- Zurich NA (Sacramento, CA)
- Sr . Workers Compensation Claims Specialist...are currently licensed in the state of California. The Senior Workers Compensation Claims Specialist ... 112053 Zurich is seeking an experienced Workman's Compensation Claims Specialist to join our team!We are specifically seeking candidates who can work remotely… more
- Providence (Mission Hills, CA)
- **Description** The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, ... case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate… more
- Zurich NA (Schaumburg, IL)
- Sr . Mass Litigation Claims Specialist 111708 Zurich is currently seeking a Sr . Claims Professional to join our Latent & Environmental team in ... Schaumburg. This is an opportunity to apply your commercial claims subject matter expertise regarding large exposures, complex coverages, and litigated matters. If… more
- Axis (Red Bank, NJ)
- …request for candidates taking part in the selection process. Job Description: AXIS is seeking a Senior Claims Specialist - Excess Claims to join our ... as well as reporting and presenting about same to senior management * In-depth knowledge of claims ,...to senior management * In-depth knowledge of claims , litigation, arbitration, and trial processes as well as… more
- HCA Healthcare (Asheville, NC)
- …where diversity and inclusion thrive? Submit your application for our Insurance and Claims Specialist (Program of All Inclusive Care for the Elderly) Program ... (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid...may vary by location._** We are seeking Insurance and Claims Specialist PACE Program, for our team… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …of Ward's Top 50 and rated A++ by AM Best. Duties We are looking for a Senior Claims Specialist - Professional Liability to join our team. Summary - ... and settle more complex first and third party insurance claims . A typical day will include the following: Evaluates...appropriate. Investigates circumstances of routine as well as complex claims to determine if and to what extent coverage… more
- NJM Insurance (Trenton, NJ)
- NJM's Workers' Compensation Claims Team is seeking a Claim Account Specialist . This is a full-time position and offers a hybrid schedule after training. The ... Claims Account Specialist will be responsible for...WC Law, medical terminology, and utilization of an automatic claims processing system. + Sr Level -… more
- Zelis (Atlanta, GA)
- Position Overview: The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement ... based on Zelis data points. During this call, the Claims Settlement Specialist must understand: (1) the...of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at… more
- Medical Mutual of Ohio (Centerville, OH)
- …with projects as directed by management. . Performs other duties as assigned. **SDC- Sr . Claims /Customer Care Specialist ** . Utilizing multiple systems, ... chat, and portal inquiries). . Under direction of more senior staff, conducts claims or inquiry related...Knowledge of Heath Insurance Portability and Accountability Act (HIPAA). **SDC- Sr . Claims /Customer Care Specialist ** **Education… more
- Axis (Chicago, IL)
- …direction, acts as highest level individual contributor directly reviewing excess casualty claims to determine nature of loss, coverage provided, and scope of claim ... and to make recommendation regarding settlement/disposition of claims . Please note this role is Hybrid/3 days in...transfer to the claim * Prepares required reports to senior management * Travels to mediations or settlement conferences… more
- Insight Global (Rancho Cordova, CA)
- …Insight Global is looking for a claim's adjustor for one of our top Claims Management/Healthcare Management companies. This individual is going to be joining the ... Claims team consisting of 7 members and reporting to the Claims Supervisor. They will be responsible for handling a caseload of 130 files that they will need to… more
- Axis (Alpharetta, GA)
- …Heights, NJ, Princeton, NJ * Highest level individual contributor directly reviewing claims to determine nature of loss, coverage provided, and scope of claim ... for the timely evaluation, reserving and disposition of assigned claims * Documents coverage, investigation, damages, reserve rationale, negotiations, etc.… more
- BrightSpring Health Services (Taunton, MA)
- …focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh ... come join our team and apply today! Responsibilities TheClaims Specialist - 3rd Party: + Manages and identifies a...+ Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing… more
- Axis (Alpharetta, GA)
- …analyze the claim exposure, determine the proper course of action, and pursue claims to conclusion * Set accurate and timely claim reserves and make referrals ... to senior members of the team where necessary * Obtain...relevant policies, review policy wordings to validate coverage for claims and escalate any issues arising * Prepare coverage… more
- Axis (Princeton, NJ)
- …analyze the claim exposure, determine the proper course of action, and pursue claims to conclusion *Set accurate and timely claim reserves and make referrals to ... senior members of the team where necessary *Obtain relevant...relevant policies, review policy wordings to validate coverage for claims and escalate any issues arising *Prepare coverage positions… more
- Axis (Alpharetta, GA)
- …and coverage. * Timely makes recommendations regarding resolution strategy for such claims including reserve adequacy; executes such strategy on behalf of the ... damages issues in connection with complex primary and excess claims and maintaining appropriate documentation * Analyzes insurance coverage...letters * Collaborates in the defense and resolution of claims * Evaluates full pending of claims … more
- CVS Health (Phoenix, AZ)
- …make health care more personal, convenient and affordable. Position Summary The Senior Claim Benefit Specialist (OPS) reviews, researches and adjudicates ... processing guidelines. May be required to learn multiple Medicaid plans. Medical claims processing experience is a basic requirement. * Works to research and… more
- First Student (Cincinnati, OH)
- …daily. Proactively investigate, evaluate, and negotiate resolution of assigned Liability claims in accordance with established best practices and assure claims ... are handled within granted autonomy limits. The adjuster will primarily manage claims valued under $750k, including claims that are in litigation. **Major… more
- Samsung SDS America (Plano, TX)
- …Account Group and its Settlement subpart as well as the company's Management/Finance Group. Claims Specialist will work on a resolution of logistics claims , ... range of industries including smart manufacturing and global logistics. Logistics Claims Operator (" Claims Operator") will be a part of Operation Group and work… more
- CVS Health (Columbus, OH)
- … claims in accordance with plan processing guidelines. - Reviews pre-specified claims or claims that exceed specialist adjudication authority or ... for claim or reconsideration. Required QualificationsRequired 2+ years of Medical claims processing experience Familiar with ICD and CPT coding Ability to… more