• Manager Benefit Administration - Sharp…

    Sharp HealthCare (San Diego, CA)
    …management team. + Knowledge of Federal and State regulations as related to benefit and claims adjudication . + Adept at being an initiator of positive change to ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
    Sharp HealthCare (08/09/25)
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  • PBM Auditor

    HUB International (Chicago, IL)
    …audits of Pharmacy Benefit Managers (PBMs) to ensure contractual compliance, accurate claims processing , and proper financial management. This role involves ... Microsoft Excel (advanced functions) and SQL. + Familiarity with PBM platforms and claims adjudication systems. + Strong understanding of pharmacy billing and… more
    HUB International (08/28/25)
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  • Pharmacy Navigator- LTC Belknap Pharmacy

    Essentia Health (Superior, WI)
    …pharmacy technician experience + Previous experience working with patient medication profiles, claims adjudication and billing, copay assistance programs as well ... of the pharmacy team and will assist in the adjudication , processing , packaging and distributive functions of...optimal specialty pharmacy performance. Team members within the Essentia Health Pharmacy will have an opportunity to be part… more
    Essentia Health (09/05/25)
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  • Emory Health Plan, Vice President - Plan…

    Emory Healthcare/Emory University (Atlanta, GA)
    …with providers, negotiate contracts (where necessary), and ensure quality of care. CLAIMS MANAGEMENT: + Oversee TPA claim processing , ensure accurate and ... with the finance team to manage the budget and financial performance of the health plan, the VP Pharmacy for performance on pharmaceutical spending targets, and the… more
    Emory Healthcare/Emory University (08/19/25)
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  • Senior Medical Biller & A/R Specialist

    Movn Health (CA)
    …experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level ... management + Deep knowledge of payer reimbursement methodologies and claims adjudication + Proficiency with multiple EHRs...plus + Prior experience in cardiovascular care or digital health startups is a strong plus About You +… more
    Movn Health (06/27/25)
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  • Insurance Billing Specialist

    TEKsystems (West Des Moines, IA)
    …a timely manner. This position requires strong decision-making ability around complex claims processing workflows and regulations that requires utilization of ... issues, repetitive errors, and payer trends to expedite claims adjudication Work accounts in assigned queues...employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee… more
    TEKsystems (09/18/25)
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  • Manager, Workers' Compensation

    Port of Seattle (Seattle, WA)
    …+ You will provide daily management, program oversight, and confidentiality to the processing and adjudication of claims and legal documents associated ... and internal auditing personnel. + You will ensure the claims record management system interfaces with multiple internal and...risk mitigation strategies. You will also partner with the Health & Safety Program Managers to review and analyze… more
    Port of Seattle (08/23/25)
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  • Supervisor, Government Programs

    Independent Health (Buffalo, NY)
    …+ One (1) year of progressive leadership/management responsibilities required. + Experience processing online Medicare Part D claims or implementing government ... regulatory compliance in benefit implementation, formulary administration, pharmacy claim adjudication , regulatory reporting (eg, PDE, EOB files), and/or audit… more
    Independent Health (09/16/25)
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  • Ops Medical Disability Case Record Spec

    MyFlorida (Miami, FL)
    …. Requisition No: 860738 Agency: Department of Health Working Title: OPS MEDICAL DISABILITY CASE RECORD ... Date: 09/20/2025 Total Compensation Estimator Tool (https://compcalculator.myflorida.com/) DEPARTMENT OF HEALTH DIVISION OF DISABILITY DETERMINATIONS OPEN COMPETITIVE OPPORTUNITY THIS… more
    MyFlorida (09/12/25)
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  • Specialty Pharmacy Technician (Certified…

    Billings Clinic (Billings, MT)
    …preparations, filling bottles/bingo cards with prescribed tablets/capsules, processing prescriptions and emergent prescriptions, adjudicating claims ... a neat and organized condition. * Processes complete prescription claims including proper adjudication /reconciliation, insurance verification, prior… more
    Billings Clinic (08/23/25)
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