- CVS Health (Hartford, CT)
- …leading modernization efforts. Strong understanding of regulatory compliance in claims processing . Preferred Experience Excellent communication and stakeholder ... At CVS Health , we're building a world of health...modernization of legacy systems-primarily IBM Mainframe platforms-used for commercial claims routing, adjudication , and operational reporting. This… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …be crucial in maintaining our high standards of accuracy and efficiency in claims processing . Compensation Highlights: Base Pay: $18.00 per hour Pay Frequency ... Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA...under demanding production and quality standards Technical proficiency with claims processing software In-depth understanding of complex… more
- Molina Healthcare (Yonkers, NY)
- …coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors. Essential Job Duties Audits the adjudication of claims ... to leadership for improvements based on audit results. Reviews timeliness of claims processing to ensure compliance with contractual and state/federal… more
- Sedgwick (Salem, OR)
- …specific 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 (Brea, CA)
- … and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzing and processing claims through well-developed action plans to an appropriate ... exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and… more
- Sedgwick (Roseville, CA)
- …specific 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)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... health savings account, and other additional voluntary benefits. # Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest… more
- Sedgwick (Oklahoma City, OK)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive | Remote As a Claims … more
- Health Care Service Corporation (Chicago, IL)
- … CLAIMS ANALYST The Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims , ... At Luminare Health , our employees are the cornerstone of...related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are handled according to the established… more
- Motion Recruitment Partners (Denver, CO)
- …CO area. Contract Duration: 2-Months Required Skills & Experience 3 years Medical Claims processing / adjudication experience. High School grad What You Will ... Medical Claims Processor / Contract / Remote Denver, CO...and your family Dental & Orthodontia Benefits Vision Benefits Health Savings Account (HSA) Health and Dependent… more
- Sedgwick (Harrisburg, PA)
- …difficult unemployment claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices or ... techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Communicates claim action/ processing with appropriate… more
- The Cigna Group (Morris Plains, NJ)
- …of: IBM Mainframes; COBOL6; JCL; VSAM; DB2; MQ; TSO/ISPF; PBM claim adjudication processing ; Inflation Reduction Act ("IRA"); CMS (HIPPA); NCPDP guidelines; ... Point of Sale; Coordination of Benefit ("COB"); manual submitted claims processing ; retail pharmacy network system; CA-7...of benefits, with a focus on supporting your whole health . Starting on day one of your employment, you'll… more
- Molina Healthcare (Racine, WI)
- …issues. Experience working in a Medicare environment is highly preferred. Claims adjudication experience is highly preferred. Job Qualifications Required ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education… more
- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… more
- AssistRx (Phoenix, AZ)
- …reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim rejections, ... teams on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data… more
- MVP Health Care (Schenectady, NY)
- …+ Meets or exceeds department quality and work management standards for claims adjudication . + Successfully completes a course of comprehensive formal ... At MVP Health Care, we're on a mission to create...information. + Is responsible for the timely and accurate adjudication of claims that are suspended to… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- Dignity Health (Bakersfield, CA)
- …role responsible for the detailed and accurate processing , review, and adjudication of complex healthcare claims . This position requires expert knowledge of ... claims processing , coding, and regulatory compliance. The Claims ...Coder (CPC) **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO)… more
- TEKsystems (Brookfield, WI)
- …according to external contract. Performs other duties and responsibilities as assigned. Skills claims processing , claims adjudication , call center, ... established time frame is reached without resolution. Monitors computerized system for claims processing errors and make corrections and/or adjustments as… more
- Trinity Health (Columbus, OH)
- …+ In conjunction with the 3rd party vendor, create/maintain DLT's for claims processing staff **Minimum Qualifications** + .Education: Associate or Bachelor's ... degree preferred + .Experience: 5 years medical claims or relevant health insurance + In depth understanding of Medicare & Medicare Advantage. + Excellent… more
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