- Cognizant (Santa Fe, NM)
- …a High School Diploma or equivalent is required + A minimum of 1 years of medical claims processing is required + Facets experience is highly preferred + ... Claims Processors to join our growing team. The ** Medical ** ** Claims Processor** is responsible for the...Responsibilities** + Responsible for reviewing the data in the claim processing system (Facets) and comparing it… more
- CVS Health (Santa Fe, NM)
- …competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience ... or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes… more
- CVS Health (Santa Fe, NM)
- …materials to manage job responsibilities. **Required Qualifications** + 2+ years of experience with medical claim processing . + 2+ years of experience in a ... claims . They will adjudicate complex, sensitive, and/or specialized claims in accordance with claim processing...on customer service platforms, specifically by using technical and claims processing expertise. + Apply medical… more
- Sedgwick (Santa Fe, NM)
- …Coverage Specialist **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex ... and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to… more
- Sedgwick (Santa Fe, NM)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim ...directions in a professional and timely manner. + Communicates claim activity and processing with the claimant… more
- Sedgwick (Santa Fe, NM)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim ...directions in a professional and timely manner. + Communicates claim activity and processing with the claimant… more
- Cognizant (Santa Fe, NM)
- …Monday to Friday 8am - 4:30pm ET **Experience:** A minimum of 2 years of claim processing is required. **Travel:** None required **About the role:** As Claims ... * Be Responsible for reviewing the data in the claim processing system and comparing with corresponding...of Facets experience. * Experience in the analysis and processing of claims for payments, utilization review/quality… more
- Cognizant (Santa Fe, NM)
- …duties as assigned by management. **Qualifications:** + A minimum of 2 years' claims processing experience is required. + Knowledge of physician practice and ... stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA...of Facets experience. + Experience in the analysis and processing of claims for payments, utilization review/quality… more
- Molina Healthcare (NM)
- …. + Manages a caseload of various types of complex claims . Procures all medical records and statements that support the claim . + Meets department quality and ... **Required Education** High School or GED **Required Experience** 3-5 years claims processing required **Preferred Education** Bachelor's Degree or equivalent… more
- Sedgwick (Santa Fe, NM)
- …FUNCTIONS and RESPONSIBILITIES** + Processes complex auto commercial and personal line claims , including bodily injury and ensures claim files are properly ... and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/ processing with insured, client, and agent or broker when… more