- Premier Administrative Solutions (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... for clients. *Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- PacificSource (Portland, OR)
- …expectations and service standards. Lead the design of scalable processes for claims adjudication and encounters submission. Explore and implement new ... in developing and enhancing processing platforms for efficient and accurate claims adjudication . Champion cross-functional processes to ensure business readiness… more
- USAA (Phoenix, AZ)
- …injury adjusting experience. Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication ... Injury Examiner , you will be responsible to adjust complex bodily injury claims , UM/UIM, and small business claims to include confirming coverage, determining… more
- Sedgwick (Riverside, CA)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | Riverside, CA Are you looking for...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver… more
- Sedgwick (Irving, TX)
- …and bodily injury claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Adjuster - Liability - Irving, TX - Hybrid...identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages… more
- Viva Health (Birmingham, AL)
- …AL Job Description The Claims Examiner II will administer all claims adjudication processes in accordance with contractual agreements along with VIVA ... with claims processing 2 years of college or equivalent claims adjudication experience Ability to thrive in a production environment where quality and… more
- Sedgwick (Dublin, OH)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | OH Jurisdiction | Hybrid Schedule Are you looking for an… more
- Sedgwick (Minneapolis, MN)
- …level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative - Liability - Richfield, MN PRIMARY PURPOSE...to identify subrogation of claims and negotiate settlements with general supervision. ESSENTIAL FUNCTIONS… more
- Mindlance (Concord, CA)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Description: Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims . I want someone who can move fast and is good… more
- Sedgwick (Meridian, ID)
- …workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative - Workers Compensation | Boise, ID Are you looking for an… more
- iSoftTek Solutions Inc (Des Plaines, IL)
- …projects and system enhancements and for Facets configurations for accurate claims adjudication . *Ensure technical solutions align with business goals ... to add a Senior Business Analyst leads the analysis and optimization of claims processes within the health insurance industry. The role involves defining business… more
- Sedgwick (Plano, TX)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... Workplaces in Financial Services & Insurance Workers Compensation | Claims Examiner | Jurisdictions: TX, OK, and LA |...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver… more
- Iconma LLC (Roseville, CA)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Our Client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Roseville, CA/ Remote location. Responsibilities: To… more
- Berkshire Hathaway Specialty Insurance (Boston, MA)
- …collaboration and partnership with the insured, broker and TPA in the handling and adjudication of claims . Analyze and draft coverage letters as appropriate and ... unique culture and history. Job Opportunity: At Berkshire Hathaway Specialty Insurance our claims professionals are an integral part of our business. Every claim is… more
- Movn Health (Los Angeles, CA)
- …billing and A/R management Deep knowledge of payer reimbursement methodologies and claims adjudication Proficiency with multiple EHRs Strong command of medical ... Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a...and payer systems is essential. Functional Responsibilities Submit clean claims via EHR to all payers within 24 hours… more
- Guardian Pharmacy, LLC (Marietta, GA)
- …and organize requested audit documentation in timely manner. Perform prescription claims adjudication including communication with insurance companies regarding ... this is the place for you. Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily… more
- Molina Healthcare (Long Beach, CA)
- …of pharmacy prior authorization requests and/or appeals. Explains Point of Sale claims adjudication , state, NCQA, and CMS policy/guidelines, and any other ... necessary information to providers, members, and pharmacies. Assists with clerical services/tasks and other day-to-day operations as delegated. Effectively communicates plan benefit information, including but not limited to, formulary information, copay… more
- Sedgwick (Ontario, CA)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... Workplaces in Financial Services & Insurance Workers Compensation | Claims Examiner | Hybrid, CA Are you looking for...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver… more
- AltaMed Health Services Corporation (Montebello, CA)
- …day. Job Overview The Claims Examiner II is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment ... related to retroactive contract rate and fee schedule changes. May resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process… more
- Rehlko, LLC (Glendale, CA)
- … claims processing. Follow-up with customers on information requested to ensure claims are moving through the adjudication process. Handle issues concerning ... Specialist provides leadership in warranty administration which includes processing claims , system maintenance, policy review, recovery and procedure updates. The… more
