- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Supervisor , Claims Review makes appropriate claim decision based on strong ... procedures, contract provisions, and state and federal legislation. The Supervisor , Claims Review works within thorough, prescribed guidelines and… more
- Sedgwick (Trenton, NJ)
- …equivalent combination of education and experience required to include two (2) years claims supervisor experience. **Skills & Knowledge** + Thorough knowledge of ... management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and… more
- Sedgwick (Trenton, NJ)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Advisor, Environmental | Professional Liability | REMOTE **Job Description Summary** ... To analyze complex or technically difficult environmental claims ; to provide resolution of highly complex nature and/or severe injury claims ; to coordinate case… more
- BrightView (Blue Bell, PA)
- …educate diverse audiences. + Prior experience in a senior-level role (eg, claims supervisor , senior adjuster, or risk management professional) with ... to be your brightest. We're looking for a Senior Claims Specialist. Can you picture yourself here? **Hybrid Schedule:**...TPAs, legal counsel, brokers, and other external partners. + Review and approve TPA reserve recommendations to ensure reserve… more
- Carrington (Cherry Hill, NJ)
- **Come join our amazing team and work remote from home!** The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses ... this position is $23.00/hr - $26.50/hr. **What you'll do:** Review reconciliation of all loan advances once the GSE...manual processes and activities. + Keep Team Lead and Supervisor informed of all trends and problems including, but… more
- Ryder System (Trenton, NJ)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling processes… more
- NJM Insurance (Trenton, NJ)
- …to the Workers' Compensation (WC) Training and Quality Assurance Management Supervisor , the WC Quality Assurance/Compliance Analyst is responsible for ensuring ... as audit program development and file selection, assuring the review process is proper and timely. + Conduct WC...data integrity, compliance, and best practices. + Collaborate with claims management in the development of meaningful action plans… more
- Shuvel Digital (Lawrenceville, NJ)
- …to make corrections and ensures accuracy for the days work. + Researches all utilization review claims for accuracy prior to billing on a timely basis. + ... GED. Experience: ESSENTIAL FUNCTIONS + Ensures responsibility to download claims from HBOC and upload claims to...+ Reports any trends and anomalies to Patient Accounts Supervisor and Patient Accounts + Manager in a timely… more
- NJM Insurance (Trenton, NJ)
- …tools. + Collect and report audit findings. + Consolidate data into report for supervisor review . + Identify trends or patterns. + Perform pre- and post-payment ... Reporting to the QC Supervisor , the Quality Control & Compliance Associate is...compliance checklist reviews for both PIP and Workers' Compensation Claims . Essential Duties and Responsibilities: + Assist the QC… more
- Cardinal Health (Trenton, NJ)
- …Collections is responsible for the timely follow-up and resolution of insurance claims . This role ensures accurate and efficient collection of outstanding balances ... receivable and increase cash flow for the organization. **_Responsibilities:_** + Review aging reports and work insurance accounts to ensure timely resolution… more
- BAYADA Home Health Care (Pennsauken, NJ)
- …+ Complete claim denial management functions to ensure timely follow-up with denied claims and complete root causes analysis to determine ways to prevent claims ... denying. + Process balance transfers, adjustment requests, refunds and corrected claims as part of accounts receivable management responsibilities. + Complete… more
- Walgreens (Philadelphia, PA)
- …the unique communities we serve as requested by Store Manager, Healthcare Supervisor , or District Manager. Operations + Counsels patients and answers questions ... and federal controlled substance laws when filling prescriptions. The Product Review /Retail Fill Process Pharmacist is responsible for ensuring that elements of… more
- Ansible Government Solutions (Philadelphia, PA)
- …calls. + Review requests for reimbursement of travel costs and reconcile claims /vouchers for payments using electronic systems. + Review ambulance claims ... possible. + The contractor shall notify the VA shift supervisor when clinic access is less than desirable or...clinic timeframes. + The contractor shall conduct a daily review of active/pending consults, Electronic Wait List, Recall list… more
- Legacy Treatment Services (Marlton, NJ)
- …Must be able to understand and read the Explanation of Benefits (EOB). Review all open charges for non-payment, short payment ineligibility, inaccurate diagnoses, no ... of services. Responsible for appealing all of the unpaid and denied claims received. Complete all corrections in CareLogic and document process. Communicate… more
- Walgreens (Trenton, NJ)
- …as immunizations. Responsible for ensuring the proper compounding, dispensation, review and verification of prescribed medications within regulatory guidelines, ... and assists in community events as requested by Store Manager, Healthcare Supervisor , District Manager or Pharmacy Manager. **Operations** + Under direct supervision… more
- Cardinal Health (Trenton, NJ)
- …to patient inquiries in a professional and timely manner. **_Responsibilities:_** + Review aging reports and work patient accounts to ensure timely resolution and ... billing questions and set up payment arrangements if needed. + Analyze claims , process payments and complete adjustments + Analyze explanation of benefits (EOBs)… more
- Cardinal Health (Trenton, NJ)
- …payment + Work average of 50 to 100 denials per day based on supervisor requirements and accounts assigned + Works closely with insurance carriers for reimbursement ... + Consults with appeals department for disputed / denied claims . + Works / Understands electronic claim interchange +...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Walgreens (Ewing, NJ)
- …as immunizations. Responsible for ensuring the proper compounding, dispensation, review and verification of prescribed medications within regulatory guidelines, ... and federal controlled substance laws when filling prescriptions. The Product Review /Retail Fill Process Pharmacist has the ultimate responsibility for ensuring that… more
- Hunterdon Health Care System (Flemington, NJ)
- …at the HMC Business Office and will be assigned to report to a Supervisor within the Business Office. The position is responsible for working collegially with the ... an efficient system for the daily electronic submission of claims , identifying errors and making the necessary corrections to...on a daily basis. + Works with the Billing Supervisor to develop and implement bill edits and prevent… more
- CVS Health (Trenton, NJ)
- …distribution of the monthly premium invoices. The Billing Premium Consultant must review invoices for reasonability and accuracy and make any necessary adjustments ... billing systems. + Execute monthly invoices on appropriate billing platform and review group specifications to ensure all appropriate information is included with… more