Key Responsibilities:Process claims and adjustments related to projects or provider disputesResearch and resolve complex claims issues and collaborate with other departmentsAct as a subject matter expert on departmental and corporate projectsRequired Qualifications:High school diploma or equivalent5...
The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client’s providers. The incumbent will assist providers with questions related to the payment of...
Key Responsibilities:Collaborates with Claims and Actuarial leadership teams to analyze claims trends and patternsDrives the creation of a robust data foundation for Workers' Compensation and Managed CarePrepares deliverables for senior leaders and supports ad-hoc requests from the Claims leadership...
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...
A company is looking for a Priority Claims Specialist III. Key Responsibilities:Maintain knowledge of DMEOPS codes and resolve unpaid claimsReview EOB's for correct reimbursement and follow up with insurance companiesFile appeals, communicate AR issues, and resolve outstanding accounts receivable pr...
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. Ability to influence others and resolve complex, disputed claims. Ability to identify and use relevant data and metrics to bes...
CCMSI is growing and we are seeking an experienced Workers' Compensation Claim Specialist to join our team in a fully remote capacity, dedicated to managing claims for a single client within the California jurisdiction. Work Environment: We believe in providing an environment where employees enjoy c...
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. Authoritative technical knowledge of claims handling and claims terminologies. Prepares reports on inve...
Experience in handling conditional demands, preferably including bodily injury claims, on behalf of an insurer as an attorney, technical specialist, claims manager or similar role sufficient in one more of the following states to develop a high degree of technical expertise: CA, FL, TX, GA, or SC. O...
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...
Manages an inventory of moderate to high complexity and exposure Healthcare claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Establishes and maintains working relati...
Zenith is a team of Workers’ Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. Investigate, analyze, and determine the extent ...
Claims Resolutions Specialist Job Description . The Claims Resolution Specialist will be the first line of contact for health providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Responds and researches issues on prov...
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...
We are seeking a dedicated and detail-oriented Medical Claims Specialist to join our team. Accurately review and respond to payment rejections and denials to ensure claims are processed correctly. Accurately post payments received from payers and patients to appropriate claims in the billing system....
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...
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 ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Establishes and maintains working relati...
Experience in handling conditional demands, preferably including bodily injury claims, on behalf of an insurer as an attorney, technical specialist, claims manager or similar role sufficient in one more of the following states to develop a high degree of technical expertise: CA, FL, TX, GA, or SC. O...
Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Establishes and maintains working relati...
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...
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...
Administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Makes decis...
Under moderate supervision performs administrative duties of moderate technical complexity in support of the Claims function. Manage and update the Claims, Medical Legal weekly staffing agenda. Claims administrative support experience preferred with preference given to experience gained in Workers’ ...