Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriat…
Skills: Claims Adjudication, Medical Terminology, CPT Codes, Claims Processing, Medical Billing
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: Perform quality review on claims, enrollment, and customer service personnel on select criteria determined by management. Audit personnel daily of randomly selected output and complete appropriate forms for …
Skills: Claims Review, Auditing, Medical Terminology, CPT Codes, Claims Processing
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: Responsible for processing reports, reconciling transactions and updating the system. Create and maintain customer eligibility in the company database, generate customer correspondence for new packets, assem…
Skills: Oral Communication, Written Communication, Problem Solving, Critical Thinking, Attention To Detail
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriat…
Skills: Claims Adjudication, Medical Terminology, CPT Codes, Claims Processing, Medical Billing
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Senior Health Data Analyst provides the analytical support for Executives and all departments including analysis, pricing, capitation, network, and provider specific reporting. Analytical support include…
Skills: Data Analysis, Project Management, SAS, SQL, Power BI
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with…
Skills: Oral Communication, Written Communication, Medical Terminology, Microsoft Office, Data Entry
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: Responsible for selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. KEY RESPONSIBILITIES: Discuss products and benefits wi…
Skills: Telemarketing, Sales, Customer Service, Medicare Regulations, Microsoft Office
Tulsa, Oklahoma, United States · Remote OK
JOB SUMMARY: The Utilization Management Clinical Pharmacist is responsible for playing a critical role in optimizing medication use, improving member outcomes, and ensuring regulatory compliance. This position serves as …
Skills: Utilization Management, Formulary Management, Clinical Policy Creation, Prior Authorization Review, Medication Therapy Management
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Data Engineer will be responsible for expanding, optimizing and monitoring our data and data pipeline architecture, as well as optimizing data flow and collection across organizational teams. The Data En…
Skills: Data Pipeline Architecture, ETL, SSIS, Data Management, Project Management
Tulsa, Oklahoma, United States · Hybrid
JOB SUMMARY: CommunityCare HMO, Inc. seeks a Machine Learning Engineer to develop machine learning models for healthcare and payer applications, including but not limited to natural language processing, medical claims, r…
Skills: Machine Learning, Natural Language Processing, Predictive Analytics, Deep Learning, ETL Workflows
Tulsa, Oklahoma, United States · Hybrid
JOB SUMMARY: CommunityCare HMO, Inc. seeks a Senior Software Engineer to perform advanced backend software development, ensuring high performance and reliability. Write efficient, maintainable code for APIs and other mid…
Skills: C#, .NET, Microsoft SQL, API Development, Object-Oriented Design
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriat…
Skills: Claims Adjudication, Medical Terminology, CPT Codes, Claims Processing, Microsoft Office
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying issues related to and/or participates in various projects aimed at identifying areas of non-compliance …
Skills: Claims Auditing, Medical Coding, Clinical Appropriateness Review, Fraud Waste and Abuse Identification, Data Analysis
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: Support revenue cycle through accurate billing, payment processing, and customer account maintenance. Plans include Medicare, Marketplace, Group coverage and EAP. Collaborates closely with internal teams and…
Skills: Accounts Receivable, Billing, Payment Processing, Customer Account Maintenance, Accounting Principles
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk memb…
Skills: Utilization Review, Clinical Review, Medical Necessity Assessment, Care Coordination, Case Management
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriat…
Skills: Claims Adjudication, Medical Terminology, CPT Codes, Claims Processing, Medical Billing
Tulsa, Oklahoma, United States · On-site
JOB SUMMARY: The Complex Claims Specialist is responsible for examining claims that require review prior to being adjudicated. Claims are generally of the largest dollar value and require extreme attention to detail and …
Skills: Claims Adjudication, Medical Billing, CPT Codes, Medical Terminology, Contract Analysis
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The Claims Examiner is responsible for reviewing and adjudicating claims to determine appropriate payment, denial, or adjustment. They must identify trends, investigate complex claims, and ensure accuracy and efficiency in processing.
Candidates must have a high school diploma and at least two years of experience in claims processing, data entry, or medical billing. Proficiency in medical terminology, CPT codes, and Microsoft applications is required.
JOB SUMMARY:
The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency.
KEY RESPONSIBILITIES:
QUALIFICATIONS:
EDUCATION/EXPERIENCE:
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
Caring for Oklahomans like no other health plan can or does.
CommunityCare is Oklahoma's largest locally owned health plan. Products offered include group and individual plans, Medicare Advantage plans, an employee assistance program and a workers' compensation plan. Located in Tulsa, CommunityCare is owned by Ascension St. John and Saint Francis Health System. CommunityCare is proud to be Oklahoma’s best choice for health care.
Offices: Two West Second Street, Suite 100, Tulsa, OK 74103, US
Caring for Oklahomans like no other health plan can or does.
CommunityCare is Oklahoma's largest locally owned health plan. Products offered include group and individual plans, Medicare Advantage plans, an employee assistance program and a workers' compensation plan. Located in Tulsa, CommunityCare is owned by Ascension St. John and Saint Francis Health System. CommunityCare is proud to be Oklahoma’s best choice for health care.
Offices: Two West Second Street, Suite 100, Tulsa, OK 74103, US
