- Delta Dental of Iowa (Johnston, IA)
- …members and providers via the telephone and internet/web services as well as process claims . You will answer inbound phone calls and make some outbound phone calls. ... You will use a robust computerized eligibility, benefits, and claims system to handle phone calls and process ...resources as needed. + Recommend improvements in workflow and processing . + Complete special projects on time with high… more
- Humana (Jackson, MS)
- …to correct multifaceted problems relating to eligibility, enrollment, billing, claims , referrals/authorizations, network operations, access to care, Defense Health ... hard copy or in person) regarding eligibility, enrollment, billing, claims , referrals/authorizations, appointment assistance, network operations, access to care,… more
- Insight Global (Bonita Springs, FL)
- …collection agencies and its clients, and is responsible for receiving inbound claims through an automatic intake process, processing , investigating and resolving ... 40 hours in a given work week. The Legal Claims group is part of the company's Legal Department...ensuring the next steps are performed to resolve the claims , including interacting with the network and clients through… more
- Molina Healthcare (GA)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... data issues (eg, provider match error rate) and Configuration issues for claims payment. * Produces reports related to provider network information. * Establishes… more
- CVS Health (PA)
- …in a cost effective manner - Knowledge of CVS Health (or other PBM) claims processing - Knowledge of retail pharmacy operations including reading prescriptions ... role, you will be based from your home and travel onsite to conduct claims audits at pharmacies throughout multiple states by reviewing prescription claims … more
- Wells Fargo (Charlotte, NC)
- …for businesses, institutions, and wealth management clients - ensuring efficient processing of securities transactions, cash transactions and loans. The team also ... of payment processes across our global network. **Fraud and Claims Management:** + Fraud and Claims Management...**Fraud and Claims Management:** + Fraud and Claims Management delivers support by partnering with product, channel,… more
- LA Care Health Plan (Los Angeles, CA)
- …incentives or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member ... stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- …regulations governing the US pharmaceutical industry, including the federal False Claims Act; Anti-Kickback Statute; Food, Drug, & Cosmetic Act; Prescription Drug ... offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- AdventHealth (Maitland, FL)
- … claims analytics Managed Care, Patient Financial services, health insurance claims processing , contract management, or medical economics Proficiency in ... using knowledge of healthcare managed care contracts and administrative claims data. + Employs existing complex models and implements...understanding professional and facility claims and managed care concepts such as risk adjustment,… more
- City of New York (New York, NY)
- …procedures, notices and other customer communications; (d) advising BCS on submitting and processing claims relating to unpaid water and wastewater charges on ... and operations, DEP is party to numerous lawsuits and claims filed with the New York City Comptroller and...the agency in Court and Comptroller personnel who adjust claims against the City. The Litigation Support Counsel will… more