- 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 ... 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
- 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 ... claims adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization review required + 7+ years experience with… more
- Randstad US (Columbia, TN)
- …essential functions of this role include: + working in a smoke free environment Skills + Claims + Medicare Compliance + Claims Processing + Detail Oriented + ... medicare claims examiner. + columbia , tennessee + posted...be received in either paper or electronic format for review . This role demands a solid understanding of medical… more
- USAA (Chesapeake, VA)
- …against our members. This will include the end-to-end claims process and settling claims in compliance with state laws and regulations. In this role, you ... is all about learning and growing. Our Associate Auto Claims Representative role may be a new career for...measured, monitored, and controlled in accordance with risk and compliance policies and procedures. **What you have:** + High… more
- Sedgwick (Columbus, OH)
- …reviews and analyzes management reports and takes appropriate action. * Performs quality review on claims in compliance with audit requirements, service ... the authority of the individual examiner. * Monitors third party claims ; maintains periodical review of litigated claims , serious vocational rehabilitation … more
- Sedgwick (Hartford, CT)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... the authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated claims , serious vocational rehabilitation … more
- Sedgwick (San Diego, CA)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... the authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated claims , serious vocational rehabilitation … more
- Sedgwick (Roseville, CA)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... the authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated claims , serious vocational rehabilitation … more
- Sedgwick (Long Beach, CA)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... over the authority of individual PL Specialists. + Maintains periodic review of claims that are litigated, sensitive, or questionable as determined by the… more
- Sysco (Houston, TX)
- …with supervisor training materials in accident investigations, effective communication in the claims process, compliance , and doctor / attorney issues + ... Performing quality review of third party claims administration, integrity of reserves and cost containment practices + Provide support with Corporate EHS team… more
- Sedgwick (Columbus, OH)
- …$300,000). + Interprets policy and client guidelines on personal and commercial lines claims to ensure compliance . + Guides field colleagues on revisions as ... years at an advanced technical level as a file reviewer of personal and commercial claims , or...experience required. **Skills & Knowledge** + Strong knowledge of claims handling and file review practices and… more
- Sedgwick (Shreveport, LA)
- …team meetings and assigns accountability for follow-up items. + Gathers important compliance / claims processing information to be presented at team meetings. + ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead Assistant - Workers Compensation (MUST RESIDE IN LOUISIANA)… more
- Prairie Ridge Health (Columbus, WI)
- …also requires corresponding with other teams on various types of errors to resolve claims needing additional review . They independently review accounts and ... insure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines. This role supports the revenue… more
- Axis (Alpharetta, GA)
- …and Legal Bill Review , partnering with Vendor's in support of ensuring compliance with billing guidelines, as well as compliance with legal and ethical ... with key AXIS stakeholders + Collaborating and coordinating with Claims Quality Assurance and Compliance to implement...various software and insurance platforms and systems including Bill Review systems such as Legal Exchange and claims… more
- Publix (Lakeland, FL)
- …team which includes daily oversight of the claims function by assigning claims and workflow, managing compliance with internally processes, as well as ... claims , claims involving fleet vehicles, etc. This also includes claims where the customer requests supervisory review /handling + respond to telephone… more
- Josselyn (Northbrook, IL)
- …Summary Conduct follow-up with payors, vendors, and clearinghouse on open insurance claims and balances in compliance with departmental policies and procedures. ... Resubmit primary and secondary claims Identify potential claim issues... Identify potential claim issues and escalate to management. Review , identify, and resolve root causes payor denials. Ensure… more
- Mechanical Concepts LLC (Shreveport, LA)
- + Accurately review , process, and submit warranty claims to manufacturer in compliance with their guidelines and policies + Track the progress of warranty ... claims and follow up with manufacturer to resolve any...with manufacturer bulletins, warranty policies, and procedures to ensure claims are filed correctly + Assist the service, parts… 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
- Randstad US (St. Paul, MN)
- sr claims reviewer . + st paul , minnesota + posted 10 days ago **job details** summary + $28 - $29 per hour + temp to perm + no requirements + category business ... send your most updated resumes to ###@randstadusa.com for immediate consideration and include "Sr Claims Reviewer - MN" in your subject line. salary: $28 - $29… more
- Whitney Young Health Center (Watervliet, NY)
- …Reviews payer coding policies and procedures to ensure that the department remains in compliance with specific claims submission rules in order to reduce denied ... Claims Coding Specialist (Req 100825) Watervliet, NY (http://maps.google.com/maps?q=1601+Broadway+Watervliet+NY+USA+12189)...of other medical coding and clinical staff to ensure compliance with departmental policies and other applicable laws and… more