- Insight Global (Woonsocket, RI)
- …two functional halves: the front end handles claim intake, processing, and adjudication , while the back end focuses on financial operations such as reconciliation, ... overpayment handling, and Explanation of Benefits generation for members and providers. Approximately 95% of the system is built on COBOL, DB2, and CICS, with some legacy data still residing in IDMS. Day to Day Work Responsibilities: . Develop and maintain… more
- Air National Guard Units (Louisville, KY)
- …Participation in direct deposit is mandatory. Must obtain and maintain a favorable adjudication of a T3 or equivalent investigation. Acceptance of a Federal position ... may terminate a military bonus. Acceptance of a Federal position will terminate Tricare Reserve Select (TRS) eligibility. This position is covered by the Domestic Violence Misdemeanor Amendment (30 Sep 96) of the Gun Control Act (Lautenberg Amendment) of 1968.… more
- RTX Corporation (Juana Diaz, PR)
- …role: Onsite. If this position requires a security clearance, DCSA Consolidated Adjudication Services (DCSA CAS), an agency of the Department of Defense, handles ... and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government website here: https://www.state.gov/m/ds/clearances/c10978.htm **This position is located in Juana Diaz, PR. Work… more
- Hubbard Broadcasting (Chicago, IL)
- …is subject to pre-employment driving record background check. A conviction, violation pending adjudication , or adverse driving record more than 3 years old or does ... not meet the major violation definition per company policy will not, on its own, disqualify an applicant. The company will use background check information in a confidential, non-discriminatory manner consistent with applicable federal, state and local law.… more
- Molina Healthcare (NE)
- …to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and regulations ... in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. ( _Use for claims specific positions only_ ) * Prepares, tracks and provides audit findings reports according to designated… more
- Bristol Myers Squibb (Madison, NJ)
- …studies ( eg , site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant deviations etc. ) + Identifies and ... builds relationships with principal investigators. Identifies and cultivates thought leaders in order to gain their inputs on emerging science in drug and biomarker research, disease knowledge, and design of clinical development studies and programs +… more
- Humana (Montpelier, VT)
- …in assembling of evidence and documentation to support successful adjudication , where appropriate. Monitors/Leads investigations to ensuring appropriateness of ... billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires… more
- Mastercard (O'Fallon, MO)
- …resolve complex cases and improve processes. Key Performance Indicators * Adjudication Accuracy Rate - Percentage of background check adjudications completed without ... errors, ensuring compliance with Mastercard policies and local regulations. * Work Authorization Compliance - Rate of verified and compliant work authorization documentation for NAM/LAC new hires, with zero tolerance for missed deadlines or non-compliance. *… more
- Sedgwick (San Antonio, TX)
- …workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and ... to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files… more
- Pacific Northwest National Laboratory (Richland, WA)
- …of federal background investigation post hire and receive a favorable federal adjudication . The tier of federal background investigation will be determined by job ... duties and national security or public trust responsibilities associated with the job. All tiers of investigation include a declaration of illegal drug activities, including use, supply, possession, or manufacture within the last 1 to 7 years (depending on the… more