- The Career Sphere (Williamsburg, VA)
- …generics, less expensive medicines, and over-the-counter products. Refers to the medical provider, as needed, to ensure medication is taken correctly, health ... and federal controlled substance laws when filling prescriptions. The Product Review /Retail Fill Process Pharmacist is responsible for ensuring that elements of… more
- The Career Sphere (South Bend, IN)
- …- Comprehensive Health & Wellness Benefits Comprehensive benefits package including medical , prescription drug, dental, vision, disability and life insurance for ... support - Walgreens provides financial support for fertility treatments, including medical procedures and prescription medications. Eligible team members can also… more
- APTIM (Santa Fe, NM)
- **Summary:** The Senior-Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to disaster losses ... and program guidelines. This position serves as a technical authority on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer … more
- APTIM (Santa Fe, NM)
- **Summary:** The Mid-Level Claims Reviewer supports the claims process by reviewing, evaluating, and documenting claims for disaster-related losses. This ... navigating documentation requirements, and contributes to a customer-focused, efficient claims lifecycle. Mid-level reviewers also identify when site inspections or… more
- Commonwealth of Pennsylvania (PA)
- Clinical Care Reviewer (County Care Management Manager) (Local Government) - Fayette County MH/ID Print ... (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5058227) Apply Clinical Care Reviewer (County Care Management Manager) (Local Government) - Fayette… 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
- Lee County Board of County Commissioners (Fort Myers, FL)
- Transportation Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/5007029) Apply Transportation Plan Reviewer Salary ... Description Lee County is seeking a skilled and detail-oriented Transportation Plan Reviewer to join the Department of Community Development in the Development… more
- Elevance Health (IN)
- …immediate consultation, and appropriate referrals. **How you will make an impact:** + Conducts medical review / claim review of beneficiary health records ... is granted as required by law._ 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
- US Tech Solutions (Columbia, SC)
- …following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge ... indicated protocol sets or clinical guidelines. Provides support and review of medical claims and...families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- US Tech Solutions (Columbia, SC)
- …Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + Performs ... A typical day would like in this role: reviewing claims for medical necessity/reviewing cam policies for non-covered... medical claim reviews for one or… more
- Centene Corporation (Harrisburg, PA)
- … claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims , medical records, claims history, ... health plans. + Provide coding/clinical decisions on first time claims , adjustments and appeals in accordance with correct coding...and health plan provider calls. + Develop and maintain review guidelines for Corporate medical coding reviews.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… more
- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Molina Healthcare (Warren, MI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- MetLife (Oriskany, NY)
- …In the office once a month for office meetings Summary of Responsibilities: Review , research, and investigate pended FEGLI Life claim submission with multiple ... system computer system . Interpret policy provisions and manually adjudicate FEGLI Life claims to make claim determinations. . Work with our customer… more
- Travelers Insurance Company (Walnut Creek, 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
- Travelers Insurance Company (Missoula, MT)
- …internal and/or external resources for specific activities required to effectively resolve claims . + Maintain and document claim file activities in accordance ... Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is… more
- Boston Mutual Life Insurance (Canton, MA)
- … Support Representative is expected to: + Prepare items for imaging, including new claims , correspondence, closed claim files, and notification of claims . + ... pending and closed claims . + Sort all Claims Services mail. + Pull claim files...and deliver to Examiners for handling. + Scan correspondence, medical records and other claim forms and… more
- Travelers Insurance Company (Phoenix, AZ)
- …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
- Sedgwick (Atlanta, GA)
- …properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state and ... claims ' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. + Approves and processes assigned claims , determines… more
