- Oracle (Richmond, VA)
- …grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for ... clinical validation) to lead the appeals initiative to review denied claims , create write-ups for appeals packets, identify trends/improvement opportunities to… more
- Cardinal Health (Richmond, VA)
- …as required, necessary, or appropriate. + Acts as a subject matter expert in claims processing. + Processes claims : investigates insurance claims ; properly ... account receivables performance and client satisfaction. + Resolves complex insurance claims , including appeals and denials, to ensure timely and accurate… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …and eligibility issues employees have with medical insurance carrier. Investigates claims status and provides additional information as necessary. Resolves routine ... supervisor for resolution. Maintains liaison with employee's insurance carriers and field activities regarding eligibility for benefits coordination of benefits and… more
- Walmart (Hampton, VA)
- …Manages facilitylevel training and execution of asset protection safety and claims and receiving procedures by reviewing the application of policiesprocedures ... Determines training needs Develops and delivers training as needed Manages claims and receiving operations by ensuring proper policies and procedures are… more
- Travelers Insurance Company (Chantilly, VA)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... results. Travelers' First-Party Claim Team is responsible for handling first-party claims , including Commercial Crime (including Fidelity), Cyber Crime, Kidnap &… more
- Sedgwick (Norfolk, VA)
- …program(s). **QUALIFICATIONS** Bachelor's degree requested, major in computer science field preferred. Project Management Professional (PMP) certification is a plus. ... application development projects preferred. Skills & Knowledge + Knowledge of claims management business and technology + Excellent oral and written communication… more
- Elevance Health (Roanoke, VA)
- …the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How ... make an impact:** + Assists higher level auditor/lead on field work as assigned and acts as auditor in...Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider… more
- Prime Therapeutics (Richmond, VA)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare, and/or related field + Must be eligible to ... with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness &… more
- Otsuka America Pharmaceutical Inc. (Richmond, VA)
- …analytics tools, and guidance on process excellence techniques for External Engagement & Field Excellence, as well as MML teams + Drive the development of annual ... Lead oversight + Drive the integration of insights from field medical teams into strategic planning processes **External Engagement...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Richmond, VA)
- …personal engagement to maximize reach and impact. + **HCP Engagement & Field Enablement:** Develop promotional tools, messaging, and training resources to empower ... the field sales team andoptimizeHCP engagement. + **KOL Engagement &...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more