- Constructive Partnerships Unlimited (Manhattan, NY)
- …quality of medical reviews and reports generated. 4. Attends Incident Review Sub Committee meetings as a standing member. 5. Reviews investigation reports for ... Nurse Reviewer Type of Position Per Diem Search Location(s)...to medically involved incidents. This position involves meticulously reviewing medical records and investigations into incidents that may infringe… 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
- 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
- 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
- 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 (Nampa, ID)
- …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
- 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
- Principal Financial Group (Des Moines, IA)
- …and legal purposes. Identify and refer claims to other resources (senior claims personnel, Medical , Law, etc) with appropriate action plan and questions. + ... customer service skills to assist with our client's disability claims - all during a time in which they...medical conditions, restrictions & limitations, disability policy provisions, claim decisions, and all other aspects of the … more
- CRC Insurance Services, Inc. (FL)
- …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...division of TIH Insurance offering the position. TIH 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
- CenterLight Health System (NY)
- …by our TPA. + Perform in-depth claims audit to confirm that all medical claims paid and denied accurately. Address any findings and observations with ... CMS, and contractual guidelines. This position emphasizes the appeals review and auditing of claims to drive...claim workflow and efficiency. + Analyze patient and medical information to identify Coordination of Benefits (COB), Worker's… more
- CRC Insurance Services, Inc. (ID)
- …**Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Acts as a liaison between ... additional activity as appropriate. 4. Determine where new loss claims should be reported. 5. Manage all claim...and commercial and multi-line knowledge 3. Ability to critically review a claim file for relevant information,… more
- AON (New York, NY)
- …What the day will look like As respects property damage and business interruption claims + Review , audit and analyze accounting books and records, financial ... Property Risk Consultant: Claim Preparation and Valuation Team, Aon Global Risk...look like As respects property damage and business interruption claims + Review , audit and analyze accounting… more