- Elevance Health (Tampa, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Zurich NA (Lansing, MI)
- …either the Executive Underwriter OR AVP, Underwriting Director Level. The hiring manager will determine the appropriate level based upon the selected applicant's ... and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance...and 8 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of Microsoft… more
- CVS Health (Fort Lauderdale, FL)
- …it all with heart, each and every day. **Position Summary** The Analyst, Account Manager at CVS Health, you will play a critical role in supporting client ... in-person support across multiple worksites, handling complex benefit and claims inquiries, and providing education during open enrollment and health-related… more
- US Tech Solutions (Columbia, SC)
- …program interventions. **Responsibilities:** + Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates… more
- The Hershey Company (Hershey, PA)
- …knowledge of global food safety, regulations and nutrition science in labeling, claims and transparency to develop policies, standards, and set company direction to ... on US food regulations including labeling, food additives, flavors, colors and claims regulations. Utilize internal and external tools and systems to evaluate… more
- Elevance Health (Seven Hills, OH)
- …DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . Primary duties may include, but are not limited to: + Analyzes and ... audits claims by integrating medical chart coding principles, clinical guidelines,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Zurich NA (Jefferson City, MO)
- …either the Underwriting Specialist OR Executive Underwriter level . The hiring manager will determine the appropriate level based upon the selected applicant's ... and 6 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance...and 4 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of line/s… more
- Corewell Health (Grand Rapids, MI)
- …Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of materials ... (external medical records, internal documentation from enterprise-wide systems including: claims payments, billing and enrollment, care management, medical, pharmacy… more
- Elevance Health (Richmond, VA)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you ... potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with… more
- State of Georgia (Ware County, GA)
- …their dependents, and survivors by assisting them in filing and managing claims for VA benefits, including compensation, pension, education, health care, and ... medical documentation to identify service-connected conditions and develop comprehensive claims . A solid understanding of medical terminology and conditions common… more