- USAA (Tampa, FL)
- …and guidelines. + Applies advanced medical expertise by serving as primary resource for Health Claims for the approach to medical risk assessment rules. + Guides ... data. + Reviews and interprets relevant medical literature for application to health claims policies and guidelines. + Collaborates with senior leaders and… more
- MGE Underground, Inc. (Paso Robles, CA)
- …| Performance | Trust | Fun How You Can Make an Impact The Safety, Health & Claims (SH&C) Coordinator is responsible for managing self-insurance and Workers' ... and effective communication with internal teams and external stakeholders regarding safety, health , and claims -related matters. + Track and ensure timely… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Claims Auditor III Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... planning audits and audit work programs that address appropriate claims and financial compliance criteria for specialty health... claims and financial compliance criteria for specialty health plans. These audits are intended to ensure that… more
- Elevance Health (Miami, FL)
- …The ** Claims Representative III** is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. ... **Job Title:** Claims Representative III **Schedule:** Monday-Friday 7am-3:30pm EST **Virtual**...50,000 members, HealthSun is one of the fastest growing health plans in South Florida. As a local plan,… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the ... to improve the quality and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health... Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of … more
- AIG (Lenexa, KS)
- …skills and experience as a valued member of the team. Make your mark in Accident and Health Claims Our Claims teams are the proven problem solvers of choice ... providing world class service to external and internal customers. + Handle Accident & Health claims as part of the A&H team, handling claims such as A&D,… more
- Mount Sinai Health System (New York, NY)
- …+ HS/GED; Associates Degree is preferred + **1-2 years of experience in medical billing or health claims , with experience in billing systems in a health care ... accounts via online work file and/or hard-copy reports; checks claims status, re-submits claims , and writes appeal...Us** **Strength through Unity and Inclusion** The Mount Sinai Health System is committed to fostering an environment where… more
- DXC Technology (Springfield, IL)
- …to work in a team environment** **Other Qualifications:** **Fellowship of Life Health Claims (FLHC) Certification is preferred** **PowerBi knowledge is desired** ... client requests for information** **Evaluates available information to validate claims ** **Verifies contract information, effective dates, status and verification of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …or GED + Excellent oral and written communication skills + 1 - 3 years of Health claims processing experience + Working knowledge of COB and MSP preferably + ... Position Purpose: The Claims Examiner is responsible for providing expertise and/or...Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting… more
- Elevance Health (Mason, OH)
- **Title: Claims Representative I ( Health & Dental) - FEP** **Mason, OH** **Location:** This role enables associates to work virtually full-time, with the ... Friday druring training; 9 AM - 5:30 PM EST after training.** The ** Claims Representative I** will be responsible for successfully completing the required basic… more
- Elevance Health (Latham, NY)
- **Title: Claims Representative I ( Health & Dental) - FEP** **Latham, NY** **Location:** This role enables associates to work virtually full-time, with the ... AM - 4:30 PM EST, Monday - Friday.** The ** Claims Representative I** will be responsible for successfully completing...Locations: New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package,… more
- Highmark Health (Frankfort, KY)
- …activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS ( Health Now ... degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar … more
- Martin's Point Health Care (Portland, ME)
- …Director, Claims & Provider Reimbursement, is responsible for oversight of health plan claims administration. The position will develop, maintain, and ... accuracy. Job Description Key Outcomes: + Drives quality, timely claims processing to allow the health plan...quality, timely claims processing to allow the health plan to achieve regulatory compliance, robust financial management… more
- UCLA Health (Los Angeles, CA)
- …a critical role in in ensuring the timely, accurate, and compliant processing of health insurance claims . The ideal candidate will be responsible for monitoring ... claims workflows, coordinating with internal departments, and maintaining compliance...experience in an HMO environment (ie, MSO, IPA, or health plan) - Required + Comprehensive knowledge of industry-standard… more
- CVS Health (Franklin, TN)
- …or staffing shortages. **Required Qualifications** * 3+ years of experience in health insurance claims processing, preferably with Medicare Supplement claims ... At CVS Health , we're building a world of health...**Position Summary** The Team Lead for the Medicare Supplement Claims Processing team is responsible for overseeing day-to-day operations… more
- UCLA Health (Los Angeles, CA)
- …Take your career to the next level. You can do all this and more at UCLA Health . The Claims Quality Auditor will be responsible for the daily audit of all ... + Knowledge of claims adjudication systems + Flexibility and adaptability UCLA Health is a world-renowned health system with four award-winning hospitals and… more
- UCLA Health (Los Angeles, CA)
- …career in an 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 ... Microsoft Word and Excel. + Good working knowledge of claims adjudication systems. UCLA Health welcomes all individuals, without regard to race, sex, sexual… more
- TEKsystems (Pasadena, CA)
- …data from the claims system Skills PPO Insurance, Claims , Claims Processing, Member Claims , Health information management Top Skills Details ... PPO Insurance, Claims , Claims Processing,Member Claims , Health information management Additional Skills & Qualifications Health / Medical Claims … more
- Prairie Ridge Health (Columbus, WI)
- Prairie Ridge Health is seeking a Claims Resolution Specialist to join the Business Services team. This position is a 1.0 FTE (40 hours per week) and works a ... Monday-Friday, day shift. The Claims Resolution Specialist is responsible for researching and resolving...+ Experience with paper and electronic billing for various health insurances, including knowledge of hospital and professional claim… more
- CHS (Clearwater, FL)
- **Overview** ** Health Insurance Medical Claims Examiner** **(Initial Training On Site - 90 days - Remote position after training in FL)** **Must live within a ... **Summary:** The Medical Claims Examiner adjudicates medical claims based on health policy provisions and... Examiner adjudicates medical claims based on health policy provisions and established guidelines. **Essential Duties and… more