Medical & Life Claims Adjudication Specialist
MCS Puerto Rico
MCS Puerto Rico is hiring for a claims analyst position focused on evaluating and processing medical and life insurance claims to optimize adjudication efficiency and ensure compliance with corporate results. The role involves analyzing complex claims, ensuring adherence to standards, and consulting with other departments as needed. The ideal candidate has a Bachelor's or Associate's degree with 2+ years in the industry, strong analytical skills, and proficiency in Excel, Word, Access, and #J-18808-Ljbffr MCS Puerto Rico
$60k - $75k
...caring culture, and enjoy work-life balance. Here, theres no... ...Financial Services & Insurance Claims Adjuster - Workers Compensation... ...knowledge and experience to adjudicate complex customer claims in the... ...May process complex lifetime medical and/or defined period medical...MedicalFull timeContract workLocal areaRemote workFlexible hours$65k - $85k
...caring culture, and enjoy work-life balance. Here, there’s no... ...Financial Services & Insurance Claim Examiner - Product Liability... ...rehabilitation; to ensure ongoing adjudication of claims within service... ...benefits offering including medical, dental vision, 401K on day one...MedicalWork at officeRemote workFlexible hours- ...DESCRIPTION Analyzes, processes, and adjudicates all types of complex claims submitted in Centers for Medicare... ...provider claims, recoveries, reinsurance, life insurance claims, and other... ...processing. Knowledge of payment rules, medical terminology, and standardized healthcare...MedicalContract workLocal areaImmediate start
- MCS Puerto Rico in San Juan seeks an experienced claims adjudicator to analyze and process CMS‑1500 and UB‑04 claims, applying the highest level... ...include handling adjustments, reimbursements, COB, and life insurance claims, with emphasis on accuracy and policy adherence...Suggested
- General Description Evaluates the handling, processing, and/or payment of medical and/or life insurance claims to seek efficiency in the claim adjudication processes of each of the analysts, according to the parameters established in the unit, and seeks continuous improvement...SuggestedLocal area
- ...in San Juan is seeking a dedicated professional for PhilHealth claims processing. The role involves ensuring compliance with PhilHealth... ...engaging with patients and healthcare providers. This is a full-time on-site position. #J-18808-Ljbffr Omnibus Bio-Medical System Inc.MedicalFull time
- ...an accredited college or university. 2 to 3years of experience in related fields. Knowledge and/or experience in medical terminology. Understanding of life and disability insurance policies, as well as proficiency with CPT and ICD 10 codes in medical terminology. Ability...MedicalTemporary workWork at officeMonday to Friday
$53k - $67k
...countries across all 7 continents. The DBA Claims Administrator is responsible for... ...plan Tax-saving options Disability and life insurance Pet insurance Note: Benefits... ...pregnancy, childbirth, breastfeeding, or medical conditions related to pregnancy, childbirth...MedicalHourly payContract workWork at officeLocal areaRemote work- ...Department in policy issuance as well as support Claims Department in the event of a claim under... ...health insurance, reinsurance, and life insurance to a diverse group of clients.... ...ancestry, mental and physical disability, medical condition, genetic information, military...MedicalFor contractorsLocal area
- UHS is seeking a Coding and Claims Specialist to serve as a liaison for Texas facilities, coordinating with ATCBO, HIM, Revenue Cycle and other... ...You'll focus on Outpatient Code Editor (OCE/APC), NCCI, and medical necessity edits, while addressing DNFB resolution, audit...Medical
- Role Purpose The Finacial Lines Claims Adjuster is responsible to manage a mixture of Financial... ...health insurance, reinsurance, and life insurance to a diverse group of clients.... ...ancestry, mental and physical disability, medical condition, genetic information, military...MedicalWork at officeLocal area
- ...and coordinate submission of all 1500 forms. Support on aging and payment reconciliation. Support on the claims process and analysis. Support on collections to medical plans. Perform any other assigned duties by the Billing & Collections Supervisor. Conduct audit reviews...MedicalWork at office
- ...Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. JOB... ...Responsible for the benefits coordination claims in cases where the insured maintains... ...Generate and analyze data through COB and medical claims reports to identify Commercial, Medicare...Medical
- ...following contract duration. For our w2 consultants, we offer a great benefits package that includes Medical, Dental, and Vision benefits, 401k with company matching, and life insurance. Rate: $42.00 to $52.00/hr. w2 Responsibilities Serve as subject expert on IT...MedicalHourly payContract workLocal areaRemote work
- ...resolve issues in configuration setup, claims processing and other operational gaps.... ...processes, Perform research and resolution of adjudication and processing issues including,... ...sex, national origin, disability status, medical condition, genetic information, protected...MedicalWork experience placementLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...passionate about working in a dynamic, fast-paced, performance-driven environment. Compensation Health Insurance Coverage (medical, dental, and vision) Life Insurance Short and Long-Term Disability Insurance Holiday Pay401(k) with match Employee Assistance Program...MedicalRotational programFull timeTemporary workSummer workFlexible hours
- ...for an accommodation or an alternative application process. Claims Analyst Claims Review & Audit Full Time Clerical San Juan, PR,... ...Essential Functions: 1. Processes claims utilizing data entry and adjudication; executes claims’ adjustments when needed. 2.Maintains a...Daily paidFull timeWork at office
- ...assigned by management. Performs special projects and other duties as may be assigned from time to time by management. As a Claims Specialist, your responsibilities will be: Responsible for providing excellent customer care with a client service mindset with the ability...
