Adjudicator Job Description Samples

Results for the star of Adjudicator

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:

Tuesday-Friday 9AM-6PM

Monday-Friday 11AM-8PM

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.

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Unemployment Claims Examiner / Adjudicator

Job Description

UNEMPLOYMENT CLAIMS EXAMINER / ADJUDICATOR

Immediate hire!

3-5 Years experience in high-volume (30-50 weekly claims) unemployment claims administration, including appeal hearings. A background working as a Claims examiner / adjudicator (level II or III) with the Texas Workforce Commission a plus. Supervisory experience within the TWC or NM DOL a big plus.The Unemployment Claims Supervisor will ensure compliance with dmDickason’s unemployment loss prevention program. You will be responsible for reducing the costs of fraudulent or malingering unemployment claims through proactive / preventive claims management, procedural awareness and staff training. Help reduce unemployment claims assessment modifier by prevailing on multiple daily claims activity. The Unemployment Claims Supervisor is also responsible for managing all unemployment claims and appeal hearings, employee records retention, storage. retrieval and management. Strong understanding of base period wages, chargebacks, effects of increased modifiers to the applicable tax rates charged employers.

Position Requirements:

  • 3-5 Years experience in high-volume (30-50 weekly claims) unemployment claims administration, including appeal hearings; Current knowledge of dealing with the TWC & New Mexico Department of Labor in contested claims hearings;

  • Must be able to effectively speak, read and write in Spanish and English. Will have to “argue” claims appeals in both English and Spanish;

  • A demonstrated knowledge of TWC response requirements, paperwork, base periods, forms and deadline procedures required;

  • Internal knowledge of the TWC & NM Department of Labor – how charge-backs to the Employer are monitored / calculated. Will keep detailed spreadsheets on claims won / lost f/ appealed / charged-back, etc.;

  • Monitor Company’s and Client’s employee handbooks to close loop-holes in unemployment claims awards.

  • Proficient in MSWord / Excel needed

Position
Responsibilities:

  • Respond / file all terminated employees’ unemployment claims in a concise and timely manner;
  • Protest all claims notices. Protest all unwarranted claims and charge-back notices for Company's 2000+ employees;

  • Research and aggressively appeal all decisions not in accordance with unemployment insurance law, or, best interest of the Company;

  • Perform a continuing audit of Company’s experience rating to verify the correctness of each years tax assessment and make improvement recommendations to senior staff;

  • Complete necessary forms to the TWC and NM Department of Labor when appealing a decision regarding unemployment awards;

  • Coordinate and present effective documentation and witnesses at all appeal hearings; Maintain a high level of confidentiality;

  • Train staff on claims prevention and proper documentation to prevent claims awards by the respective States;

  • Supervise records retention, retrieval and storage of thousands of employment related records to assure federal, state and local government compliance;

  • Oversee / respond to all (employer) requests for past employee references and employment verification requests

Benefits:

Work in a plush private corporate offices with assistants. We offer health / medical benefits, 401(k) plan, paid vacations & holidays + advancement within a large Human Resources Division, cross-training and more!

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Billling Adjudicator With CVS Health

You may also apply directly at:http://newyorkinterviews.com/job/billling-adjudicator-with-cvs-health/
The position listed below is not with New York Interviews but with CVS HealthNew York Interviews is a private organization that works in collaboration with government agencies to promote emerging careers. Our goal is to connect you with supportive resources to supplement your skills in order to attain your dream career. New York Interviews has also partnered with industry leading consultants & training providers that can assist during your career transition. We look forward to helping you reach your career goals! If you any questions please visit our contact page to connect with us directly
Position Summary:


Position Summary:

Omnicare, Inc. is a wholly owned subsidiary of CVS Health Corporation. www.cvshealth.com
What We Do
Directly, and through our subsidiaries, Omnicare provides a broad array of pharmacy-related services to long term care facilities and to other customers in the health care environment. While senior care has long been an Omnicare specialty, we also serve other targeted populations.
Overview: A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims.
Shift: Monday - Friday 11:30 am to 8 pm with rotating Sunday's

Required Qualifications:

  • High school diploma
  • Entry-Level familiarity with Excel/Access
  • Perform multiple tasks effectively
  • Able to work both independently and as part of a team

