- Cedars-Sinai (CA)
- …people throughout Los Angeles and beyond. **Req ID** : 11588 **Working Title** : Claims Examiner - Managed Care **Department** : MNS Managed Care ... **Job Description** The Claims Examiner is responsible for accurately...is a leader in providing high-quality healthcare encompassing primary care , specialized medicine and research. Since 1902, Cedars-Sinai has… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Claims Examiner III is an advanced-level role responsible for the detailed and accurate processing, review, and ... claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most...pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to… more
- Centene Corporation (Frankfort, KY)
- …Outlook, PowerPoint, Word, Xcelys, SalesForce, and Microsoft Access. Knowledge and understanding of managed care claims processing systems and medical ... audit and risk analysis. 1+ year of experience in managed care or health insurance company. **Candidate...one of the following is required: Other Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner… more
- Option Care Health (Bannockburn, IL)
- …compliance programs. + Direct experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines. + Proficiency with audit software ... no limit to the growth of your career.** Option Care Health, Inc. is the largest independent home and...large datasets, such as related to healthcare operations, billing, claims , and patient information to support Compliance activities and… more
- Molina Healthcare (Covington, KY)
- …lieu of education experience) + At least five (5) years' experience working in a Managed Care Organization or health insurance company + Minimum of two (2) ... investigative and law enforcement procedures with emphasis on fraud investigations + Knowledge of Managed Care and the Medicaid and Medicare programs as well as… more
- Sedgwick (Fort Worth, TX)
- …reports, claim adjustments, provider requests and operational expense check requests. + Queues claims for Managed Care ; transfers payment allocations; and ... Coordinator **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple...logins and the applicable security access for the company's claims management systems by determining the validity for incoming… more
- Knowledge Builders Inc. (Albany, NY)
- …current on regulatory developments affecting pharmacy benefits, health insurance, and managed care . + Click to Apply ... York State. 2. Job Description and Required Services: Financial Examiner for the Pharmacy Benefits Unit of the Health...with a strong understanding of drug pricing, rebates, and claims adjustments. In addition, the candidate must possess and/or… more