- City of New York (New York, NY)
- …position include, but are not limited to the following: 1) Set up No-fault claim files which includes issuing and processing NF2 application, confirming the ... to gather information relevant to the investigation of the claim ; 13) Investigate, identify, and report fraudulent claims... claim ; 13) Investigate, identify, and report fraudulent claims , utilize statistical data to identify claims … more
- Sedgwick (Rochester, NY)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim ...directions in a professional and timely manner. + Communicates claim activity and processing with the claimant… more
- CVS Health (Albany, NY)
- …And we do it all with heart, each and every day. Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit ... and retention by providing accurate and timely resolution in processing medical claims . You will be a...Ability to use multiple computer applications at one time. Claim processing experience. **Desired qualifications** We are… more
- MVP Health Care (Rochester, NY)
- …and Macess Systems. + Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. + ... improvement. To achieve this, we're looking for a Medical Claims Examiner to join #TeamMVP. This is the opportunity...Reviews and ensures the accuracy of all changes to claim line information based on information received from other… more
- CVS Health (Albany, NY)
- …competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience - DG system ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
- City of New York (New York, NY)
- …New York, and has a wastewater conveyance and treatment system capable of processing over 1.3 billion gallons of wastewater per day to protect the environment ... is involved in a significant amount of litigation and claims filed with the New York City Comptroller's Office....BLA is seeking qualified candidates for the position of Claim Specialist 2 in the Litigation Support Unit. This… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Essential Qualifications + Strong knowledge of contracts, medical terminology, and claim dispute processing and procedures. + Previous experience handling ... claim disputes. + Claim knowledge including professional, facility and ancillary claims...+ Strong knowledge of contracts, medical terminology, and appeals processing and procedures. + High School Diploma or GED… more
- Molina Healthcare (Yonkers, NY)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... to providers. **Job Duties** + Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Sedgwick (Albany, NY)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim ...depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client;… more
- City of New York (New York, NY)
- Job Description The Tort Division is seeking Claim Specialists Level 1. This position encompasses work of varying degrees of difficulty and responsibility performed ... assist in the preparation for trial of less serious claims for and against the City. Secures evidence by...and other persons involved. Assist attorneys by preparing and processing subpoenas, motions, affidavits, legal notices and /or other… more