Adjudicator Job Description Samples
Results for the star of Adjudicator
Sr. Claims Adjudicator
Looking for a way to influence the health and healthcare of many? If so, we’d love to hear from you! Our mission-driven organization is focused on the“Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans. UNITE HERE HEALTH serves 90,000+ workers 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! Key Attributes: + Integrity – Must be trustworthy and principled when faced with complex situations + Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required + Communication – Ability to generate concise, compelling, objective and data-driven reports + Teamwork – Working well with others is required in the Fund’s collaborative environment + Diversity – Must be capable of working in a culturally diverse environment + Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise + Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect) The purpose of this position is to receive, examine, verify and input submitted claims data, determine eligibility status, review and adjudicate claims within established timeframes, and assists less experienced staff members to resolve claim questions. In addition to performing the day to day job functions of claim analysis and payment, the Senior Claim Adjudicator may have responsibility for specified quality assurance functions, training, adjustments, certain defined medical necessity, benefit or coverage applications and other administrative duties as determined by claims department management.
Screen claims for completeness of necessary information.
Verify participant/dependent eligibility.
Interpret the applicability of benefits from the SPD/Plan Documents.
Code basic information and select codes to determine payment liability amount.
Based on established guidelines, evaluate diagnoses, procedures, services, and other submitted data to determine if additional investigation or proof is required from participants, employers, providers and other insurance carriers.
Apply knowledge and decide applicability of benefits, frequency limitations or appropriateness of care rendered and determine the validity of proof of loss documentation.
Research claims, initiate corrections, update history and refer claims to appropriate personnel.
Request overpayment refunds, maintain corresponding files and perform follow-up actions.
Maintain related claim adjudication manuals, SPD’s, memos and reference material updates.
Meet or exceed established productivity and quality goals.
Monitor inventory aging to select and process claims within established time frames and process assigned claims on a first-in, first-out basis, regardless of complexity/ difficulty.
Process claim adjustments and or assist with finalization of difficult adjustments as required or directed that are beyond the ability or experience of claim analysts.
Resolve Customer Service Inquiries on a timely basis, including difficult cases beyond the experience or ability of other claim analysts.
Perform first level quality review of high dollar claims processed by claim analysts.
Research, validate and respond to system related questions/issues from claim analysts.
Assist with training and preparation of training materials for claim staff.
Perform routine administrative functions as assigned.
Function as willing “go to” first level claim resource and answer person for less experienced or trained staff.
Perform other duties as assigned within the scope of responsibilities and requirements of the job.
High School Diploma / GED + College coursework a plus + Technical training in the area of medical terminology, ICD9 and CPT codes is a plus + Minimum of 2 years experience in a claims adjudication an automated environment + Experience utilizing a claims payment system e.g., RIMS, strongly preferred + Experience with and understanding of medical terminology, ICD9 and CPT coding usage
The candidate must demonstrate a continuing example of high production levels and excellent financial and procedural accuracy.
The position demands that the candidate maintain multiple claim type processing expertise and demonstrated ability to manage and effectively prioritize a variety of assignments, projects and administrative functions.
Work experience should include interpretation of medical benefit plans, including an understanding of limitations, exclusions, and schedule of benefits + Experience with eligibility verification, medical coding, coordination of benefits and subrogation Ability to: + Make appropriate decisions related to benefits and coverage applications within defined area of responsibility + Be able and willing to work well with other staff members as a leader in a team oriented structure + Manage competing deadlines and multiple projects in a fast-paced environment
Perform the essential functions of this job with or without reasonable accommodation ID: 2017-1362 Organization: UNITE HERE HEALTH External Company URL: https://www.uniteherehealth.org
Security Adjudicator Analyst
Government Position Title Security Adjudicator Analyst United States of America
- Virginia Reston
Job Summary AECOM is seeking a Security Analyst in Virginia. Must have ACTIVE TS/SCI w/FS Poly Duties/Tasks and Responsibilities Dependent on assignment, security analyst assistants provide a diverse range of adjudicative functions. The below list reflects some, but not necessarily all of the required daily activities and support.
