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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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PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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Processes all approved charge corrections timely, verifying proper adjudication for payor eligibility, following all Medicare/Medi-Cal/CCS and other payor guidelines. Processes all approved charge corrections timely, verifying proper adjudication for payor eligibility, following all Medicare/Medi-Cal/CCS and other payor guidelines.
$18 - $22 an hourExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Lead developers, analysts, and testers in the delivery of software solutions for supported core administration platforms, including QNXT and Capitation Adjudication (f.k.a. EZ-CAP). The Application Development Senior Manager will oversee a team dedicated to the end-to-end implementation of solutions for the core administration of Medicare Advantage and CareAllies health plans.
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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We process claims and provide customer service support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.
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Advance level (minimum 5 years) of claims processing experience and understanding of medical, dental, FSA, HRA, transplant, coordination of benefits, Medicare, hospital, professional, subrogation, and accident claims required.
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Healthcare industry experience as it relates to risk adjustment, medical claims submissions, adjudication and payment, eligibility, encounters file management in particular for Medicaid/Medicare populations.
Full-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Experience in Social Services, case management, processing disability/claims evaluation and/or adjudication, and Medicaid/Medicare knowledge a strong plus. Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange.
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Working knowledge of Employee Retirement Income Security Act of 1974, (ERISA) claims processing/ adjudication guidelines. Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination.
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Validates Medicaid, Medicare or commercial insurance drug coverage and ensures adjudication is complete addressing any error messages. Prepares routine patient orders for IV pharmaceuticals including compounding, preparation and labeling of any IV admixture including antibiotics, solutions, irrigations, narcotics, parenteral nutrition and chemotherapy.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Receive telephone, written, fax, and e-mail inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing problems. Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems.
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Review reports and research pended claims to ensure timely adjudication within accepted corporate cycle times. The Senior Claims Examiner will work on special projects related to provider and plan documents, system upgrades, implementing initiatives to improve claims processing, and turnaround times.
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Estimated Start Date: 5/6/2024 Pay Rate: $25/hr PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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Thorough understanding of Facets claims adjudication process and pricing logic, troubleshoot, identify root cause, and resolve claims processed in the Facets UI. Gain a deep working knowledge of Medicare business, IT landscape, and coordinate collaboration of the UAT team.
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