- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Senior Claims Research and Resolution Professional reports to the Claims Research ... including their applications to assignments. The Senior Claims Research and Resolution Professional follows general guidance and processes and must… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Claims Research and Resolution Professional 2 reports to the Claims Research ... objectives, including their applications to assignments. The Claims Research and Resolution Professional 2 follows general guidance and processes and… more
- Humana (Springfield, IL)
- …Eligible (HMO D-SNP) in IL, is seeking a Claims Research & Resolution Professional claims educator, who will be responsible for carrying out Humana's ... claims denials through claims education and training. The Claim Research and Resolution Professional reports to the Claims Research and… more
- Commonwealth Care Alliance (Boston, MA)
- …preferred. + Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications ... Quality Assurance for further investigation or configuration updates. + Document all research , findings, and outcomes in claims systems (eg, Salesforce, Facets)… more
- NTT DATA North America (Plano, TX)
- …the timelines to complete compliance training of NTT Data/Client -Work independently to research , review and act on the claims -Prioritize work and adjudicate ... above 98.5% PA and 99.75% FA. -Timely response and resolution of claims received via emails as...compliance training of NTT Data/Client + Work independently to research , review and act on the claims … more
- Cedars-Sinai (CA)
- …Acquires daily workflow via reports or work queue and incoming phone calls. + Research claims for appropriate support documents. + Analyzes and adjusts data, ... **Job Description** The Claims Examiner is responsible for accurately and consistently...and for accuracy of entries. + Handles in a professional and confidential manner all correspondence. + Supports core… more
- State of Massachusetts (Boston, MA)
- *Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave* The Program Integrity Claims Examiner/Job Service Representative II is ... processes within the Department of Family Medical Leave (DFML). The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed … more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr....role will also be responsible for timely review and research , as necessary on all new and revised coding… more
- ADP (San Dimas, CA)
- ADP is hiring a ** Claims Lead Examiner** . **_RESPONSIBILITIES:_** + Assist Claims Manager in monitoring the workers compensation program within the ADPTS/PEO ... that could be problematic and take steps along with Claims Manager to take steps to develop processes to...Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed. **_REQUIRED SKILLS:_** +… more
- Brighton Health Plan Solutions, LLC (NC)
- …and claims processing and procedures. + 5+ years of advanced claims adjudication experience, including facility, professional , and ancillary claims . ... About the Role The Claims Supervisor is responsible for supervising a staff...daily work to the team and monitor aging inventory resolution . + Train new hires, vendors, and existing staff… more