Clinical Policy & Claims Support Specialist
100 Horizon Healthcare Services, Inc
Horizon Blue Cross Blue Shield of New Jersey is seeking a Claims Analyst to review medical policies, prepare cases for clinical review, and track information requests to resolve clinical claims and service inquiries.
You will research member records, coordinate clinical reviews and appeals, and ensure accurate pricing and COB updates across all lines of business. Strong analytical, organizational, and communication skills are essential.
#J-18808-Ljbffr$52.79k - $70.17k
...Responsible for reviewing medical policies, preparing cases for clinical review, and tracking additional information... ...end to end resolution of clinical claims and service request/correspondence... ...improves lives-while being supported by a missiondriven organization that...PolicyLive inLocal area- ...management sessions in the community as needed Required to attend mandatory training classes in accordance with Kintock training policies Perform other work related duties as assigned by the Director. Qualifications/Requirements: Four-year degree in a social,...PolicyContract workWork experience placementTrial periodFlexible hours
$32.5 - $36 per hour
...empowering customers to achieve positive financial outcomes while supporting Intuit’s mission of “Powering Prosperity Around the World.”... ...and resources for your community in accordance with Intuit’s policies \n Bilingual (English/Spanish) communication skills are a plus...PolicyLocal area- We are hiring a Program Support Specialist for one of our clients in Hamilton, NJ . Job Description Under the supervision of Regulatory Officer... .... Research applicable federal and State laws, regulations, policies, and procedures supporting the Fair Hearing process. Scan,...PolicyTemporary workCasual workWork at office
- ...TitleThe New Jersey Judiciary Office of Probation Services, Child Support Enforcement Unit, is seeking an individual with excellent... ...for both AOC and Vicinage staff regarding complex child support policy and procedure, NJKiDS, and financial matters. Provide technical...PolicyFull timeWork experience placementInternshipWork at officeLocal areaImmediate startRemote workTrial periodMonday to FridayFlexible hours
$116k - $145k
...Premise Health Care Regional Clinical ManagerPremise's mission is to help people get, stay... ...quality program and is responsible for supporting and oversight of AAAHC standards across... ...messages and ensures implementation of policies and procedures.Assists in the identification...PolicyDaily paidFull timeContract workWork experience placementLocal areaMonday to Friday$58.24k - $76.96k
...PIP Claims Representative CURE Auto Insurance is a leading direct writer of auto insurance... ...that claims are processed within company policies, procedures, regulatory requirements, and... ...Fun, engaging in-office events that support our culture Starting Salary: $58,240 -...PolicyFull timeWork at officeLocal areaRemote workWork visaFlexible hours1 day per week$72k - $141k
...liability insurance. CNA Financial Lines has an opening for a Complex Claims Consultant handling Employment Practice Liability, Private and... ...strategy. This individual will be able to utilize claims policies and guidelines, review coverage, determine liability and damages...PolicyFull timeWork experience placementWork at officeLocal areaRemote workShift work- ...Hospital seeks a Pharmacist to perform standard hospital pharmacy duties in alignment with Baptist Health policies. The role emphasizes safe dispensing, clinical pharmacotherapy, and collaboration across care teams. Requires a pharmacy degree and Alabama state licensure...Policy
- ...Specialist, Global Contract Support Contract Support responsibilities are to provide assistance to sales with data entry and administrative activities... ...and legal rules Processes monthly renewals per policy and communication to Sales Team Reconcile Renewal Pricing...PolicyContract workWork experience placementCasual workFlexible hours
$137k - $235.75k
...Associate Director, Clinical Sciences, Ophthalmology (Early Development)Johnson & Johnson... ...clinical trial protocols and materials and supports the completion of clinical study reports... ...to the terms of their respective policies and date of hire, employees are eligible...PolicyWork at officeLocal areaWorldwide- ...Program Director in managing day-to-day clinical operations of MRSS, overseeing staff and... ...include supervising Family Intervention Specialists and Crisis Intervention Specialists, coordinating... ..., and ensuring compliance with CSOC/MRSS contracts and agency policies. #J-18808-LjbffrPolicy
- ...and seeks a Registered Nurse Outpatient Clinic. The role will contribute to person-centered... ..., care coordination and clinical support; maintain accurate documentation and escalate... ...gaps promptly, and follow role-specific policies and professional scope. Participate in orientation...PolicyPart time
$66.56k - $85.28k
