- Mass Markets (Killeen, TX)
- …expanding, industry-leading organization. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have ... 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
- AdventHealth (Apopka, FL)
- …for all activities regarding Rx Plus Pharmacy's state licensed data entry, claims adjudication , prior authorization, pharmacy specialist , and technician ... of prescription order intake of various media, technician quality assurance, claims adjudication and copay assistance, prior authorization, and prescription… more
- AON (NY)
- …is looking for a Claims Specialist II Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your ... and written communication. Skills that lead to success: + Claims adjudication experience. + Clear and professional... Specialist II Do you have experience in claims adjudication and enjoy resolving issues for… more
- UNUM (Columbia, SC)
- …demonstrating strong customer service prior to movement to the exempt level claims specialist role. **Principal Duties and Responsibilities:** + Maintain ... claims . + Develop a working knowledge of systems needed for claims adjudication . + Provide excellent customer service and independently respond to all… more
- UPMC (Pittsburgh, PA)
- UPMC WorkPartners is hiring a full-time Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The selected ... Virginia workers comp adjuster license. The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims … more
- Sedgwick (Fort Worth, TX)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Licensed Auto Claims Adjuster - Bodily Injury Specialist (New York License Required) ... claims to determine scope of damages; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Claims Research Specialist will oversee and manage research efforts related to claims overpayments, underpayments, ... and working collaboratively with providers and internal departments to enhance claims processes and improve financial outcomes. **Essential Functions:** - To… more
- University of Washington (Seattle, WA)
- …Medicine Faculty Practice Plane Services has and outstanding opportunity for a ** Claims Specialist (Patient Account Representative 2).** This position is ... responsible for claims review, clearing claim edits, and timely and accurate...rejections, or forwarding the claim to a medical coding specialist for review and coding changes prior to submitting… 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
- Molina Healthcare (Detroit, MI)
- …or GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 1-3 years' experience in claims adjudication , Claims Examiner II, or other relevant work ... **Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines,… 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
- Dignity Health (Bakersfield, CA)
- …advanced-level role responsible for the detailed and accurate processing, review, and adjudication of complex healthcare claims . This position requires expert ... knowledge of claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most challenging cases, mentor junior staff, and… more
- Independent Health (Buffalo, NY)
- …Accountable. **Essential Accountabilities** + Assist in the timely review and manual adjudication of professional claims through claim queues; meeting agreed ... fosters growth, innovation and collaboration. **Overview** The Network Reimbursement Specialist -Associate will ensure that all policies and processes that support… more
- CVS Health (Harrisburg, PA)
- …written correspondence related to claim processing issues. * Routes and triages complex claims to Senior Claim Benefits Specialist . * Proofs claim or referral ... with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical… more
- TEKsystems (Madison, WI)
- …identified claims issues, repetitive errors, and payer trends to expedite claims adjudication Work accounts in assigned queues in accordance with ... - 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 ... CT)** The primary function of the Patient Accounting Billing Specialist I is the daily management of an assigned...scrubber systems to ensure timely submission of claims in accordance with department expectations. May also perform… more
- CRC Insurance Services, Inc. (TX)
- …fostering great working relationships with insureds, brokers and underwriters in the handling and adjudication of all claims . 8. Maintain claims and suspense ... America) **Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …support in the management of contractor requests for equitable adjustments and adjudication of contractor claims . Assists in developing documents for legal ... Title: Facilities Contract Specialist (Level I/II) Non-Competitive Progression Location: United States-Virginia-Virginia Beach Job Number: 250003GB Are you ready to… more
- UPMC (Pittsburgh, PA)
- …is key to keeping operations running smoothly. + Verify electronically received claims before adjudication , clearing errored records in line with established ... things run smoothly and accurately? As a Document Process Specialist , you'll be at the front line of our..., you'll be at the front line of our claims intake process-ensuring that every paper claim and piece… more
- DATAMAXIS (Springfield, IL)
- …to make determinations relating to complex processes involving claims processing/ adjudication , recipient/provider eligibility, and third-party liability. ... projects like the following: CMS Federal Reporting, quality measures, claims processing, Medicaid program eligibility, provider enrollment, third-party liability. *… more
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