- Guardian Life (Columbus, OH)
- …ongoing claim management plans + Readily share insights and learnings with claims colleagues + Strategize with multiple business partners as appropriate ... **Complex Claims Manager, LTD Claims ** The Complex...not limited to specialized contractual requirements, unique earnings, complex medical conditions, specialized occupational demands and/or the presence of… more
- Lincoln Financial Group (Columbus, OH)
- …You will effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims ... join our Appeal Review Department in a fully remote environment. Appeal Specialists conduct reviews, investigation, and analysis of an assigned caseload of Long-Term… more
- Trinity Health (Livonia, MI)
- …files, coordinating claim process activities, opening and closing claim files, securing medical records for claims and incidents, tracking claim expenses and ... two days a week._** Claim technicians are a vital component to the IRMS Liability Claims operation. The position is responsible for maintaining electronic claim… more
- Walmart (Bentonville, AR)
- …and responsibilities; documenting case details; determining whether payment is warranted; and managing multiple claims related to a single event as required. + ... primary job location** + Leads claim investigations by conducting ongoing medical and legal reviews; commissioning field investigators, reconstructionists, and cause… more
- Wells Fargo (Chandler, AZ)
- **About this role:** Wells Fargo is seeking Fraud & Claims Operations Associate for Cards & Merchant Services (CMS) as part of Consumer Lending. Learn more about our ... violations, and merchant disputes with low to high risk within fraud and claims functional area + Review complex transactions and referrals to prevent and detect… more
- TEKsystems (Minneapolis, MN)
- …and provide information on claim changes, lessons learned, etc. The Quality Assurance Specialists will work within multiple systems to ensure the plans are ... Job Description: The Quality Assurance Specialists will be responsible for conducting quality testing...contain all of the necessary information and if the claims are adjudicating properly. If a plan is missing… more
- Sedgwick (Coralville, IA)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Truist (Whiteville, NC)
- …unresolved issues accurately, to ensure timely follow up and resolution. Servicing specialists act as client advocates to track client complaints and feedback ... One year of client servicing work experience (call center, retail, hospitality, medical , etc.) + Proficiency in computer applications (eg Windows, Microsoft Office),… more
- Beth Israel Lahey Health (Plymouth, MA)
- …with malpractice, hospital litigation and depositions. + The Director will oversee the Risk Specialists for referral of lawsuits, claims and potential claims ... and patient safety issues. + Ensures that the Risk Specialists Investigate and monitor all hospital sentinel events and... Staff Officers with tracking/trending of adverse outcomes and medical malpractice claims in order to improve… more
- State of Colorado (Lakewood, CO)
- …What We Do : The Sales Tax Accounting Section employs professionals serving as specialists in specific industries and are assigned claims which are significant ... is actively seeking an Analyst to perform in depth reviews and analysis regarding claims for refunds that are often complex in nature. Moreover, this position may… more
- Sedgwick (Houston, TX)
- …Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets ... PURPOSE** **:** To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications, along with… more
- CVS Health (Hartford, CT)
- …improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims . You will be a key link in providing our ... make health care more personal, convenient and affordable. This Claims Benefits position is Onsite at our Hartford, CT...provided under a member's health plan + Efficiently use multiple systems and screens to obtain and record claim… more
- The County of Los Angeles (Los Angeles, CA)
- …non-panel physicians on procedure for becoming approved. + Refers patients to specific medical specialists who have been certified by the State Department of ... MEDICAL SERVICE COORDINATOR, CCS (Registered Nurse, Pediatrics -...to the program. This class manages complex cases involving multiple diagnoses and requiring coordination of services provided by… more
- Sacramento County (Sacramento, CA)
- …4/4/24, 4/25/24, *5/16/24, *6/6/24 (final) Under general supervision, Construction Management Specialists serve as assistants to the Resident Engineer on the ... construction phase of a single, complex public works project or multiple projects of less complexity. The Construction Management Specialist assists in ensuring that… more
- The County of Los Angeles (Los Angeles, CA)
- …experience will be accepted DEFINITION: Provides technical lead to Environmental Health Specialists III and Environmental Health Specialists II working in a ... duties as delegated and provide technical lead guidance to Environmental Health Specialists III and Environmental Health Specialists II engaged in inspection,… more
- Regeneron Pharmaceuticals (GA)
- …cross-functionally and collaboratively with multiple field teams (Regional Directors, Oncology Medical Specialists from multiple teams, Key Account & ... via distribution of reimbursement materials and assistance to physician offices and Medical Specialists . Work with Director of Reimbursement Services to track… more
- Surgery Care Affiliates (Port Saint Lucie, FL)
- …and resolves all rejections in electronic claim clearinghouse, prepares and mails UB claims , and gathers appropriate medical records to send with claims ... teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create… more
- CVS Health (St. Paul, MN)
- …affordable. Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject ... complex issues. May handle customer service inquiries and problems. Reviews pre-specified claims or claims that exceed specialist adjudication authority or… more
- CVS Health (Albany, NY)
- …and affordable. Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines . Acts as a ... handle customer service inquiries and problems. Required Qualifications - Reviews pre-specified claims or claims that exceed specialist adjudication authority or… more
- MetLife (Oriskany, NY)
- …Unit Leader is responsible for the overall management of a team of LTD claims professionals including all activities and outcomes. In this role, the LTD Unit Leader ... duties. . **Key Responsibilities:** + Effectively manage a team of LTD Claim Specialists in a fast-paced environment to ensure individual and team performance are… more