- Molina Healthcare (Warren, MI)
- …specific policies and regulations to identify claims processing error Act as a senior claims subject matter expert , advising on complex claims ... research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most… more
- BrightView (Blue Bell, PA)
- …and optimal financial outcomes. This individual will act as a subject matter expert in claims management, guiding internal stakeholders, monitoring ... practices, subrogation efforts, litigation strategy, and settlement recommendations. Provide expert -level oversight on complex and high-exposure claims , ensuring… more
- Cardinal Health (Columbus, OH)
- …states on paper and online. Mails all paper claims . Acts as a subject matter expert in claims processing. Manages billing queue as assigned in ... things done. The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- USAA (St. Louis, MO)
- …or triage to field provider method of inspection. May serve as a subject matter expert representative for disputed claims or trials. Serves as a resource ... responsible for the investigation, negotiation, evaluation and appraisal of vehicle damage claims for both repairable and total loss vehicles to ensure estimate… more
- UnitedHealth Group (Boston, MA)
- …processes Establish relationships with customers and data senders serving as a subject matter expert for clinical and claims data Collaborate and support ... and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin… more
- BrightView (Blue Bell, PA)
- …, and workers' compensation enhancements. The Claims Manager serves as a subject matter expert and change agent, ensuring BrightView achieves strong ... (TPA) performance, ensuring alignment with BrightView's standards and cost-effectiveness Provide expert oversight of large, complex, and litigated claims ,… more
- UMB Bank (Kansas City, MO)
- …solutions, and implement change to ensure the best customer experience. Responsible to provide subject matter expert support in regard to training of ... position will report directly to the Manager, Enterprise Fraud Claims , supporting UMB's protection against multi-channel payment fraud loss....We want you to do the right thing, no matter what. And, expect more opportunities. UMBers are known… more
- Commonwealth Care Alliance (Boston, MA)
- …underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial ... 011250 CCA- Claims This position is available to remote employees...at this time. Position Summary: Reporting to the Director, Claims Operations and Quality Assurance, the Claims … more
- Sedgwick (Phoenix, AZ)
- …experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and ... a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - General Liability | Hawaii License Required Are you looking for an… more
- Sedgwick (Columbus, OH)
- …experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and ... Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote...the same assisting our public entity clients with their claims ! If you are an agile multi-line examiner with… more
- Sedgwick (Harrisburg, PA)
- …experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and ... Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive |...General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, you'll have the opportunity to… more
- Sedgwick (Raleigh, NC)
- …and directs the handling to achieve the best possible resolution. Acts as the organizational subject matter expert for line of business and key jurisdictions ... Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Complex Claims Advisor (REMOTE) Are you looking for an opportunity to join a global… more
- Insight Global (St. Paul, MN)
- …position leads and participates in system replacement and enhancement projects and serves as the subject matter expert for federal and state prompt pay laws. ... Description Insight Global is seeking a Principal level Treasury Claims Analyst. The Treasury Claims Principal is...role include the following -Participates, leads, and serves as subject matter expert during claim… more
- ManpowerGroup (Tempe, AZ)
- Our client, a leading organization in the insurance sector, is seeking a Insurance AI Subject Matter Expert (SME) to join their dynamic team. As an Insurance ... align successfully in the organization. Job Title: Insurance AI Subject Matter Expert (SME) Location:...product teams to evaluate AI models used in underwriting, claims processing, risk assessment, and pricing. Identify gaps, biases,… more
- NTT America, Inc. (Raleigh, NC)
- …pain points, architecting bespoke AI solutions. Serve as the subject matter expert for defining workflows-underwriting, claims , policy admin, actuarial, ... to deploy transformative AI solutions for core functions like underwriting, claims processing, and customer engagement. This dual-focus role demands a unique… more
- Sedgwick (Flagstaff, AZ)
- …experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and ... remote GL Adjuster role puts you at the center of resolving complex claims with flexibility and autonomy. PRIMARY PURPOSE: To analyze mid- and higher-level general… more
- Beth Israel Lahey Health (Charlestown, MA)
- …working knowledge of Epic Hospital Billing Follow Up and Denial workflows, considered as Subject Matter Expert (SME) to team and other colleagues ... Follow-Up, and Denial activities necessary to obtain payment/resolution of claims . Review the entire account to ensure claims... claims . Review the entire account to ensure claims were billed properly, payments were applied correctly, and… more
- UnitedHealth Group (Minneapolis, MN)
- …policies within the claim adjudication process through medical records review Serve as a Subject Matter Expert (SME), performing medical record reviews to ... insurance industry 2+ years of experience with health insurance claims 2+ years of experience with medical records review...equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where… more
- Oracle (Salem, OR)
- …in Utilization Review, case management, and healthcare quality preferred Responsibilities Act as subject matter expert (SME): Provide expertise for Claim ... grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for… more
- UnitedHealth Group (Minneapolis, MN)
- …and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin ... / DRG Specialist RN , you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology...AHA Coding Clinic Guidelines in the auditing of inpatient claims . Employing both industry and Optum proprietary tools, you… more
