- HUB International (Chicago, IL)
- …Microsoft Excel (advanced functions) and SQL. + Familiarity with PBM platforms and claims adjudication systems. + Strong understanding of pharmacy billing and ... of Pharmacy Benefit Managers (PBMs) to ensure contractual compliance, accurate claims processing, and proper financial management. This role involves in-depth data… more
- NTT DATA North America (Lincoln, NE)
- …role reviewing medical benefits and claims . + 2 years of claims adjudication experience, preferably in life, and supplemental products (eg, critical ... our team in Lincoln, Nebraska (US-NE), United States (US). **Position: Medical Claims Case Manager: Remote within the Continental United States** **Pay:** $22.00/hr… more
- UnityPoint Health (Ankeny, IA)
- …of identified claims issues, repetitive errors, and payer trends to expedite claims adjudication + Work accounts in assigned queues in accordance with ... of payment delays, resulting from no response, denied, rejected and/or pending claims with the objective of appropriately maximizing reimbursements and ensuring that… more
- TEKsystems (West Des Moines, IA)
- …identified claims issues, repetitive errors, and payer trends to expedite claims adjudication EPIC experience Experience with payer platforms Pay and ... of payment delays, resulting from no response, denied, rejected and/or pending claims with the objective of appropriately maximizing reimbursements and ensuring that… more
- UNC Health Care (Chapel Hill, NC)
- …resolution through write-offs, reversals, adjustments or other methods. + Verify claims adjudication utilizing appropriate resources and applications. + ... a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials. + Works… more
- CVS Health (Austin, TX)
- …strong organizational and decision-making skills. + Provide technical expertise in claims adjudication , business rules, network structures, and testing support. ... Knowledge of network programs and procedures, including retail pharmacy operations and claims adjudication + Intermediate to advance Microsoft Access database… more
- NTT DATA North America (Plano, TX)
- …team in Plano, Texas (US-TX), United States (US). Roles and Responsibilities: * Process Adjudication claims and resolve for payment and Denials * Knowledge in ... pre-established guidelines Requirements: * 1-3 years of experience in processing claims adjudication and adjustment process * Experience in professional… more
- Brighton Health Plan Solutions, LLC (NC)
- …Degree preferred or comparable experience in the healthcare field + 1+ years claims adjudication experience + Advanced claims processing including ... system + Advanced claim processing including professional, facility and ancillary claims + Investigate claim payment/pricing inquiries upon client's request + Apply… more
- CVS Health (Hartford, CT)
- …test plans and test results. + 3+ years of HRP experience. + Claims adjudication background. **Preferred Qualifications** + Knowledge of Medicare Advantage ... requirements into test scenarios to validate configurations and associated claim adjudication logic. + Trouble-shooting (HealthRules Payer) HRP repair edits and… more
- Providence (OR)
- …specialty societies, and assists with implementation of such changes to the claims adjudication and editing software. **Providence Health Plan** caregivers are ... will also be considered. + 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software. **Salary Range by Location:**… more