- Rose International (Woonsocket, RI)
- …third-party insurance settings are coded and maintained appropriately within the pharmacy adjudication system. * The Pharmacy Insurance Specialist will perform ... Hiring Organization: Rose International Position Number: 462763 Job Title: Billing Specialist - Pharmacy Insurance Specialist Job Location: Woonsocket, RI,… more
- 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
- Department of State - Agency Wide (Philadelphia, PA)
- Summary The incumbent directs and manages the Adjudication operations of the Philadelphia Passport Agency (CA/PPT/PA), in Philadelphia, Pennsylvania and serves as a ... to four subordinate supervisors that are engaged in the acceptance and adjudication of passport applications. Responsibilities Serve as an authority on resolution of… more
- BrightSpring Health Services (Englewood, CO)
- …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
- AON (NY)
- Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your experience with a globally respected firm, this ... effectively with customer. Prepare correspondence. Skills that lead to success: + Claims adjudication experience. + Excellent writing skills, specifically clear,… 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
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- Overview The Claims Specialist , under the direction of the Supervisor (with guidance from a Team Lead), is responsible for processing medical claims received ... such as EOBs, EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid or rejected based upon… 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
- 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
- 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
- UNUM (Chattanooga, TN)
- …health condition threshold to STD like plans This service is a hybrid of adjudication of an insurance claim and leaves request administration and may also apply to ... for technical expertise (FMLA,225+ state regulations), complex processing of leaves/ claims , review of medical certification, and ongoing relationship management with… more
- Sedgwick (Columbus, OH)
- …exposure claims involving litigation and rehabilitation; and to ensure ongoing adjudication of claims within company standards and industry best practices or ... to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Specialty Operations Specialist **PRIMARY PURPOSE** : To analyze complex or technically difficult… 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
