Assists in handling coverage applications and claims processes.
Helps share complex information about life and accident benefits.
Operates professionally while helping with sensitive situations.
PEHP Health & Benefits, a division of the Utah Retirement Systems, provides medical, dental, life, and long-term disability insurance plans. They are a government entity committed to customer value, market excellence, and healthcare improvement, offering competitive salaries, generous benefits, and work-life balance.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Responsible for complete, accurate and timely processing of all designated claims.
Investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership.
Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims.
Liberty Mutual provides insurance products and services. They aim to create a workplace where everyone feels valued and supported, offering comprehensive benefits and professional development opportunities to foster an inclusive culture where employees can thrive.
Investigate and determine whether medical insurance claims are recoverable from a liable third party.
Communicate and negotiate with healthcare plan members, insurance adjusters, and attorneys.
Utilize computer systems to accurately document collected information.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. With over 85 health plans and 270 million lives represented, we bring together a configurable, AI-powered platform along with expertise.
Relaying participant eligibility information to insurance carriers via email, fax or mail following standard operating practices.
Performing day-to-day data entry tasks and other clerical support tasks to facilitate the capture, transfer and maintenance of accurate and timely data/records.
Answering questions or explaining information to clients and participants, reviewing files, records and other documents to obtain information for a response to requests regarding a benefit plan or personal participant account status/activity.
HealthEquity's mission is to SAVE AND IMPROVE LIVES BY EMPOWERING HEALTHCARE CONSUMERS. They aim to make HSAs as widespread and popular as retirement accounts, providing solutions that allow American families to connect health and wealth.
Assists WC department with handling of claim tasks.
Issues medical records payments once approved by adjuster.
Maintains accurate diaries on all incident only claims.
EMC is focused on working together to create a meaningful impact. They strive to nurture growth, encourage contribution, and facilitate valuable experiences for their team members, aiming to be supportive leaders, partners, and experts.
Enroll and revalidate doctors and facilities with payors.
Process applications for licensing, permits, certifications, insurances, and relevant credentialing documents.
Review incoming insurance correspondence and mail and maintain and update credentialing spreadsheets accordingly.
CHOICE is the largest provider of pediatric dental care in the Southwest United States. They pride themselves on delivering high quality care to children in their communities.
Review EMRs to resolve patient inquiries and conduct insurance verification.
Handle a high volume of patient telephone calls and provide excellent customer service.
Document calls, resolve patient inquiries, and perform other assigned duties.
Stony Brook CPMP provides comprehensive healthcare services. While the employee count is not mentioned, they focus on delivering high-quality patient care and maintaining a supportive work environment.
Prepare documentation, review claim history, and investigate requests.
Utilize available resources to investigate claim situations for cases.
Follow-up with responsible departments and delegated entities to ensure compliance.
Centivo is an innovative health plan for self-funded employers, aiming to provide affordable, high-quality healthcare. They work with employers ranging in size from 51 employees to Fortune 500 companies and are headquartered in Buffalo, NY with offices in New York City and Buffalo.
Manage the insurance claims process and provide customer service to clients.
Analyze and approve claims and determine coverage based on medical necessity.
Resolve discrepancies, secure proper reimbursement, and follow regulations and guidelines.
CommuniCare Family of Companies delivers person-centered care as a national leader in post-acute care. They operate over 150 facilities, employing more than 19,000 employees across six states, and are dedicated to improving the lives of seniors.
Be responsible for department quality audit process related to service standards, adherence to procedural, regulatory and financial requirements.
Review the referral of, submit, monitor and track all subrogation referrals receive by the Claim department and forwarded to external vendors.
Handle overpayment, check void and refunds, including maintenance of the overpayment log.
Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With its entrepreneurial culture and a strong emphasis on analytics, they can help employers better manage their risk.
Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Coordinate with clients to gather information for unemployment claims.
File appeals to determinations with state agencies.
Prepare and submit responses to state requests.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. As a FTSE 100 Index company, they have a team of 22,500 people across 32 countries and are listed on the London Stock Exchange (EXPN).
Serve as first level system support for each assigned client
Perform ongoing audits and file reviews, ensuring data and results accuracy
Execute research and analysis to resolve participant cases
Bswift has been transforming benefits administration since 1996, making it simpler, smarter, and more human. They serve thousands of companies and millions of people nationwide, reducing administrative burdens and freeing HR teams to focus on creating thriving, people-first workplaces.
Create a welcoming experience by authentically engaging every caller, every time.
Thoroughly and accurately answer questions about customers’ healthcare accounts.
Thoughtfully listen to callers’ needs and provide appropriate solutions.
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. They research the most effective cost containment strategies and are driving down the cost of plans with innovative solutions.
Promptly and accurately record all provider information.
Monitor status of payer applications to ensure completion.
Initiate and follow through on all aspects of provider credentialing.
UnityPoint Health is committed to team members and is recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, and provide employees with support and development opportunities.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Assisting with provider credentialing by collecting documentation, entering provider data, submitting required materials to the health plan, tracking completion, and updating internal records.
Maintaining and updating provider records from various sources in internal systems to ensure accuracy and completeness.
Supporting reporting requirements, including completing health plan reports on assigned schedules.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Powered by AI and Healthguides™, Guidehealth builds connections with patients and providers.