• Workers Compensation Claims Examiner…

    Sedgwick (Madison, WI)
    …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 | Dedicated Client | NY Licensing Required...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
    Sedgwick (09/17/25)
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  • Claims Examiner | General Liability BI…

    Sedgwick (Madison, WI)
    …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 | General Liability BI | Captive |...General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, you'll have the opportunity to… more
    Sedgwick (09/06/25)
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  • Pharmacy Navigator- LTC Belknap Pharmacy

    Essentia Health (Superior, WI)
    …pharmacy technician experience + Previous experience working with patient medication profiles, claims adjudication and billing, copay assistance programs as well ... is a vital member of the pharmacy team and will assist in the adjudication , processing, packaging and distributive functions of the pharmacy working under the direct… more
    Essentia Health (09/20/25)
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  • Senior Software Engineer- COBOL coding

    Humana (Madison, WI)
    …health first** **Requires a strong foundation in COBOL mainframe development ** The Claims Adjudication System (CAS) team at Humana is essential in delivering ... core services through effective claims processing and management solutions. This position involves coding software applications based on business requirements and… more
    Humana (10/16/25)
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  • Representative, Pharmacy

    Molina Healthcare (WI)
    …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication , state, NCQA and CMS policies/guidelines, and any ... other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary… more
    Molina Healthcare (10/18/25)
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  • AI Innovation Lead - Data Science Lab

    Guardian Life (Madison, WI)
    …service logs. + Deliver solutions that enhance underwriting risk assessment, claims auto- adjudication , and customer servicing. Operational Excellence + Establish ... scalable processes, frameworks, and governance models for efficient and responsible AI/ML development, testing, and deployment. + Assess and recommend cutting-edge tools, platforms, and technologies to enhance data science workflows and model lifecycle… more
    Guardian Life (09/12/25)
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  • Senior Claim Benefit Specialist

    CVS Health (Madison, WI)
    …and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
    CVS Health (09/27/25)
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  • Specialist, Config Oversight (healthcare Medical…

    Molina Healthcare (Green Bay, WI)
    …Partners to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
    Molina Healthcare (09/24/25)
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  • Ambulatory Pharmacy Technician; 0.5FTE; Day/PM…

    Meriter-UnityPoint Health (Madison, WI)
    …inputting prescriptions into the computer system, ensuring accurate and efficient adjudication of online claims , counting/measuring and/or reconstituting drug ... patients using Meriter Outpatient Pharmacy at discharge, processing test claims for discharge medications, and processing medication prior authorizations/requests.… more
    Meriter-UnityPoint Health (10/07/25)
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  • Pharmacy Technician / Order Entry

    BrightSpring Health Services (Milwaukee, WI)
    …calculations (eg, converting milligrams) + May resolve issues of denials identified through adjudication , and follow-up claims in Point of Sale (POS) + Maintains ... processes + May produce reports and keep management informed of unpaid claims and claims pending follow-up + Provides excellent customer service to external and… more
    BrightSpring Health Services (09/24/25)
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