- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... partner in the industry. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong critical thinking… more
- CVS Health (Richardson, TX)
- …do it all with heart, each and every day. As part of the Rx Claim Adjudication team, you will be expected to be proficient in all critical functions of the ... through research and fact finding. + Experience with RxClaim or other PBM Adjudication system is preferred. + Experience on Cloud Technologies like GCP, AWS, Azure,… more
- CareFirst (Washington, DC)
- …including reconciliation, adjustments, and payment accuracy. + Strong understanding of claims adjudication and post- adjudication workflows, including error ... be demanding or otherwise challenging. + Extensive knowledge of Pre- Adjudication 837 EDI & Post- Adjudication Voucher 835...resolution and compliance requirements. + Experience with claims processing and related reporting tools. + Ability to… more
- Humana (Lansing, MI)
- …and answer provider questions. + Work with internal resources and systems (eg, claims adjudication system) to provide the Perfect Experience in all provider ... an impact** **Required Qualifications** + 5+ years of technical experience with claims systems, adjudication , submission processes, coding, claims dispute… more
- Dragonfly Health (Mesa, AZ)
- …immediate supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication . Adjust and correct authorizations in dispensing and ... of six (6) months of pharmacy technician experience. * Experience with pharmacy claims adjudication is required. Specialized Knowledge, Skills & Abilities: * PBM… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …claims processing and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written and oral communication, ... notice. Primary Responsibilities + Research and document pertinent information on claims requiring adjudication . Apply medical policy, contractual provisions,… more
- AssistRx (Orlando, FL)
- …pharma services, or HUB services environment. + Strong understanding of claims adjudication processes, reimbursement models, and affordability solutions. + ... and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances… more
- Cognizant (Dover, DE)
- …and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments. You will be a valued member of the Cognizant ... is required. **Travel:** None required **About the role:** As Claims Processor (with Facets), you will be responsible for...Facets), you will be responsible for timely and accurate adjudication of professional and hospital claims utilizing… more
- Sedgwick (Bismarck, ND)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
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