Rx Claims SME
Omni Inclusive
Job Description
In depth knowledge on RxClaim Adjudication, claims processing, MedD claims. Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR). Knowledge on business & plan configuration and plan option knowledge. Facilitate discussion with Product Owners, Business and clarify business requirements. High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.
Omni Inclusive- ...not limited to WFM, Consumer Resolution Center (CRC), Product, Claims, Call Ops, IT, Sales, Enrollment, Implementation, and Provider Ops... ...level leaders. Skills ~ Business Analysts role ~ Excel SME ~ some Data Analysis/Snowflake/Databricks ~2 years of business...ClaimsFor contractors
- Starkey Hearing Technologies in Eden Prairie, MN, seeks a hard‑working Claims Specialist to support back‑end verification and submission of insurance claims, ensuring accuracy and contractual compliance. This role involves resolving coverage and billing issues with third...Claims
$20.36 - $25.24 per hour
Starkey Laboratories in Eden Prairie, Minnesota is seeking a Claims Specialist who will support operations and financial objectives through back-end verification and submission of insurance claims. Ideal candidates have experience with medical billing/claims, a high school...ClaimsHourly pay$50k - $75k
...customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. Qualifications:...ClaimsFor contractorsWork at office- ...A leading claims adjusting firm is seeking Independent Insurance Claims Adjusters in Minnetonka, MN. The role involves helping clients recover from disasters while providing flexibility and competitive compensation. Candidates can be experienced or new and will receive...Claims
- ...A leading claims adjusting firm is seeking Licensed Claims Adjusters to join their team in the United States. This role offers the chance to help rebuild lives affected by disasters, along with the flexibility and autonomy of claims adjusting. Candidates are encouraged...Claims
$40k - $45k
...Claims Administrator At Starkey, we are in the business of connecting people and changing lives. As a world leader in the manufacturing and delivering of advanced hearing solutions, we go to work each day to ensure every person on the planet has the opportunity to hear...ClaimsContract workWorldwide- ...A leading insurance adjusting company in the United States is seeking Independent Insurance Claims Adjusters. The role offers a flexible career path allowing you to assist individuals and businesses in disaster recovery. This position includes comprehensive training to...ClaimsFlexible hours
- ...A leading claims adjusting firm in Minnesota is looking for Independent Insurance Claims Adjusters. This role provides an opportunity to assist individuals and businesses in recovery from disasters while offering flexible work conditions, autonomy, and competitive pay...ClaimsFlexible hours
- A leading claims adjusting firm is seeking Licensed Claims Adjusters to join their team in the United States. This role offers the chance to help rebuild lives affected by disasters, along with the flexibility and autonomy of claims adjusting. Candidates are encouraged...Claims
- ...in Eden Prairie, Minnesota is seeking an Accounts Receivable, Collection representative. The role involves calling on final billed claims by contacting government agencies, third party payors, and patients/guarantors. Candidates must have a verifiable High School diploma...Claims
- ...those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and... ...billed, but not received), order errors or damaged goods involving Rx drugs. May assist pharmacist in administering clinical services...ClaimsApprenticeshipWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift
$91.7k - $163.7k
...Medicaid experience Experience giving formal presentations Experience in data analytics and drawing insights Experience in Rx Claim Experience in IQPR Experience in MediSpan Experience in Reporting 360 Pay is based on several factors including but not...ClaimsMinimum wageOngoing contractFull timeWork experience placementWork at officeLocal areaRemote work- Sedgwick in Eden Prairie, MN is seeking an experienced general liability claims professional to process low-level claims, determine benefits due, and reserve values. You will settle claims up to authorized limits and coordinate action plans to resolution with appropriate...ClaimsFlexible hours
- ...Sam's Club | Medical, Dental, Vision, Rx + 401(k) with match + PTO + 100% Reimbursement of Tuition & Books | 200 American Boulevard... ...Receives merchandise and organizes receiving area; Tracks and processes claims for damaged goods; Maintains facility safety and follows forklift...ClaimsImmediate start
- ...IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for...ClaimsFlexible hours
- ...Responsibilities The Accounts Receivable, Collection rep will be calling on final billed claims by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online. Continues collection activity until account is resolved. Qualifications...Claims
$56k - $65k
VOANS is seeking a Claims Auditor to join the PACE team in a remote capacity. You will lead claims processes, audit claims, and drive corrective actions to maintain accuracy across all PACE programs. The role requires 3+ years in medical billing or auditing, strong communication...ClaimsRemote job$225k - $375k
...Join us to start Caring. Connecting. Growing together. At Optum Rx, we are transforming pharmacy care—modernizing how medications are... ...Experience with prior authorization, plan build, pricing, or claims platforms Background in AI/ML‑driven business transformation and...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work- ...development of AI-powered Revenue Cycle Management solutions in Eden Prairie, Minnesota. This role requires a focus on denial prevention and claims automation, making it essential for the candidate to have experience in healthcare technology and product management. The position...ClaimsRemote jobWork at office
$100k - $114k
...staffing and training, and budget management. The ideal candidate will have 10 years of experience, including at least 7 years in claims management and supervisory roles. A comprehensive benefits package is included along with a salary range of $100,000.00 to $114,000...ClaimsWork at office- ...Certified Epic Resolute Hospital Billing And Claims Analyst We have an immediate need of a Certified Epic Resolute Hospital Billing AND Claims Analyst to join our 100% remote team of healthcare professionals. This position requires extensive experience with Claims,...ClaimsContract workImmediate startRemote work
- ...Helping to maintain efficient patient flow in a fast paced environment Gathering and verifying insurance coverage or helping process claims paperwork Cleaning or maintaining medical equipment and supplies Responding to written and verbal patient inquiries Other...ClaimsFull timeWork at office
$17 per hour
...Overview As an Insurance Verifier/ Biller you will be responsible for the completion of medical billing-related activities including claims submission and follow-up, payment posting, denials management, refunds, claims reconciliation, insurance verification, and quality...ClaimsHourly payFull time- ...healthcare analytics and develop data-driven strategies. As part of the UHG Trend Analytics team, you will help build models, analyze claims data, and support strategic planning. The ideal candidate will have a Bachelor's degree, passed actuarial exams, and experience in...Claims
- ...documentation and be skilled in Excel. Responsibilities include overseeing safety training records, coordinating worker's compensation claims, and communicating safety information to employees. This role offers competitive pay, medical benefits, and a positive work...Claims
$22 - $27 per hour
...of relevant experience. The ideal candidate will support employees with timely communication, maintain accurate records, and manage claims efficiently. The role is on-site in Eden Prairie, MN, offering a pay range of $22 to $27 per hour. #J-18808-Ljbffr Phillips and...ClaimsHourly payPart time$66.57k - $91.52k
...communication with legal parties involved. The ideal candidate should have at least 10 years of litigation experience, including 5 years in claims management. A Bachelor's degree and Juris Doctorate are preferred. This position offers competitive pay ranging from $66,574 to $91...Claims- ...What does a Medical Billing and Coding Specialist do? A medical billing and coding specialist processes and codes healthcare claims to ensure accurate billing and insurance reimbursement, supporting the financial operations of healthcare facilities. Highlights...Claims
$78.8k - $145.13k
...technology solutions. Position Summary: Healthcare runs on data that nobody has fully figured out how to unlock - claims, clinical, social determinants, lab, Rx, mortality, pricing. The organizations that solve the access, quality, and trust challenges around that data...ClaimsHourly payFull timeTemporary workWork experience placementRemote workFlexible hoursShift work
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