- Fallon Health (Worcester, MA)
- **Overview** **The Claims Examiner position is a hybrid role working 3 days (Tuesdays, Wednesdays and Thursdays) in the office in Worcester, MA and 2 days ... us on Facebook, Twitter and LinkedIn. **Brief Summary of purpose:** The Claims Examiner should have thorough claim processing knowledge at a complex level..… more
- Sedgwick (Boston, MA)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Liability (REMOTE; NY License , BI, and Litigation Exp ... required) **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims … more
- Sedgwick (Boston, MA)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner , Bodily Injury (Auto) **PRIMARY PURPOSE** : To analyze and ... process complex auto and bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.… more
- Intermountain Health (Boston, MA)
- **Job Description:** The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims , in a timely and ... to and supports the corporation's quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely… more
- Sedgwick (Boston, MA)
- …training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a ... with management projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles reviews and… more
- State of Massachusetts (Boston, MA)
- …the major duties of which included the adjudication, examination and/or review of claims , benefits and/or taxes; the practice of law; labor relations work; claims ... Services* **Organization:** **Department of Transitional Assistance* **Title:** *Hearings Officer (Review Examiner II)* **Location:** *Massachusetts-Boston-1 Ashburton Place* **Requisition ID:**… more
- Sedgwick (Boston, MA)
- …Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing ... to advance to the next round, a recruiter will be in touch. \#claimsexaminer # claims _As required by law, Sedgwick provides a reasonable range of compensation for… more
- Prime Therapeutics (Boston, MA)
- …and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively ... compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with… more
- Prime Therapeutics (Boston, MA)
- … claims processing environment **Preferred Qualifications** + Certified Fraud Examiner or Accredited Health Care Fraud Investigator + National Pharmacy Technician ... and client initiatives; engage in cross functional analysis of medical and pharmacy claims ; lead FWA investigations for federal employee program + Stay current on… more
- Highmark Health (Boston, MA)
- …**Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) ... (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have… more