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Hybrid in Baltimore, Maryland

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4d ago

Claims AdjusterIntroduction:Immediate position for a Claims Adjuster / Processor! The selected candidate will process claims AND investigate/perform adjustments of complex Healthcare (payor) claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. The selected candidate will verify healthcare insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line

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Contract

22 - 25

Claims Adjuster

Remote

•

Yesterday

Company Description Lumen SolutionsGroupInc. is a technology consulting Services company based inFlorida. Weprovidea wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, EnterpriseTransformation. Role:Claims Adjuster Location:Baltimore, MD(Remote) Type: Contract Position Overview We

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Contract

Depends on Experience

Medical CLAIMS ADJUSTER

Hybrid in Baltimore, Maryland

•

Yesterday

Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. ESSENTIAL FUNCTIONS: 60% Proactively investigate and perform adjustments of claims. Ensu

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Contract

Depends on Experience

Claims Representative - Liability W2 only

Remote

•

5d ago

Position: Claims Representative - Liability Duration: 02+ Months contract length. Contract extension and/or Conversion to direct employee is possible Location: 100% Remote ship Required. Manager Notes: Any specific skill/ certification/ experience: 3-4 years bodily injury claims low exposure up to 25KYears of experience: 3-4years Job Description: Duties: To process low level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards a

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Contract

20 - 25

Senior Business Analyst Claims module

Remote

•

5d ago

Hiring for Senior Business Analyst Location - Remote Senior Business Analyst Claims module: Play the role of Claims Domain lead for MMIS health care projects. Drive the claims module and process, domain knowledge, performs analysis of business requirements, designs and develops documentation, ensures quality process, coordinates with customers. Works in team environment and provides guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in th

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Full-time

$60,000 - $80,000

Claims Examiner - Workers Compensation W2 Only

Remote

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5d ago

Position: Claims Examiner - Workers Compensation Duration: 03+ Months contract length. Contract extension and/or Conversion to direct employee is possible Location: Remote in California Pay Range: $52/hr to $56/hr on W2 without Benefits ship Required. Manager Notes: Experience - min 3 years of experience is needed. Public entity and County of Los Angeles Experience is a plus.SIP is mandatory.Shift timings: 8:00 4:30 Primary Purpose: To analyze complex or technically difficult workers'' compen

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Contract

52 - 56

Claims Domain Test Manager - Remote with limited travel

Remote

•

15d ago

Claims Domain Test Manager Location: Atlanta, GA or remote with limited travel during critical phases 6+ months contract to Hire Play the role of Claims Domain test manager for MMIS health care projects. Drive the test strategy and process, domain knowledge, performs analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life

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Contract, Third Party

Depends on Experience

Programmer Analyst - (Claims - Pharmacy / medical)

Remote

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22d ago

Medical Claims or Pharmacy claims or membership information. SQL Server and SQL writing Some recent experience with Data modeling & Data Warehousing (Any platform is ok, does not have to be snowflake) EDI transaction experience API integration into Data Warehouse with EDI 834 and 837.

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Contract

$50 - $60

Claims Project Manager

Remote

•

Today

Job Title: Claims Project Manager Job Location: Remote / Home Based Description: AgreeYa is a global Systems Integrator and is seeking an experienced Claims Project Manager / Scrum Master to join our growing team. The ideal candidate will have a strong background in healthcare or insurance claims processing, project delivery, and Agile methodologies. This role requires dual responsibility as both a Project Manager and Scrum Master, leading large-scale platform modernization and transformation

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Contract

Depends on Experience

Physician Emergency Department Claims Reviewer

Remote

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7d ago

< data-start="65" data-end="90">Required Skills:Active US Physician license (MD/DO).35 years of recent clinical experience (within the last 23 years) in Emergency Department (ED) Medicine.Experience in Internal Medicine is also acceptable.Experience in Managed Care environments.Expertise in conducting clinical review of claims and UM authorization requests for medical necessity.Hands-on experience with Utilization Management (UM) case reviews.Knowledge of medical coding, including CPT and HCPCS

