- 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 ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… more
- AssistRx (Phoenix, AZ)
- …reimbursement, Sites of Care and Health Care Providers. The Copay Support/ Claims Processing Specialist will adjudication , troubleshoot claim rejections, ... teams on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data… more
- WellSense (Boston, MA)
- … and Enrollment entry. Ideal candidates will maintain a broad knowledge of corporate claims processing and enrollment entry rules for use in conducting all ... Diploma or GED required** **Education Preferred** + **Bachelor's degree and/ Claims adjudication or medical billing/coding certification preferred** **Experience… 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 ... perform user acceptance testing for any impacted changes to claims processing as directed Meets or exceeds...with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and… more
- UCLA Health (Los Angeles, CA)
- …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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …contracts, Medical Policies and Payment procedures as well as capable of manually processing claims according to all outlined Policies and Procedures. This job ... Essential Qualifications + Knowledge of contracts, medical terminology, and claims processing and procedures. + 1+ year...and procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written… more
- Brighton Health Plan Solutions, LLC (NC)
- … claims processing and procedures. + 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims . + ... and respond to escalated issues and pertinent information on claims requiring adjudication . + Review and process...experience in the healthcare field preferred. About At Brighton Health Plan Solutions, LLC, our people are committed to… more
- CVS Health (Blue Bell, PA)
- …leading modernization efforts. + Strong understanding of regulatory compliance in claims processing . + Excellent communication and stakeholder management skills. ... At CVS Health , we're building a world of health...modernization of legacy systems-primarily IBM Mainframe platforms-used for commercial claims routing, adjudication , and operational reporting. This… 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
- CommonSpirit Health (Erlanger, KY)
- …to return, pend, deny or pay claims ). + Follows and ensures claims processing is consistent with applicable policies, regulations, procedures and department ... processing enhancements. + Responsible for managing the STD claims team but is not limited to the following:...Provide technical expertise and direction to team members on claims adjudication for STD. + Facilitate the… more
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