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Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description 75% Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. 20% Resolves
Posted 1 day ago
Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description 70% Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system af
Posted 1 day ago
Responsible for responding to customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 45% Ensures effective custome
Posted 1 day ago
Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Description Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
Posted 1 day ago
Job Description Summary Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non medical appeals. Determines whether to return, deny or pay cla
Posted 1 day ago
Complete desk reviews for various healthcare providers. Maintain knowledge of CMS regulations and guidance, as well as knowledge and ability to use PC and applicable software to complete assignments. Ensure timeliness and quality expectations are met for all processes. Track progress of multiple workload assignments through completion to ensure timeliness and quality expectations are met. Descrip
Posted 1 day ago
Manages a team of analysts in the accurate and timely retrieval, compilation, and distribution of data reports routinely used by internal departments and customers to make critical business decisions. Analysis may include medical costs and trending for senior management, clinical measures, limited underwriting, and provider and operations based analytics. May serve as lead of senior executive comm
Posted 1 day ago
Provides direction and guidance to customer service staff. Description 75% Directs and motivates staff responsible for accurately responding to calls, email, web, and/or written inquiries. Monitors compliance with business or contractual requirements. 15% Responsible for the coordination of customer feedback and the resolution of operational issues involving one or more functional departments. 1
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries. 15% Initiates minor /clerical adjustments based on provider request or processes adjustments or perfo
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 47 more...
Involved in all aspects of the Molecular Diagnostic Program (MoIDX) laboratory operations and serves as an internal subject matter expert, applying medical knowledge to advise decisionmakers in support of MoIDX's mission. Responsible for review and approval of documentation and reports, supporting clinical testing strategies, as well as new assay development and validation. Serves as an ambassador
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizati
Posted 1 day ago
Responsible for responding to customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 45% Ensures effective custome
Posted 1 day ago
Monitor and/or reconcile assigned general ledger accounts of a complex nature, process complex accounting activity, resolve variances, and/or document procedures to ensure accuracy of accounting information and/or financial reports, and/or compliance with established rules and/or regulations. Provide functional advice and/or training to less experienced accountants. Description 30% Prepares dail
Posted 1 day ago
Plan, design, and develop complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software development methodologies. Description 25% Develop functional design and technical s
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk in inquiries. Handles s
Posted 1 day ago
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