- CVS Health (Columbus, OH)
- …accordance with plan processing guidelines. - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing ... and applies all cost containment. measures to assist in the claim adjudication process.- Insures all compliance requirements are satisfied and all payments are… more
- Department of State - Agency Wide (Honolulu, HI)
- Summary The incumbent directs and manages the Adjudication operations of the Honolulu Passport Agency (CA/PPT/HH), in Honolulu, Hawaii and serves as a senior member ... to four subordinate supervisors that are engaged in the acceptance and adjudication of passport applications. Responsibilities Serve as an authority on resolution of… more
- BrightSpring Health Services (Englewood, CO)
- …Adjudication Specialistwill be responsible for all aspects of pharmacy and medical claims adjudication , accuracy of pharmacy and medical claims , ... Paid Time Off & Holidays Responsibilities + Processes pharmacy and medical claims accurately and efficiently, ensuring compliance with payer policies and guidelines.… more
- Community Clinic Inc. (Silver Spring, MD)
- …a more equitable health care system for everyone. Position Summary CCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical ... services provided. The Claims Specialist will assure that services are...apply knowledge of Commercial Indemnity guidelines in the processing, adjudication , and payment of claims . + Maintain… 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
- Magellan Health Services (Maryland Heights, MO)
- …Assist in testing and documenting of account specific benefits to ensure accurate claims adjudication . The position assists in ensuring system performance and ... 2+ years of claims processing experience. General Job Information Title Claims Systems Specialist I Grade 20 Work Experience - Required Claims Work… more
- Baystate Health (Springfield, MA)
- …with various levels of staff **3)** Ability to manage complexities of payer adjudication of claims and coordination of benefits **4)** Ability to work ... **The Physician Billing Claim Support Specialist is responsible for ensuring accurate and complete...elements to allow for effective and timely submission of claims .** **Job Responsibilities:** **1)** Charge Corrections - Process all… more
- Zelis (Atlanta, GA)
- Position Overview: The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement ... based on Zelis data points. During this call, the Claims Settlement Specialist must understand: (1) the...deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment… more
- Office of Personnel Management (Washington, DC)
- Summary As a Legal Administrative Specialist ( Claims Examiner) at the GS-0901-9, you will be part of Healthcare and Insurance, Office of Personnel Management. If ... which demonstrates ALL of the following: reviewing disputed health benefits claims and appeals; responding to general inquiries concerning disputed claim… 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
- Zelis (Boston, MA)
- …we're looking for a skilled Technical Writer to join our team as a specialist within our Price Optimization, Claims Editing organization. As a Technical Writer, ... tasks + Understanding of the life of a claim/claim processes (eg, claims editing, adjudication , etc) + Exceptional collaboration skills within departments… more
- Robert Half Accountemps (Fort Wayne, IN)
- …are offering a contract to permanent employment opportunity for an Insurance Follow-Up Specialist in FORT WAYNE, Indiana. This role is in the healthcare industry and ... will involve follow-ups on medical claims . The workplace environment is business casual and requires...in Insurance Follow-up, Claim Denials, Denial Management, and Claim Adjudication . * Interact with doctor offices to resolve any… more
- Medical Mutual of Ohio (OH)
- …exposure to software quality assurance and testing. . Strong knowledge of claims adjudication systems and processes. . Strong analytical and problem-solving ... preferred. . Knowledge of Project management methodologies. . Strong knowledge of claims adjudication systems and processes and contract/regulation language. .… more
- CVS Health (San Antonio, TX)
- …to assist in the claim adjudication process. * Routes and triages complex claims to Senior Claim Benefits Specialist . * Proofs claim or referral submission ... all cost containment measures to assist in the claim adjudication process. - Coordinates responses for routine phone inquiries...to claim processing issues. - Routes and triages complex claims to Senior Claim Benefits Specialist . -… more
- State of Montana (Helena, MT)
- …remain a benefit today and for future generations. We are actively seeking an * Adjudication Specialist * who values the vast resources in our treasure state as ... 24 state-owned dams and 250 miles of irrigation canals. *JOB OVERVIEW: * The Adjudication Water Resource Specialist ( Specialist ) performs a variety of duties… more
- MyFlorida (Tallahassee, FL)
- EMPLOYMENT PROGRAM SPECIALIST - 40034188 Date: May 24, 2024 Location: TALLAHASSEE, FL, US, 32399 The State Personnel System is an E-Verify employer. For more ... . Requisition No: 827002 Agency: Commerce Working Title: EMPLOYMENT PROGRAM SPECIALIST - 40034188 Pay Plan: Career Service Position Number: 40034188 Salary:… more
- CareOregon (Portland, OR)
- …benefit. + Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy… more
- Ultimate Care Inc (Brooklyn, NY)
- …documentation and work closely with healthcare providers to ensure accurate and timely adjudication of claims + Adhere to all applicable laws, regulations, and ... provider of home health care services, is seeking HR Specialist to join our team! The HR Specialist...and providing assistance to employees. You'll oversee the entire claims process, coordinating with insurance providers and managing medical… more
- Houston Methodist (Katy, TX)
- …701 S Fry Rd 77450 (Katy)** At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional ... for insurance or institutional accounts. Duties include preparing and processing claims , clearing billing edits, claim validation and submittal, and receivable… more
- Health First (Rockledge, FL)
- …Drug Manufacturer Patient Assistance Programs by entering the appropriate edits in the claims adjudication system. 7. Build, test and maintain the health plans ... that are sent in support the request. 4. Audit Pharmacy benefit adjudication system performance for speed and accuracy. Report any identified deficiencies. 5.… more