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Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, Tricare, etc), and how these payors process claims.
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Department(s): Grievance & Appeals Resolution Services (GARS)Reports to: Manager, Grievance & AppealsSalary: $24.52 - $31.04 Duration: up to 6 months Job Summary The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
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Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines. Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation.
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Requires broad training in fields such as business administration, accountancy, sales, finance/economics, computer sciences or similar vocations generally obtained through completion of a four year bachelor’s degree or equivalent work experience; Experience in retail pharmacy support, including knowledge in dealing with PBM claims processing, payment processing and reconciliation, preferred.
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Processing disability claims of minimal disability duration under close supervision. Great Place to Work®Most Loved Workplace® Forbes Best-in-State EmployerIndustry Advancement Program | Workers Compensation Claims Representative Trainee | Orange, CA (In-Office)PRIMARY PURPOSE: To be oriented and trained as new industry professional with the ability to analyze workers compensation, general liability or disability claims and determine benefits due.
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Under the direction of the Senior Supervisor, Customer Service, this position is responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.
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Analyzes and resolves specific billing edits/errors that are delaying claims for processing in EPIC. Applicant has a general understanding of outpatient Medicare reimbursement methodologies, including CPT/HCPC and UB Revenue Coding.
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Familiarity with insurance claims processing and requirements. Communicate with insurance companies regarding client’s property damage claims. As a Property Damage Specialist, you'll be responsible for managing and resolving property damage claims efficiently.
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The Insurance Collections Coordinator will assist the Insurance Collections team with accurate, detailed, and thorough medical billing processes, while utilizing their Collections billing knowledge to ensure that claims are processing and paying accurately.
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Responsible for researching denials and rejections, settling payer issues, documenting account activity, posting adjustments, and demonstrating proficiency with the XIFIN billing system to ensure all functionalities are utilized for the most efficient processing and adjudication of claims.
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Knowledge of Medical, Hospital and Dental insurance Claims is preferred. Conduent is seeking a detail-oriented and proactive individual to join our team as a Bill Processing Associate. Support the billing team by assisting in processing bills during periods of increased workload or backlog, ensuring timely and accurate completion to meet client expectations.
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The Vertex Companies, LLC (VERTEX) is a leading multidisciplinary engineering and consulting firm that provides forensic consulting, engineering design, construction management, claims & dispute resolution, and environmental solutions to insurance carriers, sureties, law firms, real estate owners, property managers, public agencies, and commercial clients.
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Train on claims processing procedures and systems. When you join the Auto Club as a Claims Representative, you’re bringing your expertise to a best-in-class organization that is focused on delivering quality service to our members.
$25.48 - $28.03 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Explain CARSTARs repair process, including insurance claims processing, payment procedures, repair techniques, repair needs and expected delivery date of repair. Educate customers on CARSTARs CSI/NPS survey (kept informed, customer service, quality of repair and on-time delivery.
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Maintains the Pharmacy area in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise/supplies, identifying shrink and damages, and ensuring a safe work environment.
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claims processing jobs in Irvine, CA
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