- Sedgwick (Albany, NY)
- …of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for ... Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- University of Rochester (Rochester, NY)
- …individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working across the ... all open account receivables to successful closure. Responsible for effective claims follow-up to obtain maximum revenue collection. Responsibilities include but are… more
- Rochester Regional Health (Rochester, NY)
- …effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials ... to improve a complex business process. RESPONSIBILITIES: + Review and accurately process claim edits in a system work queue. Accurately handle claim adjustments… more
- MetLife (Oriskany, NY)
- …performing claim adjudication with the focus on Decisional, Financial, Claims Coding and Compliance Accuracy in accordance with the Customers' plan/policy and ... goals and objectives. * Identify, remove, and challenge barriers related to claims management. Escalate to senior leaders in the organization as appropriate along… more
- Highmark Health (Albany, NY)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... claim rejection and the proper action to complete the...effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of… more
- Robert Half Legal (New York, NY)
- Description We are seeking a Claims Technical Specialist to oversee the examination, evaluation, and processing of complex claims estimates and paid claims ... policy terms and conditions in alignment with the client's Claims Philosophy. This role supports the claims ...with laws, regulations, and best practices. + Deliver superior claim outcomes through exceptional customer care and responsiveness. +… more
- Mount Sinai Health System (New York, NY)
- …to Directors for potential legal intervention, and assisting in the escalation of claims that may require involvement from insurance carriers or legal entities. The ... cycle management, with a strong understanding of both hospital and professional claims processes. ? Previous experience in a role that involved analyzing contracts,… more
- Highmark Health (Albany, NY)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- MetLife (Oriskany, NY)
- …office for meetings Key Responsibilities: * Effectively manage a team of STD Claim Specialists in a fast-paced environment to ensure individual and team performance ... indicators and delivering on customer commitments through quality and timely claim determinations including compliance with ERISA and other state and regulatory… more
- Sedgwick (Albany, NY)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more