- Sedgwick (Santa Fe, NM)
- …growth, and inclusion. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... Best Workplaces in Financial Services & Insurance General Liability Claims Examiner | Dedicated Client | Remote ... within designated authority. + Communicating claim activity and processing with the claimant and the client. + Reporting… more
- Cognizant (Santa Fe, NM)
- …* 1 year of Facets experience. * Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. * Must ... Based on this role's business requirements, this is a remote position open to qualified applicants in the United...ET **Experience:** A minimum of 2 years of claim processing is required. **Travel:** None required **About the role:**… more
- Sedgwick (Santa Fe, NM)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner Workers Comp I Remote I SE, Central, NE regions **PRIMARY ... PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving… more
- Molina Healthcare (Rio Rancho, NM)
- …Contracted Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility ... and IPA. + 2 years supervisory/management experience with appeals/grievance and/or claims processing within a managed care setting. **Preferred Education**… 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 ... + 1 year of Facets experience. + Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. + Excellent… more
- Reynolds & Reynolds (Albuquerque, NM)
- Position Description * This is a full-time, remote position working from 9:45am to 6:15pm CSTAmerican Guardian Warranty Services, Inc. (AGWS), an affiliate of ... Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In...are not limited to:-\tAnswering inbound calls-\tProvide information about claim processing and explain the different levels of contract coverage… more
- Molina Healthcare (NM)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more
- Sedgwick (Santa Fe, NM)
- …in Financial Services & Insurance French Speaking Desk Adjuster - Remote **_Bilingual/French Speaking Desk Adjuster_** **PRIMARY PURPOSE** **:** Handles losses and ... claims valued up to $15,000 for property and casualty...manages a case load using technology for efficient claim processing . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Evaluates insurance policies,… more
- Prime Therapeutics (Santa Fe, NM)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare, and/or related field + Must be eligible to ... analysis of Prime's financial pricing programs, including data extraction, storage, manipulation, processing and analysis + Analyze claims data of varying… more
- Molina Healthcare (Albuquerque, NM)
- …Provides leadership and direction to MMS Operational Units management staff (eg, Claims Processing , Provider Services, Provider Enrollment, Finance, Managed Care ... or equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high… more