- 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
- CVS Health (St. Paul, MN)
- …handle customer service inquiries and problems. Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing ... Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Reviews and adjudicates… more
- AON (Garden City, NY)
- …is looking for a Claims Specialist II Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your ... and written communication. Skills that lead to success: + Claims adjudication experience. + Excellent writing and... Specialist II Do you have experience in claims adjudication and enjoy resolving issues for… 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
- HCA Healthcare (Asheville, NC)
- …where diversity and inclusion thrive? Submit your application for our Insurance and Claims Specialist (Program of All Inclusive Care for the Elderly) Program ... may vary by location._** We are seeking Insurance and Claims Specialist PACE Program, for our team... by the Third-Party Administrator through competent review of claims adjudication compared to network contracts and… 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
- Zelis (Atlanta, GA)
- Position Overview: The Claims Support Specialist position provides comprehensive administrative support as a part of the Client Experience. The Claims ... healthcare compliance, medical billing, negotiations, or state and federal regulated claims . Education: + Bachelor's degree or equivalent experience in a healthcare… more
- BrightSpring Health Services (Oklahoma City, OK)
- …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
- 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
- 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
- New York State Civil Service (White Plains, NY)
- NY HELP Yes Agency Workers' Compensation Board Title Compensation Claims Referee (NY HELPS), WCB Item #3625 Occupational Category Legal Salary Grade 28 Bargaining ... Telecommuting allowed? Yes County Westchester Street Address Office of General Counsel, Adjudication Services 75 South Broadway City White Plains State NY Zip Code… 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
- New York State Civil Service (Albany, NY)
- …assurance activities for first-line review staff, monitoring error rates and claims adjudication volumes for performance assessment, and handling escalated ... requests for medical treatment including prior approval or authorization activities, adjudication of claims for payment and/or provider credentialing.-Conducting… more
- Access Dubuque (Dubuque, IA)
- … Specialist ** to join their team! This position will configure and maintain claims adjudication subsystems as necessary to maximize accuracy and efficiency of ... Insurance Configuration Specialist **Medical Associates** 1 Positions ID: oDo5sfwi Posted...Overview** **Description** Are you someone with a background in claims processing, medical billing or coding looking to advance… more
- Sedgwick (Seattle, WA)
- …exposure claims involving litigation and rehabilitation; and to ensure ongoing adjudication of claims within company standards and industry best practices or ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Specialty Operations Specialist **PRIMARY PURPOSE** **:** To analyze complex or technically difficult… more
- Arkansas Government Job (Fayetteville, AR)
- …equivalent ; plus two years of experience in customer service, program eligibility , claims adjudication , or a related field . Knowledge, Skills, and Abilities + ... ACOM DWS WORKFORCE SPECIALIST Date: Jun 7, 2024 Req ID: 40614...two years of experience in customer service, program eligibility, claims adjudication , or a related field. Additional… 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
- Office of Personnel Management (Washington, DC)
- Summary As a Legal Administrative Specialist at the GS-0901-12, you will be part of Retirement Services, Office of Personnel Management. If selected, you will be ... and benefit reconsideration requests as they affect denied requirement and insurance claims , survivor claims , and overpayments under Civil Service Retirement… more
- ManpowerGroup (Tempe, AZ)
- …and 2 tasks). Acquires a thorough understanding of system logic for claims adjudication , system constraints, conflicting benefit logic configurations, benefit ... Manpower is seeking well experienced Pharmacy Benefit Configuration Specialist candidates to work out of Tempe, AZ...of quality, and efficient use of resources to achieve claims adjudication accuracy. Ask your recruiter Nissi… more