- Elevance Health (St. Louis, MO)
- …+ Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide ... I** is responsible for pre and post payment and adjudication audits of high dollar claims for...documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for… more
- Cognizant (Winston Salem, NC)
- …Adjudicator in Winston Salem, North Carolina with 1 to 2 years of experience in Claims Adjudication . _Training will be 4-6 weeks In-Office, then this role will ... to manage and interpret data enhancing the efficiency of claims processing . + Collaborate with team members...FACETS experience is an added advantage + Experience in claims hospital and professional claims adjudication… more
- TEKsystems (Los Angeles, CA)
- …Regulatory Agencies What You Bring + 5+ years of hands-on experience in claims processing and system configuration + Strong analytical and problem-solving skills ... + Manage special projects related to claim denials and auto- adjudication + Identify risks and implement strategies to reduce...HMO Claims & Insurance Expertise + ✅ Claims Audits, Resubmissions & Processing + ✅… more
- CVS Health (Hartford, CT)
- …This critical role involves addressing significant challenges related to enrollment, billing, and claims processing on the Majesco LA&H Core Suite. The ideal ... on resolving high-priority defects and systemic issues impacting enrollment, billing, and claims processing + Deep-Dive Analysis & Root Cause Identification:… more
- Providence (Mission Hills, CA)
- … Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers. Providence ... **Description** The Senior Claims Specialist is responsible for the processing...loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior… more
- Aston Carter (Spokane, WA)
- …+ Identify process inefficiencies and contribute to best practice discussions. Essential Skills + Claims adjudication + Medical claim processing + Data entry ... + Minimum of 3-5 years of experience in medical claims adjudication . + Proficiency in interpreting benefit...+ Ability to work independently, prioritize tasks, and meet processing benchmarks. Work Environment The work schedule is from… more
- Centene Corporation (Harrisburg, PA)
- …the subject matter expert for other Claims Liaisons. + Analyze trends in claims processing issues and identify work process solutions + Lead meetings with ... claims issues to ensure prompt and accurate claims adjudication + Identify authorization issues and...configuration related work process changes + Analyze trends in claims processing issues and assist in identifying… more
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills &...(must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs… more
- Sedgwick (Marlton, NJ)
- …work 3 days from home!** **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate and ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Baltimore, MD)
- …growth, and inclusion. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more