- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Claims Processing Representative 1 reviews and adjudicates complex or ... specialty claims , submitted via paper. The Claims Processing Representative 1 performs basic administrative/clerical/operational/customer… more
- Humana (Santa Fe, NM)
- …based on business needs. **Preferred Qualifications** + Bachelor's Degree + Prior claims processing experience + Overpayment experience + Financial recovery ... community and help us put health first** The Bilingual Claims Research & Resolution Representative 2 manages...(Spanish / English) (see Language Proficiency Testing below)** + ** 1 or more years of Call Center or Telephonic… more
- Humana (Santa Fe, NM)
- …Previous inbound call center or related customer service experience o Previous experience processing medical claims o Bilingual (English and Spanish); with the ... help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting...and speak English and Spanish o Experience with the Claims Administration System (CAS) o Experience working with MHK… more
- Mass Markets (Albuquerque, NM)
- …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer ... and provide accurate solutions. + Use internal systems to manage accounts, process claims , and update records. + Follow scripts and procedures to ensure compliance… more
- Molina Healthcare (Santa Fe, NM)
- …Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains ... point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any...call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer… more
- Ryder System (Santa Fe, NM)
- …action plans if deficiencies are noted. Monitors staff's workflow to ensure accurate processing of claims , timely establishment of reserves, reviews and logs ... : **SUMMARY** This position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling… more
- CVS Health (Santa Fe, NM)
- …key payers to discuss reimbursement issues and payer publication notices affecting claims processing changes + Ensure daily reconciliation of electronic claim ... representatives that are responsible for contacting payers to collect on unpaid claims in a timely and accurate manner, researching and resolving payment variances,… more