- Sedgwick (Lexington, KY)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claim Representative Collision and Comprehensive Experience, Licensing is required ... value and complex cases. + Handles high volume of claims , phone calls and correspondence ensuring claim ...of claims , phone calls and correspondence ensuring claim files are properly documented; meets quality and production… more
- Sedgwick (Frankfort, KY)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Liability Claims Representative | Remote Are you looking for an opportunity to ... and gathering information to determine the exposure on the claim . + Negotiating settlement of claims within...on the claim . + Negotiating settlement of claims within designated authority. + Communicating claim … more
- Travelers Insurance Company (Frankfort, KY)
- … claim handling experience or successful completion of Travelers Outside Claim Representative training program required. + Valid driver's license required. ... claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate… more
- Sedgwick (Lexington, KY)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Commercial Auto Claims Representative - Liability **PRIMARY PURPOSE** : To analyze and ... not required. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage claims ; assesses damage, makes payments, and ensures claim files are… more
- Guardian Life (Frankfort, KY)
- **Job Posting Title** **Team Leader, Absence Claims Management (STD)** **Job Description** The **Team Leader, Absence Claims Management (STD)** is responsible ... must be able to manage and resolve issues that pertain to claim administration procedures, cost containment activities, reports, quality control and complex customer… more
- HealthEdge Software Inc (Frankfort, KY)
- …and experienced Senior Manager of Product Management to lead our Claims Value Stream.Your responsibilities include creating a high-level vision, defining product ... and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream… more
- Carrington (Frankfort, KY)
- **Come join our amazing team and work remote from home!** The Default Claims and Loss Analysis Business Analysts function as an expert resource which consults with ... reports. + Using a strong background of Default MI Claims and/or Loss Analysis identify gaps, trends and build...+ Conceptualize and design dashboards and reports that are representative of the business unit's productivity. + Strong understanding… more
- CVS Health (Frankfort, KY)
- …working with insurance companies to resolve issues associated with our patients' insurance claims . In this role you will ensure timely follow-up on all patient ... accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays);… more
- CVS Health (Frankfort, KY)
- …solutions to make health care more personal, convenient and affordable. **Customer Service Representative ** + You will work in front of a computer for approximately ... while avoiding over-committing. + Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan… more
- Pearl Interactive Network (Winchester, KY)
- …to the appropriate pre-scripted responses, read verbatim to provide basic and claims -specific information, and complete basic call log related to the phone inquiries ... by the CSR to the caller. + Refer calls as required to Customer Service Representative II. + May be required to work holidays. Overtime may be required. + Perform… more
- Molina Healthcare (Lexington, KY)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts,… more
- Highmark Health (Frankfort, KY)
- …solve complex problems representative of a broad range of service and claim scenarios. + Other duties as assigned. Including, but not limited to additional ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the … more
- Guardian Life (Frankfort, KY)
- …probability of RTW. Serve as educational resource on vocational rehab aspect of claims . Educate parties involved in claim management regarding the extent of ... The Vocational Rehabilitation Consultant provides assessment of LTD, STD and Life claims , to determine claimants' level of functionality and provide evaluation of… more
- HealthEdge Software Inc (Frankfort, KY)
- …and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream ... integrated solutions suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration capabilities, a… more
- Sutherland Global Services (Frankfort, KY)
- …and distraction-free dedicated workspace **Duties & Responsibilities;** + Assist providers with claims and claims investigations + Status Inquiries + Denial ... working in a high-volume call center environment as a customer service representative + Effective verbal and written communication skills + Strong typing and… more
- HealthEdge Software Inc (Frankfort, KY)
- …and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream ... integrated solutions suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration capabilities, a… more
- HealthEdge Software Inc (Frankfort, KY)
- …with CI/CD pipelines + ETL development experience using Talend Studio + Familiarity with Claim systems like Facets, QNXT and Health Rules Payor + Knowledge on Azure ... Employment:** Full-time, permanent **Work Environment:** The physical demands described here are representative of those that must be met by an employee to… more
- Humana (Frankfort, KY)
- …PM Eastern Monda-Friday The Rx Clinical Programs ORM Pharmacy Technician Representative 2 assists in reviewing members pharmacy history for overutilization. Job ... & problem-solving skills **Preferred Qualifications** + Previous experience with pharmacy claims + Previous experience performing pharmacy data entry + Bachelor's… more
- Wolters Kluwer (Frankfort, KY)
- …in a resolution conference to be held with the law firm and client representative , when direct appeals mediation with the law firm does not successfully resolve the ... experience and accuracy. + Strong understanding of legal terminology and claims legal situations, including multijurisdictional exposure. + Self-motivated with an… more
- Cardinal Health (Frankfort, KY)
- …needs of the patient and/or program + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance ... insurance benefit practices, preferred + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience preferred + 1-2 years experience with… more