- 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
- New York State Civil Service (Schenectady, NY)
- NY HELP No Agency Workers' Compensation Board Title Workers' Compensation Examiner , WCB Items #2361 Occupational Category No Preference Salary Grade 14 Bargaining ... accounts; or experience examining, investigating, processing, or adjusting insurance claims ; or responding to technical questions from policyholders or claimants;Or… more
- HCA Healthcare (Nashville, TN)
- …required; Bachelor's degree preferred + 4 - 5 years' experience as a Senior Claim Examiner in a managed care environment, required + Hands-on knowledge and ... plan payor, MSO, HMO, and IPA organizations with the primary function to ensure examiner payment accuracy of all claims processing including analysis of support… 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
- Molina Healthcare (NM)
- …or GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 1-3 years' experience in claims adjudication, Claims Examiner II, or other relevant work ... + Minimum of 1 year experience in healthcare insurance environment with Medicaid, or Managed Care + Strong verbal and written communication skills + Proficient… 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
- 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