- AIG (Atlanta, GA)
- Claim Compliance Reviewer Join us as a Claims Compliance Reviewer to make more of your specialist expertise and experience. Make your mark in Claims Our ... claim adjudication or claim operations experience for multi-line commercial claims . Claim Audit or file review experience...multi-line commercial claims . Claim Audit or file review experience is desirable. + Knowledge of key regulatory… more
- Randstad US (St. Paul, MN)
- claims reviewer . + st paul , minnesota + posted 3 days ago **job details** summary + $21 - $23 per hour + temp to perm + no requirements + category business and ... or send your most updated resumes to ###@randstadusa.com for immediate consideration and include " Claims Reviewer - MN" in your subject line. salary: $21 - $23… more
- Zelis (Morristown, NJ)
- …ensuring adherence to proper billing guidelines. They will work closely with Expert Claims Review and Concept Development staff to efficiently identify and ... Position Overview: At Zelis, the Itemized Bill Review Facility Reviewer is responsible for...identification of billing and coding opportunities for all payor's claims including restricted list + Review client… more
- Point32Health (MA)
- …performing clinical reviews of provider claims payment disputes, perform retrospective claims audits of medical records, and review potential quality of care ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment… more
- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr (REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia ... the state of hire. **Job Description:** As a Medical Claims Reviewer /Utilization Management Specialist, you will be...Ensure thorough documentation of each determination for utilization or claims review . + Review first-level… more
- The Hartford (Alpharetta, GA)
- …GA) that will perform Utilization Review for Work ers' Compensation Claims . An Initial Clinical Reviewer (ICR) is responsible for evaluating treatment ... Medical Reviewer - CT08BE We're determined to make a...nursing judgment, treatment criteria guidelines and Physician Advisor/Peer Clinical Review referral process. Conduct first level prospective, concurrent, or… more
- Kepro (Nashville, TN)
- …health solutions in the public sector. Acentra is looking for a Physician Medical Claims Reviewer to join our growing team. Job Summary: The primary ... responsibilities of a Physician Medical Claims Reviewer include conducting independent medical service...+ Prepare independent reviews of medical services appeals. + Review records, prepare and submit all reviews in keeping… more
- Zelis (Morristown, NJ)
- …a health care organization or provider preferred. + 2+ years of auditing or performing claims review in specialty pharmacy claims or specialty drugs + Strong ... Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre...financial negotiation with providers + 3-5 years of auditing, claims , review and/or billing experience with a… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Group Health and Workers' Compensation and ... other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to… more
- Randstad US (North Chicago, IL)
- medical reviewer /safety reviewer iii. + north chicago , illinois (remote) + posted 2 days ago **job details** summary + $45 - $51.65 per hour + contract + ... work hours: 9 to 5 education: Doctorate responsibilities: + Provide Medical Review consultant to support the US Immunology Medical Affair teams. Services provided… more
- Randstad US (Minneapolis, MN)
- loan document reviewer . + minneapolis , minnesota + posted 3 days ago **job details** summary + $19 - $20 per hour + temp to perm + high school + category business ... have high attention to detail, have previous experience managing cases, claims and pipelines, let's connect and see if this...send an updated resume to ###@randstadusa.com and include "Loan Reviewer - Minneapolis" in your subject line. salary: $19 -… more
- Zelis (TX)
- Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews ... clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA… more
- Prime Therapeutics (Columbus, OH)
- …and other internal departments as needed. **Job Description** + Pharmacy Data Review : Regularly reviews and monitors prescription claims data and prescribing ... and drives every decision we make. **Job Posting Title** Hemophilia Clinical Reviewer (ICR) **Job Description Summary** Facilitates efforts in the development of… more
- City of New York (New York, NY)
- …The Division of Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past or present recipients of ... of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical reviews and analyses..., who will: - Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to… more
- Travelers Insurance Company (Columbus, OH)
- …ensure charges are otherwise reasonable. Collaborates with Travelers colleagues managing claims or matters and interacts with outside counsel regarding changes to ... resolution of billing issues or disputes. + Utilizes claim file and document review to obtain claim strategy information and apply during review process.… more
- US Tech Solutions (Columbia, SC)
- …utilization practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim ... I would love to have someone with prior insurance/utilization review experience, but I know that is not very...meet requirements are sent on to an MD for review . Nurses will interact daily with providers, teammates, and… more
- Granville Health System (Oxford, NC)
- …overpayments for accuracy and determines if appeals are needed.# Files bankruptcy claims and appropriately adjusts account balances as needed.# Reviews and posts ... Medicare crossovers to Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated patient demographics as… more
- Crawford & Company (Atlanta, GA)
- …effort to control water mitigation costs on residential and commercial property claims . The position will be responsible for reviewing estimates and negotiating ... adjustment of losses with contractors, public adjusters, insurers, and attorneys. This position could present evidence in legal proceedings. This position will serve as a mentor for other adjusters. The position will also be responsible for assisting with new… more
- The Cigna Group (Bloomfield, CT)
- …and Change Lives? EviCore, a division of the Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. For this highly technical role, ... you'll review our claims system to ensure all configurations were input correctly per the specifications of the provider. The Claims Configuration Quality … more
- City of New York (New York, NY)
- …SNAP-CR is recruiting for four (4) Eligibility Specialists level II to function as a Claims Review Specialist, who will: - Review , process, determine and/or ... Office was enhanced by the addition of the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP-CR). SNAP-CR establishes SNAP claims for the… more