This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description ManhattanLife is seeking a Claims Specialist for our office located in De Pere, WI. This role directly supports our organization’s Claims team. Claims Specialists evaluate medical claims submissions and process the claims on our systems. Our Claims Specialists also provide customer service to our policyholders over the phone. This position has the option to be remote. Duties and Responsibilities - Evaluate claims based on documentation received and provide timely follow-ups for claims being adjudicated. - Process insurance claims with adherence to company policies and contract provisions in full accordance with the law. - Make decisions and ensure the successful resolution of inquiries and complaints by preparing accurate and timely activity reports. - Communicate via written correspondence or e-mail to claimants. Qualifications - High School Graduate or equivalent (GED). - 1-3 years of claims experience preferred. - Solid knowledge of ICD-9, ICD-10 or medical coding. - Excellent phone skills and an ability to communicate in a friendly and effective manner with our customers. - Background in insurance claims is preferred in any discipline of Medicare Supplement, Life, Health, Cancer or Disability. - Ability to read and understand policy language. - Understanding of basic medical terminology. - Ability to work independently and in a team environment. - Ability to prioritize and manage workload to meet deadlines. Travel Requirements - This position does not require travel. Professional Development - Establish annual objectives for professional growth. - Keep pace with developments in the discipline. - Learn and apply technologies that support professional and personal growth. - Participate in the evaluation process. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to: - Stand; walk; use hands to finger, handle or feel objects, type, and use mouse; - Reach with hands and arms and talk and/or hear; - Sit for extended periods of time; - Lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as: - Computers; - Phones via WebEx; - Physical phone while in office; - Photocopiers when necessary. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice. AAP/EEO Statement ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven success working in a high‑volume, production‑driven environment. - Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail. Preferred Qualifications - Self-Funding experience - DG system knowledge Education - High School Diploma required - Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description - Prepare, submit, and track insurance claims for Applied Behavior Analysis (ABA) services. - Review claims for accuracy and completeness prior to submission. - Follow up on outstanding, rejected, or denied claims with insurance providers. - Investigate and resolve claim discrepancies, denials, and payment issues. - Work closely with billing, scheduling, and clinical teams to ensure services are billed correctly. - Verify client insurance information and ensure authorizations align with billed services. - Maintain accurate records of claims, payments, and correspondence with payers. - Ensure compliance with payer requirements, company policies, and healthcare billing regulations. - Provide regular updates and reports on claim status and reimbursement trends. Qualifications - Previous experience in medical billing or claims processing, preferably in an ABA or behavioral health setting. - Strong understanding of insurance claims processes and payer requirements. - Experience working with billing systems and electronic health records (EHR). - Excellent attention to detail and problem-solving skills. - Strong organizational and time-management abilities. - Ability to communicate effectively with insurance companies and internal teams. - Knowledge of CPT codes and healthcare billing practices is preferred. - Comfortable working U.S. hours. Requirements - Remote work from home. Benefits - Fraud Disclaimer: ReWorks Solutions will never request payment during recruitment or require in-person office visits. - All official communication will come from a ReWorks Solutions email address. - Please verify any suspicious messages with our team directly.

Req ID: 361179 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Medical Claims Processor to join our team in Plano, Texas (US-TX), United States (US). NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment About NTT DATA NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D. Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.