- BroadPath Healthcare Solutions (Tucson, AZ)
- …will be crucial in maintaining our high standards of accuracy and efficiency in claims processing . **Compensation Highlights:** + Base Pay: $18.00 per hour + Pay ... Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA...demanding production and quality standards + Technical proficiency with claims processing software + In-depth understanding of… 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
- AssistRx (Phoenix, AZ)
- …reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim rejections, ... teams on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data… more
- MVP Health Care (Schenectady, NY)
- …+ Meets or exceeds department quality and work management standards for claims adjudication . + Successfully completes a course of comprehensive formal ... At MVP Health Care, we're on a mission to create...information. + Is responsible for the timely and accurate adjudication of claims that are suspended to… more
- Highmark Health (Harrisburg, PA)
- …the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special ... benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of...field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. +… more
- Elevance Health (Nashville, TN)
- …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
- PSKW LLC dba ConnectiveRx LLC (Whippany, NJ)
- …must + Health care or pharmaceutical experience, particularly in a medical claims processing , billing provider, or insurance environment + Knowledge of EOB ... EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid...a high-volume processing setting (ie, doctor's office, claims processing department, etc.) a plus. +… more
- HCA Healthcare (Nashville, TN)
- …under demanding performance standards for production and quality Technical competence with claims processing software Ability to understand and implement complex ... HCFA requirements preferred **EXPERIENCE:** Two (2) years of experience processing claims , with at least one year... claims , with at least one year of claims adjudication experience required Physician Services Group… more
- CVS Health (Annapolis, MD)
- …quality assurance, and compliance monitoring. This role ensures timely and accurate processing of Medicaid claims in accordance with state and federal ... At CVS Health , we're building a world of health...each and every day. **Position Summary** The Manager of Claims Management is responsible for overseeing Medicaid claims… 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
- HCA Healthcare (Nashville, TN)
- …reports, assigns work, maintains weekly on hand reports Monitors performance and claims processing times to ensure compliance with performance standards. Perform ... to support the unit in work distribution and accurate adjudication of claims . In addition, the position...processors and claims examiners. Technical competence with claims processing software. Supervisory skills in … 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
- TEKsystems (Milwaukee, WI)
- …+ Obtains additional information from appropriate person and/or agency as needed. Skills claims processing , claims adjudication , call center, medicaid, ... High school diploma or equivalent preferred. + 2-4 years claims processing experience required + Knowledge of...plus + Prior experience with ACA, Medicaid, or similar health plans preferred not required + Coding experience preferred… more
- Molina Healthcare (Albany, NY)
- …claims processing errors. **Essential Job Duties** + Audits the adjudication of claims using standard principles, and state-specific regulations to ... leadership for improvements based on audit results. + Reviews timeliness of claims processing to ensure compliance with contractual and state/federal… 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 (Columbia, SC)
- …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 (Augusta, ME)
- …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 (Columbia, SC)
- …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 (Rancho Cucamonga, 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
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