- 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
- 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
- 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 ... the candidate will be responsible for:** + Processing of Professional claim forms files by provider + Reviewing the...98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as… more
- NTT DATA North America (MO)
- …the timelines to complete compliance training of NTT Data/Client * Work independently to research , review and act on the claims * Prioritize work and adjudicate ... the candidate will be responsible for:** + Processing of Professional and Hospital claim forms files by provider +...98.5% PA and 99.75% FA. * Timely response and resolution of claims received via emails as… more
- Sedgwick (Sacramento, CA)
- … toward resolution . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Provides initial research /data collection on claims file. + Performs file audits according ... Best Workplaces in Financial Services & Insurance Work Comp Claims Services Associate | Hybrid | Sacramento, CA Are...professional needs **PRIMARY PURPOSE OF THE ROLE:** The Claims Services Associate is an important part of the… more