- Highmark Health (Richmond, VA)
- …including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims , and Medical Policy. The person in this position must ... resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a...of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim… more
- Elevance Health (Richmond, VA)
- Medical Coding Education Associate Sr (Hospital / Professional Claims ) **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, ... an accommodation is granted as required by law._ The ** Medical Coding Education Associate S** r is responsible for...r is responsible for the comprehensive analysis of complex claims data to generate refined and industry-relevant concepts that… more
- Elevance Health (Norfolk, VA)
- **Director II, Digital Claims Operations (Dir II Digital Ops)** Location: This role requires associates to be in-office **3 days per week** , fostering collaboration ... within a commutable distance from an office._ The **Director II, Digital Claims Operations** oversees a combined digital and operations unit(s); executes strategies… more
- Elevance Health (Roanoke, VA)
- **Title: Claims Representative I (Health & Dental) - FEP** **Roanoke, VA** **Location:** This role enables associates to work virtually full-time, with the exception ... 2/9/2026** **Hours:** **8 AM - 4:30 PM EST, Monday - Friday.** The ** Claims Representative I** will be responsible for successfully completing the required basic… more
- TEKsystems (Chesapeake, VA)
- …100 patients per month Take full ownership of billing operations, including: Claim submission Payment posting Denial management Follow ‑up and resolution ... in a timely fashion by Hospital Departments. Submit corrected claims in the event that the original claim...Keep abreast of payer-specific and government requirements and regulations Follow up on unprocessed or unpaid claims … more
- Elevance Health (Norfolk, VA)
- …, and **Microsoft Office Suite** (Excel, Word, Outlook) preferred. + Experience in ** medical claims processing** workflows and systems preferred. + Experience in ... leads. This role requires strong attention to detail, foundational claims knowledge, and the ability to follow ...and that the provider was expecting payment. + Review claim details to determine claim validity before… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical ... guidance where needed. Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against… more
- Sedgwick (Richmond, VA)
- …to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation received ... status. + Provides clear and appropriate follow -up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on … more
- Elevance Health (Richmond, VA)
- …assurance environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement ... **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on...letter writing) on lower level auditors. + Identifies new claim types by identifying potential claims outside… more
- Elevance Health (Norfolk, VA)
- …Outlook) preferred. + Working knowledge of CPT, HCPCS, and ICD-10 coding, medical claims processing workflows and systems preferred. + Experience demonstrating ... for new recovery leads. This role demonstrates a strong understanding of claims processing, coding standards, and analytical problem-solving to ensure accurate and… more