Medical Claims Specialist South Dakota State GovernmentMedical Claims SpecialistPierre, SD$19.29–$21 / hourexperience processing medical, insurance, or healthcare claims; • experience in medical billing, medical coding, revenue cycle, healthcare reimbursement, or provider office operations (preferred); • knowledge of medical terminology (preferred); • familiarity with Medicaid, Medicare, commercial insurance, or other healthcare reimbursement programs (preferred); • respond promptly and courteously to incoming phone calls from medical providers, billing agents, and recipients regarding correct Medicaid claim submission, claim status, and reimbursement through billing guidelines, policies, and procedures; • review claim records, system information, policy manuals, and fee schedules to identify submission errors, missing data, or processing discrepancies; • process medical claims that stop for manual review between incoming calls; • provide clear and courteous guidance over the phone, helping callers resolve issues related to denials, adjustments, coordination of benefits, and prior authorizations; • collaborate with other internal departments to address complex claims or policy questions that require further investigation or higher-level approval; • monitor and track claim statuses, follow up on unresolved cases, and ensure that documentation is updated accurately and completely; • educate providers on self-service tools such as electronic eligibility verification systems, diagnosis/procedure code lookup tools, claims submission portals, and online manuals/fee schedules; • maintain confidentiality and security of sensitive health and financial data in compliance with HIPAA and state regulations on confidentiality and security of health and finance data; • stay updated on changes to Medicaid policies, billing codes, and claim system processes. This role works directly with healthcare providers, medical billing offices, and Medicaid recipients to resolve claim issues, explain billing policies, and ensure accurate and timely claims processing.
Medical Claims Specialist State of South DakotaMedical Claims SpecialistPierre, SD$19.29–$21 / hourThe Ideal Candidate Will Have: experience processing medical, insurance, or healthcare claims; experience in medical billing, medical coding, revenue cycle, healthcare reimbursement, or provider office operations (preferred); knowledge of medical terminology (preferred); familiarity with Medicaid, Medicare, commercial insurance, or other healthcare reimbursement programs (preferred); respond promptly and courteously to incoming phone calls from medical providers, billing agents, and recipients regarding correct Medicaid claim submission, claim status, and reimbursement through billing guidelines, policies, and procedures; review claim records, system information, policy manuals, and fee schedules to identify submission errors, missing data, or processing discrepancies; process medical claims that stop for manual review between incoming calls; provide clear and courteous guidance over the phone, helping callers resolve issues related to denials, adjustments, coordination of benefits, and prior authorizations; collaborate with other internal departments to address complex claims or policy questions that require further investigation or higher-level approval; monitor and track claim statuses, follow up on unresolved cases, and ensure that documentation is updated accurately and completely; educate providers on self-service tools such as electronic eligibility verification systems, diagnosis/procedure code lookup tools, claims submission portals, and online manuals/fee schedules; maintain confidentiality and security of sensitive health and financial data in compliance with HIPAA and state regulations on confidentiality and security of health and finance data; stay updated on changes to Medicaid policies, billing codes, and claim system processes. This role works directly with healthcare providers, medical billing offices, and Medicaid recipients to resolve claim issues, explain billing policies, and ensure accurate and timely claims processing.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistSD$17–$31.30 / hourThe candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns. CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department.
NewLong Term Care Claims Representative - Payment Servicing Genworth Financial IncLong Term Care Claims Representative - Payment ServicingSD$45,500–$66,000 / yearYou will work in a fast -paced environment across multiple products, ensuring claims handling follows policy provisions, internal guidelines, and Compliance requirements and will be responsible for the processing and payment of long-term care claims. Your experience or education has provided you with knowledge of medical terminology, diseases/diagnoses, and the ability to understand and interpret contract language, disability processes, nursing home licensing, and rehabilitative requirements.
Claims Representative II - REMOTE Ryder System IncClaims Representative II - REMOTEPierre, SDRemoteCompensation Information: The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees: If you are a current employee at Ryder, please click here ( http://wd5.myworkday.com/ryder/d/task/1422$3.htmld ) to log in to Workday to apply using the internal application process.
NewClaims Analyst - REMOTE Ryder System IncClaims Analyst - REMOTEPierre, SDRemoteCompensation Information: The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees: If you are a current employee at Ryder, please click here ( https://wd5.myworkday.com/ryder/d/task/2998$46522.htmld ) to log in to Workday to apply using the internal application process.
