- Gallagher (Syracuse, NY)
- …Location: This role is eligible for fully remote work. Responsibilities: Apply claims management experience to execute decision-making to analyze claims exposure ... and litigation, plan the proper course of action, and appropriately resolve claims . Interact extensively with various parties involved in the claim process to… more
- Daiichi Sankyo, Inc. (Basking Ridge, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... privacy implications of business initiatives, product development, and marketing campaigns. Review relevant data protection agreements in coordination with Legal and… more
- BioAgilytix (Durham, NC)
- …other duties.Manage the Annual Employee Engagement Survey Process as well as the review of results, and action planning process. Proven ability to analyze current ... entities, including but not limited to workers compensation, unemployment claims , verification of employment, etc. Assists with the development, implementation,… more
- Daiichi Sankyo, Inc. (Basking Ridge, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... Integrated Product Development Plans, Target Product Profiles and Target Product Claims , and presentation of product development plans and budget to internal… more
- Ace Hardware Corporation (Princeton, IL)
- …setting). Provide assistance and management of LOA's and worker's compensation claims . Demonstrate knowledge of current employment laws and maintains compliance. ... depending on the month of hire Comprehensive health coverage ( medical , dental, vision and disability - up to 26...performance management approach that goes beyond the typical annual review . Your career at Ace is more than just… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4393761) Apply Plan Reviewer Salary $50,185.72 - $102,274.64 Annually ... + Questions Description JOIN OUR TEAM AS A PLAN REVIEWER ! *SALARY IS BASED ON POSSESSION OF CERTIFICATION AREA(S).... attends meetings, as required, and conducts preliminary plan review meetings with architects, engineers, developers and owners to… more
- Zelis (St. Petersburg, FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System files (eg, medical records, prior authorization, UB / ... and electronic) with a basic knowledge of the Medicare claims system + Advanced knowledge of medical ...given to BSN or higher prepared nurses with recent medical review experience in Medicare and/or Medicaid… more
- Commonwealth Care Alliance (Boston, MA)
- … results and timely communication to the business area leadership. For Medical Claim reviews, post-payment review of claims that were manually processed ... the incumbent is responsible for independent quality reviews of medical claims , and evaluating Call Center activities...ensure appropriate processes were followed and documentation is complete. ** Claims Review ** + Understand all claim… more
- Independent Health (Buffalo, NY)
- … review of Independent Health policies, contracts, clinical documentation, claims systems, pharmacy formularies, procedures and department directives is required. ... benefits and commitment to diversity and inclusion. **Overview** The Contractual Reviewer -Senior will be responsible for providing an organized, timely and… more
- City of New York (New York, NY)
- …as a Complex Medical Case Reviewer , who will: - Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to ... Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past...SSL-104b on cases involving Medical malpractice, mass medical torts, lead paint… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Fire Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4529838) Apply Fire Plan Reviewer Salary $24.13 - $49.17 Hourly ... abilities, both orally and in writing. Benefits Include: + Healthcare Coverage: Medical , dental, and vision insurance + Disability Insurance: Both short-term and… more
- Banner Health (AZ)
- …utilization review . Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review and case ... and all other departments and ancillary/support services. External customers: Medical Directors/payors/reviewers, contracted review agencies, other facilities/services,… more
- UR Medicine Home Care (Rochester, NY)
- …billing. + Reviews all documentation requests by third party payers to respond to claim denials for medical justification including but not limited to Medicare ... responsibilities, with or without reasonable accommodations: + Responsible for the review and correction of all assigned clinical documentation errors as identified… more
- CVS Health (San Antonio, TX)
- …+ Shift hours: flex schedule starting at 9am. * Reviews and adjudicates routine claims in accordance with claim processing guidelines. * Analyzes and approves ... claims that cannot be auto adjudicated. * Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies,… more
- CVS Health (Springfield, IL)
- …personal, convenient and affordable. Position Summary CCR is responsible for post service claim review to determine if specific services can be reimbursed to ... to include but not limited to the following: - Review provider claims to determine if they...coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to… more
- Travelers Insurance Company (Independence, OH)
- …This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement ... you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided...Proactively manages the process to ensure proper payment, (ie review medical bills and medical … more
- MetLife (Oriskany, NY)
- …be commutable to Oriskany, NY - TRAINING IN OFFICE Summary of Responsibilities: Review , research, and investigate pended Group Life claim submission with ... (BIOS). Interpret policy provisions and manually adjudicate Group Life claims to make claim determinations. * Work...medical reports, homicide investigations, etc.) * Mentor new Claim Examiners on Group Life procedures and workflow. Provide… more
- HCA Healthcare (Campbell, CA)
- …action. . Partner with claim management on performance management recommendation. . Weekly review of high-dollar claims . . Review and analyze audit data, ... Review routine random sampling audit of examiner processed claim (s) for accuracy and provides feedback to the examiner....you will need:** . Subject Matter Expert (SME) in medical claims processing at health plan payor,… more
- Travelers Insurance Company (Melville, NY)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... **What Is the Opportunity?** This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
