- Intermountain Health (Salt Lake City, UT)
- …the health insurance industry (Commercial Insurances, Medicare, and Medicaid); health claims billing or Third Party contracts. **Physical Requirements:** + ... about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) . Intermountain Health is an equal opportunity employer. Qualified applicants will… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is hiring a full-time Claims Examiner Workers Comp. The team is based out of downtown Pittsburgh; however this position will be predominantly ... required as needed. This position is responsible for administrative support to the claims management team. They will be responsible for claim set ups, mailing… more
- Prime Therapeutics (Topeka, KS)
- …Principal Solution Strategist for our NEW JUDI program. If you have experience with PBM/ health claims , love working in a fast-paced environment within a group ... issues and concerns and support collaborative problem solving **Preferred Qualifications** + PBM/ health experience - Claims + Experience working on and coaching… more
- Corewell Health (Grand Rapids, MI)
- …billing and enrollment, care management, medical, pharmacy and behavioral health authorizations, customer service interactions, prescription claims , medical ... , Legal and/or enrollment/eligibility Required + Working knowledge of Priority Health systems for claims payment, care management, authorizations, customer… more
- Insight Global (Burbank, CA)
- …the Health Fund. The Senior Participant Service Specialist/Analyst will process health insurance claims and answers calls from the customer (participant, ... providers, physicians, hospitals etc.) Adhere to eligibility, claims and call policies and procedures while making sound claim/call decisions. Foster strong… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... general supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment quality of ... claims in accordance with TRICARE policy requirements. This role...us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and… more
- CVS Health (Springfield, IL)
- …travel on the company's site in a cost effective manner - Knowledge of CVS Health (or other PBM) claims processing - Knowledge of retail pharmacy operations ... At CVS Health , we're building a world of health...based from your home and travel onsite to conduct claims audits at pharmacies throughout multiple states by reviewing… more
- State of Minnesota (St. Paul, MN)
- …the recovery of third-party funds where MA and/or cash subsistence programs paid for health care claims or wage loss covered by: WC; No-Fault Auto; Third-Party ... Dept / MAPE DHS Central Office + **Division/Unit** : Health Care Administration / Integrity and Accountability + **Work...on behalf of the agency in workers' compensation (WC) claims and tort claims -including, no-fault, third-party auto,… more
- Mount Sinai Health System (New York, NY)
- …The ideal candidate will have had some experience working with health administrative/insurance claims data and/or other large datasets. **Qualifications** ... and Data Science, the Department of AI and Human Health , and the Center for Child Health ...precision medicine. We leverage causal learning to analyze administrative claims data, medical records, and clinical trial data, while… more