- University of Washington (Seattle, WA)
- …Medicine Faculty Practice Plane Services has and outstanding opportunity for a ** Claims Specialist (Patient Account Representative 2).** This position is ... responsible for claims review, clearing claim edits, and timely and accurate...information, posting rejections, or forwarding the claim to a medical coding specialist for review and coding… more
- Philadelphia Insurance Companies (Seattle, WA)
- …of Ward's Top 50 and rated A++ by AM Best. We are looking for a Claims Specialist to join our team! Summary: Investigate, evaluate and settle more complex first ... and third party commercial auto insurance claims . A typical day will include the following: Thoroughly understands coverages, policy terms and conditions for broad… more
- Molina Healthcare (Everett, WA)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- Terumo Medical Corporation (Seattle, WA)
- …the Cath Lab or Interventional Radiology environment. Prior experience as a Field Clinical Specialist with a medical device company is preferred. It is Terumo's ... Field Clinical Specialist , Seattle North Date: Nov 4, 2025 Req...Req ID: 5306 Location: Seattle, WA, US Company: Terumo Medical Corporation Department: TIS Sales - Big Sky Terumo… more
- University of Washington (Seattle, WA)
- …Plan Services (FPPS)** has an outstanding opportunity for an **Insurance Follow-Up Specialist ** to join our **Medicare** team **.** **WORK SCHEDULE** + 100% FTE ... + Mondays - Fridays + 100% Remote **POSITION HIGHLIGHTS** The **Insurance Follow-Up Specialist , Medicare** is responsible for the optimal payment of claims from… more
- Molina Healthcare (Everett, WA)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Elevance Health (Seattle, WA)
- …unless an accommodation is granted as required by law._ The **Excess Loss Specialist ** is responsible for working independently reviewing claims and interpreting ... **Excess Loss Specialist ** **Location :** This role enables associates to...+ Assists auditors with obtaining information for stop loss claims . + Tracks payments from third-party administrators that have… more
- Molina Healthcare (Everett, WA)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Molina Healthcare (Everett, WA)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to… more
- CDM Smith (Seattle, WA)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs… more
- PDS Defense (Seattle, WA)
- **Light Industrial/Manufacturing** **Supply Chain Specialist 1** Seattle, WA Posted: 11/5/2025 Job Description Job ID#: 213436 Job Category: Light ... W2 Duration: 52 Shift: 1 **PDS Defense, Inc. is seeking a Supply Chain Specialist 1, in Seattle, WA. Job ID#213436** **Pay Rate: $31 - $36/hr** **Job Description:**… more
- Molina Healthcare (Everett, WA)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more
- Seattle Children's (Seattle, WA)
- …or hospital billing or accounts receivable follow-up experience. Experience working with medical claims and electronic data interchange systems, eg Epic, Relay ... Completion of the Seattle Children's Revenue Cycle Coordinator program or accredited medical billing/coding program. Minimum of two years of experience in Windows… more
- Molina Healthcare (Everett, WA)
- …to state and federal and Molina Healthcare guidelines. + Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. + ... and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists...**C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service… more
- Insight Global (Tukwila, WA)
- …License * 2 years' Experience in health care or pharmacy billing, collections, or medical claims processing * 2 years' Experience as a pharmacy technician in ... Job Description * The Pharmacy Billing Specialist is responsible to proactively audit, monitor, and analyze complex dispensing and charging information, including… more
- Molina Healthcare (Everett, WA)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical … more
- Molina Healthcare (Everett, WA)
- …care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases ... to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… more
- Molina Healthcare (Everett, WA)
- …diagnosis-related group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance ... auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review, or equivalent combination of relevant… more
- Elevance Health (Seattle, WA)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... claims . **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more
- Molina Healthcare (Everett, WA)
- …to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of ... to present those findings. **Preferred License, Certification, Association** + AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified… more