- CVS Health (Albany, NY)
- …experience. ** Preferred Qualifications** + 3 plus years of prior claim or health insurance experience. + Familiarity with medical terminology, self funding ... Qualifications** + 1 plus years knowledge of plan documents, claims research, letter writing. + 1 plus years working...letter writing. + 1 plus years working with appeals, claims , or compliance. (and/ or) + 1 plus years… more
- Molina Healthcare (Rochester, NY)
- …updates/changes within claims processing system . + Experience using claims processing system (QNXT). ** PREFERRED EDUCATION:** Bachelor's Degree or ... equivalent combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working… more
- Molina Healthcare (Buffalo, NY)
- …combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years of experience in claims as Adjuster or claims examiner in the healthcare field ... of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Comprehensive claims processing experience (QNXT) as Examiner or Adjuster +… more
- Sedgwick (Albany, NY)
- …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
- Sedgwick (Albany, NY)
- …FUNCTIONS and RESPONSIBILITIES** + Proactively and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional ... claims . Supervisory experience a plus. Specific jurisdictional expertise preferred . **Skills & Knowledge** + Subject matter expertise in worker's compensation… more
- Lincoln Financial (Albany, NY)
- …environment. You will act as a liaison between the employee (member) and the claims examiner to provide a positive customer experience during their specific ... a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence...the day, answering questions and providing information regarding their claim through the utilization of multiple applications and platforms.… more
- 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
- Sedgwick (Albany, NY)
- …and support systems. + Effectively communicates and builds relationships with the claims ' examiner , client, injured worker, attorney and supervisor. + Identifies ... recovery. + Provides recommendations for alternate clinical resources to support claim resolution. + Maintains client's privacy and confidentiality, promotes client… more
- Molina Healthcare (Syracuse, NY)
- …Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation pertinent to investigations. + Detects ... the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. +… more
- University of Rochester (Rochester, NY)
- …OIC leadership to determine corrective action, such as formal self-disclosures or claim adjustments + Assists in responding to external audits and government ... integrated health system, an Academic Medical Center, or other comparable setting preferred . + **Certifications** + One of the following credentials is preferred… more