- AssistRx (Orlando, FL)
- …our strongest asset. Join us as we continue to make a difference The Copay Lead is a critical role within the organization and is primarily responsible for the ... to support all operational and financial processes related to claim processing activities ensuring effective day-to-day operations and provide ongoing Copay program… more
- PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
- …of the Supervisor (with guidance from a Team Lead ), is responsible for processing medical claims received from patients and/or HCPs across a broad product ... rules external to the systems. Consult with the Team Lead or Supervisor for complex claims or...Health care or pharmaceutical experience, particularly in a medical claims processing , billing provider, or insurance environment… more
- Sedgwick (Shreveport, LA)
- …team meetings and assigns accountability for follow-up items. + Gathers important compliance/ claims processing information to be presented at team meetings. + ... to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead Assistant - Workers Compensation (MUST RESIDE IN… more
- The Cigna Group (Bloomfield, CT)
- …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 ... degree preferred + 3+ years of experience as a subject matter expert for claims system configuration, processing , reporting, issue triage and testing - REQUIRED… more
- Molina Healthcare (UT)
- …Interfaces with the customer in developing requirements for major complex claims testing projects within Medicare, Medicaid and Marketplace; prepares system test ... conducts research to resolve customer initiated issues related to core systems processing ; and coordinates and manages project test resources in the development of… more
- Centene Corporation (Austin, TX)
- …as the subject matter expert for other Claims Liaisons. + Analyze trends in claims processing issues and identify work process solutions + Lead meetings ... potential configuration related work process changes + Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing… more
- Apex Health Solutions (Houston, TX)
- …day to day interactions with any vendor partners that have direct impact to claims processing or pricing rules. Identifies and implements new processes, vendors, ... Shall perform and oversee user acceptance testing for any impacted changes to claims processing Demonstrate expertise in interpretation and serve as Subject… more
- Cleco (Pineville, LA)
- …technologies/current systems and analytical techniques to enhance/streamline policy renewals and claims processing and to provide additional insights to drive ... of leading practices in managing corporate insurance program and claims activities. The incumbent will lead and...program and claims activities. The incumbent will lead and drive analyzing and classifying risk exposures to… more
- ManpowerGroup (Columbia, SC)
- …Diploma or equivalent + 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience ... of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality...desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports… more
- ManpowerGroup (Columbia, SC)
- …and system errors to the appropriate departments. **Preferred Skills:** + Experience in claims processing + Excellent time-management skills + Ability to work ... and reprocessing actions in accordance with departmental guidelines. + ** Claims and Appeals Processing (40%):** + Examine...procedures and guidelines. + Refer these issues to a lead or manager for resolution. + Promptly report suspected… more
- Flexport (Dallas, TX)
- …policies and procedures + Familiarity with technology and digital tools used in claims processing + Strong understanding of risk management principles + Ability ... environment? Come join us. **Help us enhance our clients' claims experience** Join us on our mission to revolutionize...of our team, you will have the opportunity to lead innovative projects and identify ways to streamline both… more
- Apex Health Solutions (Houston, TX)
- …to day interactions with any vendor partners that have direct impact to claims processing or pricing rules. Responsible for hiring, orienting, training, ... key requirements Shall oversee user acceptance testing for any impacted changes to claims processing Provide escalation support for business or revenue impacting… more
- TEKsystems (Fresno, CA)
- …within acceptable levels Skills: Claim, Customer service, medical billing, administration, Claims processing , dental claims , Insurance, Health insurance, ... Health care Top Skills Details: Claim,Customer service,medical billing,administration, Claims processing ,dental claims Additional Skills & Qualifications:… more
- System One (Reston, VA)
- …QUALIFICATIONS Experience: 10 + years' experience in Architecture Domain - Must have experience in Claims domain - claims processing system - claims ... Job Title: Domain Architect - Healthcare Claims Location: Remote - EST/CST ONLY (onsite required...to identify and analyze pain points and opportunities (PPOs). Lead advanced modeling and analysis to meet the strategic… more
- The Cigna Group (Bloomfield, CT)
- …timeliness and accuracy of claim administration. + Evolve SLAs and oversees business partner claims processing and auditing to ensure SLAs are met, inclusive of ... The Claims Strategy and Payment Integrity Senior Manager will...current industry policies/standards (especially IFP/Medicare/Medicaid). Additionally, this individual will lead a small team and report directly to the… more
- Humana (Columbus, OH)
- …include: + Subject matter expert for pharmacy transition business operation processes and claims processing logic. + Speaker during CMS Program audits and ... caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy… more
- Conduent (Helena, MT)
- …valued every day. As the ** Claims Department Manager** , you will lead a complex medical claim processing team, overseeing daily tasks, setting priorities, ... fostering efficiency and driving operational success. **Responsibilities** Managing a claims processing department to effectively and efficiently meet… 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...to details. + The ability to adapt to and lead change in a business environment is also critical.… more
- Elevance Health (Columbus, OH)
- …7 direct reports / ~1000 FTE's **Position Responsibilities** + Oversees multiple claims processing units, executes strategies to deliver industry leading service ... **Staff VP Claims Operations (Original Claims )** **Location:** Successful...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Trinity Health (Farmington Hills, MI)
- …organization or other health care financial service setting, performing medical claims processing , financial counseling, financial clearance, accounting or ... of the revenue cycle process for an assigned PBS location. Documents claims billed, paid, settled, and follow-up in appropriate system(s). Identifies and escalates… more