Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies...
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:Review incoming claims and related documentation for accuracy and completenessAddress inquiries and concerns from drivers regarding claim status and discrepanciesEnter claim information into the processing system and apply established guidelines to determine claim eligibilityReq...
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...
Key Responsibilities:Investigate, evaluate, settle, and process casualty claims primarily over the phoneHandle various types of claims including injury and property damage claims under different coveragesComply with claims organization policies, best practices, and jurisdictional guidelinesRequired ...
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 compa...
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...
Workers’ Compensation Claims Specialist. You’ll maintain phone and written contact with all necessary parties to verify coverage and to investigate, manage and resolve medical-only claims promptly and accurately. This is an excellent career opportunity as a Claims professional. Conducting meetings o...
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...
Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies...
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...
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 ...
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 Property Claims Field Adjuster will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle minor to moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Compa...
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...
As a Field Claims Specialist, you’ll investigate, evaluate and resolve material/physical damage of a moderate to severe nature. You’ll be responsible for handling claims according to prescribed authorization and claims best practices. Maintains current knowledge of insurance and applicable product/s...
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...
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...
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...
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...
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...
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...
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...