- Premier Administrative Solutions (Clearwater, FL)
- …companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and timely service ... *Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control vendors and the… more
- VetJobs (Arlington, VA)
- …RiverTech has a great team of Personnel Security Specialists to provide adjudication support for Federal Adjudicators to make suitability and national security ... associated with a candidate to make suitability, eligibility and adjudication recommendations or determinations. Makes recommendations in accordance with regulations… 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 HEALTH ... of experience with claims processing 2 years of college or equivalent claims adjudication experience Ability to thrive in a production environment where quality and… more
- CAPPS (San Antonio, TX)
- …Applicants with the following will not be considered: Convicted or received deferred adjudication for any felony. Convicted or received deferred adjudication for ... a family member (including non-spouse partners). Convicted or received deferred adjudication for official oppression. Current requirement to register as a sex… more
- Rehlko, LLC (Glendale, CA)
- …on information requested to ensure claims are moving through the adjudication process. Handle issues concerning unit startups, registrations, and extended warranty ... changes or new warranty policies /procedures to provide enhanced warranty claim adjudication and/or reduce Kohler warranty processing costs. Maintain as needed the… more
- PacificSource (Portland, OR)
- …service standards. Lead the design of scalable processes for claims adjudication and encounters submission. Explore and implement new opportunities and innovations ... and enhancing processing platforms for efficient and accurate claims adjudication . Champion cross-functional processes to ensure business readiness and operational… more
- Lukos (Tampa, FL)
- …Vetting (CV) program), adjudicated for SCI eligibility by the DoD Central Adjudication Facility (DoD CAF) without conditions, exceptions, or waivers at the time ... Vetting (CV) program), adjudicated for SCI eligibility by the DoD Central Adjudication Facility (DoD CAF) without conditions, exceptions, or waivers at the time… more
- Lukos (Tampa, FL)
- …Vetting (CV) program), adjudicated for SCI eligibility by the DoD Central Adjudication Facility (DoD CAF) without conditions, exceptions, or waivers at the time ... Vetting (CV) program), adjudicated for SCI eligibility by the DoD Central Adjudication Facility (DoD CAF) without conditions, exceptions, or waivers at the time… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …visualization tools required Experience with pharmaceutical Longitudinal Access & Adjudication Data (LAAD) required Documented experience in successful handling of ... change processes, in eg, IT projects Excellent oral and written communication skills 5 years pharmaceutical industry experience required Proven ability to monitor, track and develop programs, and adhere to timelines Proven experience developing successful data… more
- Food Lion (North Augusta, SC)
- …maintained in accordance with regulatory requirements and company guidelines. *Monitors adjudication of third party claims, conducting follow-up as necessary to ... *Proper and accurate dispensing of prescription medication. *Operation of claim adjudication system. *Patient counseling and health advocacy. *Liaison services with… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …plans for shortfalls; Consults & recruits members for DSMB and/or adjudication committee setupStudy outputs: Draft responses to IRBs and Health Authorities; ... Collaborates with Translational Medicine and Clinical Pharmacology to ensure appropriate biomarker, PK / PD measurements; Reviews emerging clinical data regularly; Leads dose-escalation meetings; Performs quality assessment with Delivery Lead eg review… more
- Baptist Health South Florida (Miami, FL)
- …to the appropriate staff. Accurate/efficient data entry and third party adjudication , purchasing and maintaining medication stock levels, maintaining proper storage ... to the appropriate staff. Accurate/efficient data entry and third party adjudication , purchasing and maintaining medication stock levels, maintaining proper storage… more
- USAA (Phoenix, AZ)
- …understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state ... laws and regulations. Advanced negotiation, investigation, communication, and conflict resolution skills. Demonstrated strong time-management and decision-making skills. Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. Advanced… more
- Sedgwick (Riverside, CA)
- …high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering… more
- Community First Medical Center (Chicago, IL)
- …patients related to complaints or billing issues. Ensure proper submission and adjudication on all claims submitted to third party carriers, Medicaid, Medicare. ... Respond to all inquiries according to PFS policy and procedures. This job is fully on-site and Monday- Friday. ESSENTIAL DUTIES AND RESPONSIBILITIES: 1. Advocate for patients regarding complaints or billing issues. 2. Provide account resolution, within HFMA… more
- Sedgwick (Irving, TX)
- …liability and bodily injury claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to ... identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as… more
- Raytheon Technologies (Aurora, CO)
- …of our products. This position requires a security clearance. DCSA Consolidated Adjudication Services (DCSA CAS), an agency of the Department of Defense, handles ... and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government website here: https://www.state.gov/m/ds/clearances/c10978.htm We Are RTX The salary range for this role is 66,000… more
- Lockheed Martin (Moorestown, NJ)
- …-Experience with submission of Visit Requests utilizing LM Joint Personnel Adjudication System (JPAS) and LMVisit. -Experience in office space management in ... order to ensure sufficient seating for program in excess of 100 employees with multiple moves occurring each month. -Prior experience working with US Military customer preferred. EEO Lockheed Martin is an equal opportunity employer. Qualified candidates will… more
- Pennsylvania Medicine (Philadelphia, PA)
- …needed to obtain complete, accurate financial information required for claim adjudication . Immediately communicate any issue with coverage to the clinical practice ... to determine the appropriate next steps. Communicates benefit investigation information proactively to the clinical practices and to patients. Supports all myPennPharmacy services as needed. Collaborates with internal team members to gather appropriate… more
- Molina Healthcare (Long Beach, CA)
- …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 amounts, pharmacy location… more
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