- Molina Healthcare (Albany, NY)
- …or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims -related regulatory ... claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing … more
- New York State Civil Service (White Plains, NY)
- …include, but are not limited to:* Oversee all aspects of workers compensation claims processing from inception to closing* Initially determine the compensability ... NY HELP Yes Agency Insurance Fund, State Title Claims Services Representative 1/Trainee 1/2 (Group 90) - NYHELPS Occupational Category Other Professional Careers… more
- Molina Healthcare (Syracuse, NY)
- …of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors. **Essential Job Duties** + Audits the ... leadership for improvements based on audit results. + Reviews timeliness of claims processing to ensure compliance with contractual and state/federal… more
- Molina Healthcare (NY)
- …Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources to validate ... application. * Follows department processing policies and procedures including, claims processing (claim reversals and adjustments), claim recovery (refund… more
- MetLife (Oriskany, NY)
- …to the Beneficiary. May also be responsible for setting up new claims , processing incoming mail, and handling expired call-ups. Principal Responsibilities: ... e-mail for communication with agencies/OFEGLI staff and managers. 8. Processing incoming mail for new and existing claims... Processing incoming mail for new and existing claims . 9. Write manual letters and correspondence on FEGLI… more
- Axis (New York, NY)
- …to resolve complex or contentious claims . Leading initiatives to enhance claims processing efficiency and accuracy within the team. Providing expert opinions ... adept at creating and directing the development of training materials relevant to claims processing . Show a commitment to continuous professional development in… more
- Highmark Health (Albany, NY)
- …the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special ... is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various… more
- Humana (Albany, NY)
- …based on business needs. **Preferred Qualifications** + Bachelor's Degree + Prior claims processing experience + Overpayment experience + Financial recovery ... a part of our caring community and help us put health first** The Claims Research & Resolution Representative 2 manages claims operations that involve customer… more
- Molina Healthcare (Buffalo, NY)
- …with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. ... JOB DESCRIPTION Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching,… more
- New York State Civil Service (New York, NY)
- …Representative 2, the incumbent will oversee all aspects of workers compensation claims processing from inception to closing; initially determine the ... NY HELP Yes Agency Insurance Fund, State Title Claims Services Representative Trainee 1 (NY HELPS) Occupational Category Other Professional Careers Salary Grade 14… more