We have other current jobs related to this field that you can find below
-
Claims Adjudicator I
6 days ago
Aurora, United States UNITE HERE HEALTH Full timeUNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more...
-
Claims Adjudicator I
1 month ago
Aurora, United States UNITE HERE HEALTH Full timeJob DescriptionJob DescriptionUNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging....
-
General Liability Claim Handling Examiner/Adjuster
3 months ago
Aurora, United States Sedgwick Full time**The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** General Liability Claim Handling Examiner/Adjuster (On-Site/Sign-On Bonus)IF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both challenging and rewarding, join Sedgwicks talented team...
-
Cost Containment Specialist
3 months ago
Aurora, United States UNITE HERE HEALTH Full timeJob DescriptionJob DescriptionUNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging....
-
Aircraft Mechanic II
2 months ago
Aurora, United States Life Flight Network Full timeJob DescriptionJob DescriptionLife Flight Network is one of the most prominent not-for-profit air ambulance organizations. As the industry's trailblazers, we constantly raise the bar for safety, excellence, social justice, and innovation in the skies and on the ground.Being a member of our esteemed team means embarking on a career defined by distinction,...
-
Project Cost Accountant
3 weeks ago
Aurora, United States Weifield Group Contracting Full timeDescriptionAre you an accounts payable professional with 1 or more years accounting experience? Are you known for your ability to execute within your area of expertise? Do you want to be a part of a fast-growing company with endless opportunities to expand your skills, achieve your financial goals, and be in the driver's seat for your own career in...
-
Java Software Engineer II
1 week ago
Aurora, United States Raytheon Full timeDate Posted:2024-08-23Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java Software Engineer II
1 day ago
aurora, United States Raytheon Full timeDate Posted:2024-08-23Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java Software Engineer II
7 days ago
Aurora, United States Raytheon Full timeDate Posted:2024-08-23Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java Software Engineer II
2 days ago
aurora, United States Raytheon Full timeDate Posted:2024-08-23Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java/C++ Software Engineer II
4 weeks ago
Aurora, United States Raytheon Full timeDate Posted:2024-06-12Country:United States of AmericaLocation:CO106: 16470 East Hughes Drive,Aurora 16470 East Hughes Drive Building S77, Aurora, CO, 80011 USAPosition Role Type:Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java/C++ Software Engineer II
2 months ago
Aurora, United States Raytheon Full timeDate Posted:2024-06-12Country:United States of AmericaLocation:CO106: 16470 East Hughes Drive,Aurora 16470 East Hughes Drive Building S77, Aurora, CO, 80011 USAPosition Role Type:Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java/C++ Software Engineer II
3 months ago
Aurora, United States Raytheon Full timeDate Posted:2024-06-12Country:United States of AmericaLocation:CO106: 16470 East Hughes Drive,Aurora 16470 East Hughes Drive Building S77, Aurora, CO, 80011 USAPosition Role Type:Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java/C++ Software Engineer II
4 weeks ago
Aurora, United States Raytheon Full timeDate Posted:2024-06-12Country:United States of AmericaLocation:CO106: 16470 East Hughes Drive,Aurora 16470 East Hughes Drive Building S77, Aurora, CO, 80011 USAPosition Role Type:Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Java Software Engineer II
7 days ago
Aurora, CO, United States Raytheon Careers Full time*Date Posted:* 2024-08-23*Country:* United States of America*Location:* CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USA*Position Role Type:* OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter...
-
Senior Platform DevSecOps Engineer
1 week ago
Aurora, United States Raytheon Full timeDate Posted: 2024-08-20 Country: United States of America Location: CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USA Position Role Type: Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter...
-
Senior Manager, Supply Chain Legal Advisor
2 weeks ago
Aurora, United States Raytheon Technologies Full timeDate Posted: 2024-08-23 Country: United States of America Location: CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USA Position Role Type: Onsite At Raytheon, the foundation of everything we do is rooted in our values and a higher calling – to help our nation and allies defend freedoms and deter...
-
Senior Platform DevSecOps Engineer
7 days ago
Aurora, United States Raytheon Full timeDate Posted:2024-08-20Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Senior Platform DevSecOps Engineer
1 week ago
Aurora, United States Raytheon Full timeDate Posted:2024-08-20Country:United States of AmericaLocation:CO102: 16800 E Centretech Pkwy,Aurora 16800 East Centretech Pkwy Building S75, Aurora, CO, 80011 USAPosition Role Type:OnsiteAt Raytheon, the foundation of everything we do is rooted in our values and a higher calling - to help our nation and allies defend freedoms and deter aggression. We bring...
-
Terminal Clerk II
1 month ago
Aurora, Colorado, United States Estes Express Lines Full timeJob Summary:Answer telephones with a heavy call volume and direct calls with accuracy Maintain count list of items received or shipped and check against bill of lading, recording any discrepancies Prepare all paperwork and the repackaging of all OS&D freight Maintain accurate records to report all OS&D freight issues on a daily or weekly basis to terminal...
Claims Adjudicator II
2 months ago
UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity
The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day to day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries. This job will become fully remote following an approx. 6 week onsite training period.
ESSENTIAL JOB FUNCTIONS AND DUTIES
- Screens claims for completeness of necessary information
- Verifies participant/dependent eligibility
- Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents
- Codes basic information and selects codes to determine payment liability amount
- Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered
- Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers
- Handles the end to end process of Medicare Secondary Payer (MSP) files
- Processes Personal Injury Protection (PIP) claims
- Requests overpayment refunds, maintains corresponding files and performs follow-up actions
- Handles verbal and written inquiries received from internal and external customers
- Processes Short Term Disability claims
- Adjudicates claims according to established productivity and quality goals
- Achieve individual established goals in order to meet or exceed departmental metrics
ESSENTIAL QUALIFICATIONS
- 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment
- Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
- Working knowledge and experience in Subrogation and its related processes
- Experience with eligibility verification, medical coding, coordination of benefits, and subrogation
- Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes
Hourly range for this position: $20.31~$24.92. Actual hourly rate may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a full-time remote position.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
#LI-Remote