- Mass Markets (Killeen, TX)
- …trusted partner in the industry. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong ... of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a high-volume… more
- AssistRx (Phoenix, AZ)
- …claim reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim ... The Copay Support/ Claims Processing Specialist is a critical...discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and… more
- CVS Health (Lansing, MI)
- …inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- Polaris Pharmacy Services, LLC (Des Plaines, IL)
- …career advancement to all our team members. JOB SUMMARY: The Adjudication Specialist manages a portfolio of rejected pharmacy claims , ensuring timely billing ... Adjudication Specialist Job Details Job Location...and enhance our services. DUTIES/RESPONSIBILITIES: + Manage and Identify Claims Portfolio: + Review and evaluate insurance claims… more
- Transdev (Lombard, IL)
- …or watch an overview video athttps://youtu.be/ilO5cv0G4mQ About the Role: The Claims Specialist will assist the Director of Workers Compensation ... overseeing the managing the operational excellence of the Workers' Compensation Program. The Claims Specialist will play a critical role in ensuring quality… more
- Providence (Mission Hills, CA)
- **Description** The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per ... diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they… more
- Northwell Health (New York, NY)
- **Req Number** 166205 Flexstaff is hiring a CLAIMS SPECIALIST on a fulltime Temporary basis. (Coding/ Claims experience needed, Data Analysis a plus) The ... Claims Specialist will support department operations related to provider communication,...within a healthcare or managed care setting (preferred) + Claims adjudication experience + Knowledge of MLTC/… 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
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... 011250 CCA- Claims Hiring for One Year Term **_This position...the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr.… more
- Prime Therapeutics (Santa Fe, NM)
- …of that. It fuels our passion and drives every decision we make. **Job Posting Title** Claims Specialist Sr **Job Description** The Claims Specialist is ... related to specific process or support systems (eg claim adjudication system) Escalate issues when appropriate + Partner with...accredited institution or equivalent GED + 1 year of claims experience + Must be eligible to work in… more
- Robert Half Office Team (Lombard, IL)
- Description We are looking for a skilled Workers Compensation Claims Specialist to manage and enhance the operational aspects of our Workers' Compensation ... Workers' Compensation Program, ensuring efficient and quality management of claims . * Collaborate with external partners, including Third-Party Administrators, to… more
- Point32Health (MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Claims Specialist performs timely and accurate processing of claims ... Supervisor. Using analytical and problem solving skills, the Claims Specialist fully researches and resolves all...pending claims and adjustments daily and ensure claims are released timely for adjudication . +… more
- Allied Solutions (Plano, TX)
- …Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection; + Adjudicate claims within the guidelines of the ... Position Summary; This position is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster. This… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …or related field **Experience:** + Required: 1 year experience using the RxIQ claims adjudication platform + Preferred: 2 Years experience with Health Care, ... data or changes to existing clients into the PBM adjudication platform. Works closely with the Benefit Operations Supervisor...act as a lead role within the Benefit Operations Specialist team and be a liaison to management and… more
- Customs and Border Protection (San Francisco, CA)
- …Homeland Security by performing paralegal activities such as reviewing and finalizing claims , preparing cases, and participating in the work of a paralegal team. ... $131,743.00 (GS-13, Step 1) to $171,268.00 (GS-13, Step 10). In this Supervisory Paralegal Specialist position, you will become a key member of a team of Homeland… more
- TEKsystems (West Des Moines, IA)
- …identified claims issues, repetitive errors, and payer trends to expedite claims adjudication EPIC experience Experience with payer platforms Pay and ... in Iowa, Quad Cities, and Wisconsin The Insurance Billing and Follow Up Specialist II will be responsible for performing all billing and follow-up functions,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Bluebird Bio, and Gift of Life accounts to ensure accurate reimbursement and final adjudication of claims as needed. Works prebilling edits in the billing and ... based on alphabetical splits. Responsibilities of the Patient Accounting Billing Specialist include regular and consistent billing for all payers and follow-up… more
- Elevance Health (AL)
- …prevent unnecessary medical-expense spending. **Title** : Financial Operations Recovery Specialist II **Location:** This role enables associates to work virtually ... is granted as required by law. The **Financial Operations Recovery Specialist II** is responsible for the discovery, validation, recovery, and adjustments… more
- Martin's Point Health Care (Portland, ME)
- …in Microsoft Outlook, Word, Excel, TruCare and Salesforce. Experience with QNXT Claims Adjudication Platform strongly preferred. Abilities + Exceptional written ... to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This role supports Appeals quality goals through… more
- Movn Health (CA)
- …billing and A/R management + Deep knowledge of payer reimbursement methodologies and claims adjudication + Proficiency with multiple EHRs + Strong command of ... seeking a highly experienced Senior Medical Biller & A/R Specialist to take full ownership of claims ...A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a… more