- LA Care Health Plan (Los Angeles, CA)
- …management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines. Manages a specified ... additional service needs according to specific program guidelines. Uses claims processing and care management software to look up...group or managed care setting, such as a health insurance environment and/or experience as care manager in home… more
- CGI Technologies and Solutions, Inc. (Indianapolis, IN)
- …CGI is looking for a skilled Quality Analyst for data testing across insurance platforms like Applied Epic with Ivans and AL3, Guidewire, and Salesforce FSC. ... automated testing solutions to validate large volumes of policy, claims , billing, and customer data in real time. *...models to support QA, UAT, and SIT phases in insurance data projects. * Work closely with data engineers,… more
- MTA (New York, NY)
- …Location: New York, NY, United States Regular/Temporary: Regular Department: Office of Insurance & Risk Mgt Date Posted: Oct 28, 2025 Description JOB TITLE: ... POINTS: 994 DEPT/DIV: Finance SUPERVISOR: Deputy Chief, Risk and Insurance Management LOCATION: 2 Broadway, New York, NY 10004...of a staff of 2 people including the Sr Claims Administrator, 1 Analyst and approximately 7 consultants. +… more
- BD (Becton, Dickinson and Company) (Franklin Lakes, NJ)
- …personas, insights, brand positioning statements, benefit ladders, and differentiated claims , to support launches, drive adoption, and accelerate growth across ... management + Lead development and validation of differentiated product claims in collaboration with legal, regulatory, and medical teams.... Dental coverage . Vision coverage . Hospital Care Insurance . Critical Illness Insurance . Accidental… more
- Aston Carter (Dallas, TX)
- …payer follow-up activities. The role involves analyzing unpaid, underpaid, and denied claims to identify root causes and take necessary actions. Responsibilities + ... payer follow-up activities. + Analyze unpaid, underpaid, and denied claims to identify root cause and required action. +...- Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and… more
- CVS Health (AZ)
- …representatives that are responsible for contacting payers to collect on unpaid claims in a timely and accurate manner, researching and resolving payment variances, ... and managing the accurate and timely filing of claims within payer function group. **Additional responsibilities of the Accounts Receivable Supervisor include** : +… more
- Cognizant (Austin, TX)
- …interpret EOBs 835837 and respond using medical guidelines and policies Prioritize pending claims from aging basket and follow up at regular intervals to collect ... including drafting and submitting technical appeals Examine denied and underpaid claims to determine the reason for discrepancies Communicate directly with payers… more
- Elevance Health (Tampa, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Evolent (Lansing, MI)
- …articulating our value. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based on relevant ... manner that fosters expertise and cooperation. + Process and validate raw unadjudicated claims data + Use programming skills to explore, examine and interpret large… more
- The Hartford (Brea, CA)
- …- LM07EE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every ... briefs with a high degree of autonomy. Collaboration with Claims Partners is essential to achieve optimal outcomes for...team huddles, conducting in-house training for junior associates and claims partners, and engaging in claims file… more