- Jones Jones LLC (New York, NY)
- …and excellence across every level of our organization. We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise ... LLC is a trusted leader in workers' compensation defense, claims management, and regulatory compliance. With decades of industry...ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow… more
- MTA (Brooklyn, NY)
- Claims Examiner Series - Law Job ID: 12387 Business Unit: MABSTOA Location: Brooklyn, NY, United States Regular/Temporary: Regular Department: Torts Date Posted: ... and four years of full-time experience investigating and settling liability claims ; or Senior Claim Examiner One (1) year of permanent service in the title of… more
- Raphael and Associates (Rutherford, NJ)
- …a fast-paced environment. We are currently growing and are looking for a TPA Property Claims Examiner with a minimum of five years of experience in this ... Senior Property Desk Examiner (remote) Company Overview: Raphael & Associates is...(remote) Company Overview: Raphael & Associates is a third-party claims administrator and independent claims adjusting company… more
- Sedgwick (Newark, NJ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | MA, CT, NH, RI Jurisdictions | CT Licensing | ... Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...**ARE YOU AN IDEAL CANDIDATE?** To analyze **Workers Compensation** claims on behalf of our valued clients to determine… more
- Sedgwick (Newark, NJ)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Liability (Multi-State Licensing Preferred - Hybrid - Sedgwick ... one. **PRIMARY PURPOSE** **:** To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims … more
- Sedgwick (New York, NY)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Lost-Time Experience | NY License Required Are ... Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...IDEAL CANDIDATE?** To analyze **New York Lost-Time Workers Compensation** claims on behalf of our valued clients to determine… more
- Sedgwick (New York, NY)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY, NJ, KY Jurisdictions | NY License Preferred ... Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...**ARE YOU AN IDEAL CANDIDATE?** To analyze **Workers Compensation** claims on behalf of our valued clients to determine… more
- Raphael and Associates (Rutherford, NJ)
- Liability Desk Examiner (remote) Company Overview: Raphael & Associates is a third-party claims administrator and independent claims adjusting company ... our services to our client's specific needs. As a claims organization, what we do is complex. Our mission...Bodily Injury, NY Labor Law, and other complex liability claims . This position provides an opportunity for the right… more
- Sedgwick (New York, NY)
- …with management projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles reviews and ... Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner . + Monitors third party claims ; maintains periodical… more
- City of New York (New York, NY)
- …the title and have taken the most recent Workers' Compensation Benefits Examiner exam number 5141. Under direct supervision, receives and processes incoming workers' ... compensation claims . Performs tasks such as the following: Reviews accident...workers' compensation benefits. Trains less experienced Workers' Compensation Benefits Examiner . Identifies medical information needed to reach a conclusion… more
- City of New York (New York, NY)
- …Bureau of Law and Adjustment (BLA), negotiates and approves all monetary settlement of claims and lawsuits involving the City of New York. BLA investigates and, when ... in the best interest of the city, settles pre-litigation claims for and against the City of New York....11) Performing other related duties as directed. ADMINISTRATIVE CLAIM EXAMINER - 10044 Qualifications 1. A baccalaureate degree from… more
- City of New York (New York, NY)
- …is a fast-paced environment and has a demanding workload. The Hearing Examiner /Officer must be fair, impartial, disinterested, and ensure that litigants are afforded ... due process. The Hearing Examiner /Officer must ensure that administrative hearings adhere to the procedural requirements of Federal Consent Decrees which gave rise… more
- Molina Healthcare (Yonkers, NY)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to… more
- Molina Healthcare (Yonkers, NY)
- …enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims ... of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of Local, State… more
- City of New York (New York, NY)
- …advocacy through interactions with law enforcement, the criminal justice system, the medical examiner 's office, and others as necessary. The goal of this program is ... Detectives. - Assist homicide survivors in navigating the medical Examiner 's office. - Provide immediate emotional support and offering...with the completion of and filing of victim compensation claims with NYS OVS. - Prepare letters and forms… more
- Molina Healthcare (Yonkers, NY)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... + Healthcare Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Examiner (AHFI) and/or Certified Fraud Examiner (CFE)...Care Fraud Examiner (AHFI) and/or Certified Fraud Examiner (CFE) preferred. To all current Molina employees: If… more
- City of New York (New York, NY)
- …for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult managerial and legal staff in regards to ... not related to the claimant's job related injury. Assist examiner and legal staff to determine compensability of treatment...work injury and assist with medical case management of claims . Review and process high value and complicated in-patient… more
- Travelers Insurance Company (New York, NY)
- …on all accounts. Under close supervision, performs risk evaluations and claims investigations on less complex accounts as assigned. Participates in individual ... equipment breakdown, and overall insurability. Investigate less complex Equipment Breakdown claims as requested by the claim department. Evaluate elements of the… more
- New York State Civil Service (New York, NY)
- …investigation of alleged fraud.* Designation as a Certified Fraud Examiner .* Experience with statistical sampling and/or advanced statistical training.* Knowledge ... medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data.* A CPA is not required; but the position qualifies for CPA… more
- Molina Healthcare (Yonkers, NY)
- …Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation pertinent to investigations. + Detects ... Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in… more
