- Siemens Energy (Orlando, FL)
- …contractual risks, drafting and negotiating agreements, documenting, defending and enforcing claims , and advising and supporting project and site management in the ... complex contracts, able to handle multiple projects atthe same time and claim management. + Self-drivenindividual with the ability to formulate logical and pragmatic… more
- Veterans Affairs, Veterans Health Administration (Alexandria, LA)
- …and peer review. Participates in clinical review process such as tort claims , peer reviews, management reviews and administrative activities, as directed by the ... potential admissions. Performs Compensation and Pension exams and/or Tort Claim reviews. Interprets echocardiograms (including stress, dobutamine and transesophageal… more
- NHS Management, LLC (Northport, AL)
- …adjudicated prescriptions leaving the pharmacy have received a paid response or the claim has been resolved to bill to the next appropriate payor. Performs and/or ... PA's associated with all adjudicated Medicaid, Medicare D or Private Insurance claims . + Serves as the Communication liaison regarding medication or resident… more
- Cardinal Health (Trenton, NJ)
- …to patient care + Consults with appeals department for disputed / denied claims . + Works / Understands electronic claim interchange + Understands life ... cycle of primary and secondary claims + Maintains front office support relationship + Takes...+ Minimum 2 years of experience in Insurance follow-up preferred + Understanding of managed care contracts and fee… more
- HUB International (Nashville, TN)
- …experience and in-depth knowledge of insurance markets, policy provisions, claim processes, business environment, and risk mitigation, applies independent and ... responsible. These include non-routine coverage issues and questions, denial of claims , renewal strategies for key accounts, and interpretation of non-routine… more
- Walmart (Bentonville, AR)
- …space. This is a heavily matrixed environment with daily interactions with Claims , Legal, Finance, and Controllership functions. **What you'll do** : + Analyze ... and interpret complex data to inform business decisions, including loss ratios, claim frequencies, and severity of losses + Develop tactical and executive-level… more
- Henry Ford Health System (Troy, MI)
- …This includes but is not limited to: Coordinating timely and accurate claims submission for adjudication Coordinating and developing timely denial follow up ... to prevent denials. Oversee follow up to ensure all claims are resolved or responded to by the payers....Monitors and maintains acceptable work queue volumes ,for DNB's, Claim edits, Denials and follow up EDUCATION AND EXPERIENCE:… more
- Medical Mutual of Ohio (OH)
- …This is a fully remote opportunity. Eastern Time Zones preferred .** **Responsibilities** **HEDIS Analyst II** + Coordinates and collaborates interdepartmentally ... utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy, encounter, and quality measurement data. + Advanced...related field + Master's degree (MBA, MPH, or MHA) preferred + 5 years progressive experience as a HEDIS… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …Friday + 8:00am-4:30pm + Hybrid schedule The Role: + Oversee the claim and prior authorization review processes, dental regulations and procedure adherence, ... vendor to ensure the timely handling of prior authorization claim reviews; + Evaluate the quarterly approvals and denial...the request and discretion of the hiring agency. + Preferred Shift/Location: Select all location(s) and shift(s) you are… more
- CVS Health (Frankfort, KY)
- …experience. ** Preferred Qualifications** -Experience in research and analysis of claim processing a plus. **Education** -Some college preferred . -High School ... to the member to determine accuracy/appropriateness of benefit/administrative denial. -Research claim processing logic to verify accuracy of claim payment,… more