...Job Description BI Litigation Claims Specialist \n \n CURE Auto Insurance is a leading... ...Investigate the validity of claims, evaluate policy coverage, and determine if any... ...n Fun, engaging in-office events that support our culture \n \n \n \n \n \n Physical...PolicyWork at officeLocal areaRemote workWork visaFlexible hours1 day per week$50k - $60k
...Claims Correspondence Analyst The Claims Correspondence Analyst will serve as a first... ...expect: Culture of innovation, teamwork, supportive colleagues and leaders willing to invest... ...shared drive Ensure compliance and company policies, regulatory requirements and...PolicyFull timeWork at officeRemote work- ...Job Summary:The Surgical Clinical Assistant (SCA) provides assistance to the Physician and Physician's Assistant with daily administrative... ..., compliance with schedule prep, voicemail, compliance with policies and procedures, decrease wait times.Responsibilities may include...PolicyHome officeMonday to Friday
- ...join our Workers’ Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner . Both positions play a critical... ...the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a...PolicyFlexible hours
$30 - $40 per hour
...Addiction Treatment and Recovery department and seeks a Licensed Clinical Alcohol and Drug Counselor. The role will contribute to person-... ..., communicate service gaps promptly, and follow role-specific policies and professional scope. Participate in orientation, competency...PolicyHourly payPart time$50k - $55k
...Workplaces in Financial Services & Insurance Claims Representative , Auto Job Description... ...and correctly coded based on the policy. Develops and maintains action plans to... ...assignments. Performs other duties as assigned. Supports the organization's quality program(s)....PolicyFull timeContract workWork at officeLocal areaFlexible hours$56k
...focused and always one step ahead!The Reinsurance Accounting & Claims Handling Analyst is responsible for the timely and accurate recording... ...guidance and in accordance with agreed upon best practices, policies and procedures, and/or service level agreements:Record client...PolicyContract workTemporary workWork at office$25.25 per hour
...Health Place, Hamilton, NJ 08619 Job Title: Clinical Care Technician Location: RWJUH Hamilton... ...part of our collaborative nursing team, supporting Registered Nurses in providing hands-on... ...and staff, adhering to facility policies Communicate effectively with patients, families...PolicyHourly payDaily paidShift workNight shift- ...Services is seeking a Director of Workers’ Compensation Claims to lead a growing team supporting Princeton claim operations. This leader will partner... ...company objectives. Ensure adherence to all AmTrust policies, procedures, and controls. Provide consistent communication...PolicyWork at officeLocal area
- ...a Back of House colleague, you will play an essential role in supporting store operations, maintaining inventory accuracy, and ensuring... ...workers, and supervisors Read and understand employment policies and safety rules/procedures in English Be comfortable...PolicySeasonal work10 hours per weekFlexible hoursAfternoon shift
$23 - $30 per hour
Auto Claims Representative - First Notice of Loss CURE Auto Insurance is a leading direct... ...Program. Review the coverages under the policy and determine what coverages are... ...programs Fun, engaging in‑office events that support our culture Physical Actions/Environment...PolicyHourly payWork at officeLocal areaRemote workWork visaFlexible hours1 day per week$62.4k - $93.6k
Sr Representative Claims - CH08BE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too...PolicyTemporary workWork at officeRemote workMonday to Friday3 days per week- ...Greater New Jersey Behavioral Health LLC is seeking a Peer Support Specialist to join the Lawrence Township team. This full-time, on-site... ...lived experience effectively, and work collaboratively with a clinical team to support individualized wellness goals. #J-18808-LjbffrFull time
$26.73 - $42.64 per hour
...Clinical Dietician - EDU (Per Diem)Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients... ...medical record on a timely basis, in accordance with Policies and Procedures. Maintains all standards of confidentiality. Interacts...PolicyHourly payDaily paid$63.69k - $106.14k
...this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.... ..., and individualized within established guidelines and policies o Reviews clinical documentation for compliance, provides staff...Policy$16 - $18 per hour
...Seasonal Client Support Associate We are looking for someone who thrives in a welcoming, customer service-oriented environment with excellent... ...protected by applicable federal, state, or local laws. This policy applies to all terms and conditions of employment, including...PolicyHourly payExtra incomeLocal areaFlexible hours$138.4k - $212.1k
...to delivering exceptional underwriting, claims, and risk management expertise to our partners... ...external partners. The Senior Claims Specialist role is designed for professionals who... ...depth understanding of coverage issues, policy forms, contracts, regulatory...PolicyTemporary work
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