- Neighborhood Health Plan of Rhode Island (Smithfield, RI)
- …Shift Daytime Job Category Professional / Experienced Description The Policy and Claims Research Specialist is responsible for supporting the Payment Integrity ... and CES edits. Collaborates in planning, works closely with business and operational units to ensure timely resolution of...etc.) Strong understanding and experience in all aspects of claims adjudication, processing , and analysis. Ability to… more
- PharmaCord (Louisville, KY)
- …a plus. Knowledge of the specialty drug product marketplace, health insurance claims processing , and commercialization of products and working with manufacturers ... to our Talent Acquisition team immediately at ###@pharmacord.com The Pharmacy Quality Specialist is responsible for performing various types of audits, acting as a… more
- PharmaCord (Jeffersonville, IN)
- …a plus. Knowledge of the specialty drug product marketplace, health insurance claims processing , and commercialization of products and working with manufacturers ... The Quality Specialist is responsible for performing various types of...to effectively collaborate Ability to act independently with sound business intelligence Take responsibility for performance Excellent written and… more
- Aftermath Billing (Port Saint Lucie, FL)
- …Collector is responsible for managing accounts receivable for behavioral health claims , including follow-up with insurance payers and patients. This role plays ... financial health of our clients by working to resolve billing issues, processing denials, and facilitating collections in compliance with all applicable regulations.… more
- Express Employment (Bemidji, MN)
- …Resources Professional Express Employment Professionals is hiring an Experienced Human Resources Specialist for a well-established company in Grand Rapids, MN . This ... to take ownership of HR processes and play a key role in a growing business . Starting salary ranges from $65,000 - $75,000/year, based on skills and experience. Key… more
- AssistRx (Phoenix, AZ)
- The Copay Support/ Claims Processing Specialist is a critical role within the organization and is responsible for servicing inbound calls, EOB faxes, and mail ... Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication,...care or health care providers that meet the program business rules for determination of approval, denial, or pending… more
- Publix (Lakeland, FL)
- **33789BR** **Position Title:** PROFIT Plan Claims Processing Specialist , Retirement - Lakeland **Department:** Benefits Administration **Location:** ... + Being a Subject Matter Expert (SME) for the Retirement business area, + Processing beneficiary claims for PROFIT Plan distributions, + Providing… more
- BrightSpring Health Services (Louisville, KY)
- Our Company PharMerica Overview Step Into a Rewarding Role as a Claims Specialist with PharMerica! Are you ready to make a real impact in a growing organization? ... Join our PharMerica team as a Claims Specialist , where you'll play a key...office environment for those who are willing to learn claims , billing and insurance processing . Pharmacy Technician… more
- NJM Insurance (Trenton, NJ)
- NJM is seeking a Workers' Compensation (WC) Claims Specialist (I/II/Sr.) . This is a full-time position and offers a hybrid schedule after training with a ... another day in our West Trenton office. The WC Claims Specialist will be responsible for contacting...component in the growth and success of our policyholders' business operations. To meet these expectations, WC Claims… more
- Insight Global (Nashville, TN)
- …reviews and responds to claims submitted on appeal. . Support a remote claims processing team, including coordination with an offshore team based in India. . ... Specialist performs pre- and post-payment audits of external claims ; ensures that the company rigorously manages claims...bachelors degree highly preferred . 8-10+ years of Medicare claims processing experience with knowledge of CPT4… more
- Sedgwick (Indianapolis, IN)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Specialist Sr - Commercial Coverage Specialist **PRIMARY PURPOSE** ... preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management… more
- Prime Therapeutics (Des Moines, IA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Claims Audit Specialist **Job Description** The Claims Audit Specialist ... verbal, and written communication skills. + An understanding of the contracts, business and insurance principles related to claims adjudication. **Preferred… more
- Sedgwick (Orlando, FL)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Specialist , Sr. Medical Malpractice (Professional Liability) **PRIMARY PURPOSE** ... preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management… more
- Cognizant (Malvern, PA)
- … processing is required. **Travel:** None required **About the role:** As Claims Adjudication Specialist , you will be responsible for timely and accurate ... to provide flexibility wherever possible. Based on this role's business requirements, this is a remote position open to...of Facets experience. * Experience in the analysis and processing of claims for payments, utilization review/quality… more
- Mass Markets (Killeen, TX)
- …Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, ... POSITION OVERVIEW MCI is a leading Business Process Outsourcing (BPO) company that specializes in...industry. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong… more
- Commonwealth Care Alliance (Boston, MA)
- …Revenue Integrity, Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills & Abilities (must have):** ... (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims ' processing policies, coding principals and payment methodologies +… more
- New York State Civil Service (Liverpool, NY)
- NY HELP Yes Agency Insurance Fund, State Title Information Technology Specialist 2 (Programming) Claims Med Pay (NYHELPS) Occupational Category IT Engineering, ... Code 13088 Duties Description As a member of NYSIF's Claims MedPay DBL-PHS team, incumbents of these positions will...key role in developing software to meet the essential business needs of the agency. As a member of… more
- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist , you will work with internal teams to provide cutting-edge solutions that will directly improve ... management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting dashboards for… more
- NJ Transit (Newark, NJ)
- Senior Claims Documentation Specialist Risk Management & Claims Job Description: Move forward with us! At NJ TRANSIT, you'll join us in transforming the ... keyboards or other equipment such as computers, typewriters and other business machines. + Handle telephone calls, obtaining information and scheduling appointments… more
- Pacific Medical Centers (Seattle, WA)
- … Business Administration. + 2 years in Managed Care operations. + 1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice ... for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service… more