Reviews a case file to determine what additional security processing, if any, needs to be performed.
Creates written products documenting case processing, such as Memorandum for the Record an E-mail.
Advises the Sponsor of the need for additional security processing in order to render adjudicative decision and schedule or conduct additional processing at the direction of the Sponsor.
Reviews the results of all security processing to glean necessary facts and data relevant to the final recommendation.
Interviews the subject in person, by telephone, or through written correspondence to elicit clarifying information after consultation and approval of the Sponsor.
Discusses with the Senior Case Manager (SCM), Expert Adjudicators, Adjudications Board members, Polygraph Examiners, Background Investigators, Case Processing Personnel, Managers, Office of Medical Services, Customers, and other as needed to resolve information discrepancies or gaps.
Analyzes the information and indicate a nexus between the behavior of the subject and the ICD 704 issues sufficient to support a final recommendation.
Provides a final written recommendation, in sufficient detail to permit the Sponsor to make an informed, independent decision to grant, disapprove or revoke a security clearance or approval.
Maintains each security file by purging duplicate copied of SF86, unofficial notes, page flags, and other extraneous materials prior to forwarding file to the SCM. Information contained on handwritten notes shall be formalized in a Memorandum for the Record and included in the file; the information is pertinent to the adjudication, prior to removal of the handwritten note. This may require that the adjudicator accurately upload official documents into electronic file records.
Makes oral presentations to SCMs, Program Mangers, Adjudication Boards, and/or other Senior Agency officials as required.
Administers notification to the customer, identify and recommend codes of conduct issues for the Sponsor to address, input of closing information in the Office of Security (OS) data base or other tracking software/applications as needed, and/or perform other follow-up actions resulting from the disposition of the case. Protects all information and data acquired during the preparation of the analysis from unauthorized release, employing the “need to know” principle, and return all adjudicative notes to the Sponsor.
Returns to the contractor’s point of contact cases that may give rise to an actual or potential conflict of interest, organizational or otherwise.
Responds in a timely manner to inquiries from the Sponsor on the status of pending cases or any other information pertaining to adjudicative support tasks.
Manages case load effectively to meet the productivity standards set by the Sponsor.
Meets the adjudicative quality standards established by the Sponsor
Attends meetings required for all adjudicative personnel and mandatory training courses required by the Sponsor for individuals with staff-like access. IND-ICS
Minimum Requirements Minimum Qualifications Experience: Experience applying principles of the ICD 704 –Personnel Security Standards and Procedures Governing Eligibility for Access to Sensitive Compartmented Information and Other Controlled Access Program Information as mandated through the issuance of the Presidents Executive Order (EO) 13467 Reforming Processes Relating to Suitability for Government Employment, Fitness for Contractor Employees and Eligibility for Access to Classified National Security Information and endorsed by Director of National Intelligence “Knowledge and experience may include verifiable experience in conducting background investigations, consolidating and/or processing investigative inputs, creating a comprehensive applicant profile, and/or preparing an adjudicative analysis and recommendation for the USG, or on behalf of a USG customer. While all of the above examples of ICD 704 experience are relevant, the strongest candidates will be those with prior adjudicative experience.” A minimum of 3 years of adjudicative experience in a Federal or Contractor role with the Federal Government or equivalent year(s) of experience in a related field or internship as delineated below Equivalent experience in a related field may include, but is not limited to the following:
Experience analyzing, interpreting and applying personnel security policies, standards, procedures or regulations
Examining the accuracy, completeness and quality of final reports in compliance with ICD 704 requirements and guidelines and providing targeted insights to others in their write ups
Demonstrated experience in conducting pre-employment security interviews or background investigations for Federal Government job applicants, contractors and employees
Successful completion of additional training (coaching, On the job training, training courses) to develop, enhance and/or mature personal analytical and critical thinking skill sets
Successful academic record that reflects demonstrated analytical and critical thinking skills (see Education requirements section below)
Demonstrated experience conducting interviews and subsequently summarizing and verbally presenting results to senior audiences
Will be required to complete the ODNI Intro to National Security Adjudications Course within 30 days of deployment Education: High school diploma or GED. (Advanced degree may be substituted for upwards of six months of experience) An associates or B.A./B.S. degree in English or related field of study (Degree examples include, but are not limited to Criminal Sciences, Cybersecurity, Behavioral Sciences, Management, Financial or Auditing, etc…) which has a central theme/focus related to writing in a clear, concise manner and ability to articulate and defend a logical well-reasoned conclusion based on available and/or discovered/developed information. In summary, any formally approved B.A./B.S. course of study with a related emphasis which demonstrates well developed and honed critical thinking and analysis skills.
