Experience with Part D claims adjudication *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live ...
Daily follow up on clarifications and prior authorizations initiated by Claim Adjudicator technicians. * Documents entire process in WinRx for tracking purposes. Lab Support * Maintains hygienic ...
Technical/Functional Skills • Strong functional knowledge of core PBM functions specifically core adjudication, pricing, accumulators, MED D Pricing, benefit plan, patient pay and regulations • ...
Able to complete a favorably adjudicated DHS background investigation, as well as obtain a favorably adjudicated to at least a DoD Secret level (preferably TS SCI) clearance * Proven understanding of ...
This position requires an Interim Top Secret or adjudicated Secret. This will also be a contract opportunity. Our client is expecting a contract bridge extension in November that would be for an ...
Manages legal issues that can be adjudicated without the use of a defense attorney. Directs legal strategy and participates in preparation of the case for litigation. Provides testimony at hearings ...
... adjudication and case management processes. While training is provided, experience or willingness to learn is essential. Travel within Ohio is available, and candidates already on the BWC ...
Coordinates with clients/customers to clarify incomplete or missing information necessary for proper account/claim adjudication. * Claim Processing: Corrects, completes, and processes claims for all ...
Two (2) years' experience as a Claims Adjudicator or Examiner and a bachelor's degree. Equivalent work experience may be substituted for education on a year-for-year basis. Thinking about applying
Job Purpose The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department. Essential Job Duties & Responsibilities
Working knowledge of Claims Processing, correspondence and CRM platforms and adjudication strategies * Experience with Claims Testing / Auditing / QA * Solid problem solving and time management ...
S.; may work from home] to maintain and support the multi-tenant core adjudication engine of the PharmacyBenefit Management Platform for different states covering their Medicare and Medicaid Plan. To ...
May include clinic on-call responsibly to be adjudicated remotely * Assists in the training and development of support staff (ie nurses, medical assistants and receptionists) * Evaluation and ...
This level is responsible for independently reviewing simple to moderately complex claims for adjudication purposes. Refers more complex claims to higher levels. You'll be rewarded and recognized for ...
Ascendant Claims Services LLC, (an affiliate of Ascendant Commercial Insurance Inc.) is a third-party claims administrator committed to providing best in class claims adjudication solutions
A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities ...
... adjudicated truth labels. You will generate candidate models and evaluate their performance using cross-validation, iterative training, model-building and perform lock and final validation. You are ...
S. facilities fully staffed to service each of our three divisions: (1) Claims Adjudication, (2) Contact Centers, and (3) Document Management w/Mail Room and EDI Generation. Position Overview: As a ...
Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge ...
Responsible for accurate and timely adjudication of claims according to AB1455 regulatory guidelines. * Processes claims based upon contractual and/or CalOptima Health's agreements involving the use ...
Operationalize, oversee and enhance claims adjudication for companies in the service contract, protection plan, warranty or insurance spaces. * Implement actionable improvements for claims process ...
Adjudicated Counter Intelligence scope polygraph completed within the last 5 years
Experience with drug reimbursement issues and claim adjudication process * Experience with insurance benefits investigations; knowledge of U.S. Private and Government payers * Experience with HIPAA ...
... Adjudication knowledge - Ability to adapts quickly to changing direction, timelines, and people needs - curiosity Job Description Job Title: Cloud Native Senior Engineer& Duration: 7/18/2025 ...