Claims Examiner

Supporting the Claims Departments and other Examiners and troubleshoots Claims issues for internal/external stakeholders. We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits ba...

In this member facing role, you will be responsible for answering telephonic, email and walk-in requests from members regarding their medical claims. Adjudicate routine medical claims and all associated tasks in accordance with the Plan, regulatory and contractual guidelines. PPO claims processing e...

We are looking for a Claims Examiner II/III, depending on their knowledge and experience. Supports other Examiners in adjudicating claims from payors. Identifies root causes of claims payment errors and reports any issues pertaining to claims to Management. This position is not an entry level positi...

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service req...

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service req...

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service req...

The Claims Examiner I is in daily contact with team members, clients and providers. This position reports to the Claims Supervisor. Processes claims accurately, efficiently and within quality/quantity requirements. Has the ability to access research tools for accurate claims entry. ...

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service req...

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within d...

Claims Examiner Workers Compensation - Brea, CA (Hybrid). Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoin...