UNKNOWN

ADAPTED_NOW

HOUR

Deep understanding of Healthcare Payer operations, including Claims Processing, Membership, Enrollment, Provider Management, Billing, and Premium Management. Experience delivering Application Development Projects, System Upgrades & Modernization Programs, Application Support & Maintenance Initiatives, and Production Support Engagements.

Axelon

Project Manager

FEED

WHO YOU ARE: The Claims Processor is primarily responsible for processing all types of contracted and non-contracted claims accurately and timely for Medicare, Medicaid and Commercial Insurance products. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

GlobalHealth, Inc.

Claims Processor (53334)

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FULL_TIME

As a Dental Claims Processor, you'll work alongside experienced professionals while learning every aspect of dental insurance billing, including: Process and follow up on dental insurance claims. We provide comprehensive, hands-on training that gives you the skills needed to become an expert in dental insurance claims and revenue cycle management.

DY MANAGEMENT CONSULTANTS LLC

Dental Claims Processor

OTHER

Verifies and calculates hospital and physician payments, follows up on incorrect payments or denials in a timely manner and ensures proper status of accounts. Requires the use of office equipment such as computer terminals, telephones and telephone headsets, copiers, 10-key adding machine, and fax machine.

United Regional Health Care

Insurance Claims Processor I

Broadbean

The ideal candidate can independently identify systemic gaps, translate complex operational issues into actionable technical requirements, and partner with Product and Engineering to drive sustainable solutions. End-to-End Adjudication Knowledge: Demonstrated expertise in claims adjudication workflows, benefit hierarchy, health plan configuration, pend rules, and identifying systemic processing gaps.

YEAR

CollectiveHealth, Inc.

Senior Manager, Claims Systems

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Independently owns and manages scorable action items (SAIs), including assisting and executing projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions. Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.

Molina Healthcare Inc

Program Manager, Health Plan Payment Integrity (Claims & Recovery) Remote

SUMMARY: The Claims Analyst is responsible for analyzing a percentage of processed claims for accuracy according to the provider contract and company policies and procedures by performing the following and other duties that may be assigned. Minimum 2 years of relevant claims processing experience, preferably in a health care environment or a minimum of six months of internal claims processing experience.

Southeastrans, Inc.

Claims Analyst

The Claims Corrections Analyst is responsible for processing all claims corrections in the system, including voids, history corrections, stop payment and refunds. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.

HCSC

Claims Correction Analyst - LHB

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Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes.

National Interstate Corporation

Claims Processing Tech II - Hybrid

The claims escalation analyst monitors liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure that payments are made. Accurately evaluates each account in order to determine what is needed, what is left outstanding and what steps are necessary to resolve the account quickly.

Lake Charles Memorial Health System

Claims Escalations Analyst

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Researches simple to complex claims payments using tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources to validate overpayments made to providers. Enters and updates recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy; processes claims as a refund or auto debit in claim systems and in recovery application.

Molina Healthcare Inc.

Specialist, Claims Recovery-Spokane Office

Specialist, Claims Recovery-Spokane, WA Office

Requsition ID: 463856 Company: Pacific Medical Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 3060 WA USFHP Address: WA Renton 620 Naches Ave SW Work Location: Blackriver Corporate Park-Renton Workplace Type: Hybrid Pay Range: $25.61 - $39.88 Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.

Pacific Medical Center Inc

Senior Claims Specialist

In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. Minimum Requirements: Minimum three-years life and/or disability claim administration experience: solid investigation, analytical and organizational skills along with attention to detail; or the equivalent combination of relevant experience.

Sr Claims Analyst - LHB

As a Lead Claims Specialist supporting the US Family Health Plan (USFHP) at Pacific Medical Centers, you'll be the go-to authority for adjudicating purchased services claims for our enrolled capitated population - resolving complex claim situations, managing advanced processing needs, responding to customer service requests with accuracy and efficiency, and applying your expertise in TRICARE reimbursement to ensure compliant, timely claims resolution for our military beneficiary population. Requsition ID: 460401 Company: Pacific Medical Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 3060 WA USFHP Address: WA Renton 620 Naches Ave SW Work Location: Blackriver Corporate Park-Renton Workplace Type: Hybrid Pay Range: $26.90 - $41.89

Lead Claims Specialist - USFHP

Requsition ID: 447122 Company: Pacific Medical Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 3060 WA USFHP Address: WA Renton 620 Naches Ave SW Work Location: Blackriver Corporate Park-Renton Workplace Type: Hybrid Pay Range: $21.55 - $33.53 Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.

Claims Specialist - USFHP

The Analyst uses established Power BI reports to analyze payor adherence to contracted fee schedules, recognizes patterns of incorrect payment, and leads project-level remediation efforts covering underpayments, incorrect claims adjudication, credentialing-related issues, and payor policy misapplication. The Analyst prepares the reporting and data files that drive payor remediation projects and works closely with Revenue Cycle leadership, FP&A, Accounts Receivable management, billing, and credentialing to recover underpayments, resolve payor issues, and implement forward-looking process improvements.

Optima Dermatology

Payor Reimbursement & Claims Remediation Specialist

The Claims Department Manager partners closely with the Director of Claims and other organizational leaders to identify and communicate business needs, implement operational improvements, support strategic initiatives, and drive process efficiencies. This position oversees claims supervisors, claim support functions, and operational initiatives to ensure timely, accurate and compliant processing of claims while meeting client, regulatory, financial, and customer service expectations.

Insurance Administrative Solutions LLC

Manager, Claims

Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.

Guide Well

Claims Examiner I

The Clinical Pharmacist reviews claims in real time, recommends therapeutic interchanges and other clinical savings opportunities, runs Pulse's cost containment programs, produces client reporting, and is part of the team that communicates directly with members, prescribers, and clients, including at quarterly business reviews. Recommend therapeutic interchanges, generic and biosimilar alternatives, and other lower-net-cost options that maintain or improve clinical outcomes, and coordinate with prescribers and members to put changes in place.

Claims Processor Jobs in the United States

Project Manager Axelon

Claims Processor (53334) GlobalHealth, Inc.

Dental Claims Processor DY MANAGEMENT CONSULTANTS LLC

Insurance Claims Processor I United Regional Health Care

Senior Manager, Claims Systems CollectiveHealth, Inc.

Program Manager, Health Plan Payment Integrity (Claims & Recovery) Remote Molina Healthcare Inc

Claims Analyst Southeastrans, Inc.

Claims Correction Analyst - LHB HCSC

Claims Processing Tech II - Hybrid National Interstate Corporation

Claims Escalations Analyst Lake Charles Memorial Health System

Specialist, Claims Recovery-Spokane Office Molina Healthcare Inc.

Specialist, Claims Recovery-Spokane, WA Office Molina Healthcare Inc.

Senior Claims Specialist Pacific Medical Center Inc

Sr Claims Analyst - LHB HCSC

Lead Claims Specialist - USFHP Pacific Medical Center Inc

Claims Specialist - USFHP Pacific Medical Center Inc

Payor Reimbursement & Claims Remediation Specialist Optima Dermatology

Manager, Claims Insurance Administrative Solutions LLC

Claims Examiner I Guide Well

Clinical Pharmacist (Pulse PBM) ReviveHealth

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