Policy Support Specialist — Clinical Claims & Review
Horizon Blue Cross Blue Shield of New Jersey - Headquarters
Horizon Blue Cross Blue Shield of New Jersey is seeking a detail‑oriented Claims Specialist to review medical policies and manage clinical inquiries from members and providers. You will coordinate clinical review, request information, and help finalize claims while ensuring compliance with negotiated pricing and COB processes. A strong background in health care claims is essential. This full‑time on-site role offers comprehensive benefits and opportunities to impact patient care across New Jersey. #J-18808-Ljbffr Horizon Blue Cross Blue Shield of New Jersey
$211k - $400.5k
...Clinical Development Program ManagerAbbVie's mission... ...quality clinical data supporting overall product scientific... ...study integrity, and review, interpretation, and... ...events per corporate policy and regulations for those... ...or communication claiming to be from AbbVie, please...PolicyClaimsWork at officeImmediate startRemote workMonday to Friday$130k - $140k
...develop and execute clinical strategies to... ...motivating clinical support employees to deliver... ...periodic business reviews that highlight the... ...regional Clinical Specialists to execute on key... ...suspicious message claiming to be from... ...compensation plansIt is the policy of Medtronic to...PolicyClaimsFull timeH1bWork at officeLocal areaImmediate startFlexible hours$15.26 - $21.5 per hour
...Patient Support Specialist Being on medication is tough enough. We want to make getting it the... ...Responds to inbound phone calls and claims (as well as outbound calls) to/from patients... ..., welfare, and other fringe benefit policies. Employees may also participate in the...PolicyClaims- ...ensuring insurance benefits, claims, payments, and account... ...Responsibilities: Review treatment estimates... ...and office financial policies Collect and accurately... ..., account notes, and supporting documentation Work closely... ..., providers, clinical staff, and the revenue...PolicyClaimsWork at office
- ...Warranty Support Representative At Fabuwood, we believe that exceptional... ...for managing customer claims efficiently, ensuring... ...details and new orders issued. Review and determine claim outcomes... ...Ensure adherence to company policies, timelines, and quality standards...PolicyClaimsMonday to Friday
$23 per hour
Medical Biller/Claims Processing - Patient Support Representative (Home-Based)### Medical... ...(HCPs) or patients, review supporting documentation,... ...leading global provider of clinical research services, commercial... ...maintains a zero tolerance policy for candidate fraud. All information...PolicyClaimsHourly payFull timePart timeWork at officeImmediate startRemote workWork from homeWorldwide- ...Healthcare Support Specialist, Clinical ServicesThe Arc of Union County, Inc. is a leading provider of Person-Centered services to individuals with... ...with criteria as trained and in accordance with agency policies and procedure.The essential Cognitive Functions of this position...PolicyImmediate start
- ...Medical Billing & Collections Specialist NovaLab Corp | Wayne, NJ... ...CLIA-certified, COLA-accredited clinical reference laboratory committed... ...and manage medical insurance claims accurately and efficiently.... ...Ensure compliance with payer policies and billing regulations. Collaborate...PolicyClaims
- ...success! The Information Technology Support Specialist will work with as the ET&T (Enterprise... ...Ensure adherence to global standards, policies, and governance models. Vendor & Managed... ...involving local vendors. Review recurring issues and ensure corrective...PolicyFull timeLocal areaRelocation
$67.2k - $115.92k
...promotes productivity, supports work-life integration,... ...Please note that per our policy on hybrid/virtual work,... ...with providers, claims or service issues. Minimum... ...minimum of 3 years of clinical experience; or any combination... ...Florida law should review the education and...PolicyClaimsFull timeTemporary workWork experience placementWork at officeLocal areaMonday to FridayAfternoon shift1 day per week- ...thrive in a fast-paced clinical environment and love... ...insurance verification, claims submission, and... ...Supervise, train, and support front desk staff to maintain... ...regulations and dental office policies and procedures... ...payroll, and performance reviews is a plus...PolicyClaimsWork at office
$17 - $23.25 per hour
...enjoy all the tools and support – including the latest... ...with Company policies and procedures. Responsible... ..., and company policy. Reviews and complies with the... ...and resubmits) manual claims for third party program... ...pharmacist in administering clinical services including the...PolicyClaimsHourly payApprenticeshipWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift$17 - $23.25 per hour
...enjoy all the tools and support – including the latest... ...with Company policies and procedures. Responsible... ..., and company policy. Reviews and complies with the... ...and resubmits) manual claims for third party program... ...pharmacist in administering clinical services including the...PolicyClaimsHourly payApprenticeshipWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift- ...following areas: CDE (Clinical Data Exchange), Coverage... ...areas, in addition to supporting the internal growth... ...in quality management reviews of the design and performance... ...certification in Claims, E&E, Benefits Engine,... ...Affirmative Action Policy StatementAccenture is...PolicyClaimsWork experience placementLive inWork at officeLocal area
