A company is looking for a Claims Resolution Specialist. ...
The ESIS Senior Work Comp Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. Informs claimants, insureds/customers or attorney of denial of claim when applicable. Authoritative tec...
A company is looking for a Claims Clinical Specialist - Medical Review Team. ...
The Senior Claims Specialist will report directly to the Director of Risk Management. Ensure the timely logging of all new claims (delegate to Claims Assistant if necessary) and timely reporting to our Insurance Carrier, with guidance by the Dir of Risk Management. Review and approve the status of a...
A company is looking for a Senior Claims Examiner - Claims Specialist. ...
Responsible for timely, ethical, and effective handling of all assigned general liability, property, and auto claims. Investigate all claims by gathering and preserving pertinent information needed to accurately assess liability. Document all discussions, correspondence, reports and decisions that o...
Casualty Claims team in Orange, CA or Walnut Creek, CA as a. This individual will handle complex general liability and excess liability and umbrella claims of all varieties. Developing and executing claim strategies as well as resolution strategies. Working with underwriters to support policy constr...
Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company ...
Our Claims Legal Specialist will act as an expert on requirements to properly resolve matters when Sentry is faced with a conditional demand from counsel for a claimant. Experience in handling conditional demands, preferably including bodily injury claims, on behalf of an insurer as an attorney, tec...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
Under moderate supervision performs administrative duties of moderate technical complexity in support of the Claims function. Incumbent must achieve a quality claim product on an ongoing basis by consistently applying best practices within expected timeframes completing the following tasks. Manage a...
Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, dir...
Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Zenith is a team of Workers’ Compensation Specialists com...
The Claims Resolution Specialist will be the first line of contact for Health providers and will assist providers with questions related to the payment of claims and resolution of claims payment issues. Seeking a highly motivated an experienced - Claims Resolution Specialist (Customer Service) to jo...
Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Works close...
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determ...
The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and...
Communicating with claimants, employers and various medical professionals through phone and e-mail to gather necessary claim information, managing the claim process from the initial request to the return to work. Collaborating with fellow case managers, nurse case managers, and consulting physicians...
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Authorizes and ensures claim disbursemen...
CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. They will work closely with other members of the Commercial Services Operations team providing root ...
We are seeking a dedicated and detail-oriented Medical Claims Specialist to join our team. The ideal candidate will be responsible for managing the claim follow-up process to ensure accuracy, efficiency, and compliance with healthcare regulations. Accurately review and respond to payment rejections ...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determ...
Manages, investigates and resolves assigned high severity Property Loss claims under limited supervision. May assist Customer Claims Representatives with in-person inspection/policyholder contact where necessary. Investigates, determines coverage of loss and adjusts all elements of Property Loss cla...
Manages, investigates and resolves assigned high severity Property Loss claims under limited supervision. May assist Customer Claims Representatives with in-person inspection/policyholder contact where necessary. Investigates, determines coverage of loss and adjusts all elements of Property Loss cla...