- 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
- 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 (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
- UCLA Health (Los Angeles, CA)
- … payment experience in an HMO setting + Expertise in industry standard claims adjudication policies, procedures, and processes + In-depth knowledge of fee ... Computer proficiency with Microsoft Office and data visualization tools + Knowledge of claims adjudication systems (eg, EPIC-Tapestry, EZ Cap, QNXT, IDX) +… 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
- Elevance Health (Rancho Cordova, CA)
- …experience (internal applicants shall have preference over external applicants) or medical claims processing /or other health insurance or equivalent ... the associate will develop knowledge on multiple accounts to become proficient in processing and may be assigned to claims , adjustments as required.… 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
- 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 (Rancho Cordova, CA)
- …I meeting expectations on quality and quantity or three (3) years medical claims processing / health insurance customer service experience or equivalent ... Capabilities & Experiences: + Thorough knowledge of medical terminology and claims processing procedures/systems. + Effective communication and personal computer… more
- CVS Health (St. Paul, MN)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... Bring your heart to CVS Health . Every one of us at CVS ...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… 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 ...in a production environment. **Preferred Qualifications** + DG system claims processing experience. + Demonstrated ability to… 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
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …experience. AND SPECIALIZED EXPERIENCE: Six months of experience in the application and adjudication of retirement and benefits claims and the various laws, ... Title: INSURANCE CLAIMS TECHNICIAN Location: United States-Virginia-Virginia Beach Job Number:...duties relating to the administration of the Life and Health Benefits plans. Duties and Responsibilities: Counsels newly hired… more
- Humana (Indianapolis, IN)
- …occasion.** + 2+ years of health insurance claims experience, such as claims education, claims processing . + Experience working for or with key ... and assist in development of solutions to resolve those issues within our claims processing systems. + Convenes billing forums with selected provider… 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 (Richmond, VA)
- …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
- 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
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