- Lifelancer (Raleigh, NC)
- About the job Medical Promotional Review Consultant Job Title: Medical Promotional Review Consultant Job Location: Raleigh, NC, USA Job Location Type: ... our partners' most high-profile drug and device programs. The Medical Promotional Review Consultant Is Responsible For...medical textbooks, etc. and how this data supports claims made consistent with the FDA approval label. Understanding… more
- USAA (Phoenix, AZ)
- …Relocation assistance is not available for this position. What you'll do: Inspect and review quality of claim files and provide feedback to employees as ... what truly makes us special and impactful. The Opportunity As a dedicated Manager, Claims Operations, you will lead and be accountable for auto, and other claims… more
- Optum (San Juan, PR)
- …Growing together. Primary Responsibilities: Authorizes the appropriate payment or refers claims to investigators for further review Conducts data entry ... Handling issues within turnaround standards Ability to handle most claim types / cases / issues that are submitted...overtime on weekends and holidays) Preferred Qualifications: Experience in medical billing or claims Healthcare experience Pay… 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
- 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
- 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. (Glendale, 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
- Optum (San Juan, PR)
- …the end of the day, we're doing a lot of good. The objective of the Clinical Case Review - RN or Certified Medical Coder is to help reduce the medical cost ... must demonstrate an ability to maneuver through all applicable claims applications (COSMOS, UNET, Facets, Pulse, etc.), and over...Experience with Fraud Waste & Abuse or Payment Integrity Medical record review experience Knowledge of health… more
- Chubb (Chatsworth, CA)
- …benefits, scheduling medical appointments, completion and filing of necessary forms Review medical reports and information to determine compensability of ... for employees everywhere! Under direct supervision initially, performs customer service and/or claims functions while training to become a claims representative.… more
- CCMSI (Las Vegas, NV)
- …liability claims with a focus on commercial auto and trucking exposures Review and approve medical , legal, and vendor invoices; resolve disputed bills ... Overview Multi-Line Claim Representative II - Remote Salary Range: $65,000...of pay. CCMSI offers a comprehensive benefits package, including Medical , Dental, Vision, Life Insurance, 401(k), ESOP, paid time… more
- Gallagher (Glendale, CA)
- …This role is fully remote work. How you'll make an impact Apply claims management experience to execute decision-making to analyze claims exposure, plan ... the proper course of action, and appropriately resolve claims . Interact extensively with various parties involved in the claim process to ensure effective… more
- Marriott International (Bethesda, MD)
- … Claims Representative is responsible for the administration and disposition of medical only (MO) workers compensation (WC) claims . Caseload will be ... claims and responsibility is limited to non-litigated medical only and disability claims of limited...reports, provide for fee schedule or other appropriate bill review , and process for payment in accord with Marriott… more
- Reserv (Atlanta, GA)
- …fair, and compliant claim resolutions. You'll assess liability, evaluate medical treatment and injury severity, review documentation, and negotiate ... an inventory of litigated and non-litigated cases Analyze and review auto insurance claims to identify areas...claim , evaluating liability and damages related to the claim , and negotiating and settling claims with… more
- Gallagher (Oklahoma City, OK)
- …match, we encourage you to apply. Overview We are currently looking for a Claims Medical Only Representative who has a passion to provide outstanding ... administrative, claim and customer support. Do you love learning how...to make decisions and resolve issues inherent in handling claims . About You REQUIRED QUALIFICATIONS : - High School… more
- Absolute Staffing & Consulting Solutions (New York, NY)
- …are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and ... ' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. Approves and processes assigned claims determines benefits… more
- Gallagher (Rolling Meadows, IL)
- …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, plan ... the proper course of action, and appropriately resolve claims . *Interact extensively with various parties involved in the claim process to ensure effective… more
- Gallagher (Mechanicsburg, PA)
- …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
- Optum (San Juan, PR)
- …Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is ... following internal procedure to determine the viability of the claim for further review in a production...required for this position) Preferred Qualifications: Experience working with medical claims platforms Medical record… more
- The Jonus Group (Omaha, NE)
- …Collaborate with defense counsel, ensuring alignment on litigation strategy and timelines. Review and analyze medical records, legal documents, and policy ... Job Title: Senior GL Claims Representative (Litigated B/I) Job Summary We are...external stakeholders in order to deliver equitable and timely claim resolutions. This is an excellent opportunity for a… more
- Guidehouse (San Antonio, TX)
- …TX offices and three days from home. Essential Job Functions Account Review Appeals & Denials Medicare/Medicaid Insurance Follow-up Customer Service Billing UB-04 & ... reflects our commitment to creating a diverse and supportive workplace. Benefits include: Medical , Rx, Dental & Vision Insurance Personal and Family Sick Time &… more
