistance to other… 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
- Trustmark (Columbus, OH)
- …in a timely manner in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of ... our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed...claims payments. Evaluates claims activities to assess… more
- Kelly Services (Long Beach, CA)
- …Chance to make a difference in people's lives by ensuring fair and timely claims adjudication . * Collaborative and supportive work environment. What's a typical ... here in your backyard. The Company that offers insurance claims administration services, risk management, analytics, worker care and...absence management, and compliance services is looking for a Claims Assessor to work remotely. Let us help you… 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
- 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
- Humana (Columbus, OH)
- … Operations Professional analyzes, monitors and enhances business operation processes and claims adjudication logic as it pertains to pharmacy transition point ... caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy… more
- CenterLight Health System (Flushing, NY)
- …insurance experience within a healthcare or managed care setting (preferred) Claims adjudication experience Knowledge of MLTC/ Medicaid/Medicaid benefit ... JOB PURPOSE: The Claims Specialist will support department operations related to...State, Federal, and contractual guidelines. JOB RESPONSIBILITIES: + The Claims Specialist will be responsible for reviewing claims… more
- Molina Healthcare (Covington, KY)
- …or GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 1-3 years' experience in claims adjudication , Claims Examiner II, or other relevant work ... **Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines,… more
- Robert Half Accountemps (Winter Garden, FL)
- …Florida. As a Medical Claims Analyst, your primary role will be to handle claims adjudication and oversee the payment and processing of medical claims . ... Description We are in search of a Medical Claims Analyst to join our client's team located...the timely and efficient processing and payment of medical claims . * Maintain a positive rapport with key stakeholders… 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
- 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
- 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