- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... partner in the industry. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong critical thinking… more
- CVS Health (Richardson, TX)
- …do it all with heart, each and every day. As part of the Rx Claim Adjudication team, you will be expected to be proficient in all critical functions of the ... through research and fact finding. + Experience with RxClaim or other PBM Adjudication system is preferred. + Experience on Cloud Technologies like GCP, AWS, Azure,… more
- CareFirst (Washington, DC)
- …including reconciliation, adjustments, and payment accuracy. + Strong understanding of claims adjudication and post- adjudication workflows, including error ... be demanding or otherwise challenging. + Extensive knowledge of Pre- Adjudication 837 EDI & Post- Adjudication Voucher 835...resolution and compliance requirements. + Experience with claims processing and related reporting tools. + Ability to… more
- Humana (Lansing, MI)
- …and answer provider questions. + Work with internal resources and systems (eg, claims adjudication system) to provide the Perfect Experience in all provider ... an impact** **Required Qualifications** + 5+ years of technical experience with claims systems, adjudication , submission processes, coding, claims dispute… more
- Dragonfly Health (Mesa, AZ)
- …immediate supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication . Adjust and correct authorizations in dispensing and ... of six (6) months of pharmacy technician experience. * Experience with pharmacy claims adjudication is required. Specialized Knowledge, Skills & Abilities: * PBM… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …claims processing and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written and oral communication, ... notice. Primary Responsibilities + Research and document pertinent information on claims requiring adjudication . Apply medical policy, contractual provisions,… more
- AssistRx (Orlando, FL)
- …pharma services, or HUB services environment. + Strong understanding of claims adjudication processes, reimbursement models, and affordability solutions. + ... and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances… more
- Cognizant (Dover, DE)
- …and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments. You will be a valued member of the Cognizant ... is required. **Travel:** None required **About the role:** As Claims Processor (with Facets), you will be responsible for...Facets), you will be responsible for timely and accurate adjudication of professional and hospital claims utilizing… more
- Sedgwick (Bismarck, ND)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Richfield, MN)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Cognizant (Winston Salem, NC)
- …Adjudicator in Winston Salem, North Carolina with 1 to 2 years of experience in Claims Adjudication . _Training will be 4-6 weeks In-Office, then this role will ... + FACETS experience is an added advantage + Experience in claims hospital and professional claims adjudication is mandatory. + Experience in other clinical… more
- Sedgwick (Fayetteville, NC)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (West Hills, CA)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- State of Massachusetts (Boston, MA)
- …counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication , claims settlement, claims ... *Lead Claims Examiner/Job Service Representative II| Department of Family...completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process… more
- Sedgwick (San Antonio, TX)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Brighton Health Plan Solutions, LLC (NC)
- …and claims processing and procedures. + 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims . ... + Research and respond to escalated issues and pertinent information on claims requiring adjudication . + Review and process High Dollar claims and conduct… more
- Aston Carter (Spokane, WA)
- …Identify process inefficiencies and contribute to best practice discussions. Essential Skills + Claims adjudication + Medical claim processing + Data entry + ... field preferred. + Minimum of 3-5 years of experience in medical claims adjudication . + Proficiency in interpreting benefit plan documents and EOBs. + Experience… more
- Ascension Health (Austin, TX)
- …and accurately, in accordance with regulatory requirements. + Strong understanding of claims adjudication process, provider contracts, fee schedules and system ... Additional Preference: + Three (3) years of experience in health-care claims adjudication required. + Expertise in the Facets platform preferred. + Experience… more
- UCLA Health (Los Angeles, CA)
- …COB + Knowledge of medical terminology + Experience in benefit determination and claims adjudication + Ability to accurately key 6,000-8,000 keystrokes or type ... skills + Computer proficiency with Microsoft Office + Knowledge of claims adjudication systems + Flexibility and adaptability UCLA Health is a world-renowned… more