- ...Texas facilities, focusing on outpatient coding edits, NCCI, and medical necessity. You will resolve complex coding issues in real time,... ..., Revenue Cycle, and clinical teams to ensure compliant, timely claim submissions. This role demands advanced ICD-10-CM/CPT knowledge,...Medical
$75k - $90k
....S. Citizen. Based on eligibility and job status, Cadmus offers an excellent benefits package to include: medical, dental, vision, company paid disability and life insurance, 401(k) program, paid time off (PTO), paid holidays, voluntary time off (VTO), tuition reimbursement...MedicalPermanent employmentWork experience placementLocal areaWorldwide- AIG is seeking a Claims Intake Analyst (FNOL) in the Claims Department in Puerto Rico to handle initial claim reports and ensure timely setup in the claims system. You'll monitor inbox, capture details, create notes, assign to teams, assist with payments, and watch for...Work at office
- AIG LATIN AMERICA I I is hiring a Claims Intake Analyst (FNOL) to handle initial claim reports from policyholders, agents and third parties, ensuring timely and accurate setup in the claims system for efficient processing. The ideal candidate will work in a fast-paced...
- Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims processes, policy inquiries, and root-cause analysis. The role emphasizes research accuracy, cross-team collaboration, and adherence to federal requirements. You will contribute...Remote job
- APS Healthcare, Inc. in San Juan, Puerto Rico is seeking a Claims Analyst to process claims in accordance with policies and ensure quality production in the Claims Department. You will adjudicate claims, identify COB when applicable, maintain knowledge of provider contracts...
$18.56 - $31.46 per hour
...professional challenge, and a healthy work-life balance can be highly motivating and... ...establishment of exposure and settlement of assigned claims within a stipulated monetary authority.... ...for our Kemper benefits package (Medical, Dental, Vision, PTO, 401k, etc.). Kemper...MedicalContract work$61.9k - $102.9k
## Represented Casualty Claims AdjusterApply: Lake Mary, Florida: McAllen, Texas: Downers... ...professional challenge, and a healthy work-life balance can be highly motivating and... ...claimants, attorneys, body shop personnel, medical providers, and other parties.* Conduct analyses...MedicalFull timeWork at office- Amentum is seeking a DBA Claims Administrator to report injuries and illnesses to our insurance carrier's administrators and the Department of Labor. The role works remotely within the United States and requires US citizenship. You will support the DBA Claims Manager,...Remote jobWork at office
$61.9k - $102.9k
...professional challenge, and a healthy work-life balance can be highly motivating and... ...for experienced Represented Bodily Injury Claims Adjusters for our growing teams! This specialized... ...Obtain and thoroughly analyze complex medical records and data Research and apply...MedicalFull timeTemporary workFor contractorsCasual workWork at officeHome office- Sedgwick is seeking a Claims Examiner for Workers’ Compensation to analyze and adjudicate complex claims, determine benefits due, and ensure timely service delivery across WA & OR jurisdictions. Remote-work options available, with licensing in OR preferred. The role emphasizes...Remote job
- Chubb Ltd. in the United States region seeks a Financial Lines Claims Adjuster to manage FI, E&O, EPL, Cyber, Environmental and D&O claims from notification to resolution, including coverage analysis, liability, reserving and settlement. You will negotiate with claimants...
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