Claim Adjudication Jobs (NOW HIRING)

The Supervisor, Claim Adjudication Operations (CAO) ensures efforts are in alignment with the CAO team to leverage technology and process improvement for the purpose of meeting the business needs of ...

Create and maintain claim adjudication training resources * Other duties as assigned Qualifications What our team expects from you? * College degree or equivalent experience required in managed care ...

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

Perform claim testing to ensure accurate claim adjudication. * Work with the pharmacy clinical team to implement formulary updates in the claim adjudication system. * Participate in the research and ...

Perform claim testing to ensure accurate claim adjudication. * Work with the pharmacy clinical team to implement formulary updates in the claim adjudication system. * Participate in the research and ...

... 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 ...

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

Serve as claim processing subject matter expert (SME) for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines ...

Serve as claim processing subject matter expert (SME) for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines ...

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

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, communicating denied claims, and helping to resolve provider disputes (PDRs). \tAnalyze and audit claims to ensure compliance and provide solutions to resolve claims errors ...

Conducts contract review and sets rates within the claim adjudication system. * Collaborates with other departments in the organization. * Conducts follow-up activity for claims held until the claim ...

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 ...

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 ...

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 ...

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 ...

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