- Elevance Health (St. Louis, MO)
- …The ** Claims Auditor I** is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types ... ** Claims Auditor I** **Location :** This role enables...and products including specialized claims with appropriate guidance from management and peers. **How… more
- American Express (Phoenix, AZ)
- …department of AAC, and primary responsibilities will include enrolling, servicing, and adjudication of insurance policies and claims ; this role provides an ... exciting opportunity to handle claims for the Retail and Warranty products in the...to:** + Investigation by using tools available to settle claims quickly and efficiently + Maintaining state compliance +… more
- Prime Therapeutics (Santa Fe, NM)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Claims Specialist Sr **Job Description** The Claims Specialist is responsible for ... related to specific process or support systems (eg claim adjudication system) Escalate issues when appropriate + Partner with...accredited institution or equivalent GED + 1 year of claims experience + Must be eligible to work in… more
- Robert Half Office Team (Lombard, IL)
- Description We are looking for a skilled Workers Compensation Claims Specialist to manage and enhance the operational aspects of our Workers' Compensation Program. ... Workers' Compensation Program, ensuring efficient and quality management of claims . * Collaborate with external partners, including Third-Party Administrators, to… more
- AssistRx (Louisville, KY)
- DUTIES AND RESPONSIBILITIES: + Processes medical copay claims in accordance with program business rules. + Liaison with other program-specific AssistRx resources to ... daily reconciliation of batch postings, including automated/manual claim inputs. + Analyze claims for accuracy based on insurance coverage, cost of goods, allowable… more
- Golden Route Operations (Las Vegas, NV)
- …Shift Full Time Department Legal & Risk Management General Liability Claims Manager Golden Entertainment Corporate (Las Vegas, NV) Description: Summary: Administer ... general liability and automobile claims under the Company's self-insured retention. Coordinate with Surveillance,...Interact with guests and/or legal counsel resulting in claim adjudication and guest resolution + Maintain the highest level… more
- Insight Global (Stoughton, MA)
- …the approval of medications. *Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up. ... to patients by navigating a variety of pharmacy dispensing systems to adjudicate claims , refill medications, and increase adherence in patients. Below are the key… more
- Meriter-UnityPoint Health (Madison, WI)
- …inputting prescriptions into the computer system, ensuring accurate and efficient adjudication of online claims , counting/measuring and/or reconstituting drug ... patients using Meriter Outpatient Pharmacy at discharge, processing test claims for discharge medications, and processing medication prior authorizations/requests.… more
- MetLife (Bridgewater, NJ)
- … Claims automation: Given the exponential growth of the Pet business, claims cost management is essential. Enhance auto- adjudication models to substantially ... OCR, NLP and LLMs, and building a brand-new ontology for animal health claims . * Governance and data expertise: Establish governance frameworks for data modeling,… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …and/or convenience if required. Manages contractor requests for equitable adjustments and adjudication of contractor claims . Develops documents for legal review ... as required. - Senior Level Review: Provides senior-level review of junior contract specialist actions. - Policy Enforcement and Improvements: Supports and upholds NEXCOM contracting policies and procedures. Makes recommendations for and implements process… more