- USAA (Chesapeake, VA)
- …communications leading to operational excellence. What sets you apart: 5 years Injury Claims adjudication experience Minimum of 5 years of Operational experience ... special and impactful. The Opportunity Accountable for auto, property or other claims teams to deliver operational business results at scale. Responsible for member… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …& process claims from the UB04 & CMS-1500 claim forms into the claims adjudication system for all capitated & shared services accounts. This position is ... responsible for the accurate review, input & adjudication of claims using payment policies & methodologies that are consistent with and recognized by Health… more
- US Physical Therapy (Rome, GA)
- …Accurately and thoroughly document pertinent collection activity performed. + Verify claims adjudication utilizing appropriate resources and applications. + ... Initiate telephone and/or letter contact with parties responsible for reimbursement for services provided. + Edit/Update claim information to meet and satisfy billing compliance guidelines for electronic and paper claim submission. + Demonstrate knowledge of… more
- Lyric (Newtown Square, PA)
- …years of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication , or fraud, waste and abuse detection + 1+ ... to processing medical insurance claim overpayments through recovery (40%) + Review claims for missing or incomplete information, calculate payment, or validation of… more
- USAA (Chesapeake, VA)
- …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
- Ally (Springfield, IL)
- …be, too? **The Opportunity** We're looking for people interested in claim adjudication and who are focused on helping our customers while maintaining Ally's ... valuation, establishment of exposure, negotiation and settlement property and casualty claims within a predetermined settlement authority. Ensures that all assigned … more
- City of Greenville (Greenville, SC)
- …exposure to loss. Manages the Risk Management internal service fund and claims accounts, develops and administers the annual Risk budget and cost allocations, ... and directs claims management activities. The role carries significant fiscal responsibility,...processes used in acquiring information and evidence for claim adjudication , regulatory compliance, safety program development, and ADA compliance.… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …**What you'll do:** + Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment ... outcomes for reporting purposes. + Collaborate with internal teams (eg, claims processing, provider relations, special investigations unit). + Utilize auditing… more
- Interior, Bureau of Indian Affairs (Portland, OR)
- …to the applicant's successful completion of a background security investigation and favorable adjudication . If you are a male applicant born after 12/31/1959 and are ... MUST provide transcripts or other documentation to support your educational claims . Unless otherwise stated: (1) official or unofficial transcripts are acceptable,… more
- Executive Office for Immigration Review (Phoenix, AZ)
- …fall into the general categories of removal proceedings, discretionary relief, claims of persecution, stays of removal, visa petitions, administrative fines, and ... or National. Employment is contingent upon the completion and satisfactory adjudication of a background investigation. Selective Service Registration is required, as… 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 ... expanding, industry-leading organization. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong… more
- Apex Health Solutions (Houston, TX)
- … Operations Summary: Position is responsible for the timely and accurate claims adjudication and regulatory reporting functions including associated processes ... checking with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and development by… more
- UNUM (Columbia, SC)
- …oversight of BPO FTE resources deliverables. Responsibilities includes oversight of claims adjudication and payment processing across many products. ... Team Unum today! **General Summary:** The incumbent will oversee Voluntary Benefits Claims with responsibilities to include Dental and Vision Claims (including… more
- Dragonfly Health (Mesa, AZ)
- …immediate supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication . Adjust and correct authorizations in dispensing and ... of six (6) months of pharmacy technician experience. * Experience with pharmacy claims adjudication is required. Specialized Knowledge, Skills & Abilities: * PBM… 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
- Cognizant (Lansing, MI)
- …procedures. Provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic ... business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical**... Processor** is responsible for the timely and accurate adjudication of professional and hospital claims utilizing… more
- Sedgwick (Cincinnati, OH)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Atlanta, GA)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Grand Rapids, MI)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Brea, CA)
- …monitors individual claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex ... and documentation standards. + Provides technical and jurisdictional guidance on claims adjudication , including quality reviews and reserve evaluations for… more
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