- Sedgwick (Las Vegas, NV)
- …+ Responsible for managing defense counsel in litigation of serious and complex claim , litigated claims as well as complex coverage scenarios; manages defense ... of education and experience required. Experience with commercial lines claims and litigation in multiple states preferred ....lines claims and litigation in multiple states preferred . **Skills & Knowledge** + Exposure to and knowledge… more
- Zelis (St. Petersburg, FL)
- …+ 3 - 5 years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue ... concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client...What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC,… more
- Actalent (West Des Moines, IA)
- …for pending claims , auditing and pricing a wide variety of claim types, and ensuring compliance with departmental and company policies. Responsibilities + ... procedures. + Audit and price a wide variety of claim types. + Identify claims with inaccurate...independently. Additional Skills & Qualifications + Medical Coding licensure preferred ; open to candidates actively pursuing certification such as… more
- Guthrie (Sayre, PA)
- Position Summary: Responsible for non‐complex electronic and paper claim submissions to insurance payers. Coordinates required information for filing secondary and ... tertiary claims reviews and analyzes claims for accuracy,...certification in medical billing and coding or Associates degree preferred . Experience: Strong organizational and customer service skills a… more
- University of Rochester (Rochester, NY)
- …to successful closure and obtain maximum revenue collection. Researches, corrects, resubmits claims , submits appeals and takes timely and routine action to resolve ... unpaid claims . Mentors and trains new or lower level staff....accounts, resulting in payment or resolution of the outstanding claim . The Specialty A/R associate will utilize MFG and/or… more
- Hartford HealthCare (Farmington, CT)
- …Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 ... or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue… more
- Highmark Health (Dover, DE)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. ** Preferred ** + Associate degree + Pharmacy technician… more
- Sedgwick (Dublin, OH)
- …and other disability offsets; and to ensure the ongoing processing of claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Makes claim determinations to ... customer service experience. One (1) year of benefits or claims management experience preferred . **Skills & Knowledge**...year of benefits or claims management experience preferred . **Skills & Knowledge** + Excellent oral and written… more
- Zelis (St. Petersburg, FL)
- …advisory role with management of direct reports required. + Advanced competency in medical claim review and payment integrity preferred . + Ability to analyze and ... on supervising a team of Clinician's performing clinical reviews of facility claims , including UB's, Itemized Bills and medical records, to verify billing accuracy… more
- NJM Insurance (Parsippany, NJ)
- …make a determination as to coverage and course of action. + Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals. ... communication with involved parties during the course of the claim , via written and/or verbal communication, to provide relevant...capabilities + H igh school diploma or GED required. Preferred Qualifications: + Bachelor's degree + 3-5 years of… more