- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on strong ... procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer… 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...Minimum of one (1) year experience in health care claims review and adjudication to payment/denial utilizing… more
- Sedgwick (Albany, NY)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative | Auto | Remote Are you looking for an opportunity to ... YOU AN IDEAL CANDIDATE?** Join our team as a Claims Representative focused on Property Damage and...and commercial lines policies and endorsements + Ability to review and assess Property Damage estimates, total loss evaluations,… more
- Ryder System (Albany, NY)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position handles worker's compensation claims under Ryder's self-insured, self administered worker's comp program....to verify the legitimacy of an interview or Ryder representative , please contact Ryder at ###@ryder.com or ###. **Current… more
- Ryder System (Albany, NY)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The ... Director Claims directs...to verify the legitimacy of an interview or Ryder representative , please contact Ryder at ###@ryder.com or ###. **Current… more
- New York State Civil Service (Albany, NY)
- …Yes Agency Attorney General, Office of the Title Senior Consumer Frauds Representative or Consumer Frauds Representative Trainee (NY HELPS) Occupational Category ... of health care complaints, including, but not limited to billing and claims reimbursement disputes; denials of coverage for medical treatment, prescriptions, and… 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 ... from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Highmark Health (Albany, NY)
- …position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist distribution. Interpret ... added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. + Perform effective on-site visits… more
- Ryder System (Albany, NY)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling processes… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...claim processing and coding. + Escalates system issues preventing claims submission and follow-up for review and… more
- Highmark Health (Albany, NY)
- …for the implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …maintain the effectiveness of Quality Systems for managing the batch record review and release process Quality Management Activities supporting all phases of ... compliance. + Manages reports and trends to the Management Representative to help in the preparation of Management reviews...above. + Improves supplier quality performance for batch record review and release process for OAPI GMP release of… more
- CVS Health (Albany, NY)
- …representatives that are responsible for contacting payers to collect on unpaid claims in a timely and accurate manner, researching and resolving payment variances, ... and managing the accurate and timely filing of claims within payer function group. **Additional responsibilities of the Accounts Receivable Supervisor include:** +… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …to support product development and regulatory submissions. + Author and review INDs, NDAs, and other regulatory submissions, ensuring accuracy, completeness, and ... wider clinical development plans. + Serve as early-stage CMC representative of the department in effectively communicating program related...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Highmark Health (Albany, NY)
- …and report improper coordination of benefit billing practices through paid clams review . + Participate as pharmacy representative in onsite member appeals ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- Ryder System (Albany, NY)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** The ... years or more experience in employment law. + Experience managing employment claims raised with federal and/or state administrative agencies. **SKILLS & ATTRIBUTES**… more
- Albany Medical Center (Albany, NY)
- …for change and implement as indicated. Integrate customer needs, intended use claims , and regulatory requirements into development of design goals. Develop and ... care providers analytical and clinical performance goals for appropriate testing. Write, review and revise written standard operating procedures for all assays and… more
- GAP Solutions Inc (Albany, NY)
- …Assisting with drafting SOP's. + Processing personal liability insurance reimbursement claims . + Initiating tentative selection notifications, notice of results or ... employees. Research waiver and hearing requests. + Conduct desk audits, review management requests for various position management and classification actions and… more