- 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
- MVP Health Care (Schenectady, NY)
- …+ Meets or exceeds department quality and work management standards for claims adjudication . + Successfully completes a course of comprehensive formal ... At MVP Health Care, we're on a mission to create...information. + Is responsible for the timely and accurate adjudication of claims that are suspended to… more
- Dignity Health (Bakersfield, CA)
- … discrepancies for all claim types - Perform an analysis of the claims processing by reviewing contract, system configuration, benefits, financial risk (DOFRs), ... and manual adjudication to identify the cause of the erroneous claim...for audit purposes. - Collaborate with internal departments, including claims processing , UM, compliance, and provider relations,… 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
- 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
- Dignity Health (Bakersfield, CA)
- …role responsible for the detailed and accurate processing , review, and adjudication of complex healthcare claims . This position requires expert knowledge of ... claims processing , coding, and regulatory compliance. The Claims ...Coder (CPC) **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO)… more
- CDPHP (Latham, NY)
- …High school diploma or GED required. + Minimum of one (1) year experience in health care claims review and adjudication to payment/denial utilizing CPT-4, ... Representative shall assume full responsibility and ownership for all aspects regarding claims adjudication and adjustments. In addition, the incumbent will… more
- CVS Health (Hartford, CT)
- …This critical role involves addressing significant challenges related to enrollment, billing, and claims processing on the Majesco LA&H Core Suite. The ideal ... on resolving high-priority defects and systemic issues impacting enrollment, billing, and claims processing + Deep-Dive Analysis & Root Cause Identification:… more
- WelbeHealth (Phoenix, AZ)
- …or processing errors, and monetary discrepancies + Move claims free of processing errors through for full adjudication and return claims with errors ... corrections + Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change… more
- Commonwealth Care Alliance (Boston, MA)
- …specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication , clinical coding reviews for claims , settlement, ... Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills &...(must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs… more
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