- AssistRx (Orlando, FL)
- …and support all operational and financial processes related to claim processing activities. In addition, manager will ensure effective day-to-day operations and ... and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances… more
- NTT DATA North America (Ontario, CA)
- …Xcelys System **Job Summary** The Xcelys Team Lead will oversee a team of claims examiners, ensuring the accurate and timely processing of medical claims ... sourcing strategy. NTT DATA Services currently seeks Xcelys Medical Claims Team Lead to join our team...provide constructive feedback to team members. **Xcelys Platform and Claims Processing ** + Maintain subject matter expertise… more
- APTIM (Santa Fe, NM)
- …reviewers, estimators, and support personnel to ensure timely, accurate, and compliant claims processing in alignment with federal regulations and program ... **Job Overview:** The Team Lead -- Claims Review is responsible...minimum of ten (10) years of combined experience in claims /case processing roles including customer service, data… more
- Prime Therapeutics (Washington, DC)
- …fuels our passion and drives every decision we make. **Job Posting Title** Lead Claims Processor, Government Programs **Job Description** Adjudicate or submit ... and adjustments as required. + Implementation and maintenance of claims processing programs and procedures + Verify...and administrative duties as required by business need. + Lead and implement positive changes with a high level… more
- CVS Health (Blue Bell, PA)
- …leading modernization efforts. + Strong understanding of regulatory compliance in claims processing . + Excellent communication and stakeholder management skills. ... do it all with heart, each and every day. **Position Summary:** The Lead Director of Software Engineering is responsible for leading engineering teams that support… more
- Centene Corporation (Harrisburg, PA)
- …as the subject matter expert for other Claims Liaisons. + Analyze trends in claims processing issues and identify work process solutions + Lead meetings ... potential configuration related work process changes + Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing… more
- Integra Partners (Troy, MI)
- …is responsible for leading complex projects and initiatives related to claims adjudication, processing , compliance, and operational improvements. This role ... requires deep subject matter expertise in healthcare claims systems, workflows, and regulatory requirements. The PM will...PM's responsibilities include but are not limited to: + Lead and manage end-to-end projects focused on healthcare DME… more
- Sedgwick (Cincinnati, OH)
- …growth, and inclusion. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Adjuster | Dedicated Client | KY,VA,WV,IN,KS,MI,MO,NE Jurisdictions | Open to… more
- HCA Healthcare (Nashville, TN)
- …Physician's Services Group and other corporate departments that will mutually benefit the Claims Department and the organization. + Lead and/or participate in ... Do you want to join an organization that invests in you as a Senior Claims Supervisor? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300… more
- CHS (Clearwater, FL)
- … claims prior to payment. * Oversight for the ongoing management of claims processing technology, including plan building and identification of new and ... the client's stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional service to… more
- AIG (Atlanta, GA)
- …Law Firms with an annual spend of less than $500K for Insurance Claims processing and adjudication commodities. This shall include; + Negotiate commercial ... customers to manage risk. Join us as a Senior Claims Law Firm Analyst to play your part in...from AIG's Law Firm contract template; + Participate and lead Law Firm pricing negotiations; + Document and summarize… more
- CHS (Clearwater, FL)
- …guidelines, and reporting requirements; Federal and state regulations; and timeliness of claims processing . + Utilize Excel, prepares tracking and trending ... up-to-date working knowledge on regulatory requirements associated with billing and claims processing , as well as HIPAA guidelines/established Encryption… more
- Athene (West Des Moines, IA)
- …A Claims Representative at Athene is responsible for researching and processing claims requests while observing contractual and regulatory guidelines. The ... empathize with customers during difficult times. Accountabilities: + Initiates processing of new claims , investigates and reviews...potential issues with claims and refers questionable claims to Escalation-Team, Team Lead or Manager.… more
- Dignity Health (Bakersfield, CA)
- …of complex healthcare claims . This position requires expert knowledge of claims processing , coding, and regulatory compliance. The Claims Examiner ... **Minimum Qualifications:** + 3-5 years of experience in healthcare claims processing , with at least 2 years...of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population… more
- CTG (CA)
- **CTG is seeking to fill an Epic Hospital Billing Claims Analyst opening for our client in California.** **Location:** Remote **Duration:** 18 months **Duties:** + ... Lead and oversee the configuration, maintenance, and support of Epic Hospital Billing (HB) Claims functionality, with a specialized focus on Behavioral Health and… more
- CVS Health (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
- Elevance Health (San Juan, PR)
- Claims Representative I **Location Hybrid 1:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... Location: 654 Avenue Luis Munoz Rivera, San Juan, 00918** The ** Claims Representative I** responsible for successfully completing the required basic training.… more
- State of Colorado (Denver, CO)
- Nutrition Claims and Finance Consultant Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5083346) Apply Nutrition Claims and Finance ... program workplans. + Provide technical assistance to sponsors about their claims for reimbursement. + Provides subject matter expertise and oversight for… more
- Insight Global (Houston, TX)
- …A healthcare system in Houston, TX is seeking a Director of Revenue Cycle - Claims Follow Up to join their team. This a hybrid position that is responsible for ... overseeing a claims follow up team. In this role you will...ensure that billing, collections, payment/adjustments applications, correspondence and refund processing is done timely and accurately for the achievement… more
- Trinity Health (Davenport, IA)
- …organization or other health care financial service setting, performing medical claims processing , financial counseling, financial clearance, accounting, or ... way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce… more