NewCommunication Effectiveness Trainer - Allstate Claims University Allstate Insurance CompanyCommunication Effectiveness Trainer - Allstate Claims UniversitySD$62,100–$105,300 / yearCoaching, Coaching, Coaching Techniques, Collaboration, Collaborative Development, Communication, Communication Strategy Development, Cultural Awareness, Design, Development Communication, Empathic Communication, Facilitating Learning, Facilitation, Indian Culture, Instructional Design, Leadership, Learning and Development (L&D), Learning Effectiveness, Learning Materials Development, Negotiation, Objection Handling, Performance Management (PM), Project Coordination, Project Planning, Results-Oriented {+ 7 more}. Develops, designs and delivers learning offerings that are aligned to business and enterprise strategy; Ensures talent management practices are understood and supported consistently within learning offerings; Drive adoption of skills-based culture to empower and develop meaningful business-relevant skills through design and delivery of learning.
Claims Representative, Auto | Property Damage Sedgwick Claims Management Services, Inc.Claims Representative, Auto | Property DamageSD$50,000–$55,000 / yearProcesses auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Senior Analyst Claim Reporting and Special Services CVS Health CorpSenior Analyst Claim Reporting and Special ServicesSD$46,988–$112,200 / yearPosition Summary: We are looking for a highly motivated candidate who can effectively and accurately oversee and coordinate rework projects, work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims. The candidate will serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns.
NewFull-Time Call Center Representative (Urgently Hiring) MCI CareersFull-Time Call Center Representative (Urgently Hiring)South DakotaFull timeMCI organically grows, acquires, and operates companies that have synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse North American client partners across the following MCI brands: MCI BPO, MCI BPOaaS, MarketForce, GravisApps, Gravis Marketing, MarchEast, Mass Markets, MCI Federal Services (MFS), OnBrand24, The Sydney Call Center, Valor Intelligent Processing (VIP), BYC Aqua, EastWest BPO, TeleTechnology, and Vinculum.
Contact Representative (Benefits Coordinator) US Department of Health and Human ServicesContact Representative (Benefits Coordinator)SD$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
NewFull-Time Call Center Representative (Urgently Hiring) MCIFull-Time Call Center Representative (Urgently Hiring)UNAVAILABLE, SDRemoteMCI organically grows, acquires, and operates companies that have synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse North American client partners across the following MCI brands: MCI BPO, MCI BPOaaS, MarketForce, GravisApps, Gravis Marketing, MarchEast, Mass Markets, MCI Federal Services (MFS), OnBrand24, The Sydney Call Center, Valor Intelligent Processing (VIP), BYC Aqua, EastWest BPO, TeleTechnology, and Vinculum.
Manager Application Development & Support Blue Cross and Blue Shield of Kansas CityManager Application Development & SupportPierre, SD$135,440–$169,300 / yearExperience leveraging Artificial Intelligence, automation, and modern software engineering practices to improve developer productivity, accelerate software delivery, and drive business outcomes is preferred. The manager partners with business units, product teams, and IT leadership to deliver secure, scalable, and innovative solutions that improve member and provider experiences.
Nurse Practitioner - (Part-Time) - Pierre, SD Commonwealth Medical ServicesNurse Practitioner - (Part-Time) - Pierre, SDPierre, South DakotaJoin a provider-led organization that puts clinicians first—while allowing you to make a meaningful impact serving our nation’s Veterans. Why This Role is Different: Skip the uncertainty of per-exam contracting and enjoy a 1099 position with guaranteed income and built-in support.
Operations Assistant State of South DakotaOperations AssistantPierre, SD$18.45–$21.70 / hourKnowledge, Skills, and Abilities: knowledge of the different Medicaid claims payment methodologies (preferred but not required); knowledge of Medical Assistance programs and eligibility (preferred but not required); knowledge of proper business English including grammar, spelling, and punctuation; knowledge of Microsoft Office programs including Word, Excel, PowerPoint, and Access; knowledge of websites and internet navigation; This position is eligible for Veterans' Preference per ARSD 55:10:02:08. The Ideal Candidate Will Have: a passion for serving the public and display a high level of effort and commitment towards completing assignments and goals; the ability to represent the Department of Social Services with integrity and enthusiasm; -strong customer service skills.
Operations Assistant South Dakota State GovernmentOperations AssistantPierre, SD$18.45–$21.70 / hourKnowledge, Skills, and Abilities: knowledge of the different Medicaid claims payment methodologies (preferred but not required); knowledge of Medical Assistance programs and eligibility (preferred but not required); knowledge of proper business English including grammar, spelling, and punctuation; knowledge of Microsoft Office programs including Word, Excel, PowerPoint, and Access; knowledge of websites and internet navigation; This position is eligible for Veterans' Preference per ARSD 55:10:02:08. The mission of the South Dakota Department of Social Services is strengthening and supporting individuals and families by promoting cost effective and comprehensive services in connection with our partners that foster independent and healthy families.