• Specialist, Appeals & Grievances

    Molina Healthcare (Augusta, GA)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
    Molina Healthcare (10/18/25)
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  • Medical Billing Specialist

    Robert Half Accountemps (Chicago, IL)
    …offers the opportunity to play a key role in ensuring accurate billing and claims processing within the healthcare sector. The ideal candidate will bring ... * Utilize specialized billing platforms and tools, including Epaces, for claims processing . * Monitor and manage medical collections to ensure timely resolution… more
    Robert Half Accountemps (10/14/25)
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  • Claim Benefit Specialist

    CVS Health (Franklin, TN)
    …providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims . + Determines if claims processing activities comply with ... codes and other necessary data elements to ensure accurate tracking, reporting, and processing of claims in all appropriate applications. + Conducts reviews and… more
    CVS Health (10/02/25)
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  • Medical Claims Specialist - Remote

    Rising Medical Solutions (Tampa, FL)
    The Claims Specialist will assist in reviewing, processing , and coordinating claims accurately in accordance with the program requirements while ensuring ... + Maintain ongoing knowledge of program requirements + Analyze and process claims for accuracy, eligibility, and benefits coverage + Retain and strengthen… more
    Rising Medical Solutions (09/27/25)
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  • IT AVP - Data Science

    Philadelphia Insurance Companies (Bala Cynwyd, PA)
    …and automation into core business functions, such as underwriting, pricing, and claims processing , while staying ahead of industry trends, regulatory changes, ... fraud detection, and customer segmentation strategies + Claims Analysis: Analyze claims data to identify patterns, improve processing efficiency, and detect… more
    Philadelphia Insurance Companies (10/05/25)
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  • Senior Quality Analyst

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …Quality Analyst, who will oversee contract and benefit configuration to ensure accurate claims processing and network compliance. This is a remote role. Primary ... benefit setup discrepancies. + Collaborate with IT and operations to resolve claims configuration gaps. + Perform routine and complex audits of claim transactions… more
    Brighton Health Plan Solutions, LLC (10/04/25)
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  • Area Supervisor

    City of New York (New York, NY)
    …Area Supervisor, who will: - Directly and indirectly supervise staff in Claims processing /establishment of claims /recovery of manual payments/Program ... support. Track and ensure productivity of processing case actions in claims , establishment and imaging or recovery units. - Develop, complete, review and… more
    City of New York (10/01/25)
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  • Billing Coordinator - Accounts Receivable-MSH

    Mount Sinai Health System (New York, NY)
    …required. Familiarity with CPT and ICD (coding and CCI edits) + Electronic claims processing preferred. **Responsibilities** 1. Follows up on submitted claims ... secondary balances to appropriate financial class and provides documentation for processing the claims . 6. Reviews Credit Letter Sent (CLS) and transfers balance… more
    Mount Sinai Health System (09/17/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (IA)
    …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
    Molina Healthcare (10/18/25)
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  • Senior QNXT Analyst - Contract Configuration

    Molina Healthcare (Omaha, NE)
    …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education**… more
    Molina Healthcare (10/18/25)
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