- 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
- Apex Health Solutions (Houston, TX)
- … Operations Summary: Position is responsible for the timely and accurate claims adjudication and regulatory reporting functions including associated processes ... perform user acceptance testing for any impacted changes to claims processing as directed Meets or exceeds...with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and… more
- Dignity Health (Bakersfield, CA)
- … discrepancies for all claim types - Perform an analysis of the claims processing by reviewing contract, system configuration, benefits, financial risk (DOFRs), ... and manual adjudication to identify the cause of the erroneous claim...for audit purposes. - Collaborate with internal departments, including claims processing , UM, compliance, and provider relations,… more
- UNUM (Columbia, SC)
- …with oversight of BPO FTE resources deliverables. Responsibilities includes oversight of claims adjudication and payment processing across many products. ... different products and systems and distribution partners. The leader oversees significant claims processing counts with ownership over overall payment risk and… more
- Brighton Health Plan Solutions, LLC (NC)
- … claims processing and procedures. + 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims . + ... and respond to escalated issues and pertinent information on claims requiring adjudication . + Review and process...experience in the healthcare field preferred. About At Brighton Health Plan Solutions, LLC, our people are committed to… more
- Elevance Health (St. Louis, MO)
- …I :** Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide ... I** is responsible for pre and post payment and adjudication audits of high dollar claims for...or GED and a minimum of 5 years of claims processing experience including a minimum of… 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 ... Processor** is responsible for the timely and accurate adjudication of professional and hospital claims utilizing...required + A minimum of 1 years of medical claims processing is required + Facets experience… more
- Dignity Health (Bakersfield, CA)
- …role responsible for the detailed and accurate processing , review, and adjudication of complex healthcare claims . This position requires expert knowledge of ... claims processing , coding, and regulatory compliance. The Claims ...Coder (CPC) **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO)… more
- CVS Health (Hartford, CT)
- …This critical role involves addressing significant challenges related to enrollment, billing, and claims processing on the Majesco LA&H Core Suite. The ideal ... on resolving high-priority defects and systemic issues impacting enrollment, billing, and claims processing + Deep-Dive Analysis & Root Cause Identification:… more
- CareFirst (Baltimore, MD)
- … claim documents. **Preferred Qualifications** : Less than one year claims processing , billing, or medical terminology experience. **Knowledge, Skills ... & Qualifications** **PURPOSE:** Under direct supervision, reviews and adjudicates paper/electronic claims . Determines proper handling and adjudication of … more
- Centene Corporation (Dover, DE)
- …the subject matter expert for other Claims Liaisons. + Analyze trends in claims processing issues and identify work process solutions + Lead meetings with ... claims issues to ensure prompt and accurate claims adjudication + Identify authorization issues and...configuration related work process changes + Analyze trends in claims processing issues and assist in identifying… more
- CareFirst (Baltimore, MD)
- …years claims experience required. **Preferred Qualifications:** + 3 years claims processing , billing or medical terminology experience. **Knowledge, Skills ... CareFirst Office.** **PURPOSE:** Under general supervision, reviews and adjudicates paper/electronic claims . Determines proper handling and adjudication of … 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 (St. Paul, MN)
- …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 (Ontario, 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
- Sedgwick (Albany, NY)
- …growth, and inclusion. **ESSENTIAL RESPONSIBILITIES 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 (Marlton, NJ)
- …distance to office** **ESSENTIAL RESPONSIBILITIES 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 (Sacramento, CA)
- …team meetings and assigns accountability for follow-up items. + Gathers important compliance/ claims processing information to be presented at team meetings. + ... compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices… more
- Sedgwick (Nashville, TN)
- …and specific client service requirements. **ESSENTIAL RESPONSIBILITIES** + Analyzing and processing claims through well-developed action plans to an appropriate ... on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices,… more
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