- Sedgwick (Erie, PA)
- …and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on ... projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- CDM Smith (Harrisburg, PA)
- …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
- Sedgwick (Philadelphia, PA)
- …policies within assigned group. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Completes examiner update reports, claim adjustments, provider requests and ... internal and external logins and the applicable security access for the company 's claims management systems by determining the validity for incoming requests and… more
- Highmark Health (Pittsburgh, PA)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job is responsible for development and implementation of strategic audit plans utilizing ... and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Analyze and evaluate claim processes specific to professional, hospital, ambulatory surgical center,… more
- Sedgwick (Harrisburg, PA)
- …and support systems. + Effectively communicates and builds relationships with the claims ' examiner , client, injured worker, attorney and supervisor. + Identifies ... and organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Celebrate your career… more
- Prime Therapeutics (Harrisburg, PA)
- …Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the ... or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations/ claims experience. + Ability to manage workload while simultaneously working… more
- Highmark Health (Harrisburg, PA)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job is responsible for developing and maintaining an anti-fraud program which includes ... **Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC)… more