Sentences with phrase «claims adjudication process»

(5) Perform claims followup and to complete the claims adjudication process.

Learn about this claims adjudication process here.

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With this association, Bajaj Allianz health insurance policyholders will experience a transparent, more efficient and accurate cashless claims adjudication process.»

One of the major issues for injured workers from the late 1960s through the 1980s was the virtually hegemonic role played by doctors, who were employed full - time by the Workers» Compensation Board, in the claims adjudication process.

Third Party Medical Billing Experience Desired: 1 - 3 years pharmacy experience; 3 years call center experience * Skills / Knowledge Required: Familiar with the claim adjudication process.

Not exact matches

In my proposal, the Treasury Secretary would initiate the process, but then would get handed off to a special bankruptcy court for adjudication of claims.

It gives us processes for adjudicating truth claims, and imposes different evidentiary rules on adjudication depending on the context and consequences (in criminal law proof beyond a reasonable doubt; in civil law proof on the balance of probabilities).

The claims process is administered by the Indian Residential School Adjudication Secretariat (IRSAS), a quasi-judicial tribunal that operates independently from the parties to IRSSA, including the Government of Canada.

Martin has over seven years of experience representing disability claimants, helping them navigate the disability claims process and representing them at hearings in the Office of Disability Adjudication and Review.

Furthermore, trip interruption or evacuation are included in APRIL's signature «Stress Less» benefits, which bypass the frustrating claims process via instant adjudication of all applicable issues and inconveniences.

Because the adjudication of each claim is different, we are unable to provide you with an exact time frame for when we will complete the processing of your claim.

Our specialized underwriting divisions, claims processing / adjudication, small and large group case management, and international experts are committed to excellence and providing practical insurance solutions to all of our customers.

The definition of a «contributing entity» at § 153.20 provides that for the 2015 and 2016 benefit years, a contributing entity is (i) a health insurance issuer or (ii) a self - insured group health plan, including a group health plan that is partially self - insured and partially insured, where the health insurance coverage does not constitute major medical coverage, that uses a third party administrator (TPA) in connection with claims processing or adjudication, including the management of internal appeals, or plan enrollment for services other than for pharmacy benefits or excepted benefits within the meaning of section 2791 (c) of the PHS Act.

Responsible for assisting the CSC Pharmacist with the day - to - day operational needs, including adjudication of clinical claims, processing prior authorization forms and meeting the requirements of the Clinical Service Center.

* Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB / Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HIX, HMO, PPO, POS, Medicare, Medicaid, CDHP, MMIS system implementatio...

Professional Experience St. Mary's Home Care / Infinite Wellness / Concept's Family Care Net (Raleigh, NC) 01/2010 — Present Agency Manager & Billing Specialist • Manage and train team members in company policies, procedures, and industry best practices • Research, analyze and resubmit denied claims for adjudication in a timely and professional manner • Oversee the billing process including coding, keying, and submission of new billings • Communicate with clients on billing errors and corrective action plans

Professional Experience Blue Cross of California (Pomona, CA) 2005 — Present Claims Examiner / Customer Service Representative • Research, analyze, code, and process claims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaClaims Examiner / Customer Service Representative • Research, analyze, code, and process claims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims for payment in a timely, accurate, and organized manner • Adjust, void, and reopen claims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims as needed to ensure proper adjudication • Resolve inquiries, issues, and adjustments regarding benefits, policies and contracts • Oversee and support special customer service and claims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory manaclaims related initiatives • Provide exceptional in person, telephone, and email customer service ensuring client satisfaction • Train junior team members in industry best practices and corporate protocols • Offer additional administrative support including filing, data entry, and inventory management

Professional Experience Accenture (City, ST) Date — Date Lean Six Sigma (LSS) Consultant • Supported the United States Postal Service Continuous Improvement Office and Retail Service Area • Led a ZIP - Forward project validating the accuracy of POS originating Priority Mail data • Supported the United States Postal Service Finance Remediation and Compliance team • Directed ZIP - Forward project to define the Business Reply Mailer process and identify revenue leakage • Created a strategic roadmap of improvements for a new operational and financial processes • Reduced the risk of revenue loss and establish metrics for process analysis and benchmarking • Supported United States Postal Service Global Claims Accounting Services Group • Managed a ZIP - Forward Event to reduce claim backlog and overall adjudication process time • Improved mediation strategy and mitigation plan to assist in SOX certification • Provided coaching on LSS theories, methodologies, and tools to ZIP - Forward project team • Mentored a USPS employee to achieve Green Belt status