- Cedars-Sinai (CA)
- …healthcare people throughout Los Angeles and beyond. **Req ID** : 6771 **Working Title** : Claims Examiner ( Managed Care ) - Remote **Department** : MNS ... we strive for. **What will you be doing:** The Claims Examiner is responsible for accurately and... Managed Care **Business Entity** : Cedars-Sinai Medical Center **Job Category**… more
- LA Care Health Plan (Los Angeles, CA)
- Claims Examiner I Job Category: ...of healthcare claims processing experience in a managed care environment. Preferred: Previous Medi-Cal and ... $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...net required to achieve that purpose. Job Summary The Claims Examiner is responsible for the accurate… more
- Dignity Health (Bakersfield, CA)
- …care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals ... with a business objective to excel in coordinating patient care in a manner that supports containing costs while...include Paid Time Off and Sick Leave. **Responsibilities** The Claims Examiner III is an advanced-level role… more
- Intermountain Health (Columbus, OH)
- …of claims processing, claims logging, or customer service experience in a managed care environment. - and - Demonstrated minimum of 100 SPM on ten key ... **Job Description:** The Claims Examiner I is responsible for...hourly rate dependent upon experience. $18.38 - $26.65 We care about your well-being - mind, body, and spirit… more
- Health Advocates Network (Folsom, CA)
- …+ Minimum of two (2) years of Professional Billing with an emphasis on Managed Care denial follow-up and appeals processing - prior hospital billing experience ... as a general knowledge of Commercial, HMO, and Medicare Advantage claims , authorization, and documentation requirements. + Proficient in computer skills including… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 6 months of accurate, high-volume claims data entry or claims processing experience. Preferred: Managed care or Medi-Cal claims ... communication skills Licenses/Certifications Required Licenses/Certifications Preferred Required Training Preferred: Claims Examiner Training Physical Requirements Light Additional… more
- United Airlines (Chicago, IL)
- …issues by acting as a liaison to the third party administrator, payroll, ESC, managed care and other stakeholders. Partner with operations leaders to provide ... outside vendors, generate reports and make recommendations to management. Partner with United's managed care team to ensure appropriate medical care , return… more
- Fallon Health (Worcester, MA)
- …related to fraud and general risk management.Medical claim terminology, coding, and managed care expertise or clinical background. + Strong attention to ... this work is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or other...and capture results. + 5-8 years of related health care claims auditing experience in a complex… more
- Sedgwick (Columbus, OH)
- …reports, claim adjustments, provider requests and operational expense check requests. + Queues claims for Managed Care ; transfers payment allocations; and ... Taking care of people is at the heart of...78758.** **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple… more
- Humana (Columbus, OH)
- …7+ years of related compliance and/or special investigation experience in managed care or CMS. + Prior health insurance claims experience + Demonstrated ... and court appearances. + Attend federal CMS and state fraud meetings with other managed care organizations, as well as state and federal employees. **WORK… more
- Sharp HealthCare (San Diego, CA)
- …role requires a proactive approach to prevent and detect fraudulent activities within the managed care environment and requires someone with a keen eye for ... healthcare fraud investigation, preferably in a health plan, health insurance or managed care setting. **Preferred Qualifications** + 1 Year experience leading… more
- CVS Health (Plymouth, MN)
- …as needed to support cases requiring such needs as benchmarking (FCR), claim examiner support, other insurance, medical necessity, corrected claims , change in ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...dollars. Due to the variety of clinical conditions being managed , ongoing training is required for the medical economics… more
- Molina Healthcare (Miami, FL)
- …investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as ... ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all… more