Preferred Qualifications N/A
What We Offer AECOM is a place where you can put your innovative thinking and business skills into high gear and work alongside other highly intelligent and motivated people. It's a place where you can apply your skills to some of the world's most challenging, interesting, and meaningful projects worldwide. It's a place that values the diversity of our areas of practice and our people. It's what makes AECOM a great place to work and grow. AECOM is an equal opportunity employer and Minorities, Females, Veterans, and Disabled persons are encouraged to apply. For further information, please click here at http://www.aecom.com/content/wp-content/uploads/2016/01/EEO-is-the-Law-poster-supplement.pdf to view the EEO Is The Law poster. NOTICE TO THIRD PARTY AGENCIES:Please note that AECOM does not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Fee Agreement, AECOM will not consider or agree to payment of any referral compensation or recruiter fee. In the event a recruiter or agency submits a resume or candidate without a previously signed agreement, AECOM explicitly reserves the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of AECOM.Job CategorySecurity / Force ProtectionCountryUnited States of AmericaPosition StatusFull-TimeRequisition/Vacancy No.156360BR
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Automotive Mechanical Warranty Claims Adjudicator
Are you a Technician or Service Advisor looking to get off the shop floor or out of the dealership? If YES, this is the perfect opportunity for you!
Come and join a fun, motivated team of automotive professionals. Located in Strongsville, NAE/NWAN is looking for a skilled Automotive Mechanical Warranty Claims Adjudicator to be part of our claims team. Please note, this is a position that handles all claims via the phone. There is no travel involved.
This person must have automotive experience and ASE Certifications are a plus! Service Advisors, Technicians, and Experienced Claims Adjudicators meet the minimum level of experience necessary for the job.
The best candidate will be a person who has good personal relations, handles themselves well over the phone, enjoys multi-tasking, understands the processing of a warranty claim and has a great attitude. You must be comfortable navigating through multiple computer software programs including proficiency with Microsoft Office.
Due to growth of business on the west coast, potential candidates must have a flexible working schedule as we are looking to hire for the following shifts:
National Automotive Experts offers a complete compensation package including medical, dental, vision, 401(k) guaranteed benefit program, short and long term disability, life insurance, flexible spending accounts, paid time off, incentive opportunities, and an excellent work environment.
No phone inquiries please.Post a Job
Job Description: Position requires an in-scope TS/SCI clearance. Adjudicator tasks shall include: 1. Work on personnel security cases assigned by the Government.
Each case will vary in the total tasks, time and effort required to provide the deliverable, which is a written recommendation to grant, suspend, disapprove, or revoke sensitive security accesses; 2. Review and analyze assigned case files to determine if additional security processing needs to be performed in order to render an adjudicative decision. If additional security processing is necessary, the Contractor shall recommend to the Government as to what additional processing requirements should be conducted; 3.
