- Sedgwick (Detroit, MI)
- …* Compiles reviews and analyzes management reports and takes appropriate action. * Performs quality review on claims in compliance with audit requirements, ... service contract requirements, and quality standards. * Acts as second level of appeal...authority of the individual examiner. * Monitors third party claims ; maintains periodical review of litigated … more
- Sedgwick (Detroit, MI)
- …required. **Skills & Knowledge** + Strong knowledge of claims handling and file review practices and procedures + Versed in quality and auditing processes + ... Workplace(R) Forbes Best-in-State Employer Performance Assurance Analyst - Property Claims (Part Time Opportunity) **PRIMARY PURPOSE** **:** Performs comprehensive… more
- Sedgwick (Detroit, MI)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Adjuster - Workers Compensation **Our teams connect! We collaborate onsite ... 55344 **PRIMARY PURPOSE** **:** To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims… more
- Sedgwick (Detroit, MI)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Adjuster - Liability **PRIMARY PURPOSE:** To analyze mid- and higher-level ... general liability claims to determine benefits due; to ensure ongoing adjudication...filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and… more
- Sedgwick (Detroit, MI)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Commercial Auto Claims Representative - Liability **PRIMARY PURPOSE** : To analyze and process ... low to mid-level auto physical damage claims . Commercial auto claims experience is preferred....Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education &… more
- Integra Partners (Troy, MI)
- …inquiries submitted to Integra Partners from our provider/plan partners. Responsible for the review of DME claims for billing accuracy. Responsible for the ... Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the quality of life for the communities we serve. With locations in New York… more
- Sedgwick (Detroit, MI)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review all estimates and ... on property restoration scope. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + **Conducts quality reviews of contra** ctor documentation for repair estimates to… more
- Ford Motor Company (Wayne, MI)
- …quality reviews. + Maintain health chart schedule and assessments. + Maintain and review quality leadership system charts for data accuracy and work group ... forces behind our success. **In this position ** The Quality Analyst will report to the Plant Vehicle Evaluation...you'll do ** + Assist reviewing and binning early claims binning claims and customer concerns with… more
- Sedgwick (Southfield, MI)
- … system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- The Diez Group (Dearborn, MI)
- Quality Engineer Dearborn, MI (http://maps.google.com/maps?q=8111+Tireman+Ave+Dearborn+MI+USA+48126) Description Summary/Objective April Steel Processing, is ... currently seeking an individual who is passionate about quality improvement in manufacturing environments with knowledge of ISO and IATF 16949 requirements. The … more
- Walgreens (Detroit, MI)
- …Review price modify logs and ensure there are corresponding SDL (submit direct link) claims . + Review , research and resolve all third party chargebacks in a ... is received from the medical provider and submitted to Danville. + Review reports to maximize generic substitution opportunities. + Manage and collect patient… more
- American Heart Association (Detroit, MI)
- …for you to be able to integrate data from different sources (clinical, claims , patient-reported survey data, food vendors). The Database Designer is responsible for ... compliance. + Provide or facilitate training on use of claims and/or clinical trial data as needed through group...have a competitive base salary. That's why we regularly review the market value of jobs and make adjustments,… more
- Atlas (Novi, MI)
- …at any and every step of the project, and with a heart-led approach that puts quality and safety at the center of everything we do. We're just built to be better. ... and retention) of the Practice. The TPD will ensure quality client service (internal and external) through feedback and...of technology within the Practice, ATO, and Atlas. + Review , stay current, and contribute to Atlas Strategy to… more
- Integra Partners (Troy, MI)
- …to support the overall development and growth of the Customer Service, Provider Claims & Appeals and Escalations departments, playing a key role in our growth ... support for business in the following areas: operations analysis, claims & appeal analysis, payer analytics and reporting. +...that leaders can use to make business decisions. + Review data to determine operational impacts and needed actions… more
- Sevita (Livonia, MI)
- …assigned to them that are past follow-up date + Update DWF with clear concise notes as claims are worked + Review unapplied cash log for any items that can be ... across the United States. Our extraordinary team offers innovative, quality services and support that lead to growth and...to the company's commitment to serve others by sending claims to the payer in a timely and accurate… more
- Integra Partners (Troy, MI)
- … or Case Management + Experience with health insurance operations and claims processing + Familiarity with quality improvement methodologies Benefits Offered ... subject matter experts to create and deliver refresher training in partnership with Quality and department leaders. + Conducts training for new hires and refresher… more
- Planate Management Group LLC (Detroit, MI)
- …management background, outstanding project leadership skills, and a commitment to safety and quality . This is a 14-month contract, with a standard 50-hour work week, ... + Ensure project safety and accident prevention plans are implemented, and review , monitor, and coordinate safety issues with the Contractor, Post Occupational… more
- Walgreens (Detroit, MI)
- …policies inclusive of participating in the billing and submission of claims to government- sponsored health care programs, including Medicare, Medicaid, and ... payment rejections. Resolves third-party rejection problems promptly and resubmits rejected claims for payment promptly. + Manages and attains inventory budgets to… more
- Molina Healthcare (Detroit, MI)
- …Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at ... internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC… more
- ChenMed (Southfield, MI)
- …policies and procedures. Employees model and deliver the highest level of quality healthcare while working directly with patients and their families, doctors and ... with departmental policies and procedures through conferences, personal inspections and review of report. **ESSENTIAL DUTIES AND RESPONSIBILITIES:** + Reviews and… more