Claim Adjudication Jobs (NOW HIRING)

... adjudication team ... The role will also monitor and assist with Claim escalations from customers or other service areas ...

... claim adjudication process. (*) Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. Routes and triages complex claims to Senior Claim ...

Qualifications: • Experience: o Strong knowledge of Medicare Supplement and other applicable insurance policies o Healthcare claim adjudication processes o Experience handling high-volume inbound ...

Claim Adjudication: * Demonstrate a thorough understanding of healthcare and other applicable insurance claim adjudication processes to accurately address and resolve policyholder inquiries and ...

Qualifications: • Experience: o Strong knowledge of Medicare Supplement and other applicable insurance policies o Healthcare claim adjudication processes o Experience handling high-volume inbound ...

Achieve individual established goals in order to meet or exceed departmental metrics Essential Qualifications * 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment

Achieve individual established goals in order to meet or exceed departmental metrics Essential Qualifications * 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment

Knowledge of UB04 / CMS1500 claims, ICD-10 / Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission. * Proven ability to effectively and ...

Achieve individual established goals in order to meet or exceed departmental metrics ESSENTIAL QUALIFICATIONS * 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment

Experience understanding claim adjudication for member and provider reimbursements. * Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration * Knowledge of ...

Analysis of TPA claim adjudication data to determine whether appropriate action was taken to arrive at claim resolution * Identify TPA trends, behaviors, and process gaps by utilizing data and ...

Analyze prescription claims and assist with claim adjudication issues. * Research medication coverage, formulary status, and therapeutic alternatives. * Maintain accurate documentation of provider ...

... claim adjudication. - Ensures compliance with all regulatory requirements and confirms that ... payments align with company policies and procedures. - Identifies and reports potential ...

... claim adjudication. - Ensures compliance with all regulatory requirements and confirms that ... payments align with company policies and procedures. - Identifies and reports potential ...

Maintain an in-depth understanding of the claim adjudication process. * Process claims by all regulations in a timely and accurate manner, including analyzing the submitted medical treatment and ...

Remote From prototype to real-world impact - be part of a global shift by doing work that matters. - Candidate will work on RxCLAIM/Claim Adjudication enhancement projects which involve changes to ...

Understand and map core processes including claims processing, claim adjudication, policy administration, new business setup, and underwriting workflows . * Collaborate with stakeholders like claims ...

... claim adjudication environment * Experience with interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits * Working knowledge of plan design ...

... claim adjudication environment * Experience with interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits * Working knowledge of plan design ...

Remote From prototype to real-world impact - be part of a global shift by doing work that matters. - Candidate will work on RxCLAIM/Claim Adjudication enhancement projects which involve changes to ...