- 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 ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… 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. +… more
- AssistRx (Phoenix, AZ)
- …reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim rejections, ... teams on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …contracts, Medical Policies and Payment procedures as well as capable of manually processing claims according to all outlined Policies and Procedures. This job ... Essential Qualifications + Knowledge of contracts, medical terminology, and claims processing and procedures. + 1+ year...and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written… more
- Point32Health (MA)
- …(minimum years required): + Required: 2-4 years experience as a Point32Health Core Claims Processor or similar claims processing or customer service ... we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Claims Specialist performs timely and accurate processing ...pending claims and adjustments daily and ensure claims are released timely for adjudication . +… more
- Brighton Health Plan Solutions, LLC (NC)
- … claims processing and procedures. + 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims . + ... and respond to escalated issues and pertinent information on claims requiring adjudication . + Review and process...experience in the healthcare field preferred. About At Brighton Health Plan Solutions, LLC, our people are committed to… 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
- CommonSpirit Health (Erlanger, KY)
- …to return, pend, deny or pay claims ). + Follows and ensures claims processing is consistent with applicable policies, regulations, procedures and department ... processing enhancements. + Responsible for managing the STD claims team but is not limited to the following:...Provide technical expertise and direction to team members on claims adjudication for STD. + Facilitate the… more
- Independent Health (Buffalo, NY)
- …certificate and/or college degree preferred. + Six (6) months of medical claims processing /medical billing experience, customer service experience preferably in ... relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication . + Analyze, identify and research, as needed, edits… more
- TEKsystems (Fresno, CA)
- …* Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing / adjudication guidelines.* Examine a problem, set of data ... and processing medical, dental, vision and electronic claims in accordance with state, federal and health...Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination * Basic knowledge of medical… more
- Elevance Health (St. Louis, MO)
- …+ Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide ... I** is responsible for pre and post payment and adjudication audits of high dollar claims for...documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for… 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 ... to manage and interpret data enhancing the efficiency of claims processing . + Collaborate with team members...FACETS experience is an added advantage + Experience in claims hospital and professional claims adjudication… more
- Northwell Health (New York, NY)
- …conditions + Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor. Attends JOC meetings with providers as appropriate ... creating and testing compensation grids used for reimbursement and claims processing + Ensures that refund checks...within a healthcare or managed care setting (preferred) + Claims adjudication experience + Knowledge of MLTC/… more
- TEKsystems (Los Angeles, CA)
- …Regulatory Agencies What You Bring + 5+ years of hands-on experience in claims processing and system configuration + Strong analytical and problem-solving skills ... + Manage special projects related to claim denials and auto- adjudication + Identify risks and implement strategies to reduce...HMO Claims & Insurance Expertise + ✅ Claims Audits, Resubmissions & Processing + ✅… more
- Sedgwick (Troy, MI)
- …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
- CVS Health (Hartford, CT)
- …This critical role involves addressing significant challenges related to enrollment, billing, and claims processing on the Majesco LA&H Core Suite. The ideal ... on resolving high-priority defects and systemic issues impacting enrollment, billing, and claims processing + Deep-Dive Analysis & Root Cause Identification:… more
- Providence (Mission Hills, CA)
- … Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers. Providence ... **Description** The Senior Claims Specialist is responsible for the processing...loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior… more
- Aston Carter (Spokane, WA)
- …+ Identify process inefficiencies and contribute to best practice discussions. Essential Skills + Claims adjudication + Medical claim processing + Data entry ... + Minimum of 3-5 years of experience in medical claims adjudication . + Proficiency in interpreting benefit...+ Ability to work independently, prioritize tasks, and meet processing benchmarks. Work Environment The work schedule is from… more
- Centene Corporation (Harrisburg, PA)
- …the subject matter expert for other Claims Liaisons. + Analyze trends in claims processing issues and identify work process solutions + Lead meetings with ... claims issues to ensure prompt and accurate claims adjudication + Identify authorization issues and...configuration related work process changes + Analyze trends in claims processing issues and assist in identifying… 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, ... Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills &...(must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs… more