Review the results of all security processing to glean facts and data relevant to the final recommendation; 4. Interview Subjects in person, by telephone, or through written correspondence to elicit clarifying information; 5. Discuss cases with senior adjudicators, Team Chiefs, Branch management, Adjudications Board members, Polygraph Examiners, Background Investigators, Case Processing Personnel, Managers, and Customers to resolve information discrepancies or gaps; 6.
Sufficiently analyze case information in order to show a nexus between the behavior of the case subject and the lCD 704 issues sufficient to support a final recommendation; 7. Provide final written recommendations using Government formats that provide sufficient detail to enable the Government to make informed, independent decisions to grant, disapprove or revoke a Subject's security access; 8. Maintain security files and ensure that duplicate copies of the SF86, unofficial notes, page flags, and other extraneous materials are purged with approval by USG prior to forwarding files to Branch managers or returning case files to the file room; 9.
Deliver oral presentations to Branch and/or Division management, the Adjudications Board, and/or other senior organization officials as required; 10. Administer notifications to customers as approved by the USG, update information in the customer data management system, and perform other follow-up actions resulting from the disposition of cases; 11. Protect all information and data acquired during the preparation of the analysis from unauthorized release and return all adjudicative notes to the Government; 12.
Respond in a timely manner to inquiries from the Government on the status of pending cases or any other information pertaining to adjudicative support tasks under this SOW; 13. Provide a draft adjudicative recommendation to the Government for all cases worked. The Contractor shall subsequently provide a final recommendation to the Government that incorporates any Government comments provided in response to the draft recommendation that are complete, accurate, and free of spelling and grammatical errors.
For each case completed, a written recommendation whether to grant, disapprove or revoke a clearance/approval is required, in accordance with established timelines. 14. Complete cases as identified by the Government. 15. May be requested to perform 'spot' checks of previously closed adjudicative decisions to ensure they meet Government quality requirements; 16.
May also provide Adjudication training and briefings to USG and industry personnel, when approved by the USG. This could include limited TDY travel in CONUS. 17. Provide a monthly report on the number of cases opened, number of cases closed, number of board cases, number of personal interviews/telephonic interviews and the number of recommendations.
Education Bachelor's Degree in Business Administration or a related business discipline, or the equivalent combination of education, professional training or work experience. Qualifications 5-8 years of related experience in facility or industrial security administration, preferably in the government contracting industry. Quals include: 1.
Experience performing Background Investigations, Counterintelligence, or Personnel Security for US Government clearances 2. Knowledge of lCD 704 and Executive Order 12968; 3. Knowledge and proficiency in the use of Microsoft Office Suite. 4.
Direct experience as an adjudicator with USG 5. Excellent elicitation skills, both oral and written 6. Exceptional organizational skills As a trusted systems integrator for more than 50 years, General Dynamics Information Technology provides information technology (IT), systems engineering, professional services and simulation and training to customers in the defense, federal civilian government, health, homeland security, intelligence, state and local government and commercial sectors.With approximately 32,000 professionals worldwide, the company delivers IT enterprise solutions, manages large-scale, mission-critical IT programs and provides mission support services.GDIT is an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Protected Veterans/Individuals with Disabilities.
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Electronic Claims Adjudicator
Electronic Claims Adjudicator Category: Administrative Support/Clerical Facility:
UCSF Benioff Children's Hospital Oakland, Finance Center Department: CHO Children First Medical Group Schedule: Full Time Shift:
Day Shift Hours: 40 hrs/week Mon-Fri FTE: 1.00000 Job Details: High School/GED 3 to 5 Years of Experience Required Job Summary: Responsible for making sound decisions regarding the review, payment and denial of adjudicated claims.
Must adjudicate accurate claims and meet all quality standards with an error ratio less than 4.5%. Accountable for editing claims received via Electronic Data Interchange (EDI) for adjudication according to department policies and procedures and industry standards. Job Requirements: Education: High school degree/GED, Associate of Arts degree preferred.
