- Medical Mutual of Ohio (Brooklyn, OH)
- …DB2 applications. . Intermediate Microsoft Office, OnBase, database reporting skills. . Knowledge of health claims adjudication processing . . Strong math ... to advanced Microsoft Office, OnBase, database reporting skills. . Knowledge of health claims adjudication processing . . Strong math and bookkeeping… more
- CVS Health (Woonsocket, RI)
- …team, you will be responsible for facilitating effective solutions related to the adjudication and processing of pharmacy claims and newly expanded ... Bring your heart to CVS Health . Every one of us at CVS ...**Required Qualifications** + 2+ years of experience with pharmacy claims adjudication and NCPDP standards + 3+… more
- University of Utah Health (Murray, UT)
- …productive team environment. + Performs routine and complex audits on phone calls and claims adjudication . + Researches claim processing problems and errors ... those findings in reports for management. + Ensures proper adjudication policies and procedures were followed as well as...of the job as outlined above. + Experience with claims processing in a health … 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
- 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
- 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
- Kelsey-Seybold Clinic (TX)
- … Claims Operation Experience with Facility and Professional Claims Adjudication Knowledge of Medicare Claims Processing Previous experience performing ... to foster and sustain training program associated with Commercial and Medicare Advantage claims adjudication procedures, address the training needs for Claims… more
- Independent Health (Buffalo, NY)
- …or GED required. + One (1) year of experience in customer service, medical claims processing , medical billing or collections required. + Knowledge of medical ... relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication . + Analyze, identify and research, as needed, edits… 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
- Healthfirst (CO)
- …or ICD10, and HCPCS), provider contract concepts and common claims processing /resolution practices. + Previous managed care/ health plan experience in an ... editing, reference data and system functionality within the claims processing system. + Analyze explanation of...where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate claims … 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
- Sedgwick (Brea, CA)
- …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
- 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
- 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 (Philadelphia, PA)
- …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 (Irving, TX)
- …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
- 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 ... Lives?** EviCore, a line of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst. This **highly technical systems** role acts as the… more
- Sedgwick (San Diego, CA)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… more
- Sedgwick (Syracuse, NY)
- …compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. **ESSENTIAL ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… more
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