- Zurich NA (Boise, ID)
- Marine Claims Senior Claims Specialist 125273 Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and ... Basic Qualifications: + Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR + Juris Doctor and 2 or more years of… more
- St. Luke's Health System (Boise, ID)
- …of colleagues, St. Luke's is truly a great place to work. **Overview:** The Senior Pharmacy Benefits Specialist assists our members in identifying and ... accurately process prior authorization requests for medications under the pharmacy benefits . + Facilitate resolutions to issues involving claims adjudication,… more
- Molina Healthcare (Boise, ID)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER,… more
- CVS Health (Boise, ID)
- …+ Distributes work assignment daily to junior staff. + Trains and mentors claim benefit specialists. + Makes outbound calls to obtain required information ... handle customer service inquiries and problems. **Additional Responsibilities** + Reviews pre-specified claims or claims that exceed specialist adjudication… more
- CVS Health (Boise, ID)
- …Reinsurance, and/or RX claims ; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider ... amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete… more
- Prime Therapeutics (Boise, ID)
- …+ MISCELLANEOUS DUTIES: + Provide backup support to team members (SIU Coordinator and Senior SIU Specialist ) in the performance of job duties as assigned. + ... drives every decision we make. **Job Posting Title** SIU Specialist - Remote in the California market **Job Description**...Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the… more
- Zurich NA (Boise, ID)
- Sr. TPA Specialist , Complex Claims 125068 Zurich Insurance is currently looking for a Sr TPA Specialist . This position will oversee complex Liability ... Specialist analyzes highly complex coverage situations, evaluates high exposure claims , seeks/grants authority, assigns/explains reserves to senior management… more
- Highmark Health (Boise, ID)
- …months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health InsurancePlans (AHIP) **Language ... structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The...type of industry, characteristics of employee groups, or past claim experience to determine what benefits can… more