- Sedgwick (Concord, NH)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workers Compensation Complex Claims Advisor | Remote **This ... manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional expertise to...preferred. **Skills & Knowledge** + Subject matter expertise in worker 's compensation claims and/or liability… more
- Sedgwick (Concord, NH)
- … Examiner **PRIMARY PURPOSE** **:** To analyze complex or technically difficult workers compensation claims to determine benefits due; to work with ... specific requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult claims by investigating and… more
- Sedgwick (Concord, NH)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workers Compensation Claims Adjuster | Public Entity & MD, VA ... brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of...and inclusion. **PRIMARY PURPOSE OF THE ROLE:** To analyze Workers Compensation claims on behalf… more
- Elevance Health (Manchester, NH)
- **Anticipated End Date:** 2024-09-23 **Position Title:** Claims Analyst III- Overpayment Prevention **Job Description:** ** Claims Analyst III- Overpayment ... overpayment prevention opportunities. Determines specific business requirements to address complex business needs. Works with Query Developers to ensure business… more
- UMB Bank (Concord, NH)
- …change to ensure the best customer experience. + Review and decide high-value and complex card fraud claims . + Prepare regular reports on card fraud ... **Duties & Responsibilities** The Manager, Card Fraud Claims , will oversee and manage the UMB card...College Degree + TSYS TS2 and/or TSYS TMS experience ** Compensation Range:** Minimum: $69,230.00 - Maximum: $179,300.00 _The posted… more
- Elevance Health (Manchester, NH)
- …members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable ... entitled. + Determines primacy on each case using a complex set of Primacy Rules as mandated by State...enrolling in Medicare. + Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well… more
- Elevance Health (Manchester, NH)
- …and procedures. + Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment ... and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review....in good faith believes is the range of possible compensation for this role at the time of this… more
- Elevance Health (Manchester, NH)
- …other coverage for all of the company's groups and members. Performs multi complex functions and interprets complex rules, laws and contracts. Accountable for ... identify the correct formulas in order to adjudicates impacted claims , using multiple COB Formulas for the various product...in good faith believes is the range of possible compensation for this role at the time of this… more
- Sedgwick (Concord, NH)
- …and support systems. + Effectively communicates and builds relationships with the claims ' examiner, client, injured worker , attorney and supervisor. + Identifies ... Manager **PRIMARY PURPOSE OF THE ROLE:** While partnering with the injured worker , employer, and medical providers, create a case management strategy to facilitate… more
- Elevance Health (Manchester, NH)
- …will make an impact:** + Interprets and supports plan benefit design. + Resolves complex claims , benefits, and enrollment issues. + Makes routine account visits. ... interpersonal communication skills preferred. + Proven ability to resolve complex issues in a fast-paced and high-demand environment preferred....in good faith believes is the range of possible compensation for this role at the time of this… more
- Elevance Health (Manchester, NH)
- …acceptability of insurance risks and appropriate premium rates for large, complex renewal and prospect employer groups in accordance with Corporate Underwriting ... are not limited to: + Calculates renewal rates for complex group cases based on thorough analysis of the...increments or decrements. + Communicates with sales, administration and claims to assess the rating and administrative impact or… more
- Concord Group Insurance (Bedford, NH)
- …law or Company policy, or unethical behavior and misconduct + Represent the company in workers ' compensation claims , unemployment claims and litigation + ... employee relations, retention, compliance with federal and multiple state laws, compensation and benefits, workplace safety and health, records management, and the… more
- Elevance Health (Manchester, NH)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... Performs varied data analyses which may include: developing moderately complex ROI models and performs healthcare cost analysis to...in good faith believes is the range of possible compensation for this role at the time of this… more
- Elevance Health (Manchester, NH)
- …operational excellence that meets/exceeds client service and satisfaction goals for a complex book of business supporting pharmacy. **How you will make an impact:** ... strongly preferred. + Experience or knowledge of Salesforce and/or claims operating systems highly preferred. + Proficient of Microsoft...in good faith believes is the range of possible compensation for this role at the time of this… more
- Elevance Health (Manchester, NH)
- …the development of defensible pricing strategies. + Provides analytic support during complex provider negotiations. + Analyzes claims experience to identify cost ... compliance, as well as supporting the contract negotiation process. + Performs complex modeling and analytics exercises. + Performing healthcare cost analysis to… more
- Lincoln Financial Group (Concord, NH)
- …preferred * Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation , Utilization Review and/or nurse case management ... reviewing, analyzing, and interpreting medical information available for disability claims . In this role you will act as a...clinical resources (ie IME, FCE, Peer Reviews) * Discuss complex medical issues with health care providers as needed… more