- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Claims Nurse Reviewer is responsible for reviewing claims , validating ... position requires strong clinical and medical coding skills to review claims for medical necessity, appropriate coding,...part of the Complex Claims team, the Claims Nurse Reviewer will serve… more
- Lincoln Financial Group (Boston, MA)
- …a Glance** We are excited to bring on a highly motivated Integrated Absence Claims Specialist to staff our ever-growing claims organization. As an Integrated ... Claims Specialist, you will manage a workload of Short-Term Disability claims and their associated leaves. You will be responsible for conducting initial and… more
- Lincoln Financial Group (Boston, MA)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… more
- Elevance Health (Woburn, MA)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with… more
- Beth Israel Lahey Health (Winchester, MA)
- …this position: 1. Conducts initial post-offer/pre-placement physical assessment, including review of immunization status, and provides required testing or ... policy regarding program. In absence of manager, files appropriate claims reports and works as liaison with physician and...years work experience as a medical or surgical staff nurse . 3. Certified Occupational Health Nurse preferred.… more
- Marriott (Boston, MA)
- …for effective progress. + Closes files per regional guidelines. + Available to assist claims on informal review of litigated or lifetime medical claims ... **Additional Information** Nurse CARE Manager (CARE - Coordinated Action and...The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required… more
- Evolent Health (Boston, MA)
- …decisions against criteria and policy, escalating questions to the physician reviewer , and creating letters that meet regulatory and Plain Language requirements. ... against criteria and medical policies + Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes… more
- Beth Israel Lahey Health (Burlington, MA)
- …information and payments. 13. Responsible for billing of multidisciplinary liver clinic and nurse 's visits. Oversee end of month charges are completed for all clinic ... of transplants. 21. Approve all donor acquisition charges for appropriate processing. 22. Review and approve invoices from the New England Organ Bank for payment and… more