Preferred Qualifications:
  • Pharmacy technician certification highly preferred
  • Experience in pharmacy, managed care, Medicaid and/or
    Medicare organizations
Education:

High school diploma or equivalent
Business
Overview:

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nations largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-###-####. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-###-####. Please note that we only accept resumes via our corporate website:

Required Qualifications:
  • High school diploma
  • Entry-Level familiarity with Excel/Access
  • Perform multiple tasks effectively
  • Able to work both independently and as part of a team

Preferred Qualifications:
  • Pharmacy technician certification highly preferred
  • Experience in pharmacy, managed care, Medicaid and/or
    Medicare organizations
strong>Education:
High school diploma or equivalent
Business
Overview:

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nations largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-###-####. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-###-####. Please note that we only accept resumes via our corporate website:
Associated topics: blood collection, lab, laboratory, medical, medical lab science, mls, surgical technologist, technician ii, technician laboratory, toxicology

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Billing Adjudicator

Position Summary Omnicare, Inc. is a wholly ownedsubsidiary of CVS Health Corporation. www.cvshealth.com What We Do Directly, and through oursubsidiaries, Omnicare provides a broad array of pharmacy-related services tolong term care facilities and to other customers in the health careenvironment. While senior care has long been an Omnicare specialty, we alsoserve other targeted populations.

Overview : A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims Shift: Monday

  • Friday 11:30a-8p with rotating weekends/holidays Position Summary Omnicare, Inc. is a wholly ownedsubsidiary of CVS Health Corporation. www.cvshealth.com What We Do Directly, and through oursubsidiaries, Omnicare provides a broad array of pharmacy-related services tolong term care facilities and to other customers in the health careenvironment. While senior care has long been an Omnicare specialty, we alsoserve other targeted populations.

    Overview : A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims Shift: Monday

  • Friday 11:30a-8p with rotating weekends/holidays Preferred Qualifications Pharmacy technician certification highly preferred Experience in pharmacy, managed care, Medicaid and/or Medicare organizations Required Qualifications High school diploma Entry-Level familiarity with Excel/Access Perform multiple tasks effectively Able to work both independently and as part of a team Posted by StartWire

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Risk Management Claims Adjudicator

FAX: (208) 334-2307 EMAIL: hradm.idaho.gov Click Here Risk Management Claims AdjudicatorDepartment of Administration Open for Recruitment: August 9, 2017 - August 25, 2017 Announcement 08953085019 Salary Range: $22.00 to $26.00 per hour -Plus Competitive Benefits Location(s): Boise The Department of Administration is dedicated to providing responsive, cost effective, and timely support services to Idaho's policy makers, public agencies and state employees as they serve Idaho citizens.

The Department of Administration, Risk Management Program, currently has an opening for a Risk Management Claims Adjudicator in Boise. This position has the challenging responsibility of investigating and adjudicating liability, property, and physical damage claims and determining liability; negotiating claim settlements; and managing claims with outside adjusters and directing the course of legal defense. The ideal candidate will have knowledge and understanding of insurance principles and policies; litigation management experience; negotiation skills including mediation and settlement experience; experience directing the activities of independent adjusters and legal counsel; proper and casualty claims handling experience; and have some familiarity with tort claims, comparative negligence laws, and rules of civil procedure and case law.

This permanent classified position also includes a comprehensive benefit package including: PERSI Retirement Benefits, Medical/Dental Benefits and Life Insurance for both the employee and eligible dependents. Paid time off includes vacation and sick leave that begin accruing immediately upon hire and Holiday pay.

Please note: The successful candidate will be required to pass a fingerprint-based background check. Typical Responsibilities:

Claims investigation/adjudication: Investigates and determines legal liability of claims by analyzing and applying tort, federal and civil law, immunities, theories of negligence and comparative negligence, adjusting principles, insurance coverage and exclusions, and determining responsible parties and related coverages; Verifies that claims are properly filed in accordance with related laws; Determines sources and information necessary to evaluate claims; directs the collection of and retention of information; Analyzes loss reports and claims to determine severity of loss and liability of the State; Analyzes coverage and liability by researching and applying laws, insurance coverages, agency duties, policies and processes, theories of negligence, civil case law and applicable contracts; Conducts interviews with parties; Assigns and directs investigations by outside adjusters; Analyzes and evaluates evidence gathered for completeness; Evaluates bodily injury claims and works with medical personnel to interpret and analyze severity and appropriateness of injuries claimed; Develops a plan for appropriate resolution of claims and establishes appropriate case reserves; Serves as liaison between state agencies, insurance adjusters, claimants and/or attorneys regarding claims processing; Seeks subrogation to collect reimbursement. Litigation Management:

