CrawlJobs Logo

Claim Resolution Rep III

urmc.rochester.edu Logo

University of Rochester

Location Icon

Location:
United States of America , Rochester

Category Icon
Category:

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

19.62 - 26.49 USD / Hour

Job Description:

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Responsibility:

  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Researches and calculates under or overpaid claims
  • determines final resolution
  • Contacts payers on incorrectly paid claims completing resolution and adjudication
  • Adjusts accounts or processes insurance refund credits
  • Reviews and advises leadership on incorrectly paid claims from specific payers
  • Works with leadership on communication to payer representatives regarding payment trends and issues
  • Bills primary and secondary claims to insurance
  • Identifies and clarifies billing issues, payment variances, and/or trends that require management intervention
  • Assists department leadership with credit balances account reviews/resolutions and all audits
  • Coordinates response and resolution to Medicaid and Medicare credit balances
  • Requests insurance adjustments or retractions
  • Reviews and works all insurance credits in electronic health record
  • Enters electronic health record notes, documenting actions taken
  • Researches and responds to third party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations
  • Assists with patient related questions
  • Communicates and coordinates with other departments to resolve claim issues
  • Assists with all audits as needed

Requirements:

  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience

Additional Information:

Job Posted:
February 21, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Claim Resolution Rep III

New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States , Amityville
Salary
Salary:
19.00 - 29.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
March 25, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • Regular and predictable attendance, including nights and weekends
  • Ability to complete required training within designated timeframe
  • Ability to concentrate on a task over a period of time
  • Ability to pivot quickly from one task to another to meet patient and business needs
  • Ability to confirm prescription information and label accuracy, ensuring patient safety
  • Actively look for ways to help people, and do so in a friendly manner
  • Notice and understand patients’ reactions, and respond appropriately
Job Responsibility
Job Responsibility
  • Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
  • keeping patients healthy by offering immunizations and other services at the register and over the phone
  • and demonstrating compassionate care by solving or escalating patient problems
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • voluntarily traveling to stores in the market to work shifts as needed by the business
What we offer
What we offer
  • Affordable medical plan options
  • a 401(k) plan (including matching company contributions)
  • an employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • paid time off
  • flexible work schedules
  • family leave
  • dependent care resources
  • colleague assistance programs
  • tuition assistance
  • Fulltime
Read More
Arrow Right
New

Close Observer Lead

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.08 - 25.77 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree in Psychology, Sociology or related field and 2 years of experience in a hospital in-patient unit setting required
  • Bachelor's degree in human services preferred
  • Experience with caring for patients with various psychological and cognitive disorders at risk of safety to themselves and/or others preferred
  • Prior leadership experience preferred
  • Excellent communication skills, conflict management skills, and team building knowledge required
Job Responsibility
Job Responsibility
  • Assists in maintaining patient and staff safety by monitoring patients and assisting with delegated nursing care
  • Incorporates therapeutic and diversionary interventions to maintain patient safety, refocus the patient, and promote healthy behaviors as needed
  • Leads daily operations including but not limited to staff performance, and oversight of operational flows/problem-solving in collaboration with nursing leadership
  • Conducts general administrative duties to support a safe and efficient team and service to the patient
  • Assists patients with ambulation, hygiene, nutrition, linen changes, and other activities of daily living
  • Identifies potential risks and early signs of escalating patient behaviors
  • Maintains communication with team members
  • Leads routine rounding, staff meetings, and weekly updates
  • Oversees safety of patients and staff
  • Provides oversight of staff in day-to-day operations
  • Fulltime
Read More
Arrow Right
New

Medical Administrator

Robert Half is currently seeking an experienced and highly organized Medical Adm...
Location
Location
United States , Fresno
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2–4+ years of medical administrative, medical office, or healthcare coordination experience
  • High school diploma required
  • Associate or Bachelor’s degree in Healthcare Administration or related field preferred
  • Experience working with EMR/EHR systems (Epic, Cerner, eClinicalWorks, NextGen, etc.)
  • Knowledge of medical terminology, insurance verification, and patient scheduling
  • Familiarity with HIPAA regulations and healthcare compliance standards
  • Proficiency in Microsoft Office (Word, Excel, Outlook)
Job Responsibility
Job Responsibility
  • Serve as a liaison between patients, providers, insurance companies, and internal departments
  • Order and manage medical and office supplies
  • Assist with onboarding of new staff and training on administrative procedures
  • Support special projects and process improvement initiatives
  • Ensure compliance with HIPAA and healthcare regulatory standards
  • Track required certifications, licenses, and compliance documentation
  • Assist with audits, quality assurance initiatives, and policy updates
  • Generate reports related to patient volume, scheduling, and administrative metrics
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
Read More
Arrow Right
New

