- AmeriHealth Caritas (Philadelphia, PA)
- …Research and analyze case documentation, including benefit coverage, prior authorizations, claims , and regulatory guidance. + Communicate with members, providers, or ... representative to clarify appeal intent and gather missing documentation...and Resolution_** + Collaborate with internal departments such as Claims , Medical Management, Legal, and Compliance to obtain necessary… more
- Highmark Health (Montpelier, VT)
- …medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior ... of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a… more
- Army National Guard Units (Phoenix, AZ)
- …Guard members and their families on available entitlements, VA disability claims processing, benefits, and information resources in the mobilization and ... as: Veteran Affairs health, compensation and pay, education, vocational rehabilitation, life insurance , home loans, and burial benefits as well as TRICARE, Social… more
- Queen's Health System (Honolulu, HI)
- …implementing process changes, to minimize and/or prevent denials. * Follows up on insurance claims with outstanding balances; leads meetings with payors to ... Four (4) years recent progressively responsible experience as a Patient Accounts Representative in an acute care facility, demonstrating good working knowledge of… more
- Globus Medical, Inc. (Audubon, PA)
- …leave of absence and return-to-work processes with employees, managers, and insurance vendors. + Administer Short-term/Long-term Disability and Family and Medical ... Leave Act (FMLA) claims , including tracking and...**Physical Demands** **:** The physical demands listed here are representative of those that must be met by and… more
- UIC Government Services and the Bowhead Family of Companies (Letterkenny Army Depo, PA)
- …a team WORK ENVIRONMENT: The work environment characteristics described here are representative of the minimum standards an employee encounters while performing the ... and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual… more
- General Dynamics Information Technology (Fairfax, VA)
- …play a crucial role in performing the duties of a **Provider Outreach Regional Representative ** for the eMedNY Program in the NYC area. As a Training Specialist ... the company to external and/or internal customers, supporting Medicaid related claims and billing questions. You will provide assistance and problem resolution… more
- MTA (Jamaica, NY)
- …customer satisfaction by investigating customer and political inquiries or complaints, claims , legal inquiries either written or verbal and prepare appropriate ... Must possess prior experience drafting responses and/or correspondence to inquiries, claims , complaints, etc. + NY State Fundamentals of Engineering (FE)… more
- Point32Health (FL)
- …+ Required (minimum): 2-4 years' experience as a customer service or member services representative in health care or insurance + Preferred: 2 years' Appeals and ... works collaboratively with the member and/or the member's authorized representative and must demonstrate superior customer service and benefit interpretation… more
- Southland Holdings (Leadville, CO)
- …Develop and maintain a working relationship with the owner or the owner's representative + Read, understand, and plan according to the work specifications and ... as customer liaison + Manages change orders, budget schedule, claims , safety, staff, etc. + Has overall responsibility for...programs. Physical Demands The physical demands described here are representative of those that must be met by an… more