- Sedgwick (Philadelphia, PA)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | Philadelphia, PA (Hybrid) | Dedicated Client | PA… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …or related field **Experience:** + Required: 1 year experience using the RxIQ claims adjudication platform + Preferred: 2 Years experience with Health Care, ... of new client data or changes to existing clients into the PBM adjudication platform. Works closely with the Benefit Operations Supervisor in ensuring the team's… more
- Elevance Health (Indianapolis, IN)
- … systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre- adjudication claims reviews ... position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies,… more
- Sedgwick (Long Beach, CA)
- …monitors individual claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex ... and documentation standards. + Provides technical and jurisdictional guidance on claims adjudication , including quality reviews and reserve evaluations for… more
- Sedgwick (Irving, TX)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles, reviews, and analyzes management reports… more
- Molina Healthcare (Layton, UT)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication , QNXT system navigation, and strong analytical acumen. Experience ... Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination… more
- System One (Dayton, OH)
- …Previous experience managing NCPDP transactions is an advantage but not required. + Claims adjudication systems: Knowledge of FACETS or similar claims ... / HealthCare / EDI transactions real-time 270/1 276/7 and 834 Enrollment, 837 Claims , 835 Remittance Advice, etc. Strong healthcare EDI Processing - Facets … more
- Avispa Technology (Los Angeles, CA)
- …using clinical guidelines, business applications, and customer interactions to support claims adjudication and ensure high-quality service. The company offers ... necessary information * Ensure high-quality service and compliance with claims adjudication guidelines Utilization Management Technician Qualifications: *… more
- 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 America, Inc. (Oklahoma City, OK)
- …role reviewing medical benefits and claims . + 2 years of claims adjudication experience, preferably in life, and supplemental products (eg, critical ... a HC and Insurance Operations Analyst to join our team. **Posisition:** ** Claims Case Manager** **This position is eligible for company benefits including medical,… more