- Humana (Richmond, VA)
- …to Provider Claims Manager and support development of systems issue resolution + Convene billing forums with selected provider associations to share billing ... community and help us put health first** The Provider Claims Educator reports to the Claims Education...claims systems, adjudication, submission processes, coding, and/or dispute resolution **Work at Home Criteria** To ensure Home or… more
- Magellan Health Services (Albuquerque, NM)
- …abandonment rate, talk time). Comfortable adapting to change. General Job Information Title Claims Resolution Specialist Grade 20 Work Experience - Required ... detailed quality and professionalism. + Assists with claim dispute resolution through research and facilitating the ...all pertinent information is recorded both for ease of resolution by the Claims Department and service… more
- University of Rochester (Rochester, NY)
- …expertise of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative II is responsible for working across ... research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all… more
- Travelers Insurance Company (Houston, TX)
- …and execute a strategic file management plan that achieves optimal file resolution , including as appropriate: research and recommendation of counsel; litigation ... and enthusiastic team player with extensive industry experience to join our Strategic Resolution Group Claim team as a Major Case Specialist handling complex toxic… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **Position Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...role will also be responsible for timely review and research , as necessary on all new and revised coding… more
- New York State Civil Service (Albany, NY)
- …New York Title Property-Casualty Insurance Claims Administrator (Risk Managment Claims Analyst) Occupational Category Other Professional Careers Salary Grade ... carriers, insurance broker contact(s), and others as necessary. * Facilitate the resolution of property and/or builders' risk insurance claims in conjunction… more
- Travelers Insurance Company (Houston, TX)
- …of junior employees. **What Will You Do?** + In the handling large exposure claims , your responsibilities may include: + Coverage Research and Analysis - ... and execute a strategic file management plan that achieves optimal file resolution , including as appropriate: research and recommendation of counsel; litigation… more
- FM (Waltham, MA)
- …and resolution of complex coverage issues. Interprets and executes claims policies and procedures. + Provides direction and feedback to direct reports ... business operations by drawing upon state-of-the-art loss-prevention engineering and research ; risk management skills and support services; tailored risk transfer… more
- NTT DATA North America (MO)
- …the timelines to complete compliance training of NTT Data/Client * Work independently to research , review and act on the claims * Prioritize work and adjudicate ... the candidate will be responsible for:** + Processing of Professional and Hospital claim forms files by provider +...98.5% PA and 99.75% FA. * Timely response and resolution of claims received via emails as… more
- UCLA Health (Los Angeles, CA)
- …fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claims + Experience processing complex institutional ... timely data entry, and the review and adjudication of professional , ancillary, and institutional claims for services...and turn-around requirements. This role requires the ability to research and resolve complex claim issues as well as… more
- NTT DATA North America (St. Louis, MO)
- …the timelines to complete compliance training of NTT Data/Client + Work independently to research , review and act on the claims + Prioritize work and adjudicate ... the candidate will be responsible for:** + Processing of Professional claim forms files by provider + Reviewing the...98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as… more
- NTT DATA North America (St. Louis, MO)
- …the timelines to complete compliance training of NTT Data/Client * Work independently to research , review and act on the claims * Prioritize work and adjudicate ... to work **remote (MO).** **Role Responsibilities:** * Processing of Professional claim forms files by provider * Reviewing the...98.5% PA and 99.75% FA. * Timely response and resolution of claims received via emails as… more
- NTT DATA North America (MO)
- …the timelines to complete compliance training of NTT Data/Client -Work independently to research , review and act on the claims -Prioritize work and adjudicate ... team for a remote position. **Role Responsibilities** -Processing of Professional claim forms files by provider -Reviewing the policies...above 98.5% PA and 99.75% FA. -Timely response and resolution of claims received via emails as… more
- NTT DATA North America (Dallas, TX)
- …the timelines to complete compliance training of NTT Data/Client + Work independently to research , review and act on the claims + Prioritize work and adjudicate ... the candidate will be responsible for: + Processing of Professional and Hospital claim forms files by provider +...98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as… more
- Sharp Electronics Corporation (Downers Grove, IL)
- **Overview** The Claims Specialist position is responsible for Point of Sale (POS) data management and processing back-end pricing rebates/credits, including ... resolution of issues/disputes in a timely and accurate manner....errors, correct any inaccuracies in POS daily. + Investigate, research , and identify business entities with minimal information provided.… more
- Trinity Health (Livonia, MI)
- …Ability to troubleshoot problems and questions from end users and provide resolution and requested information. Ability to research , evaluates, and analyzes ... simultaneously and adapts to frequent changes in priorities. Actively pursues professional growth opportunities. Utilizes support staff appropriately and adopts new… more
- UCLA Health (Los Angeles, CA)
- …exciting new direction. You can do all this and more at UCLA Health. The Claims Quality Auditor serves as the primary point of contact for submission and ... resolution of Provider Dispute Resolutions and Appeals. They will...documentation for tracking PDR/Appeals data and conduct all pertinent research to evaluate, respond and close incoming Appeals from… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Financial Representative- Oncology Claims Follow-Up/Billing Corporate Full-Time Days** Analyses accounts and billing(s) to ensure accurate ... Telephones contacts to follow up on accounts in a professional and assertive manner + Answers all patient, third...a timely manner, to immediate supervisor for handling or resolution + Utilizes trial balance and other reports to… more
- Penn Medicine (Philadelphia, PA)
- …opportunities to enhance front end claim edits to facilitate a first pass resolution . Responsibilities: + Responsible for patient account research in relation to ... mission of providing the highest level of care to patients, conducting innovative research , and educating future leaders in the field of medicine. Working for this… more
- Black & Veatch (Overland Park, KS)
- **Paralegal - Dispute Resolution ** Date: Apr 7, 2025 Location: Overland Park, KS, US Company: Black & Veatch Family of Companies **Together, we own our company, our ... talents and perspectives to use. **The Opportunity** As the Paralegal - Dispute Resolution , you will have the opportunity to work collaboratively and under direction… more