- Sedgwick (New York, NY)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Jurisdictions | NY License Required...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
- Sedgwick (Albany, NY)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner Workers Comp I Remote I SE, Central,...: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …or related field **Experience:** + Required: 1 year experience using the RxIQ claims adjudication platform + Preferred: 2 Years experience with Health Care, ... of new client data or changes to existing clients into the PBM adjudication platform. Works closely with the Benefit Operations Supervisor in ensuring the team's… more
- Molina Healthcare (Syracuse, NY)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication , QNXT system navigation, and strong analytical acumen. Experience ... Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination… more
- Independent Health (Buffalo, NY)
- …related phone calls. The COB Coordinator will also be responsible for basic claims adjudication , performing basic claim adjustments and working defined reports. ... maintain an acceptable level of production as outlined in the Claims /COB Performance Management Policy with minimal supervision and demonstrate basic problem-solving… more
- Catholic Health Services (Centereach, NY)
- …or similar EMR platforms Experience with retail pharmacy prescription processing and claims adjudication Prior experience on pharmacy dispensing systems and ... familiar with insurance adjudication processes This role involves working with a broad array of complex disease states and medical conditions. Candidates should be… more
- Molina Healthcare (Rochester, NY)
- …of pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication , state, NCQA, and CMS policy/guidelines, and any other ... necessary information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay… more
- CDPHP (Latham, NY)
- …health information required. + Chronic Conditions knowledge preferred. + Experience in claims adjudication , billing and enrollment systems, product or pricing is ... preferred. + Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required. + Experience with Clinical Documentation Improvement preferred. + Demonstrated knowledge of medical record review and diagnosis coding within the health… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …direct compliance issues to appropriate resources for investigation and resolution of claims adjudication issues. + Ensures that activities are conducted ... according to the policies and procedures of HealthDirect. + Supports HIPAA compliance efforts to ensure policies and procedures are appropriate to meet HIPAA requirements and identifying operational obstacles to compliance and working with other employees to… more
- Centene Corporation (New York, NY)
- …DRG, HCPC reimbursement methodologies. + Documents rate negotiation accurately for proper claims adjudication . + Acts as liaison between the TRICARE beneficiary ... and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. + Identifies and refers potential cases to Disease Management, Case Management, Demand Management and… more