- Berkshire Hathaway Homestate Companies (Omaha, NE)
- …notices to providers, injured workers, claims staff, and attorneys. Act as a medical resource in regards to utilization review to Claims Support Nurse, ... positive and close working relationship with other Company staff, including the claims staff, medical bill review , claims support nurse, special… more
- RIT Solutions, Inc. (Tampa, FL)
- …multiple vendors needed for Workers' Compensation claim handling. Strong experience with claims management and medical bill review solutions. Experience ... Claims Business Analyst - Workers Comp In Office...and conduct requirements' gathering sessions, meetings, and presentations. Lead review sessions for completed business / functional requirements, with… more
- Blue Shield of California (Oakland, CA)
- …pre-service and retrospective utilization review , Appeals and Grievances, and provider claims dispute reviews. The Senior Medical Director for FEP Prior ... (IP Admission and Concurrent, Lower Level of Care, Preservice requests, Post-service medical claim review , Provider Claims Disputes, Medical pharmacy, or… more
- Oncore Electric (Dallas, TX)
- …provide itemized cost breakdowns to responsible parties, business entities, and insurance companies for review and payment of claims . Serve as a backup to the ... repair shop and obtaining other pertinent information as required. Receipt of all claims and review for thoroughness and accuracy. Verification of charges and… more
- Network Health WI (Menasha, WI)
- …changes, and industry best practices; communicate relevant updates to the team. Review and process claims within established monetary authority levels. Maintain ... Network Health is seeking an experienced Senior Medicaid Claims Analyst to join our growing team. This...HS Diploma or equivalency required Additional course work in Medical Terminology/Advanced Medical Terminology required Knowledge of… more
- Insurance Recruiting Solutions (Jersey City, NJ)
- Home Office Claims Examiner Location: Jersey City, NJ; Alpharetta, GA; Chapel Hill, NC; Chicago, IL; Hartford, CT; Scottsdale, AZ Compensation: $80,000 to $88,000 + ... collaborative work environment. With a strong emphasis on technical excellence and quality claims outcomes, we are seeking an experienced Home Office Claims … more
- Cooper University Hospital (Camden, NJ)
- …Critical Care or Operating Room nursing. 2 or more years of experience in medical record review , coding or health care auditing. Education Requirements Graduate ... choice in South Jersey. Short Description Responsible for timely completion of medical record reviews for charge integrity. Hospital bills are compared against… more
- TriNet (Dublin, CA)
- …internal colleagues. What you will do Acts as oversight by performing a thorough review for proper claim strategy (best practice claims management) and reserving ... on all assigned claims . Ensure TPA is employing proper techniques to mitigate claims expense including, but not limited to: medical care is consistent and… more
- CCMSI (Maitland, FL)
- Overview Position Title: Liability Claims Supervisor Location: Hybrid - Maitland, FL Hours: Monday - Friday, 8:00 AM to 4:30 PM ET Salary Range: $87,500-$100,000 The ... other forms of pay. A full summary of benefits-including Medical , Dental, Vision, Life Insurance, ESOP, and 401K-is available...is Hiring! We're looking for an experienced Liability Insurance Claims Supervisor to join our team. This role is… more
- Gallagher (Folsom, CA)
- …This role is fully remote work. How you'll make an impact Apply claims management experience to execute decision-making to analyze claims exposure, plan ... the proper course of action, and appropriately resolve claims . Interact extensively with various parties involved in the...depending on your job level these benefits may improve: Medical /dental/vision plans, which start from day one! Life and… more
- The CKHobbie Group (Harrisburg, PA)
- …and training. Requirements: Registered Nurse (RN) license (required) . Experience with claims analysis, medical records review , and compliance ... Job Description Position Overview: We are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of… more
- Mindlance (Concord, CA)
- …are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and ... Description: PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims … more
- Mass General Brigham (Somerville, MA)
- …and see the "big picture." Review and analyze facility and professional claims in support of MGBHP's medical and payment policies and CMS guidelines. ... audit on claims , providing coding expertise in the application of medical and reimbursement policies within the claim adjudication process through document … more
- Gallagher (Dallas, TX)
- …close but not an exact match, we encourage you to apply. Overview NEW LIABILITY CLAIMS BUSINESS = NEW CLAIMS OPPORTUNITIES **FUL LY REMOTE** Role specifics: - ... fully remote work. How you'll make an impact Apply claims management experience to execute decision-making to analyze ...depending on your job level these benefits may improve: Medical /dental/vision plans, which start from day one! Life and… more
- FutureRecruit (Spring Valley, NY)
- …to determine compensability. Establish initial and subsequent reserves for anticipated exposure. Review medical bills for a causal relationship to reported ... Worker's Compensation Claims Examiner - Full-time Location: Spring Valley, NY...claims within designated authority. Prepare and present claim review summaries for insureds, brokers, and internal contacts as… more
- USI Holdings Corporation (Portsmouth, NH)
- …general liability claims . Responsibilities: Inspect losses for adjustment parameters. Review claims and meet with clients. Attend depositions, mediations, ... experts. Communicate with management and underwriting team on larger, more complex claims . Investigate, evaluate, and negotiate resolution of complex claims .… more
- Kaiser Permanente (Denver, CO)
- …requests including analysis of Out of Area and/or Urgent Care situations Partners with medical review to review and determine appropriateness of high dollar, ... limited to: Macess, SharePoint, Health Connect, DOI issues, emails, review benefit exceptions, visiting member claims , self-funded...of six (6) months of experience researching and processing medical claims required. Minimum of six (6)… more
- Insurance Recruiting Solutions (Scottsdale, AZ)
- …jurisdictions while applying relevant policy coverage, laws, and regulations. Key Responsibilities Review new loss reports and develop initial claims action ... General Liability Claims Examiner Location: Scottsdale, AZ 85250 | Alpharetta,...Salary Range: $76,000 to $88,000 Competitive benefits package includes: Medical , dental, and vision insurance 401(k) plan with company… more
- AHMC Healthcare (Alhambra, CA)
- …human resources departments. 10. The incumbent is responsible for coordinating weekly claims review meetings with appropriate parties to ensure the handling ... Overview Primary Function As a Workers' Comp Claims Coordinator is responsible for the investigation, evaluation, disposition and settlement of the most complex … more
- GREATER NEW YORK MUTUAL INSURANCE COMPANY (New York, NY)
- …close interaction with experienced staff in providing exceptional customer service and claims handling support. Review standard operating procedures and training ... to determine correct work flow steps and document requirements when handling various claims scenarios. Develop proficiency in reviewing medical records and in… more
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