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- ...dollar thresholds and meets and maintains production and quality standards Reviews authorization and/or provider's contract and adjudicates claims accordingly. Perform any correspondence, follow-up and any projects delegated by claims supervisor. Provide...
- Position Summary: Provides direction to the Claims Unit team while monitoring daily workflows, examiner assignments and production, and ensuring compliance with health plan and regulatory requirements. Job Duties and Essential Functions: # Responsible for compliance...
- ...and handles completion of claims for returned correspondence. ~ Quality 2.1. Analyzes, processes, researches, adjusts, and adjudicates claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, i.e., co-payments...
- ...Position Responsibilities: Provide administrative support for claims processing and adjudication. Organize and manage claims-related documents for easy retrieval and accuracy. Assist in setting up new claims and updating system records. Process invoices and...
- ...high volume week Required Qualifications: At least two (2) years of relevant back-office experience can be in medical adjudication, claims processing, data entry or email support. Bachelor's Degree holders are welcome to apply . Preferred Qualifications...
- ...office equipment experience Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims. Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes and medical terminology. EXPERIENCE...
- ...2-4 years of experience in billing, payer maintenance, or health insurance operations ~ Familiarity with denial codes, claims adjudication, and reimbursement workflows ~ Proficient in Microsoft Excel and CRM systems (Salesforce preferred) ~ Detail-oriented with a...
- ...range from Retail, Business, and Airline General Sales Agent Services and Destination Management. Job Purpose: To review, adjudicate and process medical e-claims received from external medical service providers according to business requirements and agreed SLA's...
- ...members. Close coordination with providers for claims evaluation and case management. ~ Front line representative. ~ Claims adjudication based on the procedure and medical plan coverage. ~ Handle calls from clients, members and providers. ~ Establish a good rapport...
- ...efficient coordination of inquiries and cases to ensure high-quality service delivery. Responsibilities Accurate and Efficient Adjudication of Member Availments and Issuance of LOA's Review and process member availments and claims in accordance with company...
- ...healthcare revenue cycle, payer maintenance, or claims operations. ~ Familiarity with payer contracts, denial codes, and claims adjudication workflows. ~ Demonstrated success in leading cross-functional projects and system/process enhancements. ~ Skilled in...
- ...manage onsite candidate experiences. Manage the compliance requirements for new hires and other for-cause reviews – Initiate and adjudicate background check as appropriate, review findings against Asurion standards, make pass/fail determinations in partnership with...
- ...join our Insurance Operations team at MBPS. In this role, you are responsible for providing administrative support to the claims adjudication process. Position Responsibilities Provide administrative support for claims processing and adjudication. Organize and...
- ...policy guidelines. They also follow precise procedures in managing high-volume claims according to department goals and deadline. Adjudicate and process claims based on appropriate client business rules, utilizing department software and resources, interact with...
- ...negotiations, payment of members and provider, and claim coding and archiving according to ICD10 Standards. Call centre support on adjudication, complaint handling, provider communication, and problem-solving for medical services. Medical plan reviews, SoB finalisation...
- .... Identify potential blockers early (e.g., missing documents, unclear policy terms) and take corrective actions. Monitor adjudication progress and follow through until final payout own outcomes, not just tasks. Capture customer sentiment and feedback contribute...
- ...relentless pursuit of better health and where we support our client and their employees in this journey. What will you do Adjudicate disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional...
- .... Responsible for daily adjustment approvals. Assist staff in resolution of claims Monitor to ensure accounts are properly adjudicated and report variances to appropriate parties. Communicate all payor trends and issues to appropriate parties, including payors as...
- ...drive continuous improvement through RCA/CAPA. Establish and enforce quality and security expectations (gold sets, sampling, adjudication, auditability; secure environment and access controls). Requirements Strong familiarity with the Philippines BPO / data-...
- ...you to understand the nuances of benefit design while your familiarity with clinical coding systems ensures accuracy in claims adjudication. Your proven ability to develop robust policies combined with hands-on experience conducting audits positions you as a trusted advisor...
- ...processes including: • Underwriting & New Business Support • Policy Administration & Endorsements • Claims Processing (FNOL, adjudication, settlements) • Billing & Premium Accounting • Customer Service & Contact Center Operations • Ensure SLAs, KPIs,...
- ...Demonstrated experience in Screening applications and or investigation tools •Proven experience in the Investigation and Screening Adjudication process •Demonstrated problem-solving and decision-making skills •Ability to work unsupervised and adjust priorities quickly...
- ...candidates globally . This role manages the relationship with our third-party background check vendor leads background check adjudications and escalations and coordinates non-standard cases between stakeholders such as contingent starts immigration and work authorization...
- ...delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all...
- ...claims (ex. Group life AD&D Survivor Income claims TDMI Personal Benefits as well as Compassionate Assistance Program loans. Adjudicate and make independent decisions on non-contestable and contestable claims (i.e. Evidence of Insurability (E of I) and pre-existing...
- ...desirable.Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.Familiarity with payor policies, EOBs, and claim adjudication processes. Strong organizational skills with attention to detail and accuracy.Ability to work with confidential patient and...
- ...mentor a team of product managers to deliver AI strategies and build AI platforms for automated Return & Refund request and dispute adjudication, improving accuracy, efficiency, and overall operational cost effectiveness. Drive initiatives to optimise AI strategies for...
- ...As a Payment Posting Specialist , you will handle medical and vision payment posting with accuracy and efficiency, manage adjudicated claims, and reconcile payments against explanations of benefits-supporting seamless collaboration across revenue cycle teams while...
- ...Description Clinical Review Nurses – Nurse conducts clinical review of cases not meeting criteria by performing clinical intake and adjudicates (closes), requests additional clinical information or escalates to Medical Directors. Qualifications Active PRC and...
- ...products and services by which clients must operate their Visa programs. The services provided include Rules management Dispute adjudication Contract management and external Standards Body Management which are provided to ensure the safety security and integrity of the...