Experience: Minimum of three to five years experience of previous medical insurance claims required. Minimum of three to five years experience of eligibility verification and reconciliation required. Knowledge/Skills:
Knowledge of medical care delivery systems benefits and Medi-Cal government sponsored programs. Excellent interpersonal and communication skills. Knowledge of medical community.
Excellent organizational skills with attention to detail. Physical Requirements;Sit: Up to 8 hours/day Stand/Walk: 3-6 hours Bend/Stoop Up to 3 hours Reach:
Up to 3 hours Rep Use of UE/Grasp: Up to 8 Lift/Push/Pull: 15lbs This job requires the ability to hear alarms clients and/or instruction. The ability to see accurately from 20 inches to 20-ft.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of this position. 3 UCSF Benioff Children's Hospital Oakland is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status. UCSF Benioff Children's Hospital Oakland seeks candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence, and the communities we serve.
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HRA Claims Adjudicator
HRA Claims Adjudicator
Description The purpose of this position is to process more complex claims, take on more complex projects, and correspond with insured and providers in a prompt, informative, and courteous way, and interacts with other departments in order to obtain information needed to process claims. The position possesses a higher claim approval authority operating with a broad understanding and application of body of knowledge. This position acts as a mentor and provides feedback to more junior claims clerks and examiners. This position may also audit claims processing of colleagues.
Claims Processing + Reviews complex claim requests to determine eligibility for processing and escalate to management as necessary.
Audits claims processing of other colleagues.
Prepare for carrier audits as well as audit work of other colleagues.
Handles more complex claims; i.e. pre-existing conditions, other health insurance, high deductibles, etc.
Train new colleagues; mentor and provide feedback.
Makes appropriate system entries and verifies accuracy.
Ensures utilization of most up to date processes and procedures to update claims.
Identifies process improvements, offers solutions to claim problems, and communicates recommendations to management.
Manages tasks according to company guidelines.
Client Inquiries + Responds within company standards to inquiries by telephone and written communication.
- Works with colleagues across the organization to research inquiries in a prompt, courteous, and accurate manner.
Qualifications + High school diploma or equivalent required.
Minimum of one year claims experience.
Claims processing and/or medical office experience preferred.
Excellent written and verbal communication skills to effectively interact with customers on the telephone.
Excellent organizational and time-management skills to handle multiple tasks.
Detail oriented to ensure accuracy.
Analytical skills and the ability to make appropriate decisions independently.
Basic computer skills and the ability to navigate through multiple systems without assistance.
Proficient in Microsoft Office.
Appropriate license must be obtained if necessary for position.
Core competencies include: + Critical Thinking and Problem Solving + Professional/Technical Knowledge + Communicating with Impact + May need New York Adjustor’s license (only need 3 licensed for state of New York). At Mercer, we make a difference in the lives of more than 110 million people every day by advancing their health, wealth, and careers. We’re in the business of creating more secure and rewarding futures for our clients and their employees — whether we’re designing affordable health plans, assuring income for retirement or aligning workers with workforce needs. Using analysis and insights as catalysts for change, we anticipate and understand the individual impact of business decisions, now and in the future. We see people’s current and future needs through a lens of innovation, and our holistic view, specialized expertise, and deep analytical rigor underpin each and every idea and solution we offer. For more than 70 years, we’ve turned our insights into actions, enabling people around the globe to live, work, and retire well. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. At Mercer, we say we Make Tomorrow, Today . Visit www.mercer.com for more information and follow us on LinkedIn and Twitter @Mercer. Mercer LLC and its separately incorporated operating entities around the world are part of Marsh & McLennan Companies, a publicly held company (ticker symbol: MMC). Marsh & McLennan Companies offers competitive salaries and comprehensive benefits. For more information about our company, please visit us at: http://www.mmc.com/. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. For more information, please visit us at:www.mmc.com/diversity. Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.
Primary Location US-MA-Norwood Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.
