- 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
- Marriott International (Bethesda, MD)
- …and procedures. *Coordinate medical management aspects of file handling with the Nurse CARE Manager and Nurse Review Specialist. *Prepare case ... Representative is responsible for the administration and disposition of medical only (MO) workers compensation (WC) claims ....reports, provide for fee schedule or other appropriate bill review , and process for payment in accord with Marriott… 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
- Ascension (Baltimore, MD)
- …cases. Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess ... cases. Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess… more
- State of Florida (Orlando, FL)
- Requisition No: 857206 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV 1 Pay Plan: Career Service Position Number: 50556022 Salary: $72,113.08 ... 07/28/2025 Total Compensation Estimator Tool Requisition # 857206 SENIOR REGISTERED NURSE SUPERVISOR Florida Department of Veterans' Affairs Alwyn C. Cashe State… more
- Zenith (Sarasota, FL)
- …coding and bill auditing experience. Experience with/understanding of utilization/bill review , claims , managed care processing; Workers' Compensation Bill ... This position can be filled in ANY Zenith Branch Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on Workers… more
- VetJobs (Franklin, TN)
- …customers. Utilize evaluation documentation tools in accordance with department guidelines. Proactively review Claim File Analysis (CFA) for adherence to quality ... reserving, negotiating and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the claim … more
- Great American Insurance Group (Lakeland, FL)
- …Must have Workers Compensation experience. Must have Occupational Medicine. Review medical treatment plans for complex claims referred by the managed care ... discuss claims management with treating physicians, and advise internal nurse case managers on appropriate actions. Respond to questions submitted by managed… more
- Pivot OnSite Innovations (Amana, IA)
- …are the foundation for our unique culture. Job Summary: The Licensed Practical Nurse (LPN) coordinates health care for employees in the onsite clinic, overseeing ... evaluation and case management of workplace injuries as well as compliance with medical surveillance programs. The LPN relays information to employees and client key… more
- Rhino, Inc. (Maple Lake, MN)
- …within assigned production area, including but not limited to the following: Review daily production and scrap reporting and take appropriate action to continuously ... odors, heat and cold. Employee Benefits Health / Wellness Medical / Dental / Vision Plans Available If you...Rhino will reimburse you a portion of your health claims after your deductible is met. Rhino offers a… more
- Kaiser Permanente (Redwood City, CA)
- …standards for corrective action plans for improvement identified through utilization review , clinical records audit, claim denials, patient satisfaction surveys, ... compliance with administrative, legal, and regulatory requirements; partnering with and directing medical staff in large service areas to support peer review ,… more
- American Health Partners (Acworth, GA)
- …Coordination program *Perform improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and ... with physicians to correct errors or omissions and to investigate questionable claims . Consult and coordinate with health care team members to assess, plan,… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- Travelers Insurance Company (Diamond Bar, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Hospice of the Valley (Phoenix, AZ)
- … medical records for notes for orders from the patient's care team or financial review nurse assessment of a claim and determine whether a bill(s) is ... + Flexible schedules for work/life balance. **Position Profile** The Claims Review Coordinator is responsible for managing...billing, including hospice care coverage. + Provides analysis of medical claim expense data and identifies trends;… more
- Donegal Insurance Group (Grand Rapids, MI)
- …Investigate and determine compensability, pursue early return to work, issue indemnity and medical payments, manage Nurse Case Managers and Defense Counsel + Set ... it matters most. Job Summary Donegal Insurance Group has an opening for a Claim Representative in our Workers' Compensation unit. This position is available as a… more
- Guardian Life (Bethlehem, PA)
- …or Vocational Nurse who is knowledgeable in a variety of medical and behavioral health conditions. You will perform necessary outreaches to claimants or ... providers to obtain certification dates, treatment plans and any other pertinent medical information necessary to facilitate and assist claims managers in… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *SUMMARY:* We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M-… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Marriott (Bethesda, MD)
- …and procedures. * Coordinate medical management aspects of file handling with the Nurse CARE Manager and Nurse Review Specialist. * Prepare case ... Representative is responsible for the administration and disposition of medical only (MO) workers compensation (WC) claims ....reports, provide for fee schedule or other appropriate bill review , and process for payment in accord with Marriott… more