Determines direction and procedures for claims management; Works with legal counsel to develop defense strategies; Evaluates and approves aspects of discovery to be conducted by counsel; Communicates by telephone and in writing with claimants, state agencies, witnesses, adjusters, and attorneys; Determines legal and liability reserves, and monitors them for needed adjustments; Monitors course of trial proceedings and coordinates with counsel regarding proceedings; Acts as liaison between agencies and counsel; Conducts and directs settlement negotiations; Substantiates that correct settlement sums have been indicated and documents are prepared and filed accordingly; Provides claim coverage and procedural information to the public and state agency customers as necessary. Other: Mentors and provides instruction and training as assigned to other claims staff; Fills in for Claims Supervisor during absences; Monitors developments in case law and loss control issues and reports significant issues to management; Pursues recovery of state monies from responsible third-parties. Minimum Qualifications:

Experience investigating, evaluating, adjusting, and settling first and third party claims; Experience directing the activities of defense counsel and independent adjusters pertaining to civil tort law cases; Experience applying the Idaho Tort Claims Act (ITCA) in the adjudication of public entity claims; Experience applying claims management/loss control practices; Experience operating a personal computer for word processing and entering and retrieving data. Desirable Qualifications:

Experience drafting complex business correspondence.

Examination: Training and Experience. Please respond to the examination questions based on your training and experience related to this position. Scoring will be based on your responses.

Applicants must receive a minimum score of 63. You will receive notification of your results online. To preview the exam click on "Preview Exam" below.

You will not be able to take the exam from this screen. To Apply: Click on any Apply Online button to the left and follow the instructions provided to complete the Application Checklist and Qualifications for this position.

When completing or updating your online application information, please select: Department of Administration under "Agencies" Full-time employment under "Job Type/Shift" Boise under "Cities" Failure to make these selections will remove you from consideration for this position. Thank you for your interest in joining our team Preview Exam OVERTIME NOTICE:

At the discretion of the appointing authority, compensatory time off may be provided in lieu of overtime cash compensation. Hiring is done without regard to race, color, religion, national origin, sex, age or disability. In addition, preference may be given to veterans who qualify under state and federal laws and regulations.

If you need special accommodations to satisfy testing requirements, please contact the Division of Human Resources. Posted by StartWire



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Economic Sanctions Adjudication Analyst

The Economic Sanctions Adjudication Analyst is responsible for fulfilling the Anti-Money Laundering (AML)/Bank Secrecy Act (BSA) and Office of Foreign Assets Control (OFAC) requirements through enhanced evaluation, identification, and research of relationships on behalf of U.S.

Bank of both new and existing accounts.

Responsibilities include performing analysis and enhanced due diligence on results from OFAC/Sanctions and PEP watchlist screening of customer accounts according to U.S.

Bank policy and procedures. The role will partner with other Enterprise Financial Crimes Compliance (EFCC) departments and Business Lines to complete due diligence review and report details as needed to appropriate areas.

Responsibilities also include back up and support for Sanctions related escalations from Business Lines including but not limited to wire transactions, international ACH transactions (IAT) and trade finance. ESSENTIAL FUNCTIONS: Analyze output of OFAC/Sanctions and PEP watchlist screening and make decisions on appropriate action to take.

Maintain thorough documentation of analysis performed. Work cooperatively with U.S.

Bank internal departments to obtain and evaluate necessary information related to the analysis.

Assist in implementation of OFAC/Sanctions and PEP detection methods, such as training and instruction manuals Assist with departmental tracking and reporting. Support any special projects or critical casework. Actively ensures compliance with the U.S.

Bank Code of Ethics and all AML, BSA, information security, and suspicious activity reporting requirements, policies and procedures. Actively participates in any required corporate and business line training in these areas. Follows account opening procedures and understands and follows internal suspicious activity referral requirements and processes, as required for this position.

