- Elevance Health (Latham, NY)
- ** Claims Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... - Friday, between the hours of 7 am - 6 pm EST. The ** Claims Representative I** is responsible for successfully completing the required basic training. Able to… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Bilingual Claims Research & Resolution Representative 2 manages claims operations that ... researching the resolution to a pending call.** The Bilingual Claims Research & Resolution Representative 2 works...call.** The Bilingual Claims Research & Resolution Representative 2 works with English and Spanish speaking providers,… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... appeal process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative III reports to Accounts Receivable Management.… more
- CDPHP (Albany, NY)
- …invites you to be a part of that experience. The Document Service Representative shall assume full responsibility for the completion of the necessary activities ... performing a detailed mail sort, batch preparation, and scanning of all incoming claims and correspondence to facilitate and ensure compliance with all New York… more
- Sedgwick (Albany, NY)
- …Best Workplaces in Financial Services & Insurance Remote Return to Work Representative Bilingual German, Japanese, Mandarin or more **We are looking for Remote ... Determines objective, quantifiable, medically supported work restrictions for assigned claims . + Facilitates return-to-work (RTW) and accommodation efforts through… more
- CDPHP (Albany, NY)
- …invites you to be a part of that experience. The Customer Care Representative shall assume full responsibility and ownership for all aspects regarding education of ... advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as Marketing, Enrollment,… 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
- Molina Healthcare (Albany, NY)
- …or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to ... arise, making an assessment when escalation to a Senior Representative , Supervisor, or another Molina department is needed. Takes...3 - 5 years customer service, provider service, or claims experience in a managed care setting. * 3+… more
- Elevance Health (Latham, NY)
- **Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... essential face-to-face onboarding and skill development. The **Utilization Management Representative I** will be responsible for coordinating cases for… more
- Latham, The Pool Company (Latham, NY)
- …difference? A little about the position: Job Summary The Warranty Claim Representative is responsible for the triage and administration for all claim/repair ... service to resolve customer inquiries. + Ensure data integrity of all claims information by validating submitted information against ERP systems to supplement… 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)
- …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)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts,… more
- CVS Health (Albany, NY)
- …routine nature. + Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc + Maintain department ... established performance metrics at a meets or exceeds expectations level + Work together as a team and apply the Aetna Core Values in day-to-day operations + Creating a Differentiated Service Experience + Demonstrating Service Discipline + Handling Service… more
- Intermountain Health (Albany, NY)
- …service behavior standards + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB) + Translations + ... Reading + Billing + Revenue Cycle Payment Handling + Computer Literacy and troubleshooting + Attention to Detail + Customer Follow-Ups **Physical Requirements:** **Qualifications** + High School diploma or equivalent, required + Minimum of one (1) year of full… more
- Molina Healthcare (Albany, NY)
- …party administrators. + Performs enrollment functions to include call tracking, claims workflow, and encounter requests for verification and updates, PCP assignment ... activity, enrollment record error reports, enrollment/ disenrollment activity + Displays initiative to complete assigned tasks timely and accurately and balances workload to assist peers and leadership team. + Strong knowledge of Enrollment processing for… more
- Ducommun (Coxsackie, NY)
- …track program compliance to purchase order requirements. + Prepare assertions and claims to customer in accordance to contract parameters. Operational Management: + ... for invoice submittal and in resolving late payment receipts and customer claims /assertions. Development and growth of the Program: + Responsible for oversight and… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …The Director will author/review **clinical pharmacology** submission documents and representative of the department at different product development team meetings. ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …assigned disease areas within the CNS TA. + Act as a company representative and advocate in relevant medical and scientific communities for specific assigned areas ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- New York State Civil Service (Albany, NY)
- …responsible for the following;. Accept and process both original and continued claims for Unemployment Insurance. . Conduct telephone interviews with claimants in ... of certifying for benefits.. Determine the need for further fact-finding and place claims on hold pending further investigation. Work a variety of reports . Provide… more