Senior Manager, Global Performance Marketing Strategy

We’re looking for a data-driven, strategic, and highly collaborative marketing l...
Location
Location
Singapore , Singapore
Salary
Salary:
Not provided
Airwallex
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 8+ years of experience in B2B or fintech performance marketing, including strategic leadership of multi-channel global acquisition programs
  • Proven success driving measurable pipeline growth and improving marketing efficiency (e.g., LTV:CAC, payback period)
  • Hands-on understanding of SFDC, Salesforce, Building Looker tables
  • Expertise in paid search, paid social, display, and emerging channels
  • familiarity with ABM and demand generation
  • Strong analytical acumen — experience with advanced measurement, attribution, and experimentation frameworks
  • Excellent communicator with experience presenting to executive leadership
  • Demonstrated ability to collaborate cross-functionally across time zones and influence without authority
  • Experience managing or operationalizing in-house performance models preferred
  • Bachelor’s degree in Marketing, Statistics, Computer Science, Economics, or related field
Job Responsibility
Job Responsibility
  • Develop and operationalize the global performance marketing strategy across paid search, paid social, programmatic, and emerging channels
  • Partner with regional teams (APAC, EMEA, North America) to localize global frameworks into market-specific plans that drive efficiency and scale
  • Develop options for channel mix strategy, investment allocation models, and measurement frameworks tied to pipeline, revenue, and LTV:CAC goals
  • Lead quarterly planning cycles, including budget forecasting, scenario modeling, and regional investment trade-offs
  • Collaborate with the global execution team to become hands-on in campaign execution and optimization
  • Own standardized reporting to highlight growth, opportunities, and streamline communication and communication cadences for regions
  • Own the synthesis of learnings by region and be responsible for sharing out with stakeholders across the globe
  • Partner with vendors and internal teams to develop incrementality testing strategies, partnering with analytics to evolve measurement (MMMs, geo-experiments, and brand lift studies)
  • Surface insights from campaign data to influence global GTM and lifecycle strategy
  • Partner with Product Marketing to align messaging and audience segmentation strategies
  • Fulltime
Read More
Arrow Right
New

Senior Research Specialist

The Senior Research Specialist provides direct research support at the senior pr...
Location
Location
United States of America , Rochester
Salary
Salary:
63815.00 - 95723.00 USD / Year
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree required
  • Master's degree preferred
  • 5 years of related experience
  • or an equivalent
  • or a combination of education and experience required
  • Applicants should be self-motivated and capable of working independently as well as in a collaborative setting required
  • Strong interpersonal and communication skills, including written communication required
  • Ability to readily learn new experimental techniques required
  • Strong analytical, communication, organizational and computer skills required
Job Responsibility
Job Responsibility
  • Collaborates with investigators in writing protocols for the conduct of research
  • Organizes research activities in accordance with approved protocols
  • Informs staff of their responsibilities in the project
  • Develops and installs operating procedures for the laboratory
  • Ensures that health and safety practices are maintained
  • Analyzes and evaluates experimental data and interprets results
  • Prepares written reports and presentations on all on-going projects
  • Keeps abreast of trends in field of interest
  • Independently operates histological-related equipment and microscopes
  • Maintains contact with outside research laboratories, vendors and technical representatives
  • Fulltime
Read More
Arrow Right
New

Femme de Chambre

Respond promptly to requests from guests and other departments. Fill cart with s...
Location
Location
French Polynesia , Bora Bora
Salary
Salary:
Not provided
https://www.marriott.com Logo
Marriott Bonvoy
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Respond promptly to requests from guests and other departments
  • Fill cart with supplies and transport cart to assigned area
  • Enter guest rooms following procedures for gaining access and ensuring vacancy before entering
  • Replace guest amenities and supplies in rooms
  • Replace dirty linens and terry with clean items
  • Make beds and fold terry
  • Clean bathrooms
  • Remove trash, dirty linen, and room service items
  • Check that all appliances are present in the room and in working order
  • Straighten desk items, furniture, and appliances
  • Fulltime
Read More
Arrow Right
New

