- Humana (Trenton, NJ)
- **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 (Trenton, NJ)
- …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
- Ryder System (Philadelphia, PA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position handles worker's compensation claims under Ryder's self-insured, self administered worker's comp program....to verify the legitimacy of an interview or Ryder representative , please contact Ryder at ###@ryder.com or ###. **Current… more
- Ryder System (Trenton, NJ)
- _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
- NJM Insurance (Trenton, NJ)
- …extremely lucky to have had this excellent opportunity!" Overview NJM Insurance Group's Claims Analytics Department is seeking a Claims Insights Analyst Intern ... efficiency, reduce operational friction, and enhance customer experience. RESPONSIBILITIES: + Review and report on loss activity within assigned line of business.… more
- NJM Insurance (Hammonton, NJ)
- …a top-rated insurance company, is looking for a Personal Injury Protection Representative who has excellent communication skills as well as strong organizational and ... days remote once training is completed Essential Duties and Responsibilities: + Review PIP coverages and/or identify coverage issues and investigate and analyze the… more
- Highmark Health (Trenton, NJ)
- …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
- Ryder System (Trenton, NJ)
- _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
- NJM Insurance (Trenton, NJ)
- …including pre-work such as audit program development and file selection, assuring the review process is proper and timely. + Conduct WC Claim audits to ensure ... process improvements, data integrity, compliance, and best practices. + Collaborate with claims management in the development of meaningful action plans that detail… more
- Highmark Health (Trenton, NJ)
- …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
- NJM Insurance (Trenton, NJ)
- The Paralegal for the General Claims Legal department provides paralegal support to in-house staff attorneys for claims -based legal matters, assists attorneys' ... of staff attorneys. The GC Legal Paralegal develops reports to aid General Claims leadership through the analysis and assembly of data provided from various sources,… more
- Stantec (Philadelphia, PA)
- …System selection to be based on Project/Client needs as well as proactive Claims /Risk mitigation. - Oversee and approve development and management of the Project ... Development and maintenance of the Project Risk Register, based on review of contract conditions, project-specific delivery requirements, client characteristics, and… more
- CVS Health (Trenton, NJ)
- …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. (Trenton, NJ)
- …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
- NJM Insurance (Trenton, NJ)
- …+ Triaging and analyzing scorecards and outputs from predictive models for General Claims , Personal Lines, Personal Injury Protection (PIP) claims and Medical ... to fraudulent Personal Lines and Commercial Lines policies and claims . + Conduct background research on available public databases...support the need for the escalation of the claim review . + Review NJM databases, retrieve NJM… more
- Pfizer (Collegeville, PA)
- …with the following teams: + Work directly with agency partners to review , and translate media optimization reporting to business objectives + Implement the ... industry and healthcare environment, specifically with an understanding of healthcare claims data and its application to marketing optimization + We look… more
- Prime Therapeutics (Trenton, NJ)
- …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 (Philadelphia, PA)
- …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
- MISTRAS Group, Inc. (Princeton Junction, NJ)
- …legal and compliance activities at MISTRAS. and manage litigation, activities, draft, review and negotiate company agreements, review and monitor compliance and ... and counsel executives on risk mitigation. **Major Responsibilities/Activities:** + Draft, review , and negotiate a broad range of commercial agreements/renewals and… more
- Fresenius Medical Center (Malvern, PA)
- …the maintenance of appropriate billing systems within the assigned function(s). + Review , investigate and resolve outstanding claims in coordination with ... location _within the United States_ PURPOSE AND SCOPE: The Insurance Representative provides general administrative support in the insurance collections process… more