Req ID: NOR005M1
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Claims Adjudicator - Temporary (Full Time)
Description: Find what you’re looking for in your career, at PacMed as a Claims Adjudicator (TEMPORARY) in Seattle, WA. This is a Temporary Full Time position in our USFHP department and is eligible for benefits. We are seeking a Claims Adjudicator who will adjudicate claims submitted by outside purchased services for PMC’s enrolled capitated population and communicates those actions. The Adjudicator will adjust complex claims for advanced processing needs, as well as respond to Customer Service Requests and resolve problem claim situations. In this position you will:
Adjust claim benefit payments on the GE Centricity computer system; including manual calculations of complex items and manual adjustment to the system as needed to correctly adjudicate claim benefit payment for plan benefits, enrollment contracts, reimbursement schedule, provider contracts, and referral authorization.
Adjudicate Universal Billing (UB) and HCFA claims for assigned lines of business (one or two of: Commercial, Medicare, Healthy Options, Basic Health Plan, USFHP) Have experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
Adjudicate claims in accordance with all legislative and regulatory compliance requirements including Medicare Regulations, Medicaid Regulations, Washington State Insurance Code, state legislative mandates, Health Care Financing Administration (HCFA) regulations, Office of the Insurance Commissioner (OIC) requirements, and contractual obligations with other entities (such as Health Plan contractual delegation agreements).
Research unclear and unusual claims. Determine the delegation status of claims and prepare claims for submission to appropriate entity.
Qualifications: Required qualifications for this position include: + High School Diploma or equivalent experience in Health Care Business Administration.
A minimum of 2 years’ experience in Managed Care operations, including a minimum of one year claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
An understanding of financial/administrative/clinical business functions and the interfaces/relationships between applications in healthcare.
An understanding of healthcare delivery systems, healthcare insurance, managed care, third party administration, HMOs, preferred provider networks, delegation and risk products.
An understanding of provider reimbursement practices including capitation, sub-capitation, case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU and RBRVS-based fee schedules, purchased repriced network, and health plan specific schedules.
Experience with information systems supporting the administration of managed care products.
Knowledge of CPT, ICD9, HCPCS, RBRVS, ASA, and medical terminology.
Typing and 10-key skills (40 wpm and 100 spm) and CRT experience. Preferred qualifications for this position include:
Experience with GE Centricity healthcare software application.
Experience in CHAMPUS, Medicare and/or Medicaid benefits/programs.
An understanding of the principles, theories, and practices of benefit design, plan inclusions and exclusions, healthcare administration rules and regulations, subrogation, third party liability, reinsurance, and coordination of benefits.
Pacific Medical Center:
Pacific Medical Center is anexpanding network ofoutpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties.Pacific Medical Centersis affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time,Pacific Medical Centersand Providence offer diverse locations, lifestyles and practice models.Find what you are looking for in your next practice opportunity with Pacific Medical Centers!Learn more atwww.pacmed.org/providerjobs.
We offer a full comprehensive range of benefits
— see our website for details — http://pacmed.jobs/benefits/ ## Our Mission Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.
About Us Quality and respect
. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 11 outpatient clinics across the Puget Sound region and more than 150 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to nearly 100,000 patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”
About Us Quality and respect
. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 11 outpatient clinics across the Puget Sound region and more than 150 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to nearly 100,000 patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Job Category: Billing / Insurance
Req ID: 153068
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Adjudicator -Full Performance
Supporting the Most Exciting and Meaningful Missions in the World Adjudicator -Full Performance Responsibilities: Provide adjudicative support services to assist in meeting the mission requirements of customers throughout the organization. Requires full performance knowledge and experience of Federal-level adjudicative processes. Security Analyst Assistants at the Full Performance level shall provide a diverse range of adjudicative functions to include but not limited to:
review case files to determine needed security processing actions + create written products documenting case processing + advise the customer of the need for additional security processing to render an adjudicative decision
review results of all security processing relevant to the final adjudicative recommendation
conduct interviews of candidates in person, via telephone or through written correspondence + discuss and present cases to supervisors and subject matter experts as needed + provide a final written recommendation with sufficient detail to permit the sponsor to make an informed decision to regarding security clearance approval or denial + perform file maintenance to include removing duplicate copies of documents, unofficial notes, etc + responds to status inquiries in a timely manner • meets quality standards established by the customer + manages case load effectively to meet productivity standards established by the customer Qualifications:
Must be a US citizen possessing TS/SCI clearance with a polygraph at time of application.
