Get new jobs by email
- ...dictated by the business. The Role We are seeking a detail-oriented and collaborative Executive Background Screening & Adjudication Specialist who is responsible for coordination of pre-employment screening activities and operations for experienced executive and...
- ...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: • Must have an...
- ...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...
- ...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...
- ...BETTER' AT AIA If you believe in better, we'd love to hear from you. About the Role The role is responsible for adjudication and properly evaluating all billings from hospitals and doctors prior to preparation of payments DUTIES & RESPONSIBILITIES...
- ...serious adverse events, protocol inquiries, physician assessment of diagnostics, Data and Safety Monitoring Boards, and Endpoint Adjudication Committees. In collaboration with Safety Specialists and Medical Monitors, you will liaise and establish effective relationships...Remote job
- ...stakeholders. 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 ;...
- .... 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...
- ...uploading to CIMS, maintaining electronic and physical 201 files, and enforcing naming standards. Tracks and assists with DMW adjudication cases and facilitate contract cancellations when required. Prepares and submits required reports, accreditation applications,...
- ...Acquisition Team. Under minimal supervision, you'll be supporting a team of recruiters with new hire paperwork, initiating and adjudicating background checks and drug screenings. The goal is to guarantee each new hire has a first-class on-boarding experience by ensuring...
- ...providing timely and accurate response to claims enquiries/matters. Collect documents/information (where appropriate) for carriers to adjudicate claims assessment, basic checking/investigation for contestable/complicated claims should there be any disputes. Perform...
- ...Acquisition Team. Under minimal supervision, you'll be supporting a team of recruiters with new hire paperwork, initiating and adjudicating background checks and drug screenings. The goal is to guarantee each new hire has a first-class on-boarding experience by ensuring...
- ...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...
- ...coding to ensure accurate billing invoices and estimates, enhancing financial accuracy. Configure systems to support claims adjudication and drug card generation, ensuring efficient processing. Prepare and maintain access setups for company websites and mobile applications...
- ...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...
- ...~ Experience using internal applications and ability to learn PBM tools (reporting systems, issue management platforms, claims adjudication tools) ~ RxClaim experience (prior BOM or Customer Service for Rx considered solid fit) ~ Pharmacy Benefit Management (PBM) experience...
- ...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...
- ...Design and implement standardized onboarding programs for: o Contact center agents (Commercial, MA, ASO, etc.) o Claims adjudicators (Professional, Institutional, COB, Adjustments, Recovery) • Build structured training curricula, modules, lesson plans, and facilitator...
- ...General Sales Agent Services and Destination Management. Job Title: Medical Claims Processor Job Purpose: To review, adjudicate and process medical e-claims received from external medical service providers according to business requirements and agreed SLA's...
- ...Analyzing medical reports, invoices, and supporting documents to determine claim eligibility and coverage levels. Processing and adjudicating claims with accuracy and efficiency, adhering to established procedures. Communicating with insured individuals, medical...
- ...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,...
- ...Description: Organize and investigate employee complaint cases in an efficient and timely manner. Fact finding, investigation and adjudication of employee violations of code of conduct in a fair and transparent manner. Interact with employees in response to employee...
- ...Operation Management Required Qualifications: At least two (2) years of relevant back-office experience can be in medical adjudication claims processing data entry or email support. Proficient in MS Office Applications (Word PowerPoint and Excel) Bachelors...
- ...during 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...
- ...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...
- ...experience in medical billing, specifically denials and appeals Strong understanding of insurance processes, EOBs, and claim adjudication Excellent verbal communication skills (comfortable handling high call volumes) Strong attention to detail and problem-solving...
- ...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...
- ...up and handles completion of claims for returned correspondence. 2. 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...
- ...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...
- ...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...