- USAA (Colorado Springs, CO)
- …part of what truly makes us special and impactful. **The Opportunity** As a dedicated ** Claims Litigation Manager - Section II ** , you will be responsible for ... to include serious injury or property damage arising from Section II liability, questionable damages, questionable liability and questionable coverage issues. +… more
- State of Massachusetts (Boston, MA)
- …deliver program integrity. *What you'd do:* Lead Claims Examiner/Job Service Representative II , who reports to the Senior Manager of Benefit Operations & ... *Lead Claims Examiner/Job Service Representative II | Department...Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies… more
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II ** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II ** is responsible...treatment plans. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires a… more
- Elevance Health (Latham, NY)
- **Telephonic Transplant Nurse Case Manager II ** **Location: This role enables associates to work virtually full-time, with the exception of required ... Multi-State Licensure will be required.** The **Telephonic Transplant Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Columbus, OH)
- **Field Nurse - Nurse Case Manager II ** **Work location:** This field-based role located in the Columbus, OH area enables associates to primarily operate in ... 9am to 5:30pm EST The **Field Nurse - Nurse Case Manager II ** is responsible...as necessary. + Assists in problem solving with providers, claims or service issues. + Coordinate referrals to local… more
- Elevance Health (Chicago, IL)
- **Nurse Case Manager II ** **Work...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of ... employment, unless an accommodation is granted as required by law. The **Nurse Case Manager I** I is responsible for care management within the scope of… more
- Sutter Health (Burlingame, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and… more
- Elevance Health (Ashburn, VA)
- **Telephonic Nurse Case Manager II ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Chicago Transit Authority (Chicago, IL)
- Senior Manager , Claims - ( 25000081 ) **Description**...following jobs: Job Title * Project Specialists I & II - Claims * Coordinator, Claims ... to the investigation and adjusting of personal injury and property damage claims filed against and on behalf of the Authority. **Qualifications** **PRIMARY… more
- AO Smith (Lebanon, TN)
- Regional Field Service Manager II Date: Nov 5, 2025 Location(s): Lebanon, TN, US, 37090 Company: A. O. Smith Corporation Hybrid, Onsite or Remote: Remote PRIMARY ... SCOPE OF RESPONSIBILITY: Position reports to the Field Service Engineering Manager SPECIFIC DUTIES/ACCOUNTABILITIES(List in order of importance) + Aligned with… more
- Aflac (Irvine, CA)
- Account Manager II The Company: Aflac Columbus The Location: Irvine, CA, US, 92612 The Division: Group Voluntary Benefits Job Id: 7940 Opportunity: Account ... insurance, healthcare, and/or financial industry experience (internal and/or external) Account Manager II Education & Experience Required + Bachelor's Degree… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and utilizes corporate applications; core claims… more
- Elevance Health (Dearborn, MI)
- …with the CBA, the CBA provisions will prevail._** The **Clinical Care Manager II ** provides assessments, referrals, and counseling. Conducts telephone ... questions and listen to member in order to assess case and determine needs. + Give referral and/or make...+ Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer… more
- State of Massachusetts (Boston, MA)
- …or suitability is questionable or difficult to determine. 7. Prepare accurate case notations within claims management system which contain accurate, specific, ... * Claims Examiner/Job Service Representative I| Department of Family...Examiner/Job Service Representative I, who reports to the Senior Manager of Benefit Operations & Program Integrity is based… more
- Sutter Health (Oakland, CA)
- …**CERTIFICATION & LICENSURE** + RN-Registered Nurse of California Required + Certified Case Manager (CCM) Preferred. **EXPERIENCE** + Minimum of 2 years ... patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Zurich NA (Denver, CO)
- …other computer-based systems. This role will be filled at either theAttorney Level II orLevelIII.The hiring manager will determine the appropriate level based ... Liability Staff Legal Counsel II or III 128248 Zurich is looking for...conducting post-trial activities where appropriate. We look for demonstrated case analysis ability and a track record of proven… more
- LA Care Health Plan (Los Angeles, CA)
- …Social Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Accredited Case Manager ... Care Management Specialist II , D-SNP Team (12 month Assignment) Job Category:...skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and… more
- ZOLL Medical Corporation (Houston, TX)
- …Hospitalists, CT Surgeons etc.), Nurse Practitioners, Physician Assistants, nurses, case managers and administrators. Other duties include selling the value ... intake and reimbursement to ensure appropriate and timely filing of billing claims + Maintain credentialing/access to all assigned accounts at all times… more
- HCA Healthcare (Thornton, CO)
- …Do you want to join an organization that invests in you as a(an) RN Case Manager ? At HCA HealthONE Mountain Ridge, you come first. HCA Healthcare has ... a difference. We are looking for a dedicated RN Case Manager like you to be a...facilities those services required. Performs telephonic clinical reviews with claims insurance personnel to facilitate reimbursement for the delivery… more
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