Remains current on legal, regulatory AML/BSA, OFAC and PEP requirements and actions. OTHER FUNCTIONS: Analyze sanctions related escalations from Business lines (wire transactions, IAT, trade finance, etc.) and make decisions on appropriate action to take.

Basic Qualifications: Bachelors' degree or the equivalent in work experience 1 - 2 years' experience in OFAC, PEP and/or AML/BSA analysis Preferred Skills / Experience: CAMS certification Extensive knowledge of AML/BSA, OFAC, PEP and FinCEN-related laws and regulations Knowledge of U.S.

Bank's operations, systems, and practices within business units Knowledge of AML/BSA, OFAC and PEP laws and regulations Excellent communication and written skills Strong analytical abilities and problem solving skills Strong self-motivation and organizational skills Exceptional ability to multi-task and prioritize projects Ability to coordinate and work collaboratively with internal and external contacts on a daily basis Documented record of achieving results both individually and in a team setting Proficiency in Microsoft Excel, Access, Word, and/or experience in using other database applications Posted by StartWire



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Adjudication - Pharmacy Technician

Job Description: Position SummaryThe Adjudication Pharmacy Technician is responsible for preparing and submitting claims for accounts to ensure timely reimbursement.

Responsibilities may include primary or secondary or tertiary claims as assigned by supervisor.Shift Schedule:2nd Shift: 1PM - 9:30PM, 5 Days a week (Alternating Weekends and Holidays)(Shifts are subject to change per business needs) Summary of Essential DutiesSupport the Pharmacy Staff as they address billing related tasks throughout the day.Answer all calls and internal/external inquiries in a polite and professional manner.Process insurance rejections from the Reject Report and the Medicaid Report.Manage assigned facility census and change pay statuses for patients.Update Public Aid Pending spreadsheet and forward to Director of Billing and Executive VP monthly.Process and review daily rejections.Call facilities to clarify Medicaid information and individual claims with Medicaid caseworker.Submit prior authorizations for state Insurance and proper paperwork concerning Nursing and Personal Care MedicaidProcess Spend Down Patients, LTC charges monthly and enter them into database, Batch Billing for Third Party nightly and reconcile paid claims.Cash posting as directed.Perform multiple tasks effectively.Manage the census and prepare monthly statements. Qualifications & SkillsHigh school graduate or equivalent.Excellent verbal and written English communication skills are required.Must possess good mathematical skills.Must possess superior customer service skills.Prior experience in billing or medical/pharmacy field (Preferred).Pharmacy Technician License Required.Entry-level familiarity with Microsoft Word and Excel (Use of e-mail).Experience using Framework LTC and Docutrack (Preferred- Will provide training).Disclaimer:The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

All personnel may be required to perform duties outside of their normal responsibilities from time to time as needed.Company DescriptionPharmore Drugs is a privately owned long term healthcare pharmacy located in Skokie, Illinois. The company has grown to serve over 14,000 patients throughout Illinois, Southeast Wisconsin and Northwest Indiana, and is the largest independent long term care pharmacy in the state of Illinois. Pharmore Drugs is a dynamic company known for its employee friendly, customer focused, team-oriented work environment.

We provide unparalleled service and believe in the strength of partnership between the pharmacy and the long term care facilities we service. At Pharmore, customer care is our primary business at all levels and is the foundation from which the company was built. Each and every member of the organization's team is selected for their drive for excellence.



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Billing Adjudicator

Position Summary:

Omnicare, Inc. is a wholly owned subsidiary of CVS Health Corporation.

What We Do

Directly, and through our subsidiaries, Omnicare provides a broad array of pharmacy-related services to long term care facilities and to other customers in the health care environment. While senior care has long been an Omnicare specialty, we also serve other targeted populations.

Overview : A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims.

Shift: Monday through Friday 4:30pm to 1am with rotating weekends.



Required Qualifications:

•High school diploma

•Entry-Level familiarity with Excel/Access

•Perform multiple tasks effectively

•Able to work both independently and as part of a team

Preferred Qualifications:



Pharmacy experience

Education:



High school diploma or equivalent

Business Overview:

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers.

What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law.

CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at and EEO IS THE LAW SUPPLEMENT at

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health at mailto:

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-. Please note that we only accept resumes via our corporate website:



Post a Job