Top 6751 Adjudication Services Jobs

Supervisor, Focused Review
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 5 years
- Word processing
- Research
- Dental insurance
- Opportunities for advancement
Director Configuration, Benefit Administration
Healthfirst —New York, NY
- $127,500 - $236,555 a year
- Full-time
- Office
- High school diploma or GED
- Analysis skills
- Health insurance
- Dental insurance
Director of Claims
1199SEIU Family of Funds —New York, NY
- $225,900 - $282,400 a year
- Full-time
- Hybrid work
- 6 years
- Analysis skills
- Bachelor's degree
Accounts Receivable Specialist I #Full Time #Remote
61st Street Service Corp —Remote
- $23.56 - $28.85 an hour
- Full-time
- Remote
- Entry level
- Under 1 year
- Health insurance
- Paid time off
Quick Apply
Payment and Medical Policy Coordinator (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $51,264 - $101,816 a year
- Full-time
- Remote
- Microsoft Excel
- Mid-level
- Finance
- 401(k)
Quick Apply
Remote Case Processing Analyst
GCC Technologies, LLC —Washington, DC
- Remote
- English
- Mid-level
- 3 years
Claims Examiner - Remote
ImagenetLLC —Remote
- Full-time
- Remote
- Basic math
- Mid-level
- Data entry
- Paid training
- Health savings account
Long Term Care Benefit Claim Specialist
Mutual of Omaha —Remote
- $24 - $28 an hour
- Email
- Remote
- Customer service
- Mid-level
- Experience equivalent to degree accepted
- Paid holidays
- 401(k)
Claims Customer Service Representative II (Remote)
American Medical Association —Chicago, IL
- $23.63 - $30.83 an hour
- Remote
- Microsoft Excel
- Mid-level
- High school diploma or GED
- Disability insurance
- Health insurance
8d
Remote LTC Pharmacy Billing Specialist (FrameworkLTC experience)
Pharmacy Recruiting LLC. —Remote
- $18 - $24 an hour
- Full-time
- Remote
- Anatomy knowledge
- Customer service
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Payment Policy Analyst (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $58,320 - $115,830 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Mid-level
- 401(k)
Quick Apply
Pharmacy Technician / Pharmacist – Prescription Savings Representative
RX NOW —Remote
- $500 - $3,000 a month
- Part-time
- Remote
- Grocery store experience
- Communication skills
- Entry level
- Employee discount
- Flexible schedule
Quick Apply
8d
Adjudication Officer
University of California, Riverside —Riverside, CA
- $57,700 - $99,300 a year
- Full-time
- Background check
- Research
- Mid-level
Adjudication Support Assistant, Parking and Commuter Services
California State University —San Marcos, CA
- Full-time
- Background check
- University
- In-person
- Paid holidays
- Health insurance
Payment Adjudication Rep
Mount Sinai South Nassau Hospital —Hicksville, NY
- $30.64 an hour
- Full-time
- Hospital
- English
- Mid-level
Claims - Claims Examiner
Wellcove —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
Quick Apply
Collections Specialist
Vital Care Infusion Services —Remote
- $18.92 - $23.46 an hour
- Full-time
- Remote
- 5 years
- Writing skills
- English
- Health savings account
- Paid holidays
Quick Apply
Healthcare Fraud Investigator
Contact Government Services, LLC —Remote
- $85,000 - $105,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Mid-level
- 3 years
Quick Apply
SR. Claims Completion Specialist
MetLife —Remote
- $41,600 - $61,000 a year
- Email
- Remote
- Mid-level
- High school diploma or GED
- US work authorization
- Paid holidays
- Disability insurance
Claims Investigator/Examiner
AIDS Healthcare Foundation —Los Angeles, CA
- $34 - $36 an hour
- Mid-level
- Organizational skills
- Health insurance
Quick Apply

I want to receive the latest job alert for Adjudication Services

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Adjudication Services jobs near

