- Polaris Pharmacy Services, LLC (Des Plaines, IL)
- …to prevent fraud and ensure compliance with policy terms. + Resolve Rejected Claims : + Calculate benefit payments and approve claim settlements based on ... SUMMARY: The Adjudication Specialist manages a portfolio of rejected pharmacy claims , ensuring timely billing and maximum payer reimbursement. They prioritize… more
- Citigroup (Getzville, NY)
- …and product processor systems; investigate the root cause behind the delay; issue claims internally and externally; follow up until claim is paid /settled; ... & Derivatives Associate Analyst is responsible for investigating and settling compensation claims internally and externally for the EMEA and NA Capital Market… more
- Prime Therapeutics (San Diego, CA)
- …pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting ... downstream claim corrections to eliminate potential waste. **Responsibilities** + Evaluate...to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for… more
- Sedgwick (Eden Prairie, MN)
- …is preferred . **Skills & Knowledge** + Thorough knowledge of claims management practices and procedures + Excellent oral and written communication, including ... US This position is dedicated to supporting the General Liability (GL) claims team, requiring specialized knowledge and experience in handling GL claims… more
- Sedgwick (Eden Prairie, MN)
- …to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to ... specifications in assisting with questions and solving problems related to the claims application and servicing processes. + Educates and informs the customer via… more
- Alight (IN)
- … in occupational health field. + Preferred experience in disability claims management or Workers Compensation claim management. + Dedicated to providing ... as a clinical consult nurse to our non-clinical disability claim examiners. This role provides clinical expertise and guidance... examiners as they manage short- and long-term disability claims . Using MDGuidelines, which is the gold standard in… more
- Sysco (Houston, TX)
- …Provide on-going guidance and feedback to Sysco facilities on appropriate documentation and claim mitigation practices. + 10%: Prepare claims packet in Sysco ... charges and WIP to ensure timely carrier payment. **Education Preferred :** + Bachelor's degree in Business Administration (Operations Management/Supply Chain… more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** The Denials Specialist 3 role specializes in high-dollar claims , aged claims , and denied claims for complex specialties. ... denials to uncover the root cause and accurately appeal claims to ensure successful initial submission. The Denials Specialist...Denials Specialist 3 will be responsible for charge and claim review to ensure the correct information is on… more
- Robert Half Accountemps (Tampa, FL)
- …collection of signatures and necessary documents from funeral home partners to expedite claim processing. * Investigate delays in insurance claims and provide ... additional follow-up support as needed. Requirements * Previous experience in insurance, claims processing, or customer service is preferred . * Proven ability… more
- The Hartford (Lake Mary, FL)
- …we help shape the future. Sr. Performance Analytics Consultant, Auto & Property Claims Performance Analytics, The Hartford Reporting to the Director of Auto and ... Property Claims Performance Analytics, this Senior Performance Analytics Consultant role...labor and material costs, impact of storm intensity on claim severity, etc.) . Work as a thought-partner to… more