Under limited supervision, acts as highest level individual contributor directly reviewing primary and excess Financial Institutions and Management Liability claims to determine nature of loss, coverage provided, and scope of claim and to make recommendations regarding settlement/disposition of clai...
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...
Key Responsibilities:Maintain knowledge of DMEOPS CPT and ICD-10 codesReview and resolve unpaid, short paid, and denied claimsFollow up with insurance companies, submit corrected claims, and file appealsRequired Qualifications:High school education or equivalent5+ years of related experience in insu...
Phoenix Loss Control is seeking qualified individuals to fill 1099 contractor openings for Claim Recovery Specialists. The Claim Recovery Specialist Contractor is responsible for reviewing information provided on a damage, determining the liable party, invoicing the responsible party, and pursuing r...
A company is looking for a Health Claims Specialist. ...
Ensure that claims are being processed as expeditiously as possible, and that all inventories are regularly reviewed, and all possible actions are taken to move the claims to closure. Work with HDI Claims team to constantly improve TPA claim handling processes, systems, communications and overall pr...
Ability to assess coverage and tender opportunities; oversee and evaluate claim files for best outcomes; pursue and assess underlying policy limit/SIR's for reserving; audit underlying claim files; and resolve claims. Senior Claims Specialist- Construction. This position will focus on the claims man...
Revenue Integrity Analyst / Claims Review Specialist. Analyze hospital billing claims within the EHR and claim scrubber system. Resolve claim errors, edits, and other holds. Understanding of Medicare/Medi-Cal claims processing guidelines. ...
Under limited supervision, acts as highest level individual contributor directly reviewing primary and excess Financial Institutions and Management Liability claims to determine nature of loss, coverage provided, and scope of claim and to make recommendations regarding settlement/disposition of clai...
Our client, an A-rated Insurance Carrier, is seeking to add a New York Workers' Compensation TPA Claims Oversight Specialist. This person would be responsible for evaluating and reviewing New York Workers’ Compensation claims handled by Third Party Administrators (TPA) for adherence to company’s bes...
The Prudential Claims Specialist role is essential in handling retirement claims and processing financial transactions on behalf of clients. The team’s focus areas include claims processing for short-term disability, long-term disability, retirement, and death claims. This position requires high mul...
Our client, an A-rated Insurance Carrier, is seeking to add a Workers' Compensation Claims TPA Oversight Specialist This person would be responsible for promptly evaluating and reviewing New Jersey and Pennsylvania Workers’ Compensation claims handled by Third Party Administrators (TPA) for adherenc...
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...
As a Construction Defect Large Loss Claims Specialist, you will be responsible for handling and resolving complex, highly specialized, and high exposure Primary and Excess Construction Defect claims, through investigation, evaluation and disposition. Large Loss Claims Specialist - Construction. Main...
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...
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 ...
The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. Assesses policy coverage for submitted claims and notifies the insured of any issues; determine...
Under limited supervision, acts as highest level individual contributor directly reviewing primary and excess Financial Institutions and Management Liability claims to determine nature of loss, coverage provided, and scope of claim and to make recommendations regarding settlement/disposition of clai...
PMCL IN22 Grow Your Skills, Grow Your Potential Responsibilities This position is for a Property Field Inspection Claim Specialist, handling accidental and weather-related homeowners, commercial, and large loss claims. You will be the first point of contact to meet with our insureds, explain coverag...
Analyze hospital billing claims within the EHR and claim scrubber system. Resolve claim errors, edits, and other holds. Understanding of Medicare/Medi-Cal claims processing guidelines. Experience with EPIC EHR, Cirius Claim Scrubber, or other EHR system. ...
Working under minimal supervision, the Member Experience Specialist – Claims contributes to Wawanesa’s goal of delivering an exceptional and consistent claims service experience by enhancing relationships with members through tracking and trending feedback utilizing various data sources. Works colla...
Managing assigned claims across multiple jurisdictions, as well as setting the case strategy for these claims in partnership with Regional Practice Leaders and Claims management. Loss Claims Specialist - Excess Casualty. Our experienced Claims professionals use their specialized expertise to handle ...
Reviews and authorizes payment and final disposition of claims requiring adjustment and claims benefit determination for reinsurance qualification. Responsible for processing medical claims. Resolves complex, difficult or non-routine claims requiring special handling in accordance with established p...
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...