- ManpowerGroup (Tempe, AZ)
- …AI, data science, and product teams to evaluate AI models used in underwriting, claims processing , risk assessment, and pricing. + Identify gaps, biases, and ... + 7+ years of experience in the insurance industry, including underwriting, claims , risk modeling, or product management. + Strong understanding of insurance… more
- Molina Healthcare (Bellevue, WA)
- …encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** ... Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education**… more
- Centene Corporation (Queens, NY)
- …stakeholders related to operational areas. + Oversee day-to-day operations including claims processing , provider network management, member services, utilization ... Oversee implementation and optimization of health plan operations systems (eg, claims adjudication platforms, CRM tools). + Drive digital transformation initiatives… more
- UCLA Health (Los Angeles, CA)
- …Excel + Knowledge of Tableau Reporting dashboards + Understanding of Medicare/Medi-Cal claims processing guidelines + Experience with EPIC EHR, Cirius Claim ... compliance with government regulations, reimbursement issues, etc. + Analyze hospital billing claims within the EHR and claim scrubber system + Resolve claim errors,… more
- Robert Half Finance & Accounting (Carlisle, PA)
- …operations. This position plays a critical role in optimizing billing, coding, claims processing , insurance verification, and collections to ensure compliance ... * Ensure accurate medical, dental, behavioral health, and vision coding and claims submissions. * Provide strategic direction, foster staff development, and oversee… more
- CareFirst (Baltimore, MD)
- …setup of code sets used for configuration in benefits & pricing for claims processing , claims editing configuration set-up and maintenance. Analyzes ... business requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit… more
- Sierra Nevada Company, LLC (Sparks, NV)
- …+ Assist or manage the company's insurance programs, including policy renewals, claims processing , and coordination with insurance providers. + Identify and ... processes with respect to coverage placement, contract review, insurance compliance, claims management, insurance recovery, and other facets related to protection of… more
- University of Southern California (Los Angeles, CA)
- …in managed health care. General understanding including but not limited to: claims processing functionality, benefit coverage, provider network, standard billing ... standards of quality and innovation. Manages and resolves human resource and member claims and plan related issues. . Plans and conducts quality assurance reviews… more
- Health Care Service Corporation (Downers Grove, IL)
- …group health insurance account executive OR 6 years experience in group health claims processing , customer service, claims -related, and/or sales and thorough ... knowledge of managed health care products (PPO, HMO) processes and trends OR Bachelor degree and 3 years customer service/account management experience with thorough knowledge of managed health care products. * 2 years in a position which require decision… more
- HUB International (Roseville, CA)
- …Manager. **QUALIFICATIONS** + High School / GED + 1-2 years healthcare claims processing , or benefits administration preferred + Bilingual preferred **KNOWLEDGE ... Handles inbound calls on a queue system. + Assists clients and employees with various claims and benefit issues. + Respond to all phone calls and inquiries no later… more