- Humana (Indianapolis, IN)
- …and independent determination of the appropriate courses of action. The Claims Research & Resolution Professional roles and responsibilities include: + ... issues stemming from internal systems issues to the Senior Claims Research & Resolution Professional and assist in development of solutions to resolve… more
- Cedars-Sinai (CA)
- …Acquires daily workflow via reports or work queue and incoming phone calls. + Research claims for appropriate support documents. + Analyzes and adjusts data, ... **Job Description** The Claims Examiner is responsible for accurately and consistently...and for accuracy of entries. + Handles in a professional and confidential manner all correspondence. + Supports core… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** Hospital Billing Claims Certified Application Coordinator or Professional Billing Claims Certified ... Ability to troubleshoot problems and questions from end users and provide resolution and requested information. Ability to research , evaluates, and analyzes… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be ... responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...role will also be responsible for timely review and research , as necessary on all new and revised coding… more
- Providence (NM)
- …Manager, Healthcare who will:** + Be responsible for day-to-day oversight of general and professional liability claims in accordance with the System's claims ... scope of responsibility + Be responsible for investigating, evaluating and managing professional and other liability claims against the organization as assigned… more
- ADP (CA)
- ADP is hiring a Claims Lead Examiner. _RESPONSIBILITIES:_ + Assist Claims Manager in monitoring the workers compensation program within the ADPTS/PEO structure. ... that could be problematic and take steps along with Claims Manager to take steps to develop processes to...Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed. _REQUIRED SKILLS:_ +… more
- GAF (Parsippany, NJ)
- …warranty claims , which includes but is not limited to research and investigation, assignment of work orders, preparation of various communications throughout ... matters most. Team or Function Overview The Residential Warranty Claims Examiner position is a critical member of our...the life-cycle of the claim, and resolution . + Apply business reasoning and critical thinking to… more
- Apex Health Solutions (Houston, TX)
- Summary: Position is responsible for oversight of claims adjudication and regulatory reporting functions including all associated processes, reporting of key ... This position is also responsible for the timely processing and accuracy of claims and day to day interactions with any vendor partners that have direct… more
- AIG (Atlanta, GA)
- …and maintain professional working relationships with our internal recovery team, claims partners and vendor network. What you'll need to succeed + College Degree ... manage risk. Join us as a Salvage Examiner - Claims to play your part in that transformation. It's...leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency. How you will… more
- University of Rochester (Rochester, NY)
- …payment date from the payer. + Research and calculate under or overpaid claims ; determine final resolution + Re-calculate claim based on fee schedule, APC or ... companies and other third party payers to obtain payments, research and resubmit rejected claims to primary...including add-ons + Follow-up with payers on incorrectly paid claims through final resolution and adjudication, including… more
- TEKsystems (Columbia, SC)
- Job Title: Claim Resolution Specialist - Bilingual English/Spanish Location: Columbia, SC (Hybrid) Job Schedule: Flexible, Hybrid Job Hours: 8-hour shift between ... and Closers Needed) Job Type: Full-time, Flexible Schedule Job Function: Claims & Customer Service Languages Required: English/Spanish Bilingual Job Description: If… more
- Robert Half Office Team (Chicago, IL)
- …in a professional setting * Knowledge of claim administration and resolution procedures * Understanding of policy, practices, and benefit functions * Ability to ... We are offering a long term contract employment opportunity for a Claim Resolution Specialist. The role is situated in Chicago, Illinois, and involves providing… more
- TEKsystems (Chicago, IL)
- Job Title: Claim Resolution Specialist - Bilingual English/Spanish Location: Chicago, IL (Hybrid) Job Schedule: Flexible, Hybrid Job Hours: 8-hour shift between 7:30 ... with two interviewers Job Type: Full-time, Flexible Schedule Job Function: Claims & Customer Service Languages Required: English/Spanish Bilingual Job Description:… more
- Penn Medicine (Philadelphia, PA)
- …opportunities to enhance front end claim edits to facilitate a first pass resolution . Responsibilities: + Responsible for patient account research in relation to ... mission of providing the highest level of care to patients, conducting innovative research , and educating future leaders in the field of medicine. Working for this… more
- JS Held LLC (Houston, TX)
- …and often catastrophic situations. As a Manager in Intellectual Property Dispute Resolution in our Financial Experts practice, you will focus on the daily ... of reports and financial analyses/models, analyzing and critiquing opposing parties' claims , managing Analysts and working closely with the Managing Directors of… more
- Philips (Cambridge, MA)
- …ask for strategic intelligence. + Design and execute observational and economic research studies using real-world data, including insurance claims , registry, or ... outcomes research , real world evidence studies, data analytics and claims data in the medical device, pharmaceutical, consulting, or academic environment. +… more
- Medical Mutual of Ohio (OH)
- …strong focus on member experience. . Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM. Monitors ... paid claims for accuracy including for transition supply oversight. Ensures...and coordinates daily issue/response files with PBM for claim resolution . Outreaches to pharmacy/prescriber as needed. . Generates reports… more
- University of Rochester (Rochester, NY)
- …date from the payer. + Research and calculate underpaid or overpaid claims ; determine final resolution . + Re-calculate claim based on fee schedule, APC ... insurance companies and other third-party payers to obtain payments, research , and resubmit rejected claims to primary...add-ons + Follow up with payers on incorrectly paid claims through final resolution and adjudication, including… more
- University of Rochester (Rochester, NY)
- Responsibilities **General Purpose:** The Claims Resolution Representative III is responsible for working across the professional fee organization, handling ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative...(EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims ,… more
- Travelers Insurance Company (Centennial, CO)
- …or their legal representatives. + Recognizes and implements alternate means of resolution . + Manages litigated claims . Develops litigation plan with staff ... resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more