1 to 15 of 65
Sort by: Date | Relevance
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk in inquiries. Accurately documents inquiries. 15% Initiates or processes adjustments or performs other research as needed t
Posted 1 day ago
Screen, code and key claims in claims system. Ensure claims are processed in a timely manner. Description 80% Screen, code and key claims to ensure proper and accurate adjudication of claims in accordance with departmental standards for quality and production, contract regulations, policies and guidelines. 10% Correct keying errors as noted by system edits. 10% Accurately use medical review form
Posted 1 day ago
Provides education and training for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces all training and educational materials. Description 60% Develops/prepares/reviews/updates all provider education materials. These may include web based training, computer based training, ACT (ask the contractor) calls, outreach presentations/proposals
Posted 2 days ago
Ensures claims can be processed timely to meet departmental goals by reviewing claims for proper information. Returns claims or requests missing information. Description 50% Investigate claims in order to provide information that is missing or cannot be determined by processors. Contacts providers and members to obtain information necessary to process claims. 30% Screens, codes, counts, sorts,
Posted 1 day ago
Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
Posted 3 days ago
Ensures claims can be processed timely to meet departmental goals by reviewing claims for proper information. Returns claims or requests missing information. Description 50% Investigate claims in order to provide information that is missing or cannot be determined by processors. Contacts providers and members to obtain information necessary to process claims. 30% Screens, codes, counts, sorts,
Posted 1 day ago
Responsible for the management and daily operations of the technical staff responsible for devising logical, automated statistical analysis programs and procedures. Description 30% Manages the activities of research and analysis staff responsible for complex statistical analysis programming and sophisticated data interpretation to support customer requirements. 20% Maintains effective communicat
Posted 3 days ago
Screen, code and key claims in claims system. Ensure claims are processed in a timely manner. Description 80% Screen, code and key claims to ensure proper and accurate adjudication of claims in accordance with departmental standards for quality and production, contract regulations, policies and guidelines. 10% Correct keying errors as noted by system edits. 10% Accurately use medical review form
Posted 1 day ago
Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description 65% May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may
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
We are seeking a motivated Federal Business Development and Capture Manager to provide the full cycles sales process regarding new business development in the federal health care marketspace. Manages all activities of proposal development. Responsible for searching out, understanding, verbally articulating detailed analysis of RFPS, RFIS, RFQS, and other documents. Collaborates with management, Su
Posted 1 day ago
Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Description 35% Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre set auth
Posted 3 days ago
BlueCross BlueShield of South Carolina
- Birmingham, AL / Jackson, MI / Virginia Beach, VA / 5 more...
Responsible for the sales, service, and administrative activities and relationship management to prospective and existing accounts. Customarily and regularly engaged in outside sales. Description 50% Responsible for renewal and management of existing accounts. Maintains strong service relationships with clients and agents. Researches/compiles presentations and sales materials as needed. Coordina
Posted 3 days 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 custom
Posted 1 day ago
Responsible for training activities in an assigned area(s). Note some areas may require varying degrees of emphasis or concentration within this general description. Description 70% Follows project methodology to design, develop and implement trainings to include facilitating technical and non technical training from beginning to end. Responsible for revising, and updating training courses, curr
Posted 3 days ago
Email this Job to Yourself or a Friend
Indicates required fields