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Process Prescription Refills: Handle refill confirmations, review pending refills, and manage claims adjudication. Qualifications / Requirements: High School Graduate or Equivalent 2 years’ experience as a Pharmacy Technician MUST be a Nationally Board Certified Pharmacy Technician Must be certified in NC For immediate consideration, you may send your resume to kriziahcornerstonestaffing.
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This role demands meticulous attention to detail and efficiency in processing incoming requests to optimize claims adjudication. A willingness and ability to learn internal systems, particularly QNXT, is expected.
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A deep knowledge of claims adjudication typically achieved through a minimum of seven years’ experience adjudicating General Liability Bodily Injury Claims claims with exposure of $100,000 or more.
$126,400 - $180,480 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Knowledge of prior-authorization workflows, payer relations, prescription claims adjudication, and general reimbursement procedures. License Mass Registered Pharmacy Tech preferred., or Registration Pharmacy Technician Trainee required., or Certificate 1 Certfied Pharmacy Technician preferred.
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Position Summary: The Billing Specialist, Medicaid ensures proper submission and adjudication of all claims submitted to Medicaid carriers while working within the deadlines and protocols of the assignments.
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PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
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Advanced claims adjudication experience, including facility, professional, and ancillary claims. Research and respond to escalated issues and pertinent information on claims requiring adjudication.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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The Claims Adjuster is responsible for adjudication of mechanical repair claims, tire claims, and pre-paid maintenance claims. The Claims Adjuster reports to the Claims Manager and functions as a customer service representative by explaining contract coverage and claim decisions to contract holders.
$50,000 - $54,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The Associate Attorney will attend administrative hearings at the Office of Disability Adjudication and Review for Social Security disability claims, and at the Board of Industrial Insurance Appeals for Workers Compensation claims.
$75,000 - $95,000 a yearFull-timeExpandApply NowActive JobUpdated 28 days ago - UpvoteDownvoteShare Job
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Healthcare claims adjudication and/or health care customer service experience. Answer inbound calls from providers and members regarding insurance benefits, eligibility and claims.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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The role of a Collection Specialist in the Revenue Cycle Management department is to follow up on any unpaid insurance claims. Working knowledge of the adjudication process. Answer patient, client, or insurance carrier questions regarding claims.
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Experience in benefit determination and claims adjudication. Knowledge of claims adjudication systems. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor.
$24.28 - $48.04 an hourFull-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Great Place to Work®Most Loved Workplace® Forbes Best-in-State EmployerClaims Adjuster-General LiabilityPRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
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Firm understanding of Fee for Service (FFS), Managed Care claim adjudication processes from eligibility and enrollment to claims processing to funding/finance. Analysis of Medicaid enrollment, provider, and claims data, current business processes and systems, identify requirements for new processes and systems, identifying and documenting data anomalies and collaborate with cross functional teams for effective resolution.
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Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication. Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication.
ExpandApply NowActive JobUpdated 14 days ago
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