- Usaa (New Orleans, LA)
- …processes/systems/procedures to ensure compliance with laws, regulations, and policy provisions. Review claims /suppliers for fraud indicators and refers to ... May require face-to-face interactions with members and third parties. Review facts of loss and vehicle damage to determine...of inspection. May serve as a subject matter authority representative for disputed claims or trials. Serves… more
- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on strong ... procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer… more
- Sedgwick (Shreveport, LA)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative - Workers Compensation | Jurisdiction: Multi State | ... or equivalent combination of education and experience or successful completion of Claims Representative training required. Jurisdiction: Multi State - 15 states… more
- Sedgwick (Baton Rouge, LA)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative | Auto | Remote Are you looking for an opportunity to ... YOU AN IDEAL CANDIDATE?** Join our team as a Claims Representative focused on Property Damage and...and commercial lines policies and endorsements + Ability to review and assess Property Damage estimates, total loss evaluations,… more
- Sedgwick (New Orleans, LA)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative , Auto | Commercial Trucking | Remote **PRIMARY PURPOSE** : ... To analyze and process low to mid-level auto physical damage claims . Commercial auto claims experience is preferred. Having a current New York adjuster's license… more
- Ryder System (Baton Rouge, LA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The ... Director Claims directs...to verify the legitimacy of an interview or Ryder representative , please contact Ryder at ###@ryder.com or ###. **Current… more
- Mass Markets (LA)
- …staff and managerial for resolution as needed + Attend meetings and training and review all new training material to stay up-to-date on changes to program knowledge, ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service,… more
- Mass Markets (LA)
- …to complete account management tasks + Accurately document and process customer claims in appropriate systems + Follow all required scripts, policies, and procedures ... through problems solving and effective call handling + Attend meetings and training and review all new training material to stay up to date on changes to program… more
- Highmark Health (Baton Rouge, LA)
- …position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist distribution. Interpret ... added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. + Perform effective on-site visits… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Responsible for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper administration of contractual ... experience providing direct patient care with one year of authorization, medical review experience and case management is required **Skills and Abilities** +… more
- USAA (New Orleans, LA)
- …to ensure compliance with laws, regulations, and policy provisions. + Review claims /suppliers for fraud indicators and refers to Special ... require face-to-face interactions with members and third parties. + Review facts of loss and vehicle damage to determine...inspection. + May serve as a subject matter authority representative for disputed claims or trials. Serves… more
- Ryder System (Baton Rouge, LA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling processes… more
- CRC Insurance Services, Inc. (LA)
- …**Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates General ... Liability claims affecting primary and excess policies in a fast-paced...assigned. **QUALIFICATIONS** **Required Qualifications:** The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable… more
- Highmark Health (Baton Rouge, LA)
- …for the implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the… more
- CVS Health (Baton Rouge, LA)
- …representatives that are responsible for contacting payers to collect on unpaid claims in a timely and accurate manner, researching and resolving payment variances, ... and managing the accurate and timely filing of claims within payer function group. **Additional responsibilities of the Accounts Receivable Supervisor include:** +… more
- Otsuka America Pharmaceutical Inc. (Baton Rouge, LA)
- …maintain the effectiveness of Quality Systems for managing the batch record review and release process Quality Management Activities supporting all phases of ... compliance. + Manages reports and trends to the Management Representative to help in the preparation of Management reviews...above. + Improves supplier quality performance for batch record review and release process for OAPI GMP release of… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that support analysis as well ... organizations, AMA, vendor reps, and hospital administrators to exchange or review program information. Other data sources are market research consultants, AMA,… more
- Prime Therapeutics (Baton Rouge, LA)
- …with various levels of leadership within the organization, acting as a representative of the broader Financial Systems team + Provide consulting services to ... experience, preferably leveraging AI + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience in… more
- Fresenius Medical Center (New Orleans, LA)
- …determining project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global ... the consolidation, analysis and reporting of commercial revenue. Develops standards of review and analysis to facilitate accurate and timely analysis of all… more
- RxBenefits (New Orleans, LA)
- …team also assists with resolving client issues involving performance discrepancies, claims issues, and reporting. The successful Pharmacy Pricing Senior Manager will ... across internal stakeholders to foster collaborative and efficient work products + Review for accuracy and finalize all current account pricing comparisons for… more