Minimum three years Adjudicative experience at the Federal level or extensive analyst experience; investigative experience is desired by not required.
High School diploma or GED.
Must possess demonstrated analytical ability and the ability to handle a large complex workload
Must demonstrate a high level of personal integrity and the ability to discreetly handle sensitive, personal and classified case information
Must have excellent writing skills with ability to comprehend complex and multi-source data into succinct and supportable final reports
Must possess strong organizational skills and good judgment
Must be able to operate various corporate and customer specific automated systems for case tracking and status reporting
Must have a thorough understanding of the federal rules and regulations that encompass the clearance process + Demonstrated ability to produce analytic documents that require minimal editing, utilize software tools (MS Word/Excel/Power Point) + Ability and skill to elicit information during an interview with minimal direction and work effectively with a variety of individuals + Ability to provide excellent customer service + Ability to work well with various client personnel and stakeholders + Strong briefing and presentation skills An Equal Opportunity Employer. PAE’s hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran’s status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law. EEO is the Law Poster at http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf JOIN OUR TALENT NETWORK at http://www.jobs.net/jobs/pae/join PAE is a leading provider of enduring support for the essential missions of the U.S. government, its allied partners and international organizations. With over 60 years of experience, PAE supports the execution of complex and critical missions by providing global logistics and stability operations, technical services and national security solutions to customers around the world. PAE has a workforce of approximately 15,000 people in over 60 countries on all seven continents and is headquartered in Arlington, VA. In compliance with the ADA Amendments Act (ADAAA), should you have a disability and would like to request an accommodation in order to apply for a currently open position with PAE, please call Recruiting at (703) 656-6064 or email firstname.lastname@example.org with "Disability Assistance" in the subject line.
Adjudication Specialist I
Job Summary: The Adjudication Specialist I processes routine background reports according to client guidelines and monitors reports to ensure execution of client requirements.
Specific Duties: • Ensure accurate and prompt turnaround on all adjudication results • Provide and maintain in-depth working knowledge of all adjudication client guidelines • May input thorough and accurate notes when determining the adjudication result on an applicant • Provide timely follow-up and follow-through on all applicable client questions and/or concerns stemming from an adjudication result Education: • High School diploma or GED required • Prefer Associate’s degree – preferably in Criminal Justice Skills: • Excellent written and verbal communication skills • Ability to type 45 wpm with strong accuracy (test) • Position requires excellent analytical ability • Great attention to detail • The ability to work independently under constant deadlines • A teamwork oriented attitude Experience: • 2 years related experience in the background screening industry • Prior military, police or business-intelligence experience a plus • Prior criminal research, adjudication and/or quality experience a plus Other (Travel, Attendance, Physical Requirements, Testing, Training): Knowledge of word processing software (MS Word/Outlook/Excel) In exchange for your expertise, HireRight offers an excellent employee benefit package which includes: * Medical
Dental * Vision
Paid Life/AD&D Insurance
Voluntary Life Insurance
Short & Long Term Disability
Flexible Spending Accounts * 401K * Generous Vacation and Sick Program * 10 Paid Holidays
Education Assistance Program
Business Casual Attire
Generous Referral Program
Employee Discounts and Rewards
And much more! Intelligence to move forward. /*Employment contingent upon successful completion of background investigation. Pre-employment drug screening required. All resumes are held in confidence. Only candidates whose profiles closely match requirements will be contacted during this search./ / /HireRight, LLC is an Equal Opportunity EmployerMinorities / Females / Veterans / Disabilities
Organization:H10059 - Pub Rcrds - US
Title:Adjudication Specialist I
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Job Description These positions will provide professional legal support in administering the Agency
’s adjudication function by analyzing investigative reports, preparing cases for prosecution, presenting cases at informal and formal hearings, and making adjudication recommendations to Board Administrators.