Plan administrator

Robert Half is looking for a detail-oriented Plan Administrator to join our team...
Location
Location
United States , San Ramon
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven experience in administrative support, including calendar management and travel arrangements
  • Strong knowledge of compensation administration and deferred compensation plans
  • Familiarity with analyzing payroll data and performing year-end compensation reviews
  • Ability to manage multiple priorities and deadlines with exceptional organizational skills
  • Proficiency in investigating and resolving data discrepancies and recordkeeping issues
  • Excellent communication skills for liaising with vendors and addressing participant inquiries
  • Experience with compliance testing and non-discrimination analysis
  • Capability to identify inefficiencies and recommend process enhancements
Job Responsibility
Job Responsibility
  • Manage the annual online enrollment processes for multiple plans, including participant communication reviews and vendor coordination
  • Oversee plan distribution payments, ensuring accurate processing for events like vesting, scheduled distributions, separations, and domestic relations orders
  • Support Employer Discretionary allocation reviews by preparing timelines, delivering allocation data, processing deposits, and drafting communications
  • Compile and analyze compensation data from payroll systems to identify Highly Compensated Employees and assist with year-end reporting and compliance testing
  • Update and maintain plan materials to ensure accuracy and relevance
  • Collaborate with vendors and internal teams to resolve data discrepancies, file transmission issues, and recordkeeping gaps
  • Address participant inquiries regarding plan eligibility, contributions, distributions, and vesting calculations
  • Investigate payroll deduction variances and reconcile discrepancies before initiating funding requests
  • Contribute to departmental initiatives and special projects aimed at improving productivity and efficiency
  • Recommend improvements to streamline processes and enhance team effectiveness
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • company 401(k) plan
Read More
Arrow Right
New

Director, Strategic Partnerships, AI, Americas

The Director of Strategic Partnerships, AI will play a critical role in driving ...
Location
Location
United States , San Francisco
Salary
Salary:
160000.00 - 260000.00 USD / Year
Airwallex
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • A Bachelor’s degree or equivalent
  • At least 10 years of experience working in strategic partnerships, business development, product or related roles
  • Executive relationships within and deep industry knowledge of the AI space, ideally globally
  • A strong product instinct, with the demonstrated ability to identify opportunities for leveraging partners’ and Airwallex’s existing and future products
  • Expertise in crafting and executing on thoughtful partnership and product strategies with technology companies, preferably including AI-focused ones
  • Robust analytical skills and data literacy, especially the ability to create and manage investment memos and financial models
  • Exceptional written and verbal communication skills, allowing you to connect with people across functions and cultures, and communicate complex concepts to stakeholders at all levels–including senior executives–internally and externally
  • Strong deal process execution and negotiation skills, along with the hustle to progress to completion multiple complex deals in parallel, across regions
Job Responsibility
Job Responsibility
  • Intimately understand the Airwallex financial operating system products and services to ensure that the right partners are selected to support the delivery of our roadmap
  • Translate Airwallex’s key objectives into a comprehensive partnerships and outbound strategy, identifying target partners and mutually synergistic use-cases and being able to communicate and convince effectively
  • Establish and maintain strong relationships with key AI companies, externally with executives and decision makers, and internally with cross-functional leaders
  • Lead product integration scoping and structure/negotiate value exchanges and partnership agreements that are mutually beneficial, ensuring appropriate risk mitigation and securing cross-functional buy-in
  • Craft a multitude of deal types and own partner relationships across verticals, structures, and deal stages (pre-deal, implementation and post-deal partner management)
  • Collaborate closely with cross-functional teams and leadership across the company, including Legal, Compliance, Product, Engineering, Strategy, Finance, Operations and the CEO’s office – including in executing deals with new and existing partners, working operationally with partners, and ensuring seamless post-acquisition integration of acquired entities
  • Harness a strong executive network for building thought leadership at the intersection of AI and payments
  • Represent Airwallex as an executive spokesperson at events and in the media
What we offer
What we offer
  • Offers Equity
  • Offers Bonus
  • medical, dental, and vision insurance
  • a 401(k) plan
  • short-term and long-term disability
  • basic life insurance
  • well-being benefits
  • 20 paid days of vacation
  • 12 paid days of company holidays
  • Fulltime
Read More
Arrow Right