- Zurich NA (Augusta, ME)
- Sr. TPA Specialist , Complex Claims 125068 Zurich Insurance is currently looking for a Sr TPA Specialist . This position will oversee complex Liability ... Specialist analyzes highly complex coverage situations, evaluates high exposure claims , seeks/grants authority, assigns/explains reserves to senior management… more
- CVS Health (Augusta, ME)
- …handle customer service inquiries and problems. **Additional Responsibilities** + Reviews pre-specified claims or claims that exceed specialist adjudication ... day. **Position Summary** + Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. + Acts as a subject… more
- CVS Health (Augusta, ME)
- …Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims ; adjudicates complex, sensitive, and/or specialized claims in accordance ... level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine...every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our… more
- Highmark Health (Augusta, ME)
- …months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America's Health InsurancePlans (AHIP) **Language ... structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The...employee groups, or past claim experience to determine what benefits can be offered and to set the rates.… more