- Sedgwick (Madison, WI)
- …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 (Madison, WI)
- …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
- GE HealthCare (Madison, WI)
- …GE HealthCare establishes best practices in compliance with regulatory requirements. The Senior Regulatory Affairs Specialist will be involved with regulatory ... review, product labeling compliance, etc. GE HealthCare is a leading global medical technology and digital solutions innovator. Our mission is to improve lives… more
- CVS Health (Madison, WI)
- …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 (Madison, WI)
- …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
- Molina Healthcare (Madison, WI)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER,… more
- American Family Insurance - Corporate (Madison, WI)
- …opportunity. The role will support supplier and contract strategy for Claims , Product Underwriting, Legal, and Contact Centers. Position Compensation Range: ... + **Support Areas:** Supports supplier and contract strategy for Claims , Product Underwriting, Legal, and Contact Centers. + **Data-Driven Optimization:**… more
- Highmark Health (Madison, WI)
- …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