- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... of life. This involves analyzing data to inform decisions about medical use, market access, and patient access.Responsibilities- Assess the strengths, challenges,… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4918314) Apply Plan Reviewer Salary $31.25 - $45.67 Hourly Location Fort ... Department is seeking a qualified individual to fill the position of Plan Reviewer . The Plan Reviewer will be responsible for reviewing residential and/or… more
- Elevance Health (IN)
- …immediate consultation, and appropriate referrals. **How you will make an impact:** + Conducts medical review / claim review of beneficiary health records ... territory/market that they will work in.** The **Physical Therapist Reviewer ** is responsible for performing medical record...with regulations and requirements. + Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding… more
- City of New York (New York, NY)
- …appropriate, negotiate and settle claims within delegated monetary authority level; 8) Review medical providers and law firms to ensure all entities are in ... not limited to: 1) Manage individual No-fault files and review investigation reports, medical reports, bills and...to gather information relevant to the investigation of the claim ; 11) Investigate, identify, and report fraudulent claims… more
- TEKsystems (Smithtown, NY)
- Job Title: Title Real Estate Reader/Title Reviewer Job Description: As a Title Real Estate Reader, you will play a crucial role in ensuring the accuracy and ... property's title by examining public records to identify any claims , liens, encumbrances, or other issues that may affect...during the closing process. Top Skills' Details: + Title Review : Verify the complete history of a property's title,… more
- ManpowerGroup (Columbia, SC)
- …(80%)** + Perform medical reviews using established criteria and guidelines. + Review medical claims and determine reasonable charge payments. + Ensure ... authorization of medical services based on benefit guidelines. + Review interdepartmental requests for medical information to support utilization processes.… more
- Granville Medical Center (Oxford, NC)
- …overpayments for accuracy and determines if appeals are needed. Files bankruptcy claims and appropriately adjusts account balances as needed. Reviews and posts ... Medicare crossovers to Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated patient demographics as… more
- The Cigna Group (Sacramento, CA)
- …for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and ... impact of insured's medical condition, medical restrictions and limitations and expected duration. Performs leadership...impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit… more
- Granville Health System (Oxford, NC)
- …overpayments for accuracy and determines if appeals are needed.# Files bankruptcy claims and appropriately adjusts account balances as needed.# Reviews and posts ... Medicare crossovers to Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated patient demographics as… more
- Molina Healthcare (WI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Medical Mutual of Ohio (OH)
- …the continuum of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying ... stay and level of care. + Extrapolates and summarizes medical information for physician review or other...substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition… more
- CVS Health (Austin, TX)
- …+ Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. + Documents claim information in the ... making skills + Experience in a production environment. **Preferred Qualifications** + Medical claim processing experience + Medical coding background… more
- Travelers Insurance Company (Rancho Cordova, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Travelers Insurance Company (Rancho Cordova, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- The Hartford (San Antonio, TX)
- …others accomplish theirs, too. Join our team as we help shape the future. The Claim Specialist role is crucial for handling claims within the Major Case team, ... Our ideal candidate will have expertise in: product liability claims involving pharmaceuticals and medical devices. Additional...trends, etc. + Collaborate with valued business partners to review and address claim trends + Address… more
- CRC Insurance Services, Inc. (SC)
- …review the following job description:** This role is focused on technical claim handling of complex general liability claims , both litigated and ... legal budgets through resolution. 4. Determine where new loss claims should be reported. 5. Manage all claim...of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance, disability, accidental death and… more
- Boston Mutual Life Insurance (Canton, MA)
- …business/office experience. Sr. Claim Examiner: Minimum of 2 years life/ medical claims experience required. Knowledge Requirements: + Strong business ... and guidelines, in a timely manner and meeting departmental quality/production standards. + Review and process claims , evaluate medical records, and request… more
- Travelers Insurance Company (Diamond Bar, CA)
- …for quality claim handling including investigating, evaluating, negotiating, and resolving claims on losses of lesser value and complexity and provide claim ... if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. + Achieve a positive result by returning an injured… more
- WTW (New York, NY)
- … claim handling guidelines and service expectations, coordinate and conduct quarterly claim review meetings, and act as the focal relationship manager. ... **Description** **The Role:** **The claim account manager will operate within significant coverage,...client meetings, assist underwriting in their renewal process, audit claims performance against best practices, and implement value added… 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
