- CVS Health (Columbus, OH)
- …issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. The Network Relations ... Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health… more
- Sedgwick (Columbus, OH)
- …General Adjuster - Mid Atlantic Region **PRIMARY PURPOSE** : To investigate claims internationally of any size or complexity, against insurance or other companies ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Prepares loss experience reports to help… more
- Sedgwick (Dublin, OH)
- …OF THE ROLE:** To provide excellent service displaying empathy to callers regarding claims for multiple lines of business, including but not limited to, expediting ... the claims process, and providing detailed claim notes on all...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Sedgwick (Cleveland, OH)
- …Adjuster - Mid Atlantic Region **PRIMARY PURPOSE** **:** To investigate losses or claims internationally on any size National Account (Maintaining a minimum of five ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probably costs. + Prepares loss experience reports to help… more
- Evolent (Columbus, OH)
- …fostering trust, expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate ... raw unadjudicated claims data. **Qualifications Required and Preferred:** + Bachelor's degree,...health, biology) + 1+ years of professional experience in claims -based healthcare analytics with a payer, provider, clinical vendor,… more
- Zurich NA (Columbus, OH)
- …Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an Associate ... and 8 or more years of experience in the Claims or Underwriting Support area AND + Knowledge of...and 14 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance… more
- Elevance Health (Mason, OH)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Molina Healthcare (Columbus, OH)
- …**X** **PE** **R** **I** **E** **N** **C** **E:** + 5 years experience in claims review and member and provider appeal resolution. + Experience reviewing all types ... of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims , Stop Loss, Surgery, Anesthesia, high dollar complicated claims , COB and DRG/RCC… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …in ERP system. + Manage 3PL processes for inventory, returns and claims , recall activities and reporting, and product destructions. + Manage inventory reporting ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Molina Healthcare (Columbus, OH)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more