Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Western Region CBO The Western Region Consolidated Business Office provides business office services including billing, collections, cash posting, pre access management, variance and customer service to our affiliated UHS facilities. We are seeking dynamic and talented individuals to join our team. Job Description Responsible for the maintenance and processing of patient

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary This position is responsible for pr

Under the leadership of Patient Financial Services (PFS) management, the Account Specialist II is responsible for accounts receivable through claim follow up, cash collection, and denial management for services rendered by Cook Childrens Medical Center (CCMC). This positon requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies,

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The Corporate Insurance team at UHS is looking for motivated Senior Program Manager Claims to join our innovative team and contribute to the maintaining of a rolling diary of claims. This position will be located in Dallas, TX. Essential Job Duties Maintain a rolling diary of 150 175 claims at any given time. Work with Risk and Defense counsel will be available to assist

Putting People First in Pharmacy Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. W

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The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Work under normal supervision with an intermediate level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units. Resolve coverage questions, take statements and establish clear evaluation and resolution plans for claims. W ill earn a competitive salary of $62,281 $76,000 annually with annual bonus potential base

At Alcon, we are driven by the meaningful work we do to help people see brilliantly. We innovate boldly, champion progress, and act with speed as the global leader in eye care. Here, you'll be recognized for your commitment and contributions and see your career like never before. Together, we go above and beyond to make an impact in the lives of our patients and customers

Processing of appraisal requests from various commercial lending groups and the Special Assets Group. Creating detailed Requests for Proposals (RFP's) to procure bids on each assignment from eligible vendors within established SLA's. Contractually engaging the selected vendor within established SLA's. Monitoring the progress through appraisal completion/delivery, while ad

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. This

Claims Specialist, Commercial Surety Bond Claims Morristown, NJ or Remote Job Locations US NJ MORRISTOWN Job ID 2024 3789 Category Claims Type Regular Division Surety Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insuranc

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th