- Rady Children's Hospital San Diego (San Diego, CA)
- …& process claims from the UB04 & CMS-1500 claim forms into the claims adjudication system for all capitated & shared services accounts. This position is ... responsible for the accurate review, input & adjudication of claims using payment policies & methodologies that are consistent with and recognized by Health… more
- CVS Health (Hartford, CT)
- …business, including product lifecycle management, enrollment processes, billing operations, claims adjudication , and industry regulations + Technical ... critical role involves addressing significant challenges related to enrollment, billing, and claims processing on the Majesco LA&H Core Suite. The ideal candidate… more
- Levi, Ray & Shoup, Inc. (Chicago, IL)
- …Gather and document business requirements to support configuration of Facets and related claims adjudication systems. + Collaborate with IT teams to translate ... Filters Careers Added Jul 21, 2025 Business Analyst - Claims Systems (26971) Chicago, IL | Contract Apply (https://evoportalus.tracker-rms.com/LRS/apply?jobcode=26971&shownonlrs=True)… more
- US Tech Solutions (Whittier, CA)
- …accurately and timely per policy guidelines **Experience:** 2+ years of experience in claims adjudication (HMO, IPA, or hospital environment) **Skills:** + ... 3+ months contract** **Responsibilities:** + Review, adjudicate, and process medical claims for HMO patients + Work closely with affiliated medical groups… more
- WTW (Chicago, IL)
- …posted locations. **Qualifications** **Qualifications** + 5+ years' experience in health claims adjudication gained preferably in a consulting environment and/or ... will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report....in a major insurance claims administrator or health plan environment + Solid understanding… more
- Humana (Lansing, MI)
- …to make an impact** **Required Qualifications** + 2+years of health insurance claims experience, with claims systems, adjudication , submission processes, ... contracts, including contract language and reimbursement. + Experience with Humana claims systems, adjudication , submission processes, coding, and/or dispute… more
- TEKsystems (Fresno, CA)
- …* Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/ adjudication guidelines.* Examine a problem, set of data or text ... or nearby; Merced, Chowchilla, Madera, Fresno, Visalia, Hanford, or Bakersfield. Description The Claims Examiner I reports to the Supervisor of Claims . Claims… more
- Molina Healthcare (Orlando, FL)
- …and in accordance with cost control standards. **KNOWLEDGE/SKILLS/ABILITIES** + Evaluates the adjudication of claims using standard principles and state specific ... identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues. +… more
- Humana (Springfield, IL)
- …to make an impact** **Required Qualifications** + 2+ years of health insurance claims experience, with claims systems, adjudication , submission processes, ... Dually Eligible (HMO D-SNP) in IL, is seeking a Claims Research & Resolution Professional claims educator, who will be responsible for carrying out Humana's… more
- MetLife (Oriskany, NY)
- …Review claims submission for completeness and accuracy. Records data in the Claims system for adjudication and payment to the Beneficiary. May also be ... responsible for setting up new claims , processing incoming mail, and handling expired call-ups. Principal...to handle the original customer inquiry. 3. Use FEGLI claims system to access information required to handle customer… more