- CVS Health (Monroeville, PA)
- …of insurance billing or collections, accounts receivable experience, health plan claims processing or adjudication experience, or other acceptable ... + 3+ Years of insurance billing or collections, accounts receivable experience, health plan claims adjudication experience, or other acceptable… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Claims Adjudication Supervisor** **Job Class: State Program Administrator, Supervisor Senior** **Agency: Department of Employment and Economic ... deliver this new benefit to Minnesotans. **Position Purpose:** The Claims Adjudication Supervisor plays a critical role...role in the Paid Leave Division of overseeing the claims processing team, ensuring efficiency, accuracy, and… more
- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… more
- CVS Health (Richardson, TX)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...frameworks that drive the state-of-the-art Pharmacy Services - Claim Processing Application. You will work on integrating cloud-native solutions,… more
- UCLA Health (Los Angeles, CA)
- …you will play a critical role in in ensuring the timely, accurate, and compliant processing of health insurance claims . The ideal candidate will be ... will: + Coordinate and monitor the daily workflow of claims processing . + Distribute unprocessed claims... plan) - Required + Comprehensive knowledge of industry-standard claims adjudication policies, including CCI edits, COB… more
- Elevance Health (Miami, FL)
- …and experience possible. The ** Claims Representative III** is responsible for keying, processing and/or adjusting health claims in accordance with ... 50,000 members, HealthSun is one of the fastest growing health plans in South Florida. As a local plan,...interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims . + Adjusts voids and… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- CenterLight Health System (NY)
- …+ Validate Diagnosis-Related Group (DRG) grouping and (re)pricing outcomes presented by the claims processing vendor to ensure accuracy. + Attend Joint Operating ... + Proficiency in data analytics, ie SAS, SQL. + Claims adjudication and understanding of claims...in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.… more
- System One (Fairfax, VA)
- …verifying, and securing claim-related data. + Resolve both standard and complex claims through appropriate adjudication methods, including payment or denial. + ... Job Title: Claims Adjuster Location: Remote Type: Contract Compensation: $26.75...Adjuster for a contract-to-hire opportunity with one of our health insurance clients. This role involves investigating and adjusting… more
- State of Minnesota (St. Paul, MN)
- …minimum qualifications will be considered for this position.** Two (2) years* experience processing claims and/or appeals with one (1) of those years involving ... Claims Adjudicator involves lead work and handles escalated claims , ensuring accurate adjudication and compliance with...Training and mentoring of other staff to enhance their claims processing abilities. + Knowledge of techniques… more
- Independent Health (Buffalo, NY)
- …certificate and/or college degree preferred. + Six (6) months of medical claims processing /medical billing experience, customer service experience preferably in ... relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication . + Analyze, identify and research, as needed, edits… more
- Sedgwick (Glendale, CA)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and… more
- Healthfirst (NY)
- …contract terms, prepare fee schedules and accurately document file changes into the claims processing system + Research and identify published updates to payment ... and existing claims business rules within the claims processing system. + Identify claims...technical planning documents. + Ensure post implementation accuracy of claims configuration implementations and mass claim adjudication … more
- TEKsystems (Madison, WI)
- …time frame is reached without resolution. - Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed. ... Qualifications - High school diploma or equivalent preferred. - 1.5-4 years claims processing experience required (healthcare related) - Knowledge of current… more
- TEKsystems (Brookfield, WI)
- …due. Top Skills Details Claim, claims processing ,medical claims processing ,commercial lines insurance, health insurance,life insurance Additional ... Qualifications MUST: - High school diploma or equivalent preferred. - 2-4 years claims processing experience required (healthcare related) - Knowledge of current… more
- FlexStaff (Bronx, NY)
- …Subrogation conditions - Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor - Attends JOC meetings with providers as ... creating and testing compensation grids used for reimbursement and claims processing - Ensures that refund checks...within a healthcare or managed care setting (preferred) - Claims adjudication experience - Knowledge of MLTC/… more
- TEKsystems (Menasha, WI)
- …due. Pay: $19.25 Shift: Monday to Friday 8am to 5pm Top Skills Details Insurance claims Claims processing Medical claims Data Entry Medicaid Additional ... Skills & Qualifications MUST: - More than two years of claims processing experience required (healthcare related) - Knowledge of current procedural terminology… more
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills &...(must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs… more
- Sedgwick (Marlton, NJ)
- …growth, and inclusion. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Long Beach, CA)
- …client service requirements. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more