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1 year experience in health plan system (e.g., QNXT, Facets, Tapestry, etc.) QNXT, including claims, utilization management, benefits, contracts, member, call tracking, fees and code modules.
$70,310 - $85,075 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Serves as the Senior Plan leader and liaison for MHI Service Operations, including: Claims, Configuration Information Management, Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances, Member Appeals and Grievances, and other departments as required.
$122,430.44 - $238,739.34 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Work with the Billing Manager to track executed health plan agreements, to ensure claims are billed correctly per the executed agreement. As needed, work with the Billing Manager to submit Letters of Intent to health plans or medical groups that we are not yet contracted with; educate and build relationships with health plan groups to help expedite the contracting process.
$22 - $25 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
$97,000 - $107,000Full-timeExpandUpdated Today - UpvoteDownvoteShare Job
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Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not.
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We're a recognized Elite Agency award winner and a leading property and casualty broker, benefits consultant, wealth manager, and retirement plan advisor. The Claims Processor is responsible for accurate and timely processing of claims which includes claims for FSA's, HRA's, Retiree plans, Lifestyle Accounts, Parking and more.
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Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. A Grant Revenue Cycle Biller contributes to AHF by reviewing and processing claims daily, making necessary updates based on specific grant requirements.
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HSA Bank with selection of High Deductible Health Plan. Minimum of 3 years' experience handling Automobile liability, General Liability, or subrogation, as a claims representative working for either an insurance company or TPA.
$50,000 - $65,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Litigation Management - In consultation with supervisor, develop and execute a strategic file management plan, including as appropriate: research and recommendation of counsel; litigation and resolution strategies; management of loss adjustment expenses; engagement of appropriate experts; and the use of proper settlement and release terms.
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Have broad understanding of health plan wide processes, including claims processing, medical/payment policies, product implementations, provider network development and contract management.
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Offering a guaranteed salary, productivity and non-productivity incentives as well as a comprehensive benefits package that includes a group claims made malpractice insurance policy with no tail, paid vacation, sick pay, CME reimbursement, medical, dental, life, vision and disability insurance, retirement plan, health care and dependent care spending accounts, child care discounts, tuition reimbursement, free fitness center membership and an employee assistance program.
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Certified Health and Safety Technician (CHST), Certified Safety Professional (CSP) or Certified Mine and Safety Professional (CMSP) certification strongly preferred. Follow up with the corporate insurance department as regards to high value insurance claims, to ensure that documentary information has been collected, secured, and preserved so that claims will be resolved in a timely manner as required at the local office.
$109,980 - $164,971Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Manages the MCO policy submission process, including operationalizing Act 319 of the 2019 Regular Legislative Session, which includes researching managed care and fee-for-service policies, Informational Bulletins/Health Plan Advisories, and state rule, as well as tracking these policies through the approval process.
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Internal Operations and Technology : Support efforts to improve the efficiency of health plan operations (utilization management, claims payment, provider contracting) to reduce friction for members, providers, and associates.
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Keywords: Talroo-Health Plan, Claims, Auditing, QNXT. Responsible for all areas of customer service as it pertains to the acquisition and/ or retention of members for Sentara Health Plan, Inc. This includes functions associated with the administration of all group information: processing of claims, interaction with members, providers and employers.
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health plan claims jobs
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