- CVS Health (Hartford, CT)
- …of test plans and test results + 3+ years of HRP experience + Claims adjudication background + Knowledge of MedCompass and Utilization Management Configuration. ... into test scenarios to validate UM configuration and associated claim adjudication logic. + Trouble-shooting HRP repair edits and issues identified during… more
- Banner Health (Phoenix, AZ)
- …acquired over one to two years of work experience in medical claims adjudication , contract interpretations, billing and coding, and medical terminology. ... staff members. You will call upon your **background in medical billing, medical claims , customer service, and managed care** to answer complex questions and find… more
- Saint Francis Health System (Tulsa, OK)
- …oversight to maximize cash flow, reduce accounts receivable days, and ensure effective claims adjudication . This position plays a key role in monitoring ... all aspects of patient financial services including professional and hospital claims billing, cash posting, and management of patient receivables. This role… more
- AmeriHealth Caritas (Newtown Square, PA)
- …knowledge of payment integrity regulations and requirements + Experience with claims adjudication platforms (Facets, QNXT, HealthRules, Peradigm/Diamond, etc.) + ... role is shifting post-payment projects, where possible, left for prospective adjudication . A key accountability includes managing the Payment Integrity Support Desk… more
- Ardon (Portland, OR)
- …software system work queues. Must be able to understand and interpret claims adjudication issues with Pharmacy Benefit Management organizations, insurance plans, ... any identified obstacles or improvements to workflow to operational leadership. Troubleshoots adjudication issues and is well versed in the nuances of insurance… more
- ICW Group (Orlando, FL)
- …requirements are met while achieving optimal outcomes. + Ensure timely and accurate adjudication of major claims in compliance with company policies and state ... **PURPOSE OF THE JOB** The Manager of the Major Claims Unit leads a team of Major Claims... Claims Unit leads a team of Major Claims professionals responsible for handling complex, high-value, and catastrophic… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- …. Ensure solutions integrate effectively with enterprise systems such as claims adjudication , enrollment, provider management, UM/PA, care management, and ... requirements. . Support gap analysis for existing payer systems ( claims , clinical data, provider, member, authorization) to determine interoperability readiness.… more
- CVS Health (Woonsocket, RI)
- …new domains and underlying data sources. + Familiarity with pharmacy workflow and claims adjudication . + Experience as a project lead with cross-functional teams ... for evolving our current analytical competencies which monitor our claims production environment. By enabling data-driven strategic decision-making, you will… more
- Prime Therapeutics (Lansing, MI)
- …(GCP), pharmacy and industry trend, drug approval process, formulary design, and/or claims adjudication to support projects and initiatives throughout the ... is responsible for the synthesis of data findings in support of clinical claims and programs. **Responsibilities** + Synthesizes a wide variety of data and outputs… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …and data workflows. + Validate end-to-end business processes such as claims adjudication , provider data updates, enrollment transactions, pricing, and ... to support quality assurance efforts across Brighton Health Plan Solutions' core portfolios- Claims , Provider, and Enrollment. In this role, you will contribute to… more