- Artera (Green Bay, WI)
- Claims Specialist Summary Title: Claims Specialist ID:1774 Location:Green Bay, WI Department:Legal More about this job > Description JOB PURPOSE: Manage ... all claims while under the general supervision of the Claims Director. Provide monthly updates and reporting. Coordination and database management; and other… more
- Molina Healthcare (Green Bay, WI)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with… more
- Molina Healthcare (Green Bay, WI)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Green Bay, WI)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Molina Healthcare (Green Bay, WI)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system configurations… more
- CDM Smith (Green Bay, WI)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs… more
- Walgreens (Neenah, WI)
- …and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), ... for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims . + Completes execution of all pricing activities including price changes,… more
- Molina Healthcare (Green Bay, WI)
- JOB DESCRIPTION Job Summary Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating ... information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness… more
- Molina Healthcare (Green Bay, WI)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical Terminology,… more
- Acosta Group (Appleton, WI)
- …to perform the essential duties. _Responsibilities With Regard to Workers' Compensation Claims :_ You are responsible for reporting all employment related injury you ... incur to your direct supervisor as soon as possible following an incident resulting in an injury. **QUALIFICATIONS** _Education/Experience:_ High school diploma or general education degree (GED); or one to three months' related experience and/or training; or… more
- Molina Healthcare (Green Bay, WI)
- …credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. * ... Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. * Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have… more
- Molina Healthcare (Green Bay, WI)
- …enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims ... of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of Local, State… more
- Molina Healthcare (Green Bay, WI)
- …likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge ... specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program… more