- Sedgwick (Boston, MA)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr . Claims Specialist , Medical Malpractice (LTC) **PRIMARY PURPOSE** ... : To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex nature and/or severe injury claims ; to… more
- Sedgwick (Boston, MA)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Specialist Sr - Commercial Coverage Specialist **PRIMARY ... PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex nature and/or severe injury … more
- BJs Wholesale Club (Marlborough, MA)
- …Leave, Jury Duty * Benefit plans for your changing needs* o Three medical plans**, Health Savings Account (HSA), two dental plans, vision plan, flexible spending ... (must be at least 18 years old) *eligibility requirements vary by position ** medical plans vary by location Job Summary: Execute and implement strategies that will… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr . Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr . Analyst will ... specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims , settlement, claims… more
- CVS Health (Boston, MA)
- …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 (Boston, MA)
- …dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, ... Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims ; adjudicates complex, sensitive, and/or specialized claims in accordance… more
- Commonwealth Care Alliance (Boston, MA)
- …and operational coding initiatives at Commonwealth Care Alliance (CCA). The Clinical Documentation Sr . Specialist will serve as a primary resource in evaluating ... medical encounter notes/records housed either at CCA or at...Degree or equivalent experience + Possession of Certified Coding Specialist designation (CCS, CCS-P, CCA from AHIMA) or Certified… more
- CS Energy (Worcester, MA)
- The Project Controls Specialist works under the guidance of our Project Controls Leadership and in partnership with our Operations Team to provide a single point of ... Schedules, Project Forecast Sheets, and 4 Week Lookahead Reports. The Project Controls Specialist will report to the Edison, Albany, or Worchester office at least… more
- Highmark Health (Boston, MA)
- …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ... questionable claim patterns of renewal clients and issues with competitor's claims experience for prospect clients and develops recommendations to account for… more