Showing 1-20 of 37
Showing 1-20 of 37
Pharmacy Claims Reviewer jobs

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Integrated Home Care Services, Inc.Miramar, FL

UM Nurse Reviewer. This position may work closely with the claims payer to ensure proper claims payment based on the authorization or denial....

AdeccoGreen Bay, WI

Pharmacy Claims Research Assistant. You will be working to research unapplied pharmacy claims. As a Claim Reviewer your work will consist of contact with...

Molina Healthcare, Inc.Milwaukee, WI

Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review, and manages the denial process....

Optum OperationsMaryland Heights, MO

And perform of other duties as required by the reviewers manager. The Psychologist Reviewer will also participate in peer consultations, staff meetings, and...

Regal Medical GroupLos Angeles, CA

Work with CMO to facilitate language into contracts to ensure accurate claims payment. Nurse Reviewer is to effectively support the in?patient management...

UnitedHealth GroupSt. Louis, MO

The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews, Clinical Claims Review) and...

Molina HealthcareBothell, WA

Evaluates authorization requests in timely support of nurse reviewers and manages the denial process. Conducts retrospective reviews of claims and appeals, and...

UnitedHealth GroupPhiladelphia, PA

Experience with medical claims. The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews,...

UnitedHealth GroupSchaumburg, IL

Experience with medical claims. The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews,...

ConduentCherry Hill, NJ

Pharmacy Claims Reviewer. Certified Pharmacy Technician CPhT. 5+ years retail pharmacy experience. Long Term Care/Infusion pharmacy experience favorable....

ConduentCherry Hill, NJ

As a Pharmacy Claims Reviewer. As a Pharmacy Claims Reviewer, you’ll be tasked with examining a wide. Billed pharmacy claims are being accurately submitted....

State of Ohio JobsFranklin County, OH

Interacts with external customers, internal staff, Pharmacy Benefits Vendor, Manage Care Organizations, and physician reviewers on an ongoing basis....

Health ChoicePhoenix, AZ

With internal and external partners (case managers, providers, claims. Obtain all medical information needed for determination and forward to clinical reviewers...

CignaChattanooga, TN

Drive the delivery of high-quality claims analysis and materials as a peer reviewer for team members. Comprehensive understanding of claim submissions claims...

Global TPA LLCTampa, FL

Interacts with other departments including Customer Service, Claims, Provider Relations and Pharmacy to resolve member and provider appeals....

UnitedHealth GroupAnn Arbor, MI

Administrative claims healthcare data and electronic health records experience. Serve as internal reviewer of deliverables/reports/manuscripts prepared by other...

UnitedHealth GroupBoston, MA

Administrative claims healthcare data and electronic health records experience. Serve as internal reviewer of deliverables/reports/manuscripts prepared by other...

Noland Home OfficeBirmingham, AL

Trains pharmacy staff at various facilities on running reports, checking the interface status between other vendor pharmacy systems and the hospital information...

Molina HealthcareMilwaukee, WI

Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review, and manages the denial process....

Dane StreetPalm Beach Gardens, FL

We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third...


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