- The Cigna Group (Bloomfield, CT)
- …to gain knowledge of Pharmacy Benefit Management (PBM) services, including claims processing , coverage reviews, pharmacy networks, formulary management, and ... one of your employment, you'll be offered several health-related benefits including medical , vision, dental, and well-being and behavioral health programs. We also… more
- Molina Healthcare (Rio Rancho, NM)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... for strategic analysis, profitability, financial analysis, utilization patterns and medical management. + Interfaces and maintains positive interactions with… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …. Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform. . Manages case volumes and review/audit schedules, ... 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines,.... Intermediate knowledge of PC, software, auditing tools and claims processing systems. Level II (in addition… more
- Public Consulting Group (St. Paul, MN)
- …support through claim issue research. Additional this position will assist in performing claims processing , medical record audits for all implemented ... support through claim issue research. Additional this position will assist in performing claims processing , medical record audits for all implemented… more
- Humana (Frankfort, KY)
- …coding certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ... in healthcare or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies...Policies and Claims Payment Policies + CAS claims processing experience + Experience in data… more
- 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 ... Work directly with third party payers and internal/external customers toward effective claims resolution Skills epic, medical billing, follow up Top Skills… more
- Sedgwick (Dublin, OH)
- …establish expectations for return-to-work timelines and accommodations.** **Manages complex disability claims with a focus on medical compliance, duration ... connection.** **This role follows a hybrid work model, blending remote flexibility with in-office collaboration. To make that possible,...do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise,… more
- Access Dubuque (Dubuque, IA)
- …establish expectations for return-to-work timelines and accommodations.** **Manages complex disability claims with a focus on medical compliance, duration ... connection.** **This role follows a hybrid work model, blending remote flexibility with in-office collaboration. To make that possible,...do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise,… more
- City and County of San Francisco (San Francisco, CA)
- …direction, the Worker's Compensation Supervisor assists and provides first-line oversight of claims adjusting and processing teams for the Workers' Compensation ... Nurse Consultant, Nurse Manager, and/or Nurse Case Managers to review complex claims and establish medical protocols. 13. Advises the Occupational Nurse… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department of Health and Human ... innovative solutions for our clients. **Responsibilities** + Serve as Contract Medical Reviewers, to write medical eligibility determination recommendations via… more