- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... determine if an a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Humana (Springfield, IL)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- CVS Health (Springfield, IL)
- …we do it all with heart, each and every day. **Description** -Customer Service Representative is the face of Aetna and impacts members' service experience by manner ... new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates providers on our self-service… more
- TEKsystems (Chicago, IL)
- About the Role We are seeking a highly skilled and detail-oriented Patient Account Representative to join our Revenue Cycle team. This role is critical to ensuring ... + 3+ years of medical collections experience including working with denials and appeals + UB-04/hospital claims experience + EPIC + Must sit in either the… more
- Intermountain Health (Springfield, IL)
- …such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications), ... required- Familiarity with electronic remittances, required **Physical Requirements** + Interact with others by effectively communicating, both orally and in writing + Operate computers and other office equipment requiring the ability to move fingers and hands… more
- Cardinal Health (Springfield, IL)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- Highmark Health (Springfield, IL)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... a resource for technical staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy… more
- Highmark Health (Springfield, IL)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Transdev (Chicago, IL)
- …staff and applicant while providing high quality customerservice + Participate in appeals process, uponrequest + Maintain a positive attitude when interacting with ... personnel so classified. The physical demands described here are representative of those that must be met by an...legally protected status. The physical demands described here are representative of those that must be met by an… more
- Transdev (Chicago, IL)
- …staff and applicant while providing high quality customer service + Participate in appeals process, upon request + Maintain a positive attitude when interacting with ... personnel so classified. The physical demands described here are representative of those that must be met by an...legally protected status. The physical demands described here are representative of those that must be met by an… more