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Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. Specialized functions include but are not limited to the following: prescription order entry insurance adjudication troubleshooting insurance rejections filling prescriptions preparing prescriptions for final pharmacist verification delivering prescriptions to the patient bedside checking patients out through the point of sale system contacting providers with questions assisting with inventory management and restocking supplies.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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This role demands meticulous attention to detail and efficiency in processing incoming requests to optimize claims adjudication. Job Title : Provider Coordinator Work Schedule : 7:00 AM - 4:00 PM or 7:30 AM - 4:30 PM PST Job Type: This is a direct hire position Pay: $20.00 per hour Benefits : Offered Job Summary : The Provider Coordinator plays a crucial role in ensuring the accuracy and integrity of provider demographic and contract affiliation information within the health plan system.
RemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Establish direct professional relationship with key departments including the risk bearing entity (RBE), pharmacy, underwriting, medical adjudication, claims and provider relations, and assist with issues and/or concerns.
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O Chargeback Adjudication. IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. o Chargeback Adjudication.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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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. Working knowledge of Employee Retirement Income Security Act of 1974, (ERISA) claims processing/ adjudication guidelines.
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Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination. Assistant Legal Department with Member/Provider appeals/disputes.
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3+ years Health Insurance Industry experience in patient advocacy, customer service, provider relations or claims preferred. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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As a lead logistics partner (LLP), third-party logistics provider (3PL) and supply chain consultant, we help customers leverage supply chain management as a competitive advantage, reducing total system costs, transforming business processes, improving service and facilitating growth and change.
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Review reports and research pended claims to ensure timely adjudication within accepted corporate cycle times. WGAT is now the largest provider of health benefits for the agriculture industry.
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PRIMARY PURPOSE OF THE ROLE: To analyze high-level General Liability claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
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MRG Exams is a leading provider of Independent Medical Evaluations (IME) and Permanent Partial Impairment Ratings (PPIR) services for the Ohio Bureau of Workers' Compensation (BWC), third-party administrators, Managed Care Organizations (MCOs), and employers.
Full-timeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
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The claims adjuster is responsible for the adjusting of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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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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PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.
Full-timeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
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This position will also coordinate with: Compliance & Quality staff on the re-credentialing process; with Provider Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication.
Full-timeExpandApply NowActive JobUpdated 6 days ago
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