- 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 ... affordable. Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- CVS Health (Albany, NY)
- …inquiries and problems. Required Qualifications - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing ... and affordable. Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines . Acts as a… 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
- 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
- Providence (Anaheim, CA)
- **Description** The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per ... diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they… more
- Zelis (Atlanta, GA)
- Position Overview: The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement ... based on Zelis data points. During this call, the Claims Settlement Specialist must understand: (1) the...deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment… 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
- Zelis (Boston, MA)
- …we're looking for a skilled Technical Writer to join our team as a specialist within our Price Optimization, Claims Editing organization. As a Technical Writer, ... tasks + Understanding of the life of a claim/claim processes (eg, claims editing, adjudication , etc) + Exceptional collaboration skills within departments… 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
- MyFlorida (Tallahassee, FL)
- …click on the link: http://www.floridajobs.org/ The Work You Will Do: An Employment Program Specialist is a member of the Claims Processing team of the Division ... 825896 -EMPLOYMENT PROGRAM SPECIALIST - 40034182 1 Date: Apr 26, 2024...the Reemployment Assistance Program. Responsibilities includes processing Florida liable claims , providing claimant instructions and taking necessary actions relative… more
- MyFlorida (Tallahassee, FL)
- EMPLOYMENT PROGRAM SPECIALIST - 40034188 Date: Apr 10, 2024 Location: TALLAHASSEE, FL, US, 32399 The State Personnel System is an E-Verify employer. For more ... . Requisition No: 827002 Agency: Commerce Working Title: EMPLOYMENT PROGRAM SPECIALIST - 40034188 Pay Plan: Career Service Position Number: 40034188 Salary:… more
- Actalent (St. Louis, MO)
- …process + Visit clients to go over monthly billing statement + Claim adjudication Software: QS1 / Framework Skills: billing specialist , Pharmacy, pharmacy ... Description: Weekly breakdown: 25-30 hours of billing and claims 10-15 hours of pharmacy order entry Duties:...prior authorization, Claim, claim processing Top Skills Details: billing specialist Additional Skills & Qualifications: + Will assist in… more
- Actalent (St. Louis, MO)
- …month bill process Visit clients to go over monthly billing statement Claim adjudication Software: QS1 / Framework Skills: billing specialist , Pharmacy, pharmacy ... Description: Weekly breakdown: 25-30 hours of billing and claims 10-15 hours of pharmacy order entry Duties:...of the time, when billing tasks are complete Claim adjudication Prior authorizations Long term care pharmacy experience is… more
- CareOregon (Portland, OR)
- …benefit. + Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. ... Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Job Code A133 Department Pharmacy Manager Title Pharmacy Benefit… more
- Houston Methodist (Katy, TX)
- …701 S Fry Rd 77450 (Katy)** At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional ... for insurance or institutional accounts. Duties include preparing and processing claims , clearing billing edits, claim validation and submittal, and receivable… more
- St. Luke's University Health Network (Allentown, PA)
- …of 1-2 years of Pennsylvania Workers' Compensation experience with direct adjudication , supervision, and administration of workers' compensation claims with ... ability to pay for health care. The Workers Compensation/UE Specialist is responsible for working with injured employees, managers...original position or in a modified duty position. Reports claims and updates to the TPA for proper … more
- Loretto Management Corporation (Syracuse, NY)
- …supervision of the Health Information Director/Designee, the Compliance Reimbursement Specialist is responsible for analyzing documented clinical data to identify ... the patient's clinical picture, severity of illness, etc. In addition, the Specialist will identify, collect, assess, monitor and review documentation and encounter… more
- UNC Health Care (Goldsboro, NC)
- …write-offs, reversals, adjustments, refunds or other methods. 12. Verifies claims adjudication utilizing appropriate resources and applications. Reconciles ... of the unique communities we serve. Summary: The Government-Non-government Specialist is responsible for reviewing, submitting and resolving assigned insurance… more