Ability to analyze and evaluate complex data and effectively convey findings orally and in writing.
Knowledge of legal principles, practices, and processes.
Ability to effectively manage time and assignments.
Excellent organizational skills.
Excellent interpersonal skills.
Substantial experience in preparing witnesses for testimony.
Substantial experience in presenting matters in judicial or administrative proceedings
Substantial experience in drafting pleadings or memoranda based on analysis of legal and technical issues and factual reports.
Demonstrated ability to communicate effectively orally and in writing.
Law degree, bachelor’s degree, paralegal degree or coursework in law, or appropriate combination of education and equivalent experience.
Comprehensive knowledge of legal/regulatory environment
Knowledge of the Administrative Process Act * Knowledge of laws and regulations governing health regulatory boards
Special Requirements Conditions of employment for the candidate of choice include:
participation in the Commonwealth’s direct deposit program, a fingerprint based criminal history check, and completion of computer security training.
Special Instructions to Applicants Applicant need only apply to position
00273 to be considered for all three vacancies. State employees who have been affected by Policy 1.3 Layoff and possess a valid Interagency Placement Screening Form (Yellow Card) or a Preferential Hiring Form (Blue Card) must submit the card BEFORE the closing date for this position. The card may be scanned and attached to the application or faxed to (804) 527-4446. Please include your name and the position number on the fax cover sheet. The Dept. of Health Professions does not accept “See Resume” as a response to any question. Resumes will not be accepted, but cover letters may be attached to the online application. Information on the application is the primary source used for screening the position. Failure to complete any section of the application may disqualify the application for further consideration. Applications should include complete work history, including periods of unemployment if applicable. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. Dept. of Health Professions will record information from each new employee’s Form I-9 (Employment Eligibility Verification) into the Federal E-Verify system to confirm identity and work authorization. AMERICORPS, PEACE CORPS, AND OTHER NATIONAL SERVICE ALUMNI ARE ENCOURAGED TO APPLY. DHP is pleased to be exclusively accepting employment applications using the on-line employment system managed by the Department of Human Resource Management. Please view the link below to submit your completed state application for consideration no later than, Friday, August 4, 2017. If you have any questions concerning the application process or experience difficulty accessing the website, please feel free to contact Human Resources at 367-4410. https://virginiajobs.peopleadmin.com/ The Department of Health Professions has a Web presence on the Internet. Please access agency employment opportunities at: www.dhp.virginia.gov. EOE ### Contact Information
Name Sharon Williams
804-367-4410 ## Address 9960 Mayland Drive, Suite 300 Henrico, Virginia 23233 Working Title: Adjudication Specialists Role Title: Hearing Legal Servcs Offcr II - 19072 Job Open Date: 07/13/2017 Job Close Date: 08/04/2017 Open Until Filled: No Is this position funded in whole or in part by the American Recovery & Reinvestment Act (Stimulus Package)?: No Hiring Range: $48,000 to $62,500 Agency: Dept of Health Professions (223) Agency Website: www.dhp.virginia.gov Location: Henrico
087 Position Number: 00273 Job Posting Number: 1026839 Type of Recruitment: General Public
G Does this position have telework options?: No Bilingual/Multilingual Skill Requirement/Preference: No Job Type: Full-Time (Salaried) Job Type Detail: Full-Time Salaried
Non-Faculty- FTS-1 Pay Band: 05