- Molina Healthcare (Madison, WI)
- …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 (Madison, WI)
- …+ 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 (Madison, WI)
- …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 (Madison, WI)
- …+ 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
- GE HealthCare (Madison, WI)
- …GE HealthCare establishes best practices in compliance with regulatory requirements. The Senior Regulatory Affairs Specialist will be involved with regulatory ... regulatory requirements (including product testing, clinical data, etc.), product claims and country regulatory dependencies to ensure optimized sequencing for… more
- Zurich NA (Madison, WI)
- 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
- American Family Insurance - Corporate (Madison, WI)
- …opportunity. The role will support supplier and contract strategy for Claims , Product Underwriting, Legal, and Contact Centers. Position Compensation Range: ... + **Support Areas:** Supports supplier and contract strategy for Claims , Product Underwriting, Legal, and Contact Centers. + **Data-Driven Optimization:**… more
- Highmark Health (Madison, WI)
- …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
- Zurich NA (Madison, WI)
- …125444 Zurich North America is currently looking to fill an opening for a Senior Vice President for our Large Contract Surety Underwriting Team. Seeking a candidate ... approach to business relationships and oversight on strategic underwriting practices. The Senior VP is responsible for: + Developing processes and reviewing policies… more