- 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
- 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
- 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
- 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
- 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
- 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
- Public Risk Innovation Solutions and Management (Folsom, CA)
- …is reserved in accordance with OSIP Regulations and most probable value of the claim . Review the medical aspect of claims to ensure proper medical ... Review claims for allocation/contribution potential. Review subrogation efforts and provide authority regarding resolution when...Review for recommendations for all aspects of the claim (eg reserving, next steps, medical treatment… 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
- Corvel (Sandy, UT)
- …and claimant Adheres to client and carrier guidelines and participates in claims review as needed Develops and maintains professional customer relationships ... ensure specific customer service requirement to achieve the best possible outcome in the claim , supporting the goals of claims department and of CorVel. This is… 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
- Crawford and Company (Brea, CA)
- …processing of the claim . Identifies wage loss expenses and wage exposures on medical claims . Documents receipt and contents of medical reports. Interacts ... up to, but not exceeding, $2,500 after compensability has been determined. Evaluates medical claims for potential fraud issues, loss control and recovery in… more
- Tristar Insurance (Concord, CA)
- …for moving the claim to resolution. Meets with clients to discuss on-going claims or review open claim inventory. Effectively controls expenses on all ... - $100000.00 Salary Job Shift Day Job Category Insurance Claims Examiner III (Hybrid) Please make sure that you...through temporary, transitional, alternate, or modified work. Manages all medical aspects of a claim file with… more
- National Indemnity Company (Omaha, NE)
- …contracts and applicable law, within documented authority. What will you do? CLAIM INVESTIGATION: Investigate assigned claims reported under insurance contracts ... claims , assignment and direction of independent adjusters and review of public and other records and documents. Contact...regarding information and documents necessary to evaluate and resolve claims , claim processes and related matters, and… more
- AHMC Healthcare (Alhambra, CA)
- …human resources departments. 10. The incumbent is responsible for coordinating weekly claims review meetings with appropriate parties to ensure the handling ... claims adjuster to enable the successful settlement and disposition of serious claims . 5. Documents and communicates all claim activities timely and… 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
- 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
- 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
- Gallagher (St. Peters, MO)
- …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
- CLAIMS MANAGEMENT RESOURCES INC (Oklahoma City, OK)
- …Negotiate settlements with damagers and insurance companies as applicable. Review claim information and request/research additional reference material ... go-getter? Determine how much youcanmake while investigating and resolving claims .Get your career started, no college degree required! Here...both our customers and other parties involved in a claim . Our business is driven by Core Four principles:… more
- Warrior Insurance Network (Oak Brook, IL)
- …assigned including coverage, liability status, and damages that are applicable for each claim Process Bodily Injury, and coverage claims in accordance with ... liability and damages on all claims and notify re-insurer on qualifying claims Prepare and present claim evaluations for the appropriate settlement authority… more
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