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Combine in-depth analysis of business unit requirements and comprehensive understand of core system capabilities, knowledge of claim processing, provider and vendor setup, authorizations and business processes in order to determine optimal core system setup to process claims, case management, and grievance and appeals with a high degree of accuracy and auto-adjudication.
$161,634 a yearFull-timeExpandApply NowActive JobUpdated 20 days ago - UpvoteDownvoteShare Job
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The Configuration Analyst is responsible for updating the managed care claims processing platform, loading of provider data, including demographic data and fee schedules according to established policies and procedures.
RemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Subject Matter Expert (SME) in medical claims processing at health plan payor, Managed Services Organization (MSO), Health Maintenance Organization (HMO) and/or Independent Practice Association (IPA) organization.
$46.6 an hourFull-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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The medical biller is responsible for timely processing and submission of complete and accurate claims to Medicare, Medi-Cal, managed care organizations, and private insurance. Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
$50 an hourFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Review with customers and walk-through the repair process: Greet customers by phone or in-person; explain to customers about the collision repair process, including insurance claims information, processing, and payment procedures.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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From self-service claim filing software to backend fraud detection, we’re the engine that powers claims processing for some of the largest insurers in the world. Claims processing (i.e. should we pay this claim.
$220,000 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Lead the entire billing cycle from claims submission to payment processing as well as troubleshoot EOBs, appeal non-covered and low pay claims, follow-up on claims, and drive positive coverage determinations through external appeals.
Full-timeExpandApply NowActive JobUpdated 20 days ago - UpvoteDownvoteShare Job
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You will initiate warranty claims and process returns on failed equipment. Processes failed vendor hardware devices using online/other tools, including information processing, packaging, shipment, and receipt of return for Return Merchandise Authorization (RMA) devices.
$40.72 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Build collaborative relationships with peers, employees, other departments, affiliates, and agencies to administer fair and compliant workers’ compensation claims. General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and PowerPoint), Microsoft Access, and other software applications to support word processing, spreadsheet, and database functions.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Develop and modify contracts under the general direction of the manager or director, provider network. Provides contract management services for the provider network agreements. Provides analytical support for budgeting and contracting in addition to offering support and ongoing education to the provider network.
$28.42 - $42.63 an hourFull-timeExpandApply NowActive JobUpdated 20 days ago - UpvoteDownvoteShare Job
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This consultant will primarily provide claims and payor data (eligibility, medical, vision, lab,pharmacy) ETL services using SSIS/SSMS to modify existing processes and create new processes to support the waiver team for reporting, and other duties as assigned.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Responsible for coordination, review, and accuracy of all ECM claims, ensuring timely processing monthly. Supervise, support, and evaluate the performance of ECM Case Managers and Community Outreach Workers, providing guidance, training, and mentorship to ensure optimal client outcomes and service delivery.
Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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The ideal candidate will have worked in-depth for top payers across one or more domains (Enrollment & Benefit Administration, Claims processing & Reimbursements, Member & Provider Portals/Service, Clinical & Care management, Funding & Billing, Reporting.
RemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Oversees multiple claims processing units, executes strategies to deliver industry leading service results. Requires a BA/BS in business administration or a related field and a minimum of 10 + years of management experience in claims that includes adjustments in the managed care and/or insurance industry, experience driving AI/RPA initiatives and transformations; or any combination of education and experience which would provide an equivalent background.
Full-timeExpandApply NowActive JobUpdated 24 days ago - UpvoteDownvoteShare Job
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In general, the Patient Financial Coordinator will be responsible for all aspects of patients’ financial account with regard to reimbursement, including referral intake and authorization processing, billing, and collections.
Full-timeExpandApply NowActive JobUpdated 20 days ago
claims processing jobs in Sunnyvale, CA
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