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Claims and Policy Processor Jobs

1000+ jobs

Working as a liaison between Operations and the Chief Medical Officer (or delegate), this position will assure all current and new clinical edits (CEs), and related changes to the Plan’s adjudication system are clinically sound and in accordance with BMCHP business requirements, Industry Standards and BMCHP Medical Policy. The individual will be responsible for gathering and writing final CE busin...

Description McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Health Solutionsdelivers industry-leading clinical evidence and expert technology to help payers and providers collaborate for better healthcare outcomes at lower costs. Our solutions reduce unnecessary healthcare utilization while improving outcomes; opera...

Description McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Health Solutionsdelivers industry-leading clinical evidence and expert technology to help payers and providers collaborate for better healthcare outcomes at lower costs. Our solutions reduce unnecessary healthcare utilization while improving outcomes; opera...

PNO Claims Payment Policy Consultant Requisition ID 137626 Business Overview Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportun...

About Us: We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach. Responsibilities: ...

About Us: We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach. Responsibilities: ...

General Overview: Screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appro...

General Overview: Screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appro...

Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees — including nurses, rehabilitation therapists, soci...

Description / Position Overview The City Learn about the City of Colorado Springs as an employer and what our beautiful city has to offer as a place to live and work by clicking on this link: https://hr.coloradosprings.gov/sites/default/files/human_resources/candidate_information_packet.pdf This information may change annually. Claim Processor As a Claim Processor, you will perform complex cle...

Description: This role must maintain strong knowledge of industry trends and the competitive marketplace and be able to proactively identify organizational and technological strengths, weaknesses, opportunities and threats along with overall management of risk. Responsibilities: · Serve as business owner of all claims IT projects including developing the strategy and creating a multiyear ro...

Job Summary: Our Claims Processing Representative will process and develop Veteran Administration (VA) claims for missing information in accordance with VA regulations and guidelines. Characteristics and Responsibilities: Correct payment errors on a post-processing basis, including edit resolution, credits, additional payments, statistical adjustments and recoupments. Analyze claims to determi...

Description Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to ...

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a tea...

JOB SUMMARY: The primary purpose of this position is to examine and process claims from UB04 and CMS-1500 into the claims adjudication system for all capitated and shared services accounts. This position is responsible for the accurate review, input and adjudication of claims using reasonable payment policies and methodologies that are consistent with and recognized by, health plans, nationally re...

Job Description JOB TITLE:Claims Examiner ICUSTOMER JOB DESC: JOB SUMMARY:Under close supervision, this position processes routine claims within a single product line to determine type and amount of benefit payable. Performs limited duties, subject to review and approval, for the processing of such claims assigned, consistent with applicable policies, procedures and department guidelines.ESSENTIA...

Under limited supervision, responsible for the overall automotive and general liability claims processing for the City of Portsmouth. Prepares requests for investigation from specific city department personnel; obtains necessary investigative reports; police reports; acquires statements from employees and citizens both internal and external from the office to determine the city’s liability; accura...

[[id]] Job Summary The Audit Analyst is responsible for the quality review of functionally specific processes within operations services (claims, customer contact and membership) to ensure quality service goals and standards are met and/or identify areas where improvement can be achieved. Evaluates and interprets report data for management review. Provides feedback regarding associate performanc...

Non-Exempt Full-Time: M-F 8:30a – 5:00p Job Summary Processes all types of claims and adjustments in accordance with established department policies and procedures. Assists management staff with ensuring departmental and company-wide objectives area met. Essential Functions and Responsibilities 1. Processes all types of claims, promptly and accurately, as assigned via the document management syste...

Claims Processor II Department: CHOC Managed Service Organization Facility: Copley Drive - Kearny Mesa Union: Schedule: Casual - Full Time - Benefits Eligible Shift: Days Hours: 8-hr shifts Req Number: 44809.4 Job Details: JOB SUMMARY: The primary purpose of this position is to examine and process claims from UB04 and CMS-1500 into the claims adjudication system for all capitated and sha...