- Sedgwick (Chicago, IL)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner l Liability l Bodily Injury l Some Litigation l Chicago, IL -… more
- CVS Health (Springfield, IL)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... At CVS Health , we're building a world of health...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… more
- Health Care Service Corporation (Quincy, IL)
- …ie URAC, NCQA standards and health insurance legislation.** **Awareness of claims processes and claims processing systems.** **PC proficiency to ... within 24 months of hire** **3 years experience in claims processing operations and reporting systems, including...include Microsoft Word and Excel and health insurance databases.** **Verbal and written communication skills with… more
- UnityPoint Health (Rock Island, IL)
- …3-4 years of healthcare revenue cycle experience - understand healthcare financial terms, claims processing & adjudication , terminology. *Specific offers are ... contact for the finance department and banks for these related services. Why UnityPoint Health ? At UnityPoint Health , you matter. We're proud to be recognized as… more
- DATAMAXIS (Springfield, IL)
- …stakeholders to make determinations relating to complex processes involving claims processing / adjudication , recipient/provider eligibility, and third-party ... in projects like the following: CMS Federal Reporting, quality measures, claims processing , Medicaid program eligibility, provider enrollment, third-party… more
- Highmark Health (Springfield, IL)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent… more
- Humana (Springfield, IL)
- …CFE, AHFI) * Experience testifying in court * Understanding of healthcare industry, claims processing , and investigative process development * Experience in a ... **Become a part of our caring community and help us put health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading… more
- Humana (Springfield, IL)
- …Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience ... - What it takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with… more
- Humana (Springfield, IL)
- …Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a ... **Become a part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent… more
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