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Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process. 3+ years Health Insurance Industry experience in patient advocacy, customer service, provider relations or claims preferred.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or by fax at (202) 690-7442.
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Description: 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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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 18 days ago - UpvoteDownvoteShare Job
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Escalates failed and complex background check cases to the recruiters and TALT for adjudication. You will be essential to ensuring a great candidate & hiring manager experience, interview scheduling, the pre-employment & adjudication processes, and working on ad-hoc projects/assignments.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Monitor changes in State and Federal laws, rules or fee schedules that impact medical bill review/re-pricing and ensure they are integrated into workflows (and Smart Advisor via Mitchell) for proper adjudication.
RemoteExpandApply NowActive JobUpdated 13 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. Experience in Social Services, case management, processing disability/claims evaluation and/or adjudication, and Medicaid/Medicare knowledge a strong plus.
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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 9 days ago - UpvoteDownvoteShare Job
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Subject to satisfactory adjudication of background investigation and/or fingerprint check. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social.
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The ideal candidate will have extensive knowledge of the UI system and several types for UI Frauds, fraud remediation processes, and relevant regulations, including a deep understanding of the UI programs, Special Programs, Adjudication, payment, charging, adjustment and overpayment, key interfaces related to Fraud detection in UI systems, federal reports, and fraud data analytics of the UI system.
$85 - $90ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Interface and coordinate activities between QIC project directors/medical directors and adjudication team, client and project end user (i.e. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
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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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5+ years experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment. Leave Benefits: Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off.
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Research and resolve claims based on assignment, which could include contacting payers via phone or website, contacting practices, working across departments, writing appeals, and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims.
ExpandApply NowActive JobUpdated 2 days ago
adjudication job
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