- The Cigna Group (Bloomfield, CT)
- …to utilization management, case management, network, contracting, pharmacy, and service operations ( claims ). This is an entry to mid-level position for a physician ... Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state… more
- Kohler Co. (Bristol, PA)
- …delivery. Identify and resolve delivery issues and drive process improvements. + ** Claims & Pricing Administration:** Oversee resolution of claims , deductions, ... audits, and pricing discrepancies. Ensure accurate billing and credit processing aligned with company policies. + **Service Optimization & Sales Support:** Balance… more
- Amentum (Washington, DC)
- …Senior Paralegal to assist with the Radiation Exposure Compensation Act (RECA/Downwinders) claims team. The Senior Paralegal role is crucial in ensuring the ... efficient and accurate handling of incoming materials supporting claims filed under RECA. This position is responsible for following specific guidance and standard… more
- UIC Government Services and the Bowhead Family of Companies (Letterkenny Army Depo, PA)
- …have general computer knowledge. Working knowledge of internet software; spreadsheet software, word processing software and MS Office Suite is a plus. + Ability to ... and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual… more
- City of New York (New York, NY)
- …and claiming data for data entry into multiple database systems for agency claims submitted annually for Federal and State reimbursement. - Analyze fiscal year ... claims , revenue, invoices and payment vouchers to ensure alignment...monthly Expense, Payment and Claiming reports to ensure accurate processing . Analyze, review and provide recommendations for Agency Program… more
- BrightStar Care (Naples, FL)
- …an experienced medical Billing and Payroll Specialist . Responsibilities include weekly processing of billing and payroll.. Managing Authorizations , appeals and re- ... submission of claims . Posting cash etc. Must be detail oriented...to produce a statement or claim. * Investigate rejected claims , verify this information with the health provider, and… more
- UIC Government Services and the Bowhead Family of Companies (Fort Eustis, VA)
- …Service Lines. + Able to conduct staff, interagency, and intra-agency coordination, processing of messages to include, but not limited to, Execution Orders, Requests ... and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual… more
- Catholic Health Services (Melville, NY)
- …for accurate and timely hospital billing, follow up, collections, cash processing and customer service related activities. Responsibilities: + Reviews, corrects and ... approves all primary and secondary billing, submits hard copy or electronic claims to appropriate payors. + Reviews and edits any rejections stemming from electronic… more
- Pilgrim's (Sumter, SC)
- …safety and medical areas of the site. Spend time being visible in the processing plant and other site locations. Conduct periodic safety and health audits and track ... program by attending regularly scheduled meetings, providing supporting documentation for claims in litigation, and assist the Occupational Health Nurse/Third Party… more
- AmeriHealth Caritas (Newtown Square, PA)
- …of provider engagement strategies that promote transparency and trust throughout the claims auditing process + Act as a liaison between payment integrity operations ... Evaluate and implement AI-driven solutions, including machine learning, natural language processing (NLP), and predictive models to identify improper payments and… more