- CVS Health (Chicago, IL)
- …Formulary and/or Rebate knowledge beneficial. Experience with Caremark business systems, claims adjudication , formulary, drug, and client systems with an ... emphasis on the RxClaim adjudication platform beneficial. Medicare knowledge beneficial. Ability to work independently and with people across functional area.… more
- Molina Healthcare (Racine, WI)
- …issues. Experience working in a Medicare environment is highly preferred. Claims adjudication experience is highly preferred. Job Qualifications Required ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education Bachelor's… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Medicaid regulatory compliance;work experience preferred. Knowledge and; proficiency in claims adjudication standards & procedures preferred. Solid knowledge ... performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. Analyzes data as part of the investigative… more
- CVS Health (St. Paul, MN)
- …Excel skills (complex formulas, dynamic visualizations, VBA). Experience with eligibility, claims adjudication , reserving, or financial reporting in the managed ... care industry. Familiarity with Google Cloud Platform (GCP). Background in health services research or epidemiology. Education Bachelor's degree in business, finance, public health, or a related field required. Anticipated Weekly Hours 40 Time Type Full time… more
- Insight Global (San Leandro, CA)
- …system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate ... telephone or letter contact to patients to obtain additional information as needed. Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manage and maintain desk inventory, complete reports, and… more
- Wipfli LLP (Milwaukee, WI)
- …experience including knowledge in pre-authorization, pre-admission processes, denials management, claims adjudication , etc. Provider compliance and reimbursement ... business process optimization experience including knowledge of edits, denials, holds, reimbursement, etc. Senior living cost reporting data analysis knowledge of key performance indicators for reimbursement and national benchmarks Experience in California and… more
- Humana (Providence, RI)
- …Background in Medicare and/or Medicaid product management or support. Familiarity with Claims Adjudication Systems (CAS). Knowledge of X12 transaction sets and ... standards. Proficiency in SQL for data analysis and management. Work-At-Home Requirements WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …The Senior Claims Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA contracted plans. Your expertise will ... Overview BroadPath is hiring a detail-oriented Senior Claims Examiner to train and work from home!...work from home! Join our team as a Senior Claims Examiner and play a crucial role in ensuring… more
- Health Care Service Corporation (Chicago, IL)
- …will invest in your professional development. Job Summary CLAIMS ANALYST The Claims Analyst is responsible for the accurate adjudication and processing of ... medical, dental, vision, or other related claims , including related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are… more
- Guardian Life (Columbus, OH)
- …service logs. Deliver solutions that enhance underwriting risk assessment, claims auto- adjudication , and customer servicing. Operational Excellence Establish ... scalable processes, frameworks, and governance models for efficient and responsible AI/ML development, testing, and deployment. Assess and recommend cutting-edge tools, platforms, and technologies to enhance data science workflows and model lifecycle… more