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Contract

Depends on Experience

Physician ED Claims Reviewer

Remote

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7d ago

Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various system

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Third Party, Contract

Depends on Experience

Healthcare Claims Integration Consultant

Remote

•

Today

Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) Location Remote (USA) Overview We are seeking a highly experienced Healthcare Claims Integration Consultant to support a strategic healthcare initiative focused on dual claims processing, payer integration, and cost optimization in collaboration with Aetna and related healthcare programs. This role is critical to supporting a large-scale healthcare transformation involving Medicare and Medicaid coordination, dua

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Contract

Depends on Experience

Workers Comp, Lost Time Claims Subject Matter Expert (User Research) - AI SaaS

Remote or New York, New York

•

Today

About Us: EvolutionIQ's mission is to deliver state of the art technology that helps insurance claims teams make claims handling more accurate, fair, and efficient, so that more people impacted by injury or illness can continue their lives with dignity and stability. We are currently experiencing massive growth and to accomplish our goals, we are hiring world-class talent who want to help build and scale internally, and transform the insurance space. Our team is our #1 priority, and we have been

Full-time

Senior Healthcare Business Analyst (Payer Claims / Medicare / Medicaid)

Remote

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11d ago

Job Title: Senior Healthcare Business Analyst (Payer Claims / Medicare / Medicaid)Location: [Remote]Employment Type: Full-Time Job DescriptionWe are seeking an experienced Senior Healthcare Business Analyst with extensive knowledge of the healthcare payer domain and strong expertise in commercial claims processing, Medicare, and Medicaid systems. The ideal candidate will serve as a liaison between business stakeholders and technical teams, driving requirements gathering, solution design, and su

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Full-time

$60,000 - $80,000

Claims Resolution Representative

Remote

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Today

Claims Resolution Representative: Remote Job Summary: The Claims Resolution Representative plays a vital role in ensuring accuracy and adherence to the applicable guidelines. This position serves as a crucial liaison between members, providers, agencies, and the internal claims department, demonstrating leadership, collaborative skills, and commitment to achieving results. *This position is remote within the United States, but applicants can expect to work Eastern Time regular business hours wit

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Full-time

Depends on Experience

Claims Specialist

Remote

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11d ago

Position: Claims Specialist Location: Remote Duration: FTE/ Direct Hire Responsibilities: To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments. Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous) Review and analyze medical information (i.e. attending physician

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Full-time

45000 - 50000

Technical Analyst(RCM and Claims)

Remote

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6d ago

Role Technical Analyst(RCM and Claims) Location Remote Job Description: Note - We need technical people who can write/run SQL Queries. Role Overview: Develop Revenue Cycle Data product strategy in partnership with product directors, product managers, peers in Architecture and Delivery, and ADDG Leadership Team. Manages the strategy and lifecycle of products, features and/or enhancements from conceptualization through requirements gathering, product specification and roadmap, imp

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Third Party, Contract

Depends on Experience

Business Analyst (Healthcare Claims)

Remote

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6d ago

Job title : Business Analyst Location : Remote Employment Type : Fulltime Senior Business Analyst Claims module: Play the role of Claims Domain lead for MMIS health care projects. Drive the claims module and process, domain knowledge, performs analysis of business requirements, designs and develops documentation, ensures quality process, coordinates with customers. Works in team environment and provides guidance throughout the entire life cycle. Responsible to meet customer expectations, troub

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Full-time

Depends on Experience

Life Insurance Claims Specialist

Remote

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12d ago

Our client, a major Life Insurance carrier is seeking a Life Insurance Claims Specialist for a long term (2 year minimum) contract position. This job can be worked remotely. The Life Insurance Claims Specialist will review contestable death claims, life insurance policy reinstatement requests, and evaluate Medical Information Bureau (MIB) inquiries for an existing book of business. Life Insurance Claims Specialist responsibilities include the following: Contestable claims review will require an

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Contract

$40 - $45

Epic HB Claims Analyst

Remote

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8d ago

Job SummaryWe are seeking an experienced Senior Epic Resolute Revenue Cycle Analyst/Administrator to support, optimize, and enhance Epic Hospital Billing (HB), Professional Billing (PB), and Single Billing Office (SBO) applications. The ideal candidate will possess extensive experience in Epic Revenue Cycle operations, system configuration, workflow optimization, claims management, and revenue integrity initiatives. This role will partner with revenue cycle leadership, finance teams, operational

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Third Party, Contract

60 - 65

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