- CERiS (Fort Worth, TX)
- …for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings and providing ... written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules Experience with claims denials and appeals… more
- AUROBINDO (Durham, NC)
- …resumes, conducting phone screens, and interviewing.Assist with benefits administration including medical , dental, vision, COBRA and 401(k), health and welfare open ... and documentation in accordance with legal requirementsPerformance ManagementCoordinate performance review cycles and goal-setting processes.Support managers in delivering feedback… more
- UnitedHealth Group (Los Angeles, CA)
- …Excellence, a national OptumCare team, is currently seeking an experienced National Medical Director to join our growing Value Innovations efforts. This key ... will provide expertise and leadership on population, specifically Clinical Documentation Review with expertise in application of DRG coding and clinical operations.… more
- Chubb (Walnut Creek, CA)
- …to case closure ensuring strong customer relations are maintained throughout the process. Review and assess new medical -only claims to determine eligibility ... Job Description Chubb is currently seeking a Workers' Compensation Medical Only Claim Examiner for our West Coast/Pacific region. The successful applicant will… more
- Intercare Holdings Insurance Services, Inc. (Rocklin, CA)
- …date plan of action outlining activities and actions anticipated for ultimately resolving the claim . Form a partnership with the medical case manager to maximize ... Full-time, Temporary Description Summary: Reports directly to the unit Claims Supervisor and may be called upon to provide...warranted and in strict accordance with assigned authority levels. Review all medical bills for appropriateness prior… more
- County of Los Angeles, CA (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. Attends Utilization Review Committee meetings to ... year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.**...steps to view correspondence, and we will not consider claims for missing notices to be a valid reason… more
- MCI Careers (Wichita, KS)
- …necessary information and notify business partners regarding messages, inquiries, and claim reporting Utilize knowledge base and training to accurately answer ... surrounding confidential information and personal information Attend meetings and training and review all new training material to stay up-to-date on changes to… more
- Blue Cross Blue Shield of Arizona (Phoenix, AZ)
- …Health Services Division such including utilization management, quality management, case management, medical claims review , and pharmacy management. Specific ... HEDIS, dispute resolution, regulatory compliance, care and disease management, concurrent review , precertification, medical claims reconsideration and… more
- Eisai, Inc (Nutley, NJ)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... pharmaceutical laws and industry guidelines including the Anti-Kickback Statute, False Claims Act, federal and state pricing-related laws and regulations, PhRMA Code… more
- American Recruiting and Consulting Group (Jacksonville, FL)
- …Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims , and promoting evidence-based healthcare. ESSENTIAL DUTIES ... to the Medicare program. * Provide clinical consultation to internal teams (eg, medical review staff, appeals teams) and external stakeholders. * Provide the… more
- MCI Careers (Wichita, KS)
- …to complete account management tasks Accurately document and process customer claims in appropriate systems Follow all required scripts, policies, and procedures ... and effective call handling Attend meetings and training and review all new training material to stay up-to-date on...cars! Health Benefits: Full-time employees are eligible for comprehensive medical , dental, and vision coverage after 60 days of… more
- Hankey Group External (Los Angeles, CA)
- Claims Supervisor Los Angeles | Remote |Auto Insurance Claims Pay Range: $75,000- $98,000 Per Year. The exact starting compensation to be offered will be ... We take pride in offering comprehensive insurance solutions and ensuring a seamless claims process for our customers. We are currently seeking a dynamic and… more
- CRC Group (Fort Worth, TX)
- …activities may change from time to time. 1. Effectively manage assigned team of Claims Examiners and performance of same. 2. Review all new losses assigned ... English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Through technical direction and oversight, the… more
- Core Specialty (Dallas, TX)
- …will be responsible for the direct handling of Commercial Garage and General Liability claims from receipt of claim or suit through resolution or trial/appeal. ... to obtain insured's knowledge of the allegations in the claim /suit. Analyse coverage for application to claim ...increases for presentation to management and upper management for review . Communicate with manager as to critical new developments… more
- BlueCross BlueShield of South Carolina (Columbia, SC)
- …resolve these inquiries. Other responsibilities include review and adjudication of claims and/or non- medical appeals, determining whether to return, deny or ... research as needed to resolve inquiries. Reviews and adjudicates claims and/or non- medical appeals. Determines whether to...standards and examining guidelines. Another responsibility is to enter claims into the claim system after verifying… more
- Progressive Casualty Insurance Company (Portland, ME)
- …and local laws Evaluate and handle claim payments and resolution of claims without payments Review and determine validity of any supplement requests ... process with body shops Document information related to the claim and make decisions consistent with claims ...Benefits 401(k) with dollar-for-dollar company match up to 6% Medical , dental & vision, including free preventative care Wellness… more
- Berkley (Trenton, NJ)
- …appropriate contractual provisions to the medical facts and specifications of the claim Review and adjudicate claims within approved authority limits ... perform quality review and evaluation of all claim submissions received and logged into our claims... experience Prior experience handling first dollar payer insurance ( medical healthcare claims ) Experience with medical… more
- MCI Careers (Wichita, KS)
- …center locations. We offer competitive compensation, performance-based bonuses, comprehensive medical , dental, and vision benefits, paid vacation and holidays, and ... sales opportunities and meet revenue targets Ensure accurate and timely payroll review and submission Track and analyze individual and team performance, addressing… more
- APS Medical (Toledo, OH)
- …$17 to $25 per hour Fully Remote *Weekends Off *Opportunities for Growth APS Medical Billing, located in Toledo Ohio, is seeking experienced Medical Billers to ... locations throughout the United States. Responsibilities Follow up on unresolved claims within the standard billing cycle Investigate, identify, research, and appeal… more
- Gallagher (Buffalo, NY)
- …role is eligible for fully remote work How you'll make an impact Apply claims management experience to execute decision-making to analyze claims exposure and ... litigation, plan the proper course of action, and appropriately resolve claims . Interact extensively with various parties involved in the claim process to ensure… more
