• Medical Claims Adjudication…

    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 ... UB or HCFA paper or EDI information. + Evaluate medical records to determine if the service rendered was...of Facets experience. + Experience in the analysis and processing of claims for payments, utilization review/quality… more
    Cognizant (08/01/25)
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  • Claims Examiner - Workers Compensation…

    Sedgwick (Santa Fe, NM)
    …client service requirements. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation REMOTE |...medical , dental vision, 401K on day one. \#claimsexaminer # claims _As required by law, Sedgwick provides a reasonable… more
    Sedgwick (08/23/25)
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  • Claims Processor (with Facets) - Healthcare…

    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
    Cognizant (08/22/25)
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  • Claims Examiner Workers Comp…

    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
    Sedgwick (06/29/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Rio Rancho, NM)
    …Contracted Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility ... including 2 years in a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims , Surgery,… more
    Molina Healthcare (07/18/25)
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  • Remote - Claims Adjuster…

    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
    Reynolds & Reynolds (07/03/25)
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  • Senior Analyst, Medical Economics…

    Molina Healthcare (Roswell, NM)
    …of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
    Molina Healthcare (07/10/25)
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  • Lead Specialist, Appeals & Grievances…

    Molina Healthcare (Las Cruces, NM)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... + Min. 3 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
    Molina Healthcare (08/24/25)
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  • Specialist, Appeals & Grievances - Remote

    Molina Healthcare (Roswell, NM)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
    Molina Healthcare (08/24/25)
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  • Remote Bilingual Call Center Representative…

    Mass Markets (Clovis, NM)
    …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer ... and provide accurate solutions. + Use internal systems to manage accounts, process claims , and update records. + Follow scripts and procedures to ensure compliance… more
    Mass Markets (07/25/25)
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