$86k - $239.5k
...and services that support the needs of medical... ...(MM), Solution Specialists, and internal Centers... ...-national patient claims, channel, and... ...business and information reviews with senior client... ...provider of clinical research services,... ...a zero tolerance policy for candidate fraud...PolicyClaimsFull timeContract workPart timeImmediate startRemote workWorldwide$124k - $280k
...use case development across clinical decision support, population health risk... ...processing clinical notes, claims data, ADT feeds, and other... ...team on client engagements, reviewing developed models, providing... ...forth within the following policy: more about how we work:...PolicyClaimsFull timeH1b$18 per hour
...business is providing patient support programs on the behalf of our... ...sales, medical device support, clinical support, and medical affairs our... ...) Experience in medical claim processing is a plus Bi-lingual... ...and maintains a zero tolerance policy for candidate fraud. All information...PolicyClaimsHourly payFull timeContract workPart timeImmediate startRemote workWork from homeWorldwideShift work- ...Project teams, Affiliates, Clinical Development, and the... ...plan development, reviewing manuscript drafts and... ...how these activities support the overall Medical Affairs... ...various compliance policies in place for global and... ...approach with regards to claims.Critical thinking –...PolicyClaimsWork at officeFlexible hours3 days per week
- ...Human Resources Generalist to support their manufacturing operation.... ...onboarding, performance management, policy administration, and compliance... ...' compensation, unemployment claims, and employee accommodations.... .... Support performance review and talent development processes...PolicyClaimsHourly payFull timeLocal area
- ...broad range of commercial, clinical, and operational... ...operations. This position will support technology-related... ...Transactions Structure, draft, review, negotiate, and advise... ..., and organizational policies. Serve as legal... ..., and evolving claims on sharing electronic health...PolicyClaimsHourly payFull timeContract workTemporary workPart timeFor contractorsFor subcontractorFlexible hoursShift workWeekend workDay shift
$725 per month
...encouraged to apply. To support our associates in their... ...community. Strengthens clinical processes within... ...of resident charts and reviews documentation performed... ...assessments as required by policy and as described/allowed... ...Workers' Compensation claims by appropriately evaluating...PolicyClaimsHourly payPermanent employmentFull timeTemporary workPart timeFlexible hoursShift workNight shiftAfternoon shift$27 - $33 per hour
...as a Revenue Cycle Specialist—Full Cycle . What... ...as each office you support. This role... ...will be able to: Review all patient insurance... ...processes to ensure clean claims submission to... ...navigate insurance policies, benefits, and exclusions... ...public, patients, clinical offices, and...PolicyClaimsWork at office- ...structured test plans and test cases. Review test cases created by team members to... ...maintenance, enhancement, and Production Support in IT systems. Knowledge of SAP BAPI/... ...applications, particularly Guidewire or similar Policy/Claim Administration Systems. Proficient in...PolicyClaims
- ...responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarificationUse a customer-focused, needs-based review process to educate customers about insurance optionsYou will receive:Base plus...PolicyClaimsBase plus commissionFor contractors
$70k - $90k
...Claims SpecialistOur client is a well-established independent... ...Summary:As a Claims Specialist, you will serve as the... ...strategy.Conduct claim reviews and analyze liability and damages to support informed advocacy on behalf... ...coverage concepts, policy language, and carrier claim...PolicyClaims$71.6k
...an Associate Data Engineer to support the S&S Data Science team's... ...sources into our underwriting, claims, and business intelligence... ...subject to our privacy notices and policies, visit for more information.... ...salary ranges are regularly reviewed and adjusted in accordance...PolicyClaimsRemote work$77k - $202k
...that help insurance organizations improve policy, claims, and billing processes within our... ...focused mindset to changing priorities, and support the development of solutions that help... ...to deliver assigned workstreams- Reviewing deliverables from junior team members and...PolicyClaimsFull timeH1b- ...! \n \n The Information Technology Support Specialist will work with as the ET&T (Enterprise... ...Ensure adherence to global standards, policies, and governance models. \n \n \n Vendor... ...involving local vendors. \n Review recurring issues and ensure corrective...PolicyLocal areaRelocation
- ...license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation... ...compliance with Concentra Physician Review policies, procedures, and performance... ...and peer reviewed literature that support sound and objective decision making...PolicyClaimsTemporary workFor contractorsLocal areaRemote workMonday to FridayFlexible hours
$20 - $25 per hour
...Medical Records Specialist Department: RCM: Clinical Documentation & Coding Employment... ...Prepare, organize, review, and send required medical... ...and organizational privacy policies Communicate effectively... ...or issues with records, claims, or requests to management...PolicyClaimsFull timeWork at office
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