- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... expanding, industry-leading organization. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong… more
- CVS Health (Richardson, TX)
- …do it all with heart, each and every day. As part of the Rx Claim Adjudication team, you will be expected to be proficient in all critical functions of the ... through research and fact finding. + Experience with RxClaim or other PBM Adjudication system is preferred. + Experience on Cloud Technologies like GCP, AWS, Azure,… more
- WellSense (Boston, MA)
- …Diploma or GED required** **Education Preferred** + **Bachelor's degree and/ Claims adjudication or medical billing/coding certification preferred** **Experience ... Claims Quality Assurance Inspector WellSense Health Plan is...against established corporate guidelines and protocols specific to claim adjudication and Enrollment entry. Ideal candidates will maintain a… more
- Apex Health Solutions (Houston, TX)
- … Operations Summary: Position is responsible for the timely and accurate claims adjudication and regulatory reporting functions including associated processes ... checking with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and development by… more
- UCLA Health (Los Angeles, CA)
- …random and focus audits of all claim processing activities to identify inaccurate claims adjudication . This will involve reviewing UB04 and CMS 1500 healthcare ... claims and adjustments for accuracy, and appropriate application claims adjudication , including CMS regulations, Department of Financial Responsibility… more
- Dragonfly Health (Mesa, AZ)
- …immediate supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication . Adjust and correct authorizations in dispensing and ... of six (6) months of pharmacy technician experience. * Experience with pharmacy claims adjudication is required. Specialized Knowledge, Skills & Abilities: * PBM… more
- CHS (Clearwater, FL)
- …insurance companies, employers, and members. In this pivotal role, you'll oversee claims adjudication , drive operational strategy, and ensure high accuracy and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process, including clearinghouses, claims cost control… more
- NTT DATA North America (Ontario, CA)
- … systems / operational improvements **Required Qualifications and skills:** -5+ years claims adjudication experience -1+ year experience in Xcelys or equivalent ... claims adjudication systems -1 year of expertise in coding (CPT, ICD-10, HCPCS) **Preferred Qualifications:** -Deep knowledge of provider contracts, pricing,… more
- NTT DATA North America (Ontario, CA)
- …process enhancements + Feedback from peer and leadership reviews **Required:** + 5+ years claims adjudication experience + 3+ years of experience in Xcelys ... claims adjudication systems + Expertise in coding (CPT, ICD-10, HCPCS) + Deep knowledge of provider contracts, pricing, regulatory guidelines + Excellent… more
- AssistRx (Orlando, FL)
- …pharma services, or HUB services environment. + Strong understanding of claims adjudication processes, reimbursement models, and affordability solutions. + ... and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances… more
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