• Medical Claims Specialist

    Rising Medical Solutions (Milwaukee, WI)
    The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring ... With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers,… more
    Rising Medical Solutions (09/26/25)
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  • RN Medical Claim Review Nurse Remote

    Molina Healthcare (Milwaukee, WI)
    …- 5:00pm. **Essential Job Duties** * Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases ... management for denial and modification of payment decisions. * Independently re-evaluates medical claims and associated records by applying advanced clinical… more
    Molina Healthcare (10/19/25)
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  • Investigator, Coding Special Investigative Unit…

    Molina Healthcare (Milwaukee, WI)
    …to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of ... to present those findings. **Preferred License, Certification, Association** + AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified… more
    Molina Healthcare (10/22/25)
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