Claims Audit Analyst - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement) Denver Health and Hospital AuthorityClaims Audit Analyst - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)Denver, ColoradoInteract and collaborate with other corporate groups such as Provider Relations, Member Services, Information Systems, Compliance, Third Party Recovery, Finance, Patient Accounts, Enrollment, Utilization Management and Product Line Managers. Daily data analysis and research of claims processing to ensure benefit structures and operation processes are adhering to the rules, regulations and contractual requirements by CMS, DOI, contracted and non- contracted providers.
Claims Process Specialist LancesoftClaims Process SpecialistOakland- Remote, CARemote$18Job duties include: Examine garnishments, levies, liens and information subpoenas to ensure accuracy, completeness and legal sufficiency. Claims include garnishments, levies, liens and information subpoenas received from creditors and taxing authorities.
Claims Adjuster- Bilingual American International GroupClaims Adjuster- BilingualAtlanta, GAAIG Warranty delivers a full range of service solutions including warranty management administration, extended service programs, customer service support, service network management, claims processing services, and service contract underwriting. Your Contribution: The Claims Examiner- Bilingual are the ones our clients turn to in times of need and will act with speed, composure, compassion and knowledge to solve problems and the work they do every day is the heart of AIG's business.
Facets Configuration Analyst TegriaFacets Configuration AnalystOregonOur lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way. This role collaborates with business stakeholders, operations teams, and IT partners to translate business requirements into system configurations that support health plan administration, claims processing, provider management, and benefit administration functions.
Certified Clinical Coder - Texas Medicaid - Medical Billing/Coding Texas Health and Human Services CommissionCertified Clinical Coder - Texas Medicaid - Medical Billing/CodingAustin, TX$4,523.16–$7,253.83The Certified Clinical Coder Program Specialist V in this position must be proactive in seeking input from other staff in the Medicaid and CHIP Services Department and demonstrate the ability to work as an effective team member within Medical Benefits as well as other divisions and business areas within HHSC. Acts as the liaison with HHSC staff and other business areas and HHS agencies by providing complex technical assistance and guidance on medical benefit coding and billing related changes during workgroups and meetings.
Service Rep OPL / OPEIU Highmark IncService Rep OPL / OPEIUNYProvides quality customer service in a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members, providers, internal and external customers; Processes and adjusts claims. Responds to and resolves inquires from subscribers, members, providers, facilities, groups, other plans and other departments: Communicates and interacts with internal and external customers in a clear, unambiguous, concise, professional and empathetic fashion.
Provider Service Representative III L.A. Care Health PlanProvider Service Representative IIILos Angeles, CAThe Provider Service Representative (PSR) III is the first point of contact for providers and stakeholders, delivering complete and accurate support on eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless support across the provider service journey. Required: At least 3 years of Managed Care experience in provider relations or customer service, including 1 year of experience handling provider inquiries related to claims, benefits, authorizations, and payments in a contact center environment.
Payment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required) Excellus BCBSPayment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required)Rochester, New YorkMinimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems.
PASRR Specialized Services Reviewer Texas Health and Human Services CommissionPASRR Specialized Services ReviewerAustin, TX$4,263.16–$5,521.16Provide technical assistance and policy clarification to external providers on PASRR procedures, policies, and rules, including requests for nursing facility specialized services submitted through the TMHP Long Term Care (LTC) Online Portal and IDD habilitative specialized services processed through manual procedures. This position performs highly complex senior-level work and is responsible for assisting the manager and the PASRR Specialized Services Lead with reviewing, adjudicating, and authorizing requests for specialized services under the PASRR program.
Claims Resolution Specialist, Covered California CalOptimaClaims Resolution Specialist, Covered CaliforniaOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist, Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Claims Examiner Texas Children's HospitalClaims ExaminerBellaire, TXCurrently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time.
Claims Coordinator ServiceMaster RestoreClaims CoordinatorRedlands, CA$25–$30 / hourAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call.
Field Property Claims Adjuster: Tucson, AZ Farmers Group, Inc.Field Property Claims Adjuster: Tucson, AZTucson, AZRemoteExposure to some or all of the following environments when in the field: Uncontrolled outside environmental conditions, Excessive noise levels, Chemicals Chemical/Biological conditions, Moving mechanical parts, Areas considered dangerous, Conditions which could affect the respiratory system or skin such as fumes, odors, dust, mists, gases, oils, smoke, soot, or poor ventilation. Candidates Must be Willing and Able to: Climb Ladders to inspect roofs, and be comfortable working on rooftops, multiple times per day, Work in small, confined spaces that have been damaged; such as attics and crawlspaces.
NewClaims Representative Entry Level Sentry InsuranceClaims Representative Entry LevelDavenport, IAWe’re proud to be recognized for the culture we’ve built, earning spots on Forbes’ lists for America’s Best Midsize Employers and Best Employers for New Grads , as well as Newsweek’s America’s Greatest Workplaces for Women and Diversity . As an entry-level Claims Rep, you will: Gain knowledge to verify coverage, compensability, and reasonable payments by thoroughly reviewing the policy, reviewing accident details, and other pertinent information related to the claim.
NewClaims Examiner I Clever Care Health PlanClaims Examiner IHuntington Beach, CAThis position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, and other staff in the office; therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
NewCustomer Claims Processing Representative Pet Food Experts IncCustomer Claims Processing RepresentativePawtucket, RIWith a rich history spanning over 80 years, Pet Food Experts has evolved from a small family-run business into the nation's leading pet specialty distributor, proudly serving over 10,000 pet retail locations nationwide. The Claims Processing Representative will be responsible for accurately investigating claims, processing discrepancy credits, and interacting with business partners in a professional manner where the focus is on expedient and accurate completion of tasks.
Medical Claims Processor (Hybrid) Redirect HealthMedical Claims Processor (Hybrid)Phoenix, ArizonaMedical Claims Processor helps ensure claims are handled accurately and thoughtfully, so people can focus on getting the care they need without stress, confusion, or unexpected costs. In this role, you will: Serve members, clients, providers, and internal operations teams who rely on clear, accurate claims processing.
Field Inspector - Exterior Restorations and Insurance Claims Specialist Legacy Restoration LLCField Inspector - Exterior Restorations and Insurance Claims SpecialistLenexa, KSFull timeOUR IDEAL FIELD INSPECTOR - EXTERIOR RESTORATIONS AND INSURANCE CLAIMS SPECIALISTWe're looking for a dedicated professional who can meet the following qualifications:Reliable transportation capable of hauling a ladderAbility to set up and climb ladders, inspect steep and multi-story roofs, and safely navigate exterior environmentsComfortable working outdoors in varying weather conditionsComfortable climbing steep roofs (12' pitch and higher) Preferred Qualifications:Familiarity with AccuLynx and prior experience with exterior restorations or insurance claim inspections ABOUT USWhen homeowners need exceptional home repairs, whether after a storm, an accident, or simply the passage of time, they know to call Legacy Restoration! Legacy Restoration, LLC is hiring a full-time Field Inspector - Exterior Restorations and Insurance Claims Specialist in Kansas City, KS.If that sounds like you, apply today and step into a rewarding role with impact from day one.
Insurance Claims Coordinator IrvineInsurance Claims CoordinatorIrvine, California$60,000–$75,000 / yearPosition Overview As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call.
Inland Marine Claims Adjuster The Hanover Insurance Group IncInland Marine Claims AdjusterWorcester, MAIndividuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at:HRServices@hanover.com and include the link of the job posting in which you are interested. Compensation: The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience.