- State of Minnesota (St. Paul, MN)
- **Working Title: Claims Adjudication Manager ** **Job Class: State Program Administrator, Director** **Agency: Department of Employment and Economic ... do is more than just a job.** At the State of Minnesota, employees play a critical role in...deliver this new benefit to Minnesotans. **Position Purpose:** The Claims Adjudication Manager provides leadership,… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** The Senior Product Manager , Claims will define the product strategy, vision, and value ... be essential** **.** This includes a strong grasp of claims intake, adjudication , payment, appeals, denials, and...is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company… more
- HUB International (Traverse City, MI)
- …company's long-range plans for growth, profitability, and customer service. + Manage the claims function to ensure effective and accurate adjudication of ... service contract division is seeking an individual(s) to lead and manage the claims function for its limited warranty and extended service contract business. The… more
- New York State Civil Service (Menands, NY)
- …No Telecommuting allowed? Yes County Albany Street Address Office of General Counsel, Adjudication Services 150 Broadway City Menands State NY Zip Code 12204 ... NY HELP Yes Agency Workers' Compensation Board Title Compensation Claims Referee (NY HELPS), WCB Item #4042 Occupational Category...and privileges of competitive class employees of New York State . While serving permanently in a NY HELPS title,… more
- Elevance Health (Houston, TX)
- …to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims . + Adjusts voids and reopens claims ... ** Claims Representative II (Health & Dental)** **Must be...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- LA Care Health Plan (Los Angeles, CA)
- …to achieve that purpose. Job Summary The Claims Supervisor works with the Claims Manager to oversee the daily operations of the claims department. ... must maintain an up-to date knowledge of national and state -wide standards and regulations pertaining to claims ...Care. Track and trend the metrics associated with the claims adjudication . Prepare and present written and… more
- Sedgwick (Shreveport, LA)
- …great place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in- State Employer Claims Team Lead Assistant - Workers Compensation (MUST RESIDE ... compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices… more
- ManpowerGroup (CA)
- …**Duration:** 14-Oct-2024 - 11-Jan-2025 (Potential to extension) **Pay Rate:** $49 ** Manager 's note:** + **Workers Compensation Claims Adjuster (3+ years ... workers' compensation claims , determine benefits due, manage high exposure claims involving litigation and rehabilitation, ensure ongoing adjudication of … 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 ... **Staff VP Claims Operations (Original Claims )** **Location:** Successful...DC), Hawaii; Jersey City, NJ; Nevada; New York; Washington State In addition to your salary, Elevance Health offers… more
- CenterWell (Columbus, OH)
- … Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication , including method of payment, co-pay or deductible amounts, ... community and help us put health first** The Pharmacy Claims Representative 2 adjudicates pharmacy claims and...Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will… more
- CenterLight Health System (NY)
- JOB PURPOSE: The Senior Project Manager , Claims Payment Integrity supports the Senior Vice President and the Director in the day-to-day operations of the ... Claims Operations Department. The position performs and delivers accurate...and vendor oversight to ensure compliance with federal and state guidelines and meets health plan regulatory and provider… more
- Elevance Health (Columbus, GA)
- …benefit determinations (non-payable categories, savings and payments) and/or re-entering claims using PAC (pre- adjudication correction) process for original ... **Title: Claims Representative I (Health & Dental)** **Location:** This...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CVS Health (Columbus, OH)
- …with all Pharmacy and state department of insurance appeal related processes and state regulations, and claims adjudication , including claims ... to make health care more personal, convenient and affordable. **Position Summary** The Manager , Pricing must have expertise and knowledge of the Pharmacy claims … more
- Point32Health (Canton, MA)
- …applications/filings, and day-to-day benefit adjudication matters. Overall, the Senior Manager will be responsible for managing a multi- state portfolio with ... information and meet applicable regulatory requirements and timelines. The Senior Manager works closely with claims , membership operations, clinical services,… more
- New York State Civil Service (Albany, NY)
- …post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of ... NY HELP Yes Agency Health, Department of Title Eligibility Program Manager 2 (NY HELPS) - 15449 Occupational Category Other Professional Careers Salary Grade 29… more
- New York State Civil Service (Albany, NY)
- …post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of ... NY HELP Yes Agency Health, Department of Title Eligibility Program Manager 1 (NY HELPS) - 79434 Occupational Category Other Professional Careers Salary Grade 27… more
- LA Care Health Plan (Los Angeles, CA)
- …Directory API, Payer to Payer API, Pre Authorization API Experience working on: Claims - Intake, adjudication , premium billing, capitation and FFS check runs, ... Enterprise Shared Services Program Manager II (ALD) Job Category: Administrative, HR, Business...II (ALD) Job Category: Administrative, HR, Business Professionals Department: Claims Data and Support Services Location: Los Angeles, CA,… more
- Arkansas Children's (Little Rock, AR)
- …required attachments before being filed to payer (clean claim). 2. Expedites proper adjudication of claims by payer to maximize reimbursement and minimize older ... given for claim not being adjudicated and how we might overcome lack of adjudication . 3. Reviews adjudicated claims to assure they were properly adjudicated with… more
- AECOM (Fairbanks, AK)
- …and let's get started. **Job Description** **AECOM** is seeking a **Construction Project Manager IV** to be based in one of the following locations: **Fairbanks, ... AK.** AECOM is seeking a highly qualified resilient Construction Project Manager to provide embedded on-site PM/CM support for Federal LPOE (Land Port of Operation)… more
- Mount Sinai Health System (New York, NY)
- …of pharmacy benefits plan and contracted pharmacies to ensure for appropriate claims adjudication , drug pricing, and reimbursement + Support financial, quality ... Trade Center Health Program (WTCHP) seeks a Clinical Pharmacy Manager that reports to Senior Manager , Pharmacy...requirements throughout employment, as set forth by New York State regulations . + Achieves annual requirement of 15… more