- 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
- Viva Health (Birmingham, AL)
- …with claims processing 2 years of college or equivalent claims adjudication experience Ability to thrive in a production environment where quality ... The Claims Examiner II will administer all claims adjudication processes in accordance with contractual...claims when indicated. Correctly match authorizations to ensure claims are processing appropriately based on established… more
- PacificSource (Portland, OR)
- …and enhancing processing platforms for efficient and accurate claims adjudication . Champion cross-functional processes to ensure business readiness ... This position is responsible for key functions of operations, including claims processing , encounters processes, payment integrity, compliance with state… more
- Sedgwick (Riverside, CA)
- …exposure claims involving litigation and rehabilitation; to ensure 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 | Riverside, CA Are you looking for an opportunity to join… more
- AltaMed Health Services Corporation (Montebello, CA)
- …-related issues. Minimum Requirements HS Diploma or GED Minimum of 3 years of Claims Processing experience in a managed care environment. Experience in reading ... day. Job Overview The Claims Examiner II is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment… more
- University Health (San Antonio, TX)
- …is required. Five years HMO/PPO claims experience are required. Amisys claims processing system experience is preferred. Knowledgeable of all benefit ... of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims ...contracts used in business operations and reporting assuring auto adjudication . Perform in accordance with company standards and policies.… 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
- Sedgwick (Ontario, CA)
- …specific 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
- Sedgwick (Tennyson, TX)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Bodily Injury - Richfield, MN, Plano, TX, Irving, TX, Chicago,… more
- Rehlko, LLC (Glendale, CA)
- …the Warranty Specialist provides leadership in warranty administration which includes processing claims , system maintenance, policy review, recovery and ... Provide information to Kohler distributors, dealers, and OEMs concerning warranty claims processing . Follow-up with customers on information requested to… more
- Mount Sinai Hospital (New York, NY)
- …*Analyze contract language to ensure proper interpretation and application of terms during claims processing . *Ensure that all contract terms are being adhered ... Description Mount Sinai is one of the largest US health systems with a strong reputation for quality of...related regulations. ? Familiarity with contract terms, NYS regulations, claims processing , and healthcare reimbursement models. ?… more
- iSoftTek Solutions Inc (Des Plaines, IL)
- …and specifications including for Facets system configurations, ensuring efficient claims processing , compliance, and alignment with organizational goals. ... Requirements *Develop strategies to meet first pass resolution benchmarks and improve claims processing accuracy. *Collaborate with IT teams to translate… more
- Movn Health (Los Angeles, CA)
- …experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level ... A/R management Deep knowledge of payer reimbursement methodologies and claims adjudication Proficiency with multiple EHRs Strong...a plus Prior experience in cardiovascular care or digital health startups is a strong plus About You You… more
- Guardian Pharmacy, LLC (Marietta, GA)
- …and organize requested audit documentation in timely manner. Perform prescription claims adjudication including communication with insurance companies regarding ... then this is the place for you. Responsible for processing customer bills and insurance claims in...& Financial Competitive pay 401(k) with company match Family, Health & Insurance Benefits (Full-Time employees working 30+ hours/week… more
- Baptist Memorial Health Care Corporation (Memphis, TN)
- …controls designed to ensure that processes and practices lead to appropriate adjudication of claims for denial prevention. This role requires thorough ... revenue integrity, billing, coding, cash applications, payment variances and adjustment processing including federal and state regulations and guidelines. The Denial… 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 ... manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state… more
- 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
- 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 (Wellesley, MA)
- … adjudication / claims processes analysis. Facilitate effective solutions related to adjudication and processing of pharmacy and vaccine/medical claims , ... At CVS Health , we're building a world of health...**Required Qualifications** + 2+ years of experience with pharmacy claims adjudication and NCPDP standards + 3+… more
- MVP Health Care (Schenectady, NY)
- Commercial Claims Processing Associate, Claims Examiner Headquarters Office, 625 State Street, Schenectady, New York, United States of America * Rochester ... America Req #2572 Friday, June 20, 2025 At MVP Health Care, we're on a mission to create a...or exceeds department quality and work management standards for claims adjudication . + Successfully completes a course… more
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