Average salary: $155,649 /yearly
More statsSearch Results: 19 vacancies
...professional audits, complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudication requirements for claims processing, payment and procedural accuracy. In addition, this position is responsible to assist with...
Suggested
Hourly pay
Holiday work
Full time
Traineeship
Casual work
Immediate start
Remote job
Relocation bonus
Flexible hours
...functions to ensure health plan and regulatory compliance.
Education and Experience Required:
High School Diploma and 3 years adjudication experience in a managed care setting
Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding
Knowledge of HMO, DHS,...
Suggested
Hourly pay
...in Project Management preferred.
Excellent time management skills.
Outstanding communication skills.
Knowledge of Claim adjudication process (Professional Institutional).
Fee schedule knowledge.
Diagnosis and procedures codes knowledge preferred....
Suggested
Hourly pay
Holiday work
Full time
Casual work
Relocation bonus
Flexible hours
..., Systems Analysis, and Design
~**Current/active U.S Government issued DoD Secret Clearance; clearance must have been issued/adjudicated in the past five (5) years
~ Experience as an AFSIM developer/analyst, including making and validating movers, creating observers...
Suggested
Holiday work
Local area
Outdoor
Work alone
Relocation package
Flexible hours
Shift work
...etc. Submits required Utilization Management (UM) reports to the health plans in a timely fashion. Will coordinate with the Claims Adjudicator and Case Managers relating to patients referrals, claims or case management. Will coordinate with patients, Managed Care Dept.,...
Suggested
Hourly pay
Full time
...plan and regulatory compliance.
Participate with training determined by Unit Senior Manager and Auditing Staff regarding Claims Adjudication education issues discovered in reconsideration reviews.
Provide primary support to the Senior Manager of Appeals including...
Suggested
Hourly pay
Holiday work
Full time
Contract work
Casual work
Relocation bonus
Flexible hours
...successfully perform the duties of the position.
Specialized Experience is experience in the development, examination, investigation, adjudication, or authorization of claims for retirement, survivors, and disability insurance, pension programs, health insurance, income...
Suggested
Permanent employment
Full time
Temporary work
Part time
Remote job
Relocation
...responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims...
Suggested
Contract work
Local area
Shift work
...Citizen or National.
Males born after 12-31-59 must be registered for Selective Service or exempt.
Subject to satisfactory adjudication of background investigation and/or fingerprint check.
Successful completion of one-year probationary period, unless...
Suggested
Remote job
Permanent employment
Full time
Temporary work
Part time
Work experience placement
Second job
Relocation
Gangs
Monday to Friday
...employment screening (criminal background, drug testing, and/or education verification). A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job...
Suggested
Local area
Gangs
...assigned product group.
Recommend, investigate, and document new product opportunities.
Coordinate with SIOP Manager/Process in adjudicating and prioritizing demand and Engineering leadership to ensure resource supply is adequate to meet supply plan.
Champion new...
Suggested
Holiday work
Permanent employment
Temporary work
Worldwide
...Citizen or National.
Males born after 12-31-59 must be registered for Selective Service or exempt.
Subject to satisfactory adjudication of background investigation and/or fingerprint check.
Successful completion of one-year probationary period, unless...
Suggested
Remote job
Permanent employment
Full time
Temporary work
Part time
Work experience placement
Second job
Relocation
Gangs
Monday to Friday
...review all incoming claims to verify if required fields are populated.
Process claims information into the computerized claims adjudication system.
Ability to process claims in the allotted time based on departmental policies and procedures.
Maintain all required documentation...
Suggested
Hourly pay
Flexible hours
Summary Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial...
Suggested
Hourly pay
...claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation...
Suggested
Local area
Flexible hours
...Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client...
Full time
Local area
Shift work
...operates the ‘California Conditional Release Program,’ a specialized intensive community supervision and treatment program for people adjudicated as “Sexually Violent Predators” and court-ordered to transition from in secure residential treatment in the community.
Liberty...
Hourly pay
Part time
Work experience placement
Immediate start
Remote job
Work from home
Home office
Trial period
Flexible hours
Shift work
Monday to Friday
...bring your big ideas to help solve problems for some of the world's best brands?
Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
Deliver innovative customer-facing solutions to clients who...
Flexible hours
...training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
ESSENTIAL FUNCTIONS...
Contract work
Local area
Flexible hours