Customer Experience Representative jobs in Remote

Business Process Analyst jobs in Washington, DC

Billing Specialist jobs in Remote

Director jobs in New York, NY

Senior Customer Service Representative jobs in Chicago, IL

Fraud Investigator jobs in Remote

Policy Analyst jobs in Baltimore, MD

Director Of Administration jobs in New York, NY

Collection Agent jobs in Remote

Senior Claims Specialist jobs in Remote

Claims Examiner jobs in Los Angeles, CA

Medical Coordinator jobs in Baltimore, MD

Accounts Receivable Clerk jobs in Fort Lee, NJ

Claims Examiner jobs in Tampa, FL

Benefit Specialist jobs in Remote

Claims Examiner jobs in Remote

No Experience Warehouse jobs in Fort Lauderdale, FL

Hiring Immediately No Experience jobs in Castle Rock, CO

Customer Experience Representative jobs in Dallas, TX

Customer Experience Representative jobs in Nashville, TN

Supervisor, Focused Review

Delta Dental of Michigan -
Okemos, MI

Apply Now

Job Details

Full-time

Benefits

Dental insurance
Opportunities for advancement

Qualifications

Contract documentation review
Healthcare financial misconduct investigations
Contract review
Word processing
Spreadsheets
Contract interpretation
Research
Internal investigations
Health insurance knowledge
Healthcare billing investigations
Insurance investigations
Presentation preparation
Productivity software
Insurance (Financial sectors)
Technical Proficiency
Data analysis software

Full Job Description

Job Title:

Supervisor, Focused Review

Number of Positions:

Location:

Okemos, MI

Location Specifics:

Hybrid Position

Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Plans, organizes, and supervises the Provider Auditor Focused Review Special Investigation Unit (SIU) , including oversight of data research and review, and audit and investigation activities. E nsures all team operations align with corporate and departmental goals and objectives, maintains compliance with applicable standards and policies, and supports continuous improvement in Focused Review processes.

Primary Job Responsibilities:

Supervises and monitors the daily administrative and technical functions of the Focused Review SIU teams, data research and review, and audit and investigation activities to ensure efficient, compliant operations that support departmental and corporate goals and objectives.
Supports staff recruitment, onboarding, and development by assisting with interviewing, training, mentoring, and evaluating team members to promote accountability and achievement of individual and team objectives.
Oversees staff engaged in data research, report development, and analytics, serving as a resource for audit and research questions and providing guidance to internal and external stakeholders on reporting issues, provider agreements, processing policies, client contracts, and regulatory compliance for both commercial and government programs.
Implements and enforces policies, procedures, and standards for audits and investigations, and assists in preparing departmental reports and analyzing business processes to ensure compliance with regulatory requirements for both commercial and government programs.
Facilitates communication with law enforcement and legal representatives by supporting the preparation of documentation and responses to subpoenas, and assisting with administrative or judicial proceedings related to fraud, waste, and abuse.
Builds and maintains collaborative relationships with business partners to provide operational support, clarify requirements, and promote effective use of SIU services and solutions.
Acts as a liaison for staff and internal departments, providing expertise and interpretation of dental policies, procedure codes, and processing guidelines related to claims adjudication, fraud, waste, and abuse activities.
Assists in developing and implementing departmental strategies, goals, and objectives to support continuous improvement and operational excellence.
Supports budget monitoring and resource allocation for the Focused Review SIU teams as directed by management.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor’s degree in business administration , criminal justice, or related field a nd five years of experience conducting investigations, audit s, or complex data analy sis within the insurance industry. Previous leadership experience is preferred , as well as experience reviewing claims activity, provider behavior, or group contract compliance. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of the insurance industry operations; strong investigative skills related to fraud, waste, and abuse; proficiency with analytic al tools, word processing, spreadsheet, and presentation software skills; strong verbal and written communication skills, strong organizational and analytical skills; the ability to lead investigative teams ; the ability to interpret contract language and identify indicators of fraudulent activity ; the ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Professional certifications such as CFE, CIA, AHFI are preferred .

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Apply Now

Refine Your Search

Adjudication Services jobs

Supervisor, Focused Review

Director Configuration, Benefit Administration

Director of Claims

Accounts Receivable Specialist I #Full Time #Remote

Payment and Medical Policy Coordinator (Remote)

Remote Case Processing Analyst

Claims Examiner - Remote

Long Term Care Benefit Claim Specialist

Claims Customer Service Representative II (Remote)

Remote LTC Pharmacy Billing Specialist (FrameworkLTC experience)

Payment Policy Analyst (Remote)

Pharmacy Technician / Pharmacist – Prescription Savings Representative

Adjudication Officer

Adjudication Support Assistant, Parking and Commuter Services

Payment Adjudication Rep

Claims - Claims Examiner

Collections Specialist

Healthcare Fraud Investigator

SR. Claims Completion Specialist

Claims Investigator/Examiner

I want to receive the latest job alert for Adjudication Services

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected