- CDM Smith (Albany, NY)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting, auditing, and investigative… more
- University of Rochester (Rochester, NY)
- …to successful closure and obtain maximum revenue collection. Researches, corrects, resubmits claims , submits appeals and takes timely and routine action to resolve ... unpaid claims . Mentors and trains new or lower level staff....accounts, resulting in payment or resolution of the outstanding claim . The Specialty A/R associate will utilize MFG and/or… 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
- Molina Healthcare (Albany, NY)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- City of New York (New York, NY)
- …to the Bureau's Claim Prepares used to track and identify all claims submitted for reimbursement. - Assist with the management of the distribution of scanned ... is critical to tracking and cataloging of all BCR claims , as well as the submission of all DSS...data, which includes approximately 3,200 DSS/HRA/DHS and other agency claims submitted annually for Federal and State reimbursement on… more
- Raphael and Associates (New York, NY)
- …Adjuster to apply their knowledge of negligence theories while investigating Liability claims . This position provides an opportunity for the right candidate to ... : + End to end management of liability field claims according to client guidelines and state requirements. +...to provide superior reports so that proper evaluations of claim values can be made. + Appropriately represent the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
- CDPHP (Latham, NY)
- …the timely and accurate facilitation and handling of all incoming paper claim and correspondence documents. All tasks are performed on-site. This includes performing ... mail sort, batch preparation, and scanning of all incoming claims and correspondence to facilitate and ensure compliance with...service levels. Ownership is assumed for all aspects of claims examining and data entry on the FormWorks system,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the insurance contract. + Reviews and audits the Insured's benefit file and claim payment to encourage timely submission of claims . Responsible for ensuring ... Insured, Insured's family, care providers, and adjudication of the claims . All work is directed under the terms and...State time service standards. (this includes the task of claim payment) + Works closely with all providers and… more
- Leviton (Melville, NY)
- …looking for a Deduction Representative I to join the Credit, Accounts Receivable & Claims department. We need individuals who thrive on challenges and are eager to ... I is responsible for evaluating, processing, and resolving customer claims (deductions), working together with customers and various internal departments.… more