- Sedgwick (Irving, TX)
- …disability case management and routine claim determinations based on medical documentation and the applicable disability plan interpretation including determining ... and making timely payments/approvals and adjustments, medically managing disability claims ; coordinates investigative efforts, thoroughly reviewing contested claims… more
- Access Dubuque (Dubuque, IA)
- …disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- Pfizer (Olympia, WA)
- …Previous experience in field-based medical /outcomes role in Oncology + Experience analyzing health care data ( claims , electronic health records, other ... of care and improving patient outcomes (f) Optimize patient centricity of Medical communications and deliverables, incorporating Health Literacy and cultural… more
- The Cigna Group (Bloomfield, CT)
- … medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, ... including novel treatments, to support high-quality clinical decision-making across medical and behavioral health conditions, diseases, treatments, and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …each opportunity. The role also includes the development and communication of market segment medical claims expense trends with the aim to provide insights that ... of our trend management initiatives in the areas of medical policy, payment policy, care management, pharmacy, health...of initiatives to improve members health and health care quality and moderate claims trends… more
- Trinity Health (Ann Arbor, MI)
- …Type:** Full time **Shift:** **Description:** **Department:** Home Infusion **Location:** Trinity Health Ann Arbor **About the Department** Infusion pharmacy is a ... Billing Assistance + Drug card billing for home infusion pharmacy patients, troubleshoot claims rejections, finalize and adjust drug claims for submission. +… more
- Avera (Sioux Center, IA)
- …**Worker Type:** Regular **Work Shift:** Day Shift (United States of America) Sioux Center Health is seeking a qualified individual to join our team! Sioux Center ... Health has been designated a Top 100 Critical Access...school diploma or GED required, training or education in Medical Terminology preferred. Secretarial experience preferred but not required,… more
- Houston Methodist (Houston, TX)
- …area No **Company Profile:** Houston Methodist is one of the nation's leading health systems and academic medical centers. Houston Methodist consists of eight ... and claim edits, payor rejections, unresolved or no response insurance claims and processing of financial correspondence. The Insurance Biller demonstrates general… more
- Hunterdon Health Care System (Flemington, NJ)
- …monitoring all aspects of the collection of outstanding debts owed to the health system including following up directly with commercial and governmental payers to ... include following up with payers to ensure timely resolution of all outstanding claims via phone, emails, fax, or payer portals. Responsible for identifying and… more
- Elevance Health (Mason, OH)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... abuse. **How you will make an Impact:** + Examines claims for compliance with relevant billing and processing guidelines...to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in… more