- Actalent (Tempe, AZ)
- …applications to perform analysis, obtain information, and enter data necessary for claims adjudication . This position requires strong reasoning skills to ... Authorization Operations team where you will play a crucial role in processing prior authorization requests. You will ensure accuracy, timeliness, and productivity… more
- Highmark Health (Dover, DE)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent… more
- MetLife (Bridgewater, NJ)
- …use of OCR, NLP and LLMs, and building a brand-new ontology for animal health claims . * Governance and data expertise: Establish governance frameworks for data ... Claims automation: Given the exponential growth of the Pet business, claims cost management is essential. Enhance auto- adjudication models to substantially… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . Demonstrates compliance with all applicable legislation and ... health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate,… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . Demonstrates compliance with all applicable legislation and ... policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Bachelor's degree with a minimum of two years' experience in long term care insurance claims processing . + Must have the ability to review and interpret medical ... and communication with Insured, Insured's family, care providers, and adjudication of the claims . All work is...appropriate plan of care for Insured in conjunction with health care personnel at the physician office, hospital, home… more
- MyFlorida (Orlando, FL)
- …incumbent's primary responsibility is to perform duties that assist us with the processing of Social Security disability claims . This position requires the ... Website (http://www.dms.myflorida.com/workforce\_operations/human\_resource\_management/for\_job\_applicants/e\_verify) . Requisition No: 860084 Agency: Department of Health Working Title: OPS RECORDS ANALYST - 64858427 Pay… more
- AdventHealth (Apopka, FL)
- …patient, drug, medication directions, refills and prescriber are selected + Processes claims adjudication and copay assistance billing for new prescription ... Day One + Career Development + Whole Person Wellbeing Resources + Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . Demonstrates compliance with all applicable legislation and ... health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate,… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . Demonstrates compliance with all applicable legislation and ... health management program interventions. + Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to… more