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...
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 ...
Team Lead - Medicare Specialist. ...
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...
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. Third-Party Claims Administrator (TPA). Audit a representative sampling of each TPA and program's claims at least on...
A company is looking for a Claims Examiner - Claims Specialist. ...
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. Vice-Versa the adjuster can commun...
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 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...
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. Generally, 6 to 10 ye...
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 is seeking to bring on a Texas Workers’ Compensation Claims Examiner to join their operations. The ideal candidate will have experience in managing mid to complex Texas Workers' Compensation claims from inception to close, possess strong analytical skills, and demonstrate excellent custom...
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...
Team Lead - Medicare Specialist. ...
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...
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 Claims Documentation Specialist II is responsible for creating, editing and updating documents that will provide an in-depth record of the procedures, policies and workflows used by L. ...
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. At A...
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...
Processes all types of medical claims and adjusts medical disputed claims (Professional and Facility) according to department, contract, and regulatory requirements. Responsible for processing, auditing, and adjusting all facility medical claims, appeals and prepayment audits. Troubleshoots claims t...
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...
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...