- CareFirst (Baltimore, MD)
- …terms, conditions, definitions, and financial guarantees, translating them into claim -level mapping and reconciliation processes. Validate that each eligible ... claim receives the correct rebates and discounts, applying exclusions...supply chain, or analytics. + 3 years management experience. ** Preferred Qualifications:** + MBA or other graduate degree in… more
- CareFirst (Baltimore, MD)
- …with demonstrated leadership skills. + Must have proficiency in the service, claims or enrollment & billing area. ** Preferred Qualifications:** + Bachelor's ... client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Reviews and resolves complex… more
- CareFirst (Baltimore, MD)
- …a liaison between the UM clinical teams, the technical support teams, and the claims operations teams. Ensures alignment of authorization to claims processing by ... use of a working knowledge of claims system configuration, including claims edits. The ideal candidate will have a deep understanding of proper plan design… more
- Sysco (City Of Industry, CA)
- …effective medical case management to mitigate lost time frequency of Workers' Compensation claims with focus on use of the Transitional Duty Program. + Establish ... external healthcare providers, insurance carriers and third-party administrators to contain claim costs. + Develop, implement, and evaluate strategies to provide… more
- Omni Hotels (San Antonio, TX)
- …accurate documented enrollment for all eligible associates. + Monitor unemployment insurance claims and actively work to reduce claim liability through detailed ... Training Program directed to entry level candidates with an Associate 's Degree or higher to develop their management skills...Previous experience in a hotel or a related field preferred + Has strong interpersonal skills and is customer… more
- Trinity Health (Columbus, OH)
- …all related information according to department policies and procedures. + Conducts claim review as required for appropriate claims processing. + Ability ... Plan's Medical Management Plan. **What we are looking for:** + Education: Associate Degree in Nursing. Bachelor's Degree as appropriate. + Licensure / Certification:… more
- ADP (Roseland, NJ)
- …degree; certificate of completion from an ABA-approved paralegal certification program or an Associate degree in paralegal studies preferred + 5-7 years of ... stakeholders and partners. + Manage and track litigation portfolio including lawsuits, claims , small claims , subpoenas, client escalations, and other routine… more
- University of Washington (Seattle, WA)
- …as part of UW Medicine coordinated quality assurance programs. + Identify potential claims to reduce their adverse effects on the organization's human, physical and ... collaborate as necessary with others in the management of claims . This position provides both strategic direction and direct...Medical Center as needed. This position reports to the Associate Director, Clinical Risk Management, for UWMC, and to… more
- Henry Ford Health System (Troy, MI)
- …to review bankruptcies, assisting with Coordination of Benefits, third party liability claims , etc. 5. Initiates and resolves account receivable errors with the ... and adding or removing balances to/from external collection agencies, coding errors, claim filing errors, etc. 6. Effectively discusses the patients' options for… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …Accurately document benefit verification results in pharmacy systems. . Troubleshoot rejected claims and perform necessary claim adjustments. . Assist in ... insurance coverage, identifying payer requirements, and facilitating prior authorizations. The associate will also assess patient eligibility for admission based on… more
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