- State of Massachusetts (Chelsea, MA)
- …translation duties, in social work or social casework, claims adjudication , job placement, recruitment, employment counseling, vocational or rehabilitation ... counseling. /*_Preferred Qualifications:_*/ ** * Knowledge of specific local office procedures and requirements. * Knowledge of continuing changes in laws, rules, regulations, programs, policies, procedures, specifications, standards and guidelines governing… more
- State of Georgia (Fulton County, GA)
- …statewide is especially preferred. + Experience preparing briefs and cases for adjudication in Superior Court, the Office of State Administrative Hearings, and ... before an Administrative Law Judge, the Georgia Court of Appeals, and the Georgia Supreme Court. + Experience interacting directly with the Georgia Department of Law as a state agency attorney. Extensive experience with compliance, consent orders, citation… more
- BrightSpring Health Services (Valdosta, GA)
- …issues and report out. + Complete follow up process to ensure full adjudication of claims. + Identifies adjustments throughout the month for assigned Operations. + ... Timely follow up on insurance claim denials, exceptions, or exclusions. + Maintain open communication with Billing Specialist, Cash Application Analyst and Operations. + Send cash transfer & check requests to the cash team. + Reading and interpreting insurance… more
- Devereux Advanced Behavioral Health (Orlando, FL)
- …denied or rejected claims, working closely with payors to ensure proper adjudication + Validate rate changes against contractual agreements prior to billing. + ... Maintain documentation and adhere to compliance requirements **Position Details:** **Salary:** **_Ranges from $63,000 - 71,820 / annual_** (rate is based on education and relevant experience) **Schedule: Full time position;** **_Monday-Friday 9am-5pm_**… more
- Essentia Health (Superior, WI)
- …pharmacies, third parties, and software vendor to work through claims adjudication and processing issues coverage of patients' medications to achieve excellent ... patient care and desired outcomes + Provide direct patient interaction and counseling patients with their Manufacturer-based Patient Assistance Program medications Educational Requirements: + Pharm.D. or BS Pharmacy from a college of pharmacy accredited by the… more
- CVS Health (Richardson, TX)
- …with Synon and ALDON. + Experience with RxClaim or similar pharmacy claim adjudication systems. + Background in Healthcare or Pharmacy Benefit Management (PBM). + ... Experience in legacy system modernization. + Familiarity with IBMi integration with cloud platforms. + Experience in AI-driven system health monitoring. Education Bachelor's degree in computer science, Information Systems, or related field (or equivalent… more
- Sedgwick (Wausau, WI)
- …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 RESPONSIBILITIES MAY INCLUDE:** + Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files… more
- Insight Global (St. Paul, MN)
- …* Conduct after-hours deployment activities/System administration support for adjudication changes and weekend production/test environment releases (mandatory). * ... Develop and maintain custom built CL, RPG, and Synon code for system administration and impact assessment. * License management, Menu access control, Sockets/Subsystem handling, LPAR security schemas/PowerHA tool. * Handling audit requirements/reporting for… more
- Parsons Corporation (Washington, DC)
- …RFIs and prepare material for CDAO's DAAI-related engagements + Support staffing, adjudication , and tasker management within ETMS2 on behalf of the OCDAO _Policy, ... Strategy & Operations_ + Provide subject matter expertise in Data/AI/Tech policy to support development of strategic frameworks (eg, Data Framework, Application Framework, AI/ML strategy documents) + Lead or contribute to drafting, reviewing, and coordinating… more
- Government National Mortgage Association (Ginnie Mae) (Washington, DC)
- …If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the ... USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a… more