- Artera (Milwaukee, WI)
- Claims Specialist Summary Title: Claims Specialist ID:1772 Location:Milwaukee, WI Department:Legal More about this job > Description JOB PURPOSE: Manage ... all claims while under the general supervision of the Claims Director. Provide monthly updates and reporting. Coordination and database management; and other… more
- Molina Healthcare (Racine, WI)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... overpayment notification and supporting documentation such as explanation of benefits, claims and attachments. + Maintains and reconciles department reports for… more
- Molina Healthcare (Racine, WI)
- 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
- Molina Healthcare (Racine, WI)
- 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 (Racine, WI)
- …Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine Medicare appeal and claim outcomes.… more
- Molina Healthcare (Racine, WI)
- …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 ... days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and...fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific positions… more
- Molina Healthcare (Racine, WI)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system configurations… more
- CDM Smith (Racine, WI)
- …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
- Walgreens (Greenfield, WI)
- …and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), ... for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims . + Completes execution of all pricing activities including price changes,… more
- Deloitte (Milwaukee, WI)
- …wants to work in a collaborative environment? As an experienced Epic Professional Billing Specialist , you will have the ability to share new ideas and collaborate on ... onsite client service delivery. Work you'll do/Responsibilities As a Project Delivery Specialist (PDS) at Deloitte, you will work within an engagement team and… more
- Generac Power Systems (Waukesha, WI)
- …we continue to push new boundaries. The Senior Industrial Technical Support Specialist is responsible for providing advanced technical support to our authorized ... dealer personnel on how to navigate Generac's warranty systems and submit claims electronically. + Troubleshoots with the dealer technician to resolve highly complex… more
- Brunswick (Menomonee Falls, WI)
- …recreation._ **Position Overview:** Navico Group is seeking a **Senior Technical Specialist ** to enhance service delivery across our electronics solutions network. ... Experience processing replacement orders + Prior Experience with warranty policies, claims and processing + Professional poise and presence with excellent… more
- Molina Healthcare (Racine, WI)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical Terminology,… more
- Acosta Group (Franklin, WI)
- …to perform the essential duties. _Responsibilities With Regard to Workers' Compensation Claims :_ You are responsible for reporting all employment related injury you ... incur to your direct supervisor as soon as possible following an incident resulting in an injury. **QUALIFICATIONS** _Education/Experience:_ High school diploma or general education degree (GED); or one to three months' related experience and/or training; or… more
- Molina Healthcare (Racine, WI)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Elevance Health (Waukesha, WI)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines...Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder. +… more
- Molina Healthcare (Racine, WI)
- …enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims ... of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of Local, State… more
- Molina Healthcare (Racine, WI)
- …likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge ... specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program… more
- Elevance Health (Waukesha, WI)
- …facing projects or initiatives. This position will serve as the Employment Specialist and Self-Direction Specialist for Anthem's Wisconsin Family Care health ... but not limited to: enrollment, eligibility, fiscal intermediary operations, claims payment, member communications, and coordination of services is preferred.… more
- GE HealthCare (Waukesha, WI)
- …: Drive the development of new clinical evidence that substantiates product claims and differentiates GE HealthCare MR solutions in the market. Ensure compliance ... including roles such as MR technologist, clinical researcher, product development specialist , or clinical sales expert. + Proven ability to independently operate… more