- GAP Solutions Inc (Albany, NY)
- …Assisting with drafting SOP's. + Processing personal liability insurance reimbursement claims . + Initiating tentative selection notifications, notice of results or ... each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Claims Representative shall assume full responsibility and ownership for all aspects regarding ... and Billing to resolve provider inquiries as defined within Claims Operations procedures. The Claims Representative is required to handle multiple product… more
- Sedgwick (Albany, NY)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers' Compensation Claims Representative | NY Lost-Time Experience | NY Licensing **Are ... Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...YOU AN IDEAL CANDIDATE?** To analyze **New York Lost-Time** claims on behalf of our valued clients to determine… more
- Sedgwick (Albany, NY)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Auto Claims Representative | PIP | Remote **PRIMARY PURPOSE** : To analyze and ... process low to mid-level auto and transportation claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage regarding PIP and lower level… more
- Elevance Health (Latham, NY)
- ** Claims Representative I** **Location** - **Virtual** : This role enables associates to work virtually full-time, with the exception of required in-person ... unless an accommodation is granted as required by law. The ** Claims Representative I** is responsible for successfully completing the required basic training.… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Claims Processing Representative 2 adjudicates pharmacy claims and processes pharmacy ... support assignments. Performs computations. Typically works on semi-routine assignments. The Claims Processing Representative 2 determines whether to return,… more
- Travelers Insurance Company (Albany, NY)
- …is responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment ... multiple state jurisdictions. Claim types include moderate complexity Bodily Injury claims . Provides quality claim handling throughout the claim life cycle (customer… more
- New York State Civil Service (Albany, NY)
- …Yes Agency Insurance Fund, State Title Assistant Insurance Fund Services Representative Occupational Category Clerical, Secretarial, Office Aide Salary Grade 13 ... the NYS Segment.* Work up and process Workers' Compensation claims .* Approve and deny medical bills.* Respond to claimant...aren't limited to: Admnv Assistant 1, Business Services Center Representative 1, Program Aide; OR* Four years of customer… more
- Ellis Medicine (Schenectady, NY)
- The Accounts Receivable Representative will be responsible for achieving accurate and timely accounting of all Inpatient and Outpatient accounts receivable as set by ... outstanding accounts receivable with insurance companies and patients. + Claims in dispute with payers are reviewed daily to...the provider and payers are in agreement for appropriate claims reimbursed. + Monthly meetings with all payers to… more
- Cardinal Health (Albany, NY)
- …done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- Elevance Health (Latham, NY)
- **Grievance/Appeals Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/Appeals Representative I** is responsible for reviewing, analyzing and processing member complaints… more
- Humana (Albany, NY)
- …community and help us put health first** The Provider Installation Representative 2 administers the installation of assigned provider accounts. Performs set-up, ... preparation of administrative documents and materials. The Provider Installation Representative 2 performs varied activities and moderately complex administrative/operational/customer… more
- Momentive Performance Materials Inc. (Niskayuna, NY)
- Job Title: Senior Customer Service Representative Summary:In this role, you will be the primary contact for customer support-related activities. You will provide ... focus on execution. + Receive, enter, and manage customer non-conformance claims , ensuring accurate complaint entry, coding, coordinator assignment, and clear… more
- Intermountain Health (Albany, NY)
- …**Essential Functions** . Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re-bills of ... insurance claims , and all aspects of insurance follow-up and collections....issues, credit balances, sequencing of charges, and non-payment of claims . . Reconcile accounts, research and resolve various issues… more
- Humana (Albany, NY)
- …of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and practitioner ... to determine if an appeal or further request is warranted. The Appeals Representative 4 IRT (Internal Review Team) + Review documents + Building cases +… more
- Highmark Health (Albany, NY)
- …ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with ... sales and customer service to respond to client/broker/member inquiries regarding provider contract, claim/member issues or provider file/record/directory discrepancies. Consult with dental director/dental advisers regarding clinical-related questions and… more
- Molina Healthcare (Albany, NY)
- …setting. **Required Experience** + 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed ... healthcare administration and/or Provider Services. + 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ie, physician, group and hospital contracting, etc. + Working… more
- Molina Healthcare (Albany, NY)
- …member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job ... Qualifications** **REQUIRED EDUCATION** : HS Diploma or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment… more
- Molina Healthcare (Albany, NY)
- …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ... necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary… more
- Ryder System (Albany, NY)
- …**SUMMARY** This position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling ... complex and high exposure bodily injury and property damage claims . **Maintain an active inventory of claims ,...to verify the legitimacy of an interview or Ryder representative , please contact Ryder at ###@ryder.com or ###. **Current… more
