- Sedgwick (Dover, DE)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Surety Claims Specialist **PRIMARY PURPOSE** **:** To analyze complex or technically difficult ... surety and surety bond claims ; to provide resolution of highly complex nature and/or...coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned… more
- Sedgwick (Dover, DE)
- …mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Examiner - Liability IF YOU CARE, THERE'S A PLACE FOR YOU HERE For a ... Sedgwick supports and resolves property, general, auto, product and professional liability claims . We help our clients maintain brand protection in times of crisis.… more
- Carrington (Dover, DE)
- **Come join our amazing team and work remote from home!** The Sr Claims Recovery & Analysis Analyst is responsible for performing financial reconciliation on all ... to completion that falls within the scope of the Claims Recovery & Analysis Department. + Prepare Claims...and requirements that resulted in the loss. + Keep Supervisor informed of all trends and problems including, but… more
- Highmark Health (Dover, DE)
- …are met. Represent the department in compliance audits as it relates to the supervisor functions. + Act as subject matter expert for benefit plan and claims ... processing + Research and investigate any privacy or compliance concerns (CMS, HIPAA, internal policy, etc).Complete root cause analysis and address remediation process with impacted employees. + Participate in process improvement initiatives as appropriate,… more
- Mathematica (Dover, DE)
- …predictions with a large multiyear sample of Medicare beneficiaries with detailed claims data about millions of people. Mathematica's team reached the second round ... involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources...obtain work outside CMS. Staff will work with their supervisor to get re-staffed, however if they are unable… more
- Mathematica (Dover, DE)
- …large secondary data sources such as Medicaid (T-MSIS, TAF) administrative claims data to effectively answer research questions and guide decision-making about ... and practical knowledge of administrative healthcare data (eg commercial claims , hospital claims , and Medicare or Medicaid...obtain work outside CMS. Staff will work with their supervisor to get re-staffed, however if they are unable… more
- Mathematica (Dover, DE)
- …include: * Assisting with quantitative analyses using Medicaid enrollment, claims /encounter, financial and program data to support program monitoring, improvement, ... high attention to detail * Familiarity with Medicaid enrollment, claims , financial, or program data is preferred * Excellent...obtain work outside CMS. Staff will work with their supervisor to get re-staffed, however if they are unable… more
- Mathematica (Dover, DE)
- …and maintaining clinical quality measures, supporting states with implementing all-payer claims databases, alternative payment models, or tools to support analytics, ... policy issues. * Familiarity with Medicare or Medicaid enrollment, claims , financial, or program data is preferred. * Excellent...obtain work outside CMS. Staff will work with their supervisor to get re-staffed, however if they are unable… more
- Walgreens (Milford, DE)
- …the unique communities we serve as requested by Store Manager, Healthcare Supervisor , District Manager or Pharmacy Manager. Operations + Counsels' patients and ... ways to further promote productivity. + Ensures the accurate processing of insurance claims to resolve patient issues and prevent payment rejections. Follows up with… more
- Walgreens (Bridgeville, DE)
- …to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... management. Reviews KPI's with Pharmacy Manager, Store Manager, and Healthcare Supervisor . + Develops and maintains good relationships with local medical community… more
- Humana (Dover, DE)
- …years or more years of equivalent work experience in Grievance and Appeals, Claims , Authorizations, CMS, Provider Disputes and/or healthcare industry + 1 or more ... insights/findings to Senior Leadership + 2 or more years of leadership ( Supervisor , Manager or above) experience + Strong knowledge of Medicare and Medicaid… more
- Sunrun (Dover, DE)
- …driver's license + Three years of this experience must be as a manager, supervisor , or equivalent position of leadership + Strong knowledge of safety regulations for ... risk assessment + Familiarity with the insurance industry, specifically Workers' Compensation claims + Working knowledge of the Microsoft Office Suite and common… more
- CVS Health (Dover, DE)
- …Conducts assessments that consider information from various sources, such as claims , to address all conditions including co-morbid and multiple diagnoses that ... to clinical resources and other interdisciplinary team members.* Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming… more
- Walgreens (Seaford, DE)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... one's own performance, solicits for constructive feedback, and leverages Healthcare Supervisor as mentor and coach. **Communication** + Communicates with pharmacy… more