UNKNOWN

FEED

Support the Claims Department with ongoing efficiency improvements; perform project management, resolve problematic claims processing issues utilizing research and analysis to determine root causes; identify and recommend corrective actions;ensure successful system and procedural modifications. Lead cross-functional teams (Payment Integrity, Provider Claims Resolution, Grievance and Appeals, Provider Network Management, Customer Service) to track/monitor the resolution of Claims Issue (medical, hospital and dental) for HMO/PPO claims (Facets).

YEAR

EmblemHealth Inc

Senior Claims Project Specialist (Facets Required)

RN Clinician is responsible for reviewing provider post-payment inquiries and claim reconsiderations to ensure accurate coding in accordance with established coding guidelines, CMS guidelines, Health Plan Coding Payment Policy, and Claim Payment Policy. Ensures compliance with health plan policy and other regulatory agencies such as Bureau of Insurance (BOI), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and Virginia Department of Medical Assistance Services (DMAS).

Sentara Healthcare employees strive to make our communities healthier places to live, and we're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. Sentara hospitals, programs, and employees are consistently recognized for innovation, clinical achievements, and overall excellence.

Sentara Healthcare Inc

Clinical Claims Reviewer/ RN

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders.

Markel Corporation

Senior Claims Examiner, Excess Construction

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ADAPTED_NOW

This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. .  . Lead AI solutions in Claims: FNOL intake and triage, document and email intake (OCR/IDP, i.e. optical character recognition and intelligent document processing), claim summarization, fraud and SIU (special investigations unit) signals, reserving support, litigation prediction, and adjuster copilots.

IT Director, Claims

Markel Corporation jobs

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, and show measurable results in edit accuracy, speed, or client value. The ideal candidate brings deep clinical editing and coding expertise, a strong analytical instinct, and an open, practical interest in how AI can help us build better content, faster, while keeping quality and clinical accuracy at the center.

Machinify

Content Innovation, Claims Editing Multiple Levels

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking New York policy changes, and show measurable results in edit accuracy, speed, or client value. You will learn Machinify's content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current New York Medicaid coverage against state policy; and deliver a prioritized list of New York content gaps and opportunities.

Content Innovation, Claims Editing - NY Medicaid Multiple Levels

Content Innovation, Claims Editing (Multiple Levels)

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking new approvals, label changes, and HCPCS updates, and show measurable results in edit accuracy, speed, or client value. You will learn Machinify's content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current drug editing coverage against high-cost therapeutic areas; and deliver a prioritized list of specialty drug content gaps and opportunities.

Content Innovation, Claims Editing - Specialty Pharmacy Multiple Levels

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking new approvals, label changes, and HCPCS updates, and show measurable results in edit accuracy, speed, or client value. You will learn Machinify’s content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current drug editing coverage against high-cost therapeutic areas; and deliver a prioritized list of specialty drug content gaps and opportunities.

Content Innovation, Claims Editing – Specialty Pharmacy (Multiple Levels)

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking New York policy changes, and show measurable results in edit accuracy, speed, or client value. You will learn Machinify’s content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current New York Medicaid coverage against state policy; and deliver a prioritized list of New York content gaps and opportunities.

Content Innovation, Claims Editing - NY Medicaid (Multiple Levels)

You’ll help design the future of how we do it by working closely with our software engineering team to fine-tune internal tools and make our platform even better. Deep familiarity with dental billing software and comfort with tools like Google Workspace, Slack and remote connection softwares.

DayDream

DayDream Claim Specialist

Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.

HOUR

Ensemble Health Partners

Patient Access Specialist - PRN

Appcast Exclusive 1

Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving and processing physician orders, and utilizing a overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.

Patient Access Specialist - PT 28 Hours Weekly Emergency Department

Patient Access Associate Specialist - Full Time

Patient Access Specialist - Part Time

Responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving and processing physician orders, and utilizing a overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.

Insurance Claims Specialist Jobs in the United States

Senior Claims Project Specialist (Facets Required) EmblemHealth Inc

Clinical Claims Reviewer/ RN Sentara Healthcare Inc

Senior Claims Examiner, Excess Construction Markel Corporation

IT Director, Claims Markel Corporation

Content Innovation, Claims Editing Multiple Levels Machinify

Content Innovation, Claims Editing - NY Medicaid Multiple Levels Machinify

Content Innovation, Claims Editing (Multiple Levels) Machinify

Content Innovation, Claims Editing - Specialty Pharmacy Multiple Levels Machinify

Content Innovation, Claims Editing – Specialty Pharmacy (Multiple Levels) Machinify

Content Innovation, Claims Editing - NY Medicaid (Multiple Levels) Machinify

DayDream Claim Specialist DayDream

Patient Access Specialist - PRN Ensemble Health Partners

Patient Access Specialist - PT 28 Hours Weekly Emergency Department Ensemble Health Partners

Patient Access Associate Specialist - Full Time Ensemble Health Partners

Patient Access Specialist - Part Time Ensemble Health Partners

Patient Access Specialist FT Ensemble Health Partners

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