- Molina Healthcare (Syracuse, NY)
- …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 (Albany, NY)
- …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
- Molina Healthcare (Syracuse, NY)
- …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
- Trinity Health (Albany, NY)
- …Risk Adjustment Coding Specialist -St. Peter's Health Partners - Full-time - Remote **POSITION PURPOSE:** The Risk Adjustment Coding Specialist works in a team ... diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system...services. Using billing system work queues and natural language processing (NLP) tools to support addressing HCC codes for… more
- Molina Healthcare (Yonkers, NY)
- …in Medicaid, Medicare, and Marketplace lines of business. + Familiarity with QNXT claims processing platform. + Knowledge of legal procedures related to complex ... across a wide range of subrogation case types-including automobile-related claims (eg, no-fault/PIP), workers' compensation, general liability, medical malpractice,… more
- Molina Healthcare (Yonkers, NY)
- …of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Yonkers, NY)
- **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
- Molina Healthcare (Buffalo, NY)
- …**Required Experience** + 3-5 Years of experience with healthcare-related data ( claims /encounters, provider, CMS/EDGE response files, etc. + 3-5 Years of experience ... of programming experience in python to support automated data validation / processing at scale (functions and objects) **PHYSICAL DEMANDS** Working environment is… more
- Molina Healthcare (Buffalo, NY)
- **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
- Ryder System (Albany, NY)
- …to areas such as: I-9 compliance, Pre-employment services, Unemployment Insurance claims , Immigration Services, Leave Administration, Drug and Alcohol program, HR ... etc.) required + Two (2) years or more relevant work experience (ie processing mass data uploads, payroll, organizational changes, etc.) required + Proficient in… more