- State of Minnesota (St. Paul, MN)
- **Working Title: Claims Adjudication Manager** **Job Class: State Program Administrator, Director** **Agency: Department of Employment and Economic Development** ... systems to deliver this new benefit to Minnesotans. **Position Purpose:** The Claims Adjudication Manager provides leadership, direction, and oversight for the… more
- CVS Health (Scottsdale, AZ)
- …-Working within turnaround times to meet client performance guarantees for claims processing . -Meeting productivity and accuracy standards **Required ... a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic images in a production environment.… more
- Elevance Health (Houston, TX)
- …The ** Claims Representative II ( Health & Dental)** is responsible for keying, processing and/or adjusting health claims in accordance with claims ... ** Claims Representative II ( Health & Dental)**...interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims . + Adjusts voids and… more
- Apex Health Solutions (Houston, TX)
- …of Claims Operations. Position is responsible for oversight of claims adjudication and regulatory reporting functions including all associated processes, ... with any vendor partners that have direct impact to claims processing or pricing rules. Identifies and...standards, practices, and processes focused on timely and accurate adjudication of claims With limited direction, translates… 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
- UCLA Health (Los Angeles, CA)
- …compliance. You will be responsible for implementing and maintaining efficient claims adjudication processes that utilize technology to automate workflows ... with at least 2 years managing personnel in a claims processing environment + Extensive knowledge of...(NCCI) edits and their relation to clinical logic in claims adjudication + Experience with Microsoft Office… more
- Highmark Health (Pittsburgh, PA)
- …**systems and technology** **will be essential.** **This includes k** nowledge of claims processing platforms, data management systems, and relevant technologies ... the Delivery team. **A d** **eep understanding of the health ** **insurance** ** claims process** **will be essential**...like AI/ML to optimize claims processing . **ESSENTIAL RESPONSIBILITIES** + Understand the… 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
- PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
- …must + Health care or pharmaceutical experience, particularly in a medical claims processing , billing provider, or insurance environment + Knowledge of EOB ... EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid...a high-volume processing setting (ie, doctor's office, claims processing department, etc.) a plus. +… more
- CenterLight Health System (Flushing, NY)
- …Subrogation conditions + Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor + Attends JOC meetings with providers as ... compensation configuration by creating and testing compensation grids used for reimbursement and claims processing + Ensures that refund checks are logged and… more
- LA Care Health Plan (Los Angeles, CA)
- …Certificate Education Preferred Experience Required: At least 6 months of accurate, high-volume claims data entry or claims processing experience. Preferred: ... (Mid.) - $55,818.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by...business, including complex claims . Data Entry of Claims in Core adjudication system. Checking the… more
- CVS Health (St. Paul, MN)
- …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 ...organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Reinsurance / Stop… more
- Elevance Health (Columbus, OH)
- … claims , for the Government Business and Commercial Division to include claims adjudication , payment disputes, and adjustments that meets all compliance and ... 7 direct reports / ~1000 FTE's **Position Responsibilities** + Oversees multiple claims processing units, executes strategies to deliver industry leading service… 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
- CenterLight Health System (NY)
- …+ Manage, in collaboration with the Director, functions related to claim processing , including monitoring of pending claims , appeals, recoupments, pricing, ... JOB PURPOSE: The Senior Project Manager, Claims Payment Integrity supports the Senior Vice President...ensure compliance with federal and state guidelines and meets health plan regulatory and provider contract requirements as well… more
- Healthfirst (FL)
- …benefits, claims editing, reference data and system functionality within the claims processing system. + Analyze explanation of coverage documents to assist ... where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate claims ...and eligibility administration systems (ie PowerMHS or any other claims processing systems). + Proficiency in medical… more
- Sedgwick (Columbus, OH)
- …growth, and inclusion. **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 (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
- 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
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