Resolve denied claims by reviewing supporting documentation, calculating benefits due, and composing appeal letters.
Analyze claims to determine validity of denial/recovery options and draft convincing correspondence to effect reimbursement.
Build relationships with insurance carriers, patients, attorneys, and employers while documenting all actions to resolution.
Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists, it is one of the fastest-growing privately-held companies in North America with a passionate, fast-moving culture.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Accurately review, process, and adjudicate health insurance claims in compliance with company policies and regulatory requirements.
Resolve system edits, audits, and claims errors through research and approved references.
Contribute to team-wide goals by processing claims and reducing daily inventory.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started in 2012 to create the kind of health insurance company we would want for ourselves, and we are a growing team committed to changing health care.
Analyze hospital claims to identify discrepancies between expected and actual insurance reimbursements.
Investigate underpayments and payment variances by examining coding errors, billing discrepancies, and payer policies.
Collaborate with insurance carriers and internal stakeholders to resolve billing issues and improve revenue recovery outcomes.
This partner company specializes in healthcare revenue integrity, helping hospitals recover appropriate reimbursement for services. The team fosters a collaborative, inclusive culture focused on continuous improvement and professional development.
Oversee day-to-day claims operations and provide technical leadership to resolve complex issues.
Implement policies and procedures compliant with state and federal regulations to ensure accuracy and timeliness.
Monitor claims quality, identify trends, and drive process improvements for operational excellence.
Centene provides access to high-quality healthcare and innovative health solutions to help people live healthier lives. It values diversity and offers a supportive culture with flexible work options.
Turn complex medical and pharmacy claims data into actionable insights for healthcare outcomes.
Develop and maintain analytical tools and support real-world evidence studies.
Collaborate with clinical, product, and technology teams to improve data integration and automation.
Jobgether is an AI-powered job matching platform that connects candidates with employers. It streamlines applications by sharing top-fitting candidates directly with hiring companies.
Research and resolve premium payment exceptions and discrepancies in premium reports.
Process premium payments through approved electronic systems, including E-Pay and Virtual Terminal.
Communicate with insureds, producers, and internal departments to support accurate and timely premium administration.
Protective helps protect customers against life's uncertainties by providing insurance and financial protection. It fosters a culture focused on employee wellbeing, offering comprehensive benefits and an inclusive workplace.
You advise clients on benefits package design and analyze financial models for renewals.
You manage RFP processes and analyze carrier proposals to guide client decisions.
You collaborate with internal teams to ensure smooth open enrollment and continuous improvement.
Melita is an HR, Benefits, and Payroll outsourcing company serving small and mid-sized employers in the U.S. and abroad. Founded over 30 years ago, we are a results-driven organization known for our high-integrity approach to building relationships with clients and partners.
Process medical claims and appeals accurately and timely, following health plan policies and procedures.
Maintain detailed notes, research claim issues, and communicate outcomes with claimants and teams.
Support customer success teams, escalate operational issues, and help improve claims processes.
Sana is a health plan solution built for small and midsize businesses, with integrated primary care services to make healthcare easy. Founded in 2017, the company is remote-first with a fully distributed team across the U.S., and values curiosity, ownership, and speed.
Build and maintain healthcare analytics tools to improve medical and prescription medication use.
Develop Evio's digital health tools that deliver real-time clinical insights to physicians at the point of care.
Collaborate with clinicians and technology teams to analyze claims data and enhance ETL processes.
Evio is a pharmacy solutions company founded by health plans to transform how high-cost medications are delivered. With backing from Blue Cross Blue Shield plans serving over 20 million members, Evio values culture, diversity, and transparency.
Manage AR portfolios, denial analysis, and aging accounts.
Develop dashboards and reports to identify performance gaps.
Collaborate with teams to drive revenue cycle improvements.
They help healthcare organizations improve financial performance and revenue cycle operations through data-driven analysis and automation. They foster a collaborative culture focused on innovation, professional growth, and continuous improvement.
Conduct job evaluations, market pricing, and salary benchmarking to assess internal equity and external competitiveness.
Support the design and administration of compensation programs, including salary structures, merit increases, and incentive plans.
Collaborate with HR, Payroll, and stakeholders to provide actionable insights and maintain data integrity.
Our partner is a dynamic, remote-first organization focused on strategic Total Rewards and compensation initiatives. The culture emphasizes collaboration, data integrity, and continuous improvement in a fast-paced environment.
Acquire investigative techniques and work with experts to determine accident causes and fault.
Independently manage a claims inventory, including investigations, medical record reviews, and damage evaluations.
Resolve cases by negotiating settlements with individuals or attorneys.
Liberty Mutual is a leading property and casualty insurer helping people embrace today and confidently pursue tomorrow. They are a Fortune 100 company recognized as a Great Place to Work and one of Forbes' best employers for diversity and new graduates.
Independently adjudicate complex life and health claims, including contestable, accidental death, and accelerated death benefit cases.
Collaborate with claimants, attorneys, reinsurers, and internal teams to gather evidence and determine liability.
Analyze medical records, underwriting evidence, and investigative findings to make well-supported claim decisions.
Banner Life Insurance Company provides life insurance and financial protection products, focusing on long-term customer and community impact. The company values meaningful work, professional development, and a collaborative culture of ambition and wellbeing.
Manage recovery files from initial review through resolution, identifying third-party reimbursement opportunities.
Investigate claims, coordinate with attorneys, adjusters, and carriers, and negotiate recovery matters.
Review plan documents, ensure HIPAA compliance, and maintain a high-volume caseload with strict deadlines.
The company focuses on recovering healthcare costs for benefit plans, ensuring affordable health benefits for employees and their families. It is recognized for an inclusive, collaborative, and respectful workplace culture, and has received regional and national workplace awards.
Conduct investigations and inspections to assess damage, estimate costs, and determine settlement amounts.
Analyze medical, financial, and job information to determine eligibility for benefits based on statutory criteria.
Settle claims in accordance with standards and negotiate with all parties involved to ensure smooth processing.
Desjardins Group is the largest cooperative financial group in North America, offering a full range of financial products and services. With over 52,000 employees and named one of Canada's top employers, they foster a people-first culture and are committed to equity, diversity, and inclusion.
Serve as the department's subject matter expert on stop loss administration, reimbursement, and contract interpretation.
Conduct regular audits of claim submissions and tracking, then implement corrective actions to improve accuracy and efficiency.
Onboard and coach new Stop Loss Specialists while maintaining training materials and leading process improvement initiatives.
Personify Health offers a personalized health platform that brings health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The company is mission-driven and focused on empowering people to lead healthier lives, with a culture that values diverse perspectives.
Provide subject matter expertise on Payment Integrity claims processing edits, vendor edits, and reimbursement policies.
Respond to internal and external inquiries and disputes while documenting industry standard coding rules and recommending policy changes.
Collaborate with partners to scope, prioritize, and deliver solutions using data insights and process improvements.
Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members. Founded in 2012, the company fosters a culture of transparency, collaboration, and authenticity as an Equal Opportunity Employer.
Acts as a central point of contact and provides analytical problem-solving support to Commercial and Medicare Appeals and Grievances staff.
Researches, analyzes, and implements changes to processing procedures to increase department efficiency and meet regulatory compliance.
Supports training, documentation, and compliance activities while serving as a subject matter expert on appeals module configuration.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, providing health insurance and wellness programs. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."