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$72.8k - $130k
...expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical records review. Serve as a Subject Matter Expert (SME), performing medical record reviews to include quality audits, as well as validation...ClaimsMinimum wageFull timeWork experience placementLive inLocal areaRemote workMonday to FridayShift work- 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
- ...developing Big Data solutions using Spark + PythonHighly proficient in Python and SQL4+ years of experience working with medical and rx claims, eligibility tables and provider dataExperience designing and deploying reporting data modelsExperience with CICD tools such as...Claims
$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- ...not limited to WFM, Consumer Resolution Center (CRC), Product, Claims, Call Ops, IT, Sales, Enrollment, Implementation, and Provider Ops... ...Lots of automation pipeline work. SDLP to store data. Excel sme, pulling the work in python. Required Skills: Data Analysis...ClaimsFor contractorsImmediate start
- ...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:...ClaimsWork at officeFlexible hours
$134.6k - $230.8k
...per week.Primary Responsibilities:Act as a subject matter expert (SME) in advanced data science, artificial intelligence, and machine... ...in the healthcare industry, particularly working with clinical, claims, or healthcare operational dataPreferred Qualifications:...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$112.7k - $193.2k
...data products in a business environmentExperience working as a key SME to executive or C-Suite stakeholdersExperience deploying AI... ...GCPExperience working with healthcare datasets and standards such as claims, EHR, ICD, CPT, SNOMED, FHIR, or HL7External contributions such...ClaimsMinimum wageFull timeWork experience placementLocal areaRemote work$91.7k - $163.7k
...The ideal candidate will be a subject matter expert in healthcare claims data, with deep experience in business intelligence tools,... ...research and emerging trendsServe as an industry thought leader and SME in professional and facility medical claims, pricing, and cost managementCreate...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$91.7k - $163.7k
...scale. Join us to start Caring. Connecting. Growing together. Optum Rx, a UnitedHealth Group company, with over 24,000 employees... ...role will build a solid understanding of PBM pricing fundamentals, claims and contract data flows, analytical tools, and the systems used to...ClaimsMinimum wageFull timeContract workWork experience placementLocal areaRemote work- ...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
...transcription services, as well as an always-on personal voice assistant. Job Details We are looking for a hard‑working, detail‑oriented Claims Specialist that will be responsible for supporting Start Hearing operations, systems, and financial objectives. You will support...ClaimsContract workWorldwide$24 - $26 per hour
...place for you. Starting Pay Range: $24-$26 Schedule: Monday-Friday 9am-5pm Responsible for processing customer bills and insurance claims in an accurate and timely manner. This includes assisting with all daily and month‑end billing functions, procedures and reporting....ClaimsFull timeTemporary workWork at officeMonday to FridayFlexible hours- We are looking for a detail-oriented individual to support claims negotiation activities within the health insurance space for a contract position. This role focuses on coordinating with healthcare providers to establish reimbursement arrangements for out-of-network services...ClaimsContract workRemote work
- 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
- 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
$17 - $20.5 per hour
...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...ClaimsHourly payApprenticeshipWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift- 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
$60.2k - $107.4k
...with billing, editing, and denials teams to investigate and resolve claim holds, rejections, and denials Analyze trends in denials or... ...in pro-fee coding ~1+ years in supervisory or lead experience (SME experience will be considered for qualification) and the ability...ClaimsRemote jobMinimum wageFull timeWork experience placementLocal area- A dynamic insurance claims organization is seeking Licensed Claims Adjusters to join their team in Wayzata, Minnesota. This role offers excellent flexibility and competitive compensation. Ideal candidates will have experience handling claims, and those without experience...ClaimsFlexible hours
- ...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
$59.7k - $111.2k
...States of AmericaJob Type: RegularCategory: ConsultingIndustry: Real EstateSalary: 90000Posted Date: 2026-08-19Worker’s Compensation Claims Consultant - ClaimsOur not-so-secret sauce.Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result...ClaimsMinimum wageLocal areaNight shift$17 - $20.5 per hour
...including those to physicians.Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and... ..., but not received), order errors or damaged goods involving Rx drugs.May assist pharmacist in administering clinical services including...ClaimsHourly payApprenticeshipWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift- ...programs, and QA audit support. The role ensures quality records are accurate and timely, aligning with FDA regulations and product claims programs. You'll collaborate with Food Safety, QA, and Regulatory Affairs teams, maintain SOPs and archives, manage customer...Claims
$16 - $18 per hour
...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. Ensures compliance with state and local laws regarding...ClaimsHourly payWork experience placementSeasonal workLocal areaImmediate startFlexible hoursShift workAfternoon shift- ...UnitedHealth Group seeks a Senior EDI Solutions Analyst to lead end-to-end trading partner integrations of MMS with multiple claims systems, focusing on the EDI 278 (Authorization/Referral) transactions. You will work in a cloud-based environment using Azure, Postgres...Claims
$164.6k - $282.2k
...UnitedHealthcare, Optum Financial, Optum Health, Optum Insight, and Optum Rx. In addition to transforming the health care journey through... ..., and automatic speech recognition applied to clinical notes, claims, faxes, referrals, prior authorizations and recorded...ClaimsMinimum wageFull timeContract workWork experience placementWork at officeLocal areaRemote work- Sedgwick in Eden Prairie, MN is seeking a Claims Examiner - Liability for Premises & Slips/Falls with a nationwide jurisdiction. This hybrid role blends remote work with in‑office collaboration to support top clients. You will analyze complex liability claims, negotiate...ClaimsWork at officeRemote work
- Sedgwick is seeking a Claims Examiner for liability, bodily injury, and GL claims, with hybrid work options near Minnesota. You’ll analyze claims, determine benefits, and negotiate settlements to support clients across industries. National licensing may be required; NY...ClaimsFlexible hours
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