- Lyric (King Of Prussia, PA)
- …of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication , or fraud, waste and abuse detection + ... of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and...+ Develop and execute data mining audits that identify claims not paid in accordance with Client's payment policy… more
- Elevance Health (West Des Moines, IA)
- …** Claims Representative III ( Health & Dental)** is responsible for keying, processing and/or adjusting health claims in accordance with claims ... ** Claims Representative III ( Health & Dental)**...interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims . + Adjusts voids and… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …contracts, Medical Policies and Payment procedures as well as capable of manually processing claims according to all outlined Policies and Procedures. This job ... Essential Qualifications + Knowledge of contracts, medical terminology, and claims processing and procedures. + 1+ year...and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written… 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 ... with any vendor partners that have direct impact to claims processing or pricing rules. Responsible for...standards, practices, and processes focused on timely and accurate adjudication of claims Demonstrate expertise and serve… more
- LA Care Health Plan (Los Angeles, CA)
- …for the supervisory/management experience requirement. Demonstrated depth of knowledge and experience in processing Health Plan claims of a complex nature. ... the Plan's core system produces a high level of claims auto adjudication . Develops policies and guidelines... claims . Skills Required: Solid understanding of standard claims processing systems and claims … more
- Elevance Health (Columbus, GA)
- **Title: Claims Representative I ( Health & Dental)** **Location:** This position will work a **hybrid model (remote and office)** . The ideal candidate will live ... benefit determinations (non-payable categories, savings and payments) and/or re-entering claims using PAC (pre- adjudication correction) process for original… more
- Highmark Health (Columbus, OH)
- …**Required** + 1 year of related experience **Preferred** + 1 year of claims processing experience + Inquiry resolution system, OCWA, Oscar, Outlook experience ... correcting errors and/or performing quality control review and final adjudication of paper/electronic claims . Determines whether to...guidelines. + Knowledge of operating systems specific to claim processing . + Ability to review claims and… more
- Community Clinic Inc. (Silver Spring, MD)
- …and concerns. + Exhibit and apply knowledge of Commercial Indemnity guidelines in the processing , adjudication , and payment of claims . + Maintain current ... center personnel in maintaining accuracy in data elements and processing crucial to effective claims processing...providers are insured for malpractice under the Federal Tort Claims Act. ** CCI Health Services is… more
- CommonSpirit Health (Erlanger, KY)
- …to return, pend, deny or pay claims ). + Follows and ensures claims processing is consistent with applicable policies, regulations, procedures and department ... processing enhancements. + Responsible for managing the STD claims team but is not limited to the following:...Provide technical expertise and direction to team members on claims adjudication for STD. + Facilitate the… more
- CVS Health (Albany, NY)
- …dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, ... Bring your heart to CVS Health . Every one of us at CVS ...manage job responsibilities. **Required Qualifications** + 2+ years medical claims processing experience. + Experience in a… more
- The Cigna Group (Bloomfield, CT)
- …Senior Analyst. This highly technical systems role requires the review of our claims processing system to ensure all configurations were input correctly into ... RC3 systems Preferred + 3+ years of experience with claims adjudication , claims data types...of benefits, with a focus on supporting your whole health . Starting on day one of your employment, you'll… more
- Spokane County (Spokane, WA)
- …37.5 hours per week. Positions allocated to this classification are responsible for adjudication , processing , and reserving claims filed by Spokane County ... with Labor & Industries to ensure proper coverage. The position includes reviewing, processing , and adjudicating claims and the management of the Spokane County… more
- Sedgwick (Columbus, OH)
- …client service requirements. **ESSENTIAL RESPONSIBLITIES 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 (San Francisco, CA)
- …client service requirements. **ESSENTIAL RESPONSIBLITIES 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
- 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 (Phoenix, AZ)
- …client service requirements. **ESSENTIAL RESPONSIBLITIES 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 (Richfield, MN)
- …client service requirements. **ESSENTIAL RESPONSIBLITIES 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 (Irving, TX)
- …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 (Austin, TX)
- …team meetings and assigns accountability for follow-up items. + Gathers important compliance/ claims processing information to be presented at team meetings. + ... compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices… more
- The Cigna Group (Bloomfield, CT)
- …degree preferred + 3+ years of experience as a subject matter expert for claims system configuration, processing , reporting, issue triage and testing - REQUIRED ... and Change Lives?** EviCore, a division of the Cigna Group is hiring a Claims System Configuration Lead Analyst. This highly technical systems role acts as the… more
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