- GAP Solutions Inc (Madison, WI)
- **Position Objective:** As a Junior Human Resource Specialist , apply HR skills in support of managers, program staff and customers on the full range of HR topics ... Assisting with drafting SOP's. + Processing personal liability insurance reimbursement claims . + Initiating tentative selection notifications, notice of results or… more
- Zurich NA (Madison, WI)
- Marine Claims Senior Claims Specialist 126574 Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and ... and 6 or more years of experience in the Claims and/ or Litigation Management area.OR + Juris Doctor...and 2 or more years of experience in the Claims and/ or Litigation Management area.OR + Zurich Certified… more
- Artera (Madison, WI)
- Claims Specialist Summary Title: Claims Specialist ID:1773 Location:Madison, 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 (Madison, WI)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... overpayment notification and supporting documentation such as explanation of benefits, claims and attachments. + Maintains and reconciles department reports for… more
- Molina Healthcare (Madison, WI)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides support for ... claims activities including reviewing and resolving member and provider...Experience:** + Call center experience + Be familiar with claims + Great computer and MS Office skills +… more
- Sedgwick (Madison, WI)
- …Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims ... and RESPONSIBILITIES** + Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information… more
- Molina Healthcare (Madison, 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 (Madison, WI)
- …Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine Medicare appeal and claim outcomes.… more
- Molina Healthcare (Madison, WI)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and...fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific positions… more
- Molina Healthcare (Madison, 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 (Madison, 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 (Mount Horeb, 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
- Datavant (Madison, WI)
- …and life experiences to realize our bold vision for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials across the ... practices, and proficiency in multiple electronic systems and software tools. The specialist serves as a key liaison between coding, billing, utilization review,… more
- American Family Insurance - Corporate (Madison, WI)
- As an Advertising Compliance Specialist , you will provides a full range of compliance oversight, advice and services with specialist knowledge in support of the ... on enacted changes in legislation and regulations to assist with sales, claims or product development and maintenance. * Collaborate with various business units… more
- Molina Healthcare (Madison, WI)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more
- Molina Healthcare (Madison, 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
- Western Digital (Madison, WI)
- …**Job Description** **Position Summary** We are looking for a **Retail Compliance Specialist ** to join the Western Digital Fulfillment Operations Team to be ... chargebacks, late deliveries, labeling errors, incorrect shipments. Review and validate claims received from retail partners to determine legitimacy and compliance… more
- CVS Health (Madison, WI)
- …each and every day. **Position Summary** The **Senior Accounts Receivable Specialist ** prepares accounting and financial records and reports, including general ... monthly invoices in accounting system. + Enter and process monthly fee claims for ancillary product offerings via claim system. **Required Qualifications** + 2+… more
- Cardinal Health (Madison, WI)
- …to meet and exceed revenue and profitability objectives. The _Sr. Specialist , Business Intelligence_ provides Product & Solutions Marketing support to internal ... methodology and requirements gathering is a plus. + Basic understanding of operations and claims processing in pharmacy or other healthcare related area is a plus. +… more
- Molina Healthcare (Madison, WI)
- …to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists with interdepartmental issues ... **I** **E** **N** **C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed… more
