- AmeriHealth Caritas (Detroit, MI)
- …services. Discover more about us at www.amerihealthcaritas.com . **Job Summary** The Medicare LTSS Care Coordinator is responsible for overall management of member's ... and internal requirements. Under the supervision of the Supervisor Medicare LTSS Operations, the Medicare LTSS Care...+ May also assist in problem solving with providers, claims or service issues. + May direct the work… more
- Humana (Boise, ID)
- …will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. ... Analyst r will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for...closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …and maintains new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that ... Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage to support internal strategies and external customer… more
- BlueCross BlueShield of North Carolina (NC)
- …Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, ... **Job Description** The Manager, Medicare Claims , oversees end-to-end claims...demand + Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering,… more
- Travelers Insurance Company (Irvine, CA)
- …appropriate to resolve claims . Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of ... Apply deep technical expertise to assist in the resolution of highly complex claims . Mentor other Claim Professionals + Participate in Telephonic and/or onsite… more
- University of Rochester (Rochester, NY)
- … to obtain and verify insurance coverage. + Follows up on unpaid accounts working claims . + Reviews reasons for claim denial. + Reviews payer website or contacts ... open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Researches, corrects, resubmits … more
- NJM Insurance (NJ)
- …transparent, empathetic support and collaborative engagement during the life of a claim . The WC Claims Department takes pride in being a key component ... NJM's WC Claims Department is seeking an experienced Claims...practices and company guidelines, and timely, accurate documentation of claim activity + Provide a high level of customer… more
- Sedgwick (Roseville, CA)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim ...Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the… more
- LA Care Health Plan (Los Angeles, CA)
- Senior Manager, Claims Administration Job Category: Management/Executive Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Senior… more
- LA Care Health Plan (Los Angeles, CA)
- …provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support . This position ensures that adjustment decisions are ... Senior Manager, Claims Adjustments Job Category: Management/Executive Department: Claims...that may require corrective action. Partners with Legal to support claim -level discovery, case review, and preparation… more