Claims Analyst Salary at Caremore BETA

Job Description Job Description POSITION SUMMARY The Configuration Analyst will be responsible for supporting all aspects of system configuration ensuring that all system configurations are programmed accurately for Authorizations and Claims. RESPONSIBILITIES-DUTIES Configure rates based on provider contracts to ensure accurate payments of claims and capitations to providers. Configure rates based on vendor contracts to ensure accurate payments. Maintain system configuration based on data received from contracting Audit accuracy of Fee schedules in test environment prior to in-loading in production Assign Fee Set Assignments by line of business or health plan code Program and audit Interest Payment Program and audit RBRVS Geographical Adjustment Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system as necessary Coordinating with internal departments to resolve and assist with system related issues/builds Other duties may

LABORATORY ASSISTANT I-III Print (https://www.governmentjobs.com/careers/longbeach/jobs/newprint/4686447) Apply ? LABORATORY ASSISTANT I-III Salary $1,660.16 - $2,627.44 Biweekly Location City of Long Beach, CA Job Type Classified - Full-Time, Permanent Job Number J28AN-25 Department Multiple Departments - (CL) Opening Date 10/25/2024 Closing Date 11/8/2024 4:30 PM Pacific + Description + Benefits + Questions DESCRIPTION Applications are available online beginning Friday, October 25, 2024, through 4:30 pm, Friday, November 8, 2024. Salary Information: Grade I - $1,660.16 - $2,265.76 Bi-Weekly Grade II - $1,743.60 - $2,384.48 Bi-Weekly Grade III - $1,924.56 - $2,627.44 Bi-Weekly Vacancy Information: Current vacancy is with the Utilities Department. Future vacancies may occur in the Health & Human Services Department. EXAMPLES OF DUTIES Under immediate supervision assists laboratory personnel in performing physical and chemical tests; cleans and sterilizes laboratory work surfaces and su

Company Description CCG Talent Management is not only a business solutions company but a company that believes success starts with the individual. CCG Business Solutions has been consulting and providing talent placement services since 2007. Our team understands the principles of connecting purpose to business. We are currently recruiting for a Business Analyst III. Job Description The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications. This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements. This position will develop report and analysis for the department. It is responsible in communicating and coordinating with IT on a day-to-day department related efforts. The Business Analyst I

Job Description Job Description Nature & Scope: Positional Overview Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to join our team. The ideal candidate will analyze complex workers’ compensation claims, determine benefits due, and manage high-exposure cases involving litigation and rehabilitation. This role requires expertise in California Workers’ Compensation laws, strong negotiation skills, and the ability to ensure claims are handled in compliance with industry best practices and client requirements. Role & Responsibility: Tasks That Will Lead To Your Success · Investigate, analyze, and process complex workers’ compensation claims to determine exposure and benefit eligibility. · Develop and implement action plans to ensure appropriate and timely resolution of claims. · Calculate and assign reserves, ensuring reserve adequacy throughout the claim lifecycle. · Approve and process benefit payments, adjustments, and settlements within designated authority le

Director Risk and Underwriting Overview: In this role, you will play a key role in driving the organization's risk strategy, ensuring operational resilience, and safeguarding data integrity across complex and dynamic business environments. This includes overseeing the identification, monitoring, and mitigation of risks across the entire merchant portfolio, with a focus on maintaining the quality, accuracy, and consistency of data and transactions. You will lead teams of risk analysts and department specialists to implement, review, and optimize risk and compliance processes and procedures, ensuring alignment with regulatory requirements and industry best practices. Responsibilities: Design and implement a comprehensive risk management framework tailored to the needs of the organization and aligned with industry best practices. Develop policies and systems to prevent fraud, manage alerts, and oversee investigations, including coordination with law enforcement as required. Oversee and op

Job Description Job Description POSITION SUMMARY The Manager of Systems Configuration is responsible for managing and oversee the systems Configuration, Benefits and Provider Data, ensuring accurate reflection of provider contracts and claims payments. RESPONSIBILITIES-DUTIES Manage Contract Configuration and Benefits Analyst work assignment Responsible for inventory, delegation and audit for the Contract Configuration and Benefits Department Plan, manage, oversee and audit configuration of Financial Responsibility by LOB Fee Schedules by LOB Modifier Set Tables Component Unit Schemes by scheme name (RVUs – Facility and Non Facility) Single Unit Schemes by scheme name (RVU – Anesthesia Units) Anesthesia Decimal Table and Set numbers (Related to units and time) Incident Types, Subtypes and Action codes cross department Service Code Categories Plan and manage configuration of Medicare, Medi-Cal fee schedules on a monthly and quarterly basis to include all states Design and implement new

THIS OPENING IS FOR OUR RESOURCE CENTER IN ALISO VIEJO. Please only apply if you are able and willing to work from our Aliso Viejo location. Thank you!!!#hpstedna Position: Audits and Appeals Analyst Description: Covenant Care is a Resource Center supporting 30+ Skilled Nursing Facilities, Assisted Living Communities, and a Home Health Division from its corporate offices in beautiful Aliso Viejo, California. Schedule: This is an in-office position: Monday - Friday at Aliso Viejo offices to monitor mail boxes, compile (print, fax, mail) appeal packets and interact with other staff members. Education and Experience: High School Degree required, (Associates or Bachelors preferred) Minimum of 3 years experience in a skilled nursing facility or similar environment Primary Responsibilities Include: Oversees multiple Payer Portals acting as Resource for facility Business Office Managers Initiates tracking process after receipt of Medical Documentation Requests Verify contract language vs. pay

Job Description JOB DESCRIPTION Job Summary Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. Participates in defect resolution for assigned component Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. Assists in planning and coordination of application upgrades