Medicare Claims Adjudicator I
Solis Health Plans
Solis Health Plans is seeking a Claims Examiner I in Florida to adjudicate Medicare and DSNP claims accurately and timely, applying benefit plans and regulatory guidelines to new, reprocessed, and overturned claims to ensure proper payment and compliance. Responsibilities include reviewing and processing claims, resolving disputes, and collaborating with Provider Relations, Appeals & Grievances, and Configuration teams to support member and provider satisfaction while maintaining quality and #J-18808-Ljbffr Solis Health Plans
- ...Claims Adjudicator The Claims Adjudicator is responsible for reviewing, analyzing, and processing health insurance claims in accordance with established guidelines, contractual benefits and terms, and regulatory requirements. The claims adjudicator ensures that all claims...ClaimsWork at office
- VIP Universal Medical Insurance Group (VUMI) is seeking a detail-oriented Claims Adjudicator to review and process health insurance claims. The ideal candidate possesses at least 2 years of experience and is bilingual in Spanish or Portuguese. Responsibilities include...ClaimsWork at office
- ...Join Our Team as an Insurance Claims Examiner - Make an Impact in Healthcare Payment Accuracy... ...in managing healthcare claims within Medicare and Dual Eligible Special Needs Plans (... ...you will be responsible for the precise adjudication of medical claims, applying benefit...ClaimsWork at officeLocal area
- ...turn into a long-lasting and rewarding career! Job Description Claims Processing: investigate insurance claims; properly resolve by... ...receiving payment. Update patient files for insurance information, Medicare status, and other changes as necessary or required....ClaimsPrivate practice
- Sompo seeks a Sr. Casualty Claims Counsel to join its US Casualty Claims team. The role supports claims involving emerging risks, long-term exposure, and complex coverage issues across multiple US office locations. The candidate will bring 5+ years of insurance claims...ClaimsWork at office
- A national healthcare recruiting firm is seeking a candidate with 2-3 years of experience in claims processing and billing. The role involves investigating insurance claims, verifying patient eligibility, and updating records accordingly. Strong customer service skills...Claims
- Guardian Dentistry Partners is seeking a Revenue Cycle Specialist to follow up on outstanding insurance claims across multiple dental offices, resolve aging balances, and boost collections. You will analyze RCM processes, propose improvements, and work with leadership...ClaimsRemote job
- Guardian Corporate is seeking a Revenue Cycle Specialist - Claims Follow Up to review and resolve outstanding dental insurance claims across multiple offices. You will identify opportunities to reduce aging, boost collections, and support training on revenue cycle improvements...ClaimsRemote job
$120k - $160k
...commercial general liability, commercial property (including business interruption and environmental matters), errors and omissions claims involving attorneys, agents, and accountants, as well as directors and officers coverage.Candidate ProfileJD from an ABA-accredited...ClaimsFlexible hours- ...specialty services. This role focuses on resolving unpaid or denied claims, educating patients on complex insurance benefits, and ensuring... ...procedures and services. Work with commercial insurance, Medicare, Medicaid, and specialty-specific payers. Initiate appeals for...Claims
- ...Florida bar is required. Minimum of five years of litigation experience, preferably prosecuting and/or defending product defect claims, property damage claims, construction issues, or property insurance claims. Experience working with various forensic experts (e....ClaimsWork at office
$20 - $23 per hour
...office and two working remotely) Continually seek to understand and act upon client needs, concerns and priorities on various types of claims including but not limited to: Health Insurance, Worker's Compensation and Motor Vehicle Accident claims. Utilize various client...ClaimsHourly payFull timeWork at officeRemote workShift work- Extenteam is seeking a Property Insurance Claims Processor for a fully remote, full-time role. You will support Risk Management by handling administrative tasks, processing incoming claims, and reconciling claims data across providers and invoices. The position emphasizes...ClaimsRemote jobFull time
- ...experience will be considered for partnership opportunities. Lewis Brisbois is a recognized leader in the area of insurance coverage and claims. Our Insurance Coverage Practice focuses on interpreting contracts of all kinds and representing insurers in complex coverage...ClaimsWork at office
- Kemper is seeking a remote SIU Investigator to conduct field and desk investigations of insurance claims from home in the Miami-Dade area, traveling as needed. Responsibilities include analysis, evidence development, and coordinating with NICB and law enforcement, with...ClaimsRemote job
$125k - $135k
...commercial general liability, commercial property (including business interruption and environmental matters), errors and omissions claims involving attorneys, agents, and accountants, as well as directors' and officers' coverage.#LI-HYBRIDCandidate ProfileJD from an...ClaimsFlexible hours$40k - $70k
...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...Claims- ...Focus: Cost Control & Litigation Management (GL & Auto Claims) Position Summary The Risk Manager is responsible for controlling risk exposure and minimizing financial loss for a telecommunications construction company, with primary responsibility for major insurance...ClaimsContract workFor subcontractor
- ...insurance purposes, including authorization or referrals when needed. Preparing billing information and assisting with insurance claims processing, including follow-ups on unpaid or denied claims. Coordinating with Medical Staff: Communicating with...ClaimsWork at office
- ...Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations.Preferred Qualifications... ...Administration, Pharmacy, Business, or a related field.Knowledge of Medicare and Medicaid pharmacy benefit structures.Familiarity with data...Claims
- ...to join our onsite team in Miami with a hybrid schedule after probation. The role focuses on managing pre‑litigation auto insurance claims, negotiating settlements, and delivering excellent customer service while adhering to regulatory standards. Qualified candidates...ClaimsTrial period
- ...Claims Examiner We are seeking a Claims Examiner to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing...ClaimsWork at office
- ...throughout Florida and the United States is looking for an attorney to join their team focused on the defense of first party property claims. This associate position will assist with all aspects of litigation, including review of claims file, drafting status reports to...ClaimsFull timeWork at office
- A healthcare company in Miami is seeking a Senior Claims Review and Adjusting professional. Responsibilities include managing claims... ...least 5 years of relevant experience, and extensive knowledge of Medicare/Medicaid claims policies. This challenging role requires strong...Claims
- ...Functions: The Labor & Employment Counsel is a member of Areas' in-house Legal Department, supporting labor and employment relations and claims across the company's travel, hospitality, food and beverage, and retail operations. This role manages the company's relationship...ClaimsContract work
$70k - $95k
...Job Description: Title: Claims Advocate – Risk Services Fully remote for Florida based candidates | Experience: Looking for a Claims Advocate that has commercial experience in at least two lines of business (General Liability, Worker's Compensation, Professional...ClaimsFull timeRemote work- ...and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.NeueHealth delivers clinical care to health consumers... ...Specialist is responsible for the accuracy of the super bill/claim prior to transmission to payer, including validation of...Claims
- ...Product Manager / Product Owner – AI is responsible for end-to-end ownership of AI initiatives for a specific Line of Business or claims domain. This role partners directly with business stakeholders to define AI-enabled improvements to claims operations, cost control...ClaimsRemote work
- ...position as a Personal Injury Case Manager/Paralegal. The position's duties include corresponding and communicating with clients, opening claims with insurance companies and requesting records from medical facilities. Applicant will need some experience in analyzing medical...Claims
- ..., requirements, and forms; verifying proper reimbursement is received for services provided; processing and following up insurance claims; documenting and coding information, interpreting medical records and analyzing, recording, and reconciling accounts receivable transactions...Claims
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