Trabajos adjudicator en Wisconsin (WI) State

Claims Adjudicator Location: US-WI-Madison Department: Preneed Claims Payrate Min/Max: USD $20.00/Hr./USD Scheduled Hours: 40, 8am - 4:30pm CST Monday - Friday Contract Duration: 6 months with the ...

The Supervisor, Claim Adjudication Operations ensures the streamlined operation of the Claim Adjudication Operations team in alignment with customer-focused objectives. This individual will plan ...

As an Adjudication Technician you will be vital in making a difference in our members' lives and well-being. You will be working to find solutions, assist Serve You Rx members with their prescription ...

Analyze and implement requests including adjudication hierarchy, pharmacy network rates and formulary management configuration with a high degree of accuracy * Import and validate Member Prior ...

Works with other areas in the Revenue Cycle to obtain information necessary to correct errors or supply additional information as necessary for claim adjudication. Remains up-to-date on regulatory ...

Mitigate the risk of errant adjudication of claims, especially those with a financial impact to Navitus, members, clients, or pharmacies * Acquire understanding of Navitus' claims adjudication system ...

This individual will understand and interpret data from the Navitus data warehouse, the Navitus claims adjudication system, pharmacy network databases, NCPDP pharmacy files, Medi-Span files, pharmacy ...

The Intensive Supervision Youth Competency Program is designed to address the needs of youth adjudicated by juvenile court and whose behavior puts them at risk for an out-of-home placement. The Youth ...

The Analyst, Accumulator Claims Extract ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting ...

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

Analytics, Benefit Systems, Claims Adjudication Development, Client Services, Compliance, Data Services, Government Programs, Implementation, and Member Service, ensuring COB is administered and ...

Minimum 1 year product management/development, pharmaceutical claims adjudication system, pharmacy, or health insurance is required. Experience in the health, biomedical, or pharmaceutical fields is ...

Teach other courses in the elementary, early childhood, or special education programs that fit the background of the candidate * Assist with portfolio adjudication * Other duties as assigned ...

PBM experience, including PBM claims adjudication experience, is preferred. * Knowledge of Medicare Advantage and Part D Communications & Marketing Guidelines. * Experience articulating regulatory ...

Responsible for the timely and accurate adjudication of claims for providers inside and outside of Dental Associates. * Is a liaison between IT, sales and member services and the clients for the ...

Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity. * Continuously review and pro-actively identify areas of opportunity ...

Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity. * Continuously review and pro-actively identify areas of opportunity ...

Bachelor/Associate Degree in business related field; or equivalent combined education and experience required. * 1-3 years related work experience preferably in pharmaceutical claims adjudication ...

Minimum 1 year product management/development, pharmaceutical claims adjudication system, pharmacy, or health insurance is required. Experience in the health, biomedical, or pharmaceutical fields is ...

Provide outstanding customer service and technical expertise, working efficiently with the insured, brokers and underwriters in the handling and adjudication of claims. * Analyze and draft coverage ...

Knowledge of health care processes and pharmaceutical claims adjudication systems preferred * Participate in, adhere to, and support compliance program objectives * The ability to consistently ...

Contestable claims including referring claims to Underwriting as needed. xi. Rider claims including accidental death, child/family rider, and spouse rider. d. Accurately calculate cost basis on basic ...