- Lincoln Financial (Olympia, WA)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Molina Healthcare (Tacoma, WA)
- …and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate 's Degree or ... **Job Description** **Job Summary** The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims , coordinating,… more
- Zurich NA (Olympia, WA)
- …you. Overview: + Monitor business processes to identify opportunities for customer care 's improvements. + Handle first and third-party claims taking ... Auto Claims Call Center Senior Represent 127692 Zurich is...area OR + Zurich Certified Insurance Apprentice including an Associate Degree and No prior experience required in the… more
- Humana (Olympia, WA)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs ... of decisions to internal associates, and possible participation in care management. May occasionally participate in discussions with external physicians… more
- Evolent (Olympia, WA)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... a mission with a company behind it. **What You'll Be Doing:** ** Associate Director, Performance Analytics - Oncology & Member Product Focus** **Overview:** Evolent… more
- Evolent (Olympia, WA)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...our specialty programs and administrative platform. Role Overview The Associate Director role on Client Analytics will support both… more
- Walgreens (Lacey, WA)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Molina Healthcare (Tacoma, WA)
- …and regulatory requirements, while meeting production goals. * Communicates with health care providers to clarify questions and request any missing information. * ... credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. *… more
- Molina Healthcare (Tacoma, WA)
- …**I** **E** **N** **C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed ... care or healthcare environment. + Strong verbal and written communication skills. To all current Molina employees: If you are interested in applying for this… more
- Humana (Olympia, WA)
- …**Required Qualifications** + Three or more years work experience reading and interpreting claims within a managed care /health care environment + Familiarity ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...are Monday-Friday, 8 hours/day, and 5 days/week in the associate 's home time zone. Some schedule changes/adjustments might be… more
- Humana (Olympia, WA)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- Molina Healthcare (Tacoma, WA)
- …to Molina Medicare's maximum STAR ratings. **Job Qualifications** **Required Education** Associate 's Degree or 4 years of Medicare grievance and appeals experience. ... **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager… more
- Molina Healthcare (Tacoma, WA)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... participates in special projects as requested. **JOB QUALIFICATIONS** **Required Education** Associate degree in Business or equivalent combination of education and… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …party reimbursement agencies, and stays current with coding updates ensuring clean claims are submitted for adjudication. + Performs a comprehensive review of the ... data. + Analyses, trends, and identifies front end edits based on denied claims . Correct or compose appeal letters when appropriate. Works closely with the insurance… more
- Humana (Olympia, WA)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more
- Humana (Olympia, WA)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (Olympia, WA)
- …achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business ... an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Humana (Olympia, WA)
- …have expertise in conducting retrospective observational studies using administrative claims data using a collaborative approach across multiple stakeholders. Humana ... + An understanding of research methodology and the managed care arena, and how it applies to health outcomes...with cloud base analytics platforms + Experience with clinical, claims , pharmacy or other healthcare data. + Strategic thinking… more
- CVS Health (Olympia, WA)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... recommend solutions. **Required Qualifications** + 1 plus years knowledge of plan documents, claims research, letter writing. + 1 plus years working with appeals, … more
- Molina Healthcare (Tacoma, WA)
- …in FWA or related work. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud ... investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable… more