- 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 ... 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
- Molina Healthcare (Rochester, NY)
- …updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these ... communicate written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims … more
- CVS Health (NY)
- … claim or reconsideration. **Required Qualifications** - 18+ months of medical claim processing experience. - Experience in a production environment. - ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
- Sedgwick (Albany, NY)
- …FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage and lower level injury claims ; assesses damage, makes payments, and ensures claim files are ... and pursues subrogation opportunities; secures and disposes of salvage. + Communicates claim action/ processing with insured, client, and agent or broker when… more
- Molina Healthcare (Rochester, 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
- 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
- City of New York (New York, NY)
- Job Description The Tort Division is seeking a Claim Specialists Level 1. This position encompasses work of varying degrees of difficulty and responsibility ... 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
- Molina Healthcare (Buffalo, NY)
- …independently reviewing and processing simple to moderately complex High dollar claims and knowledge of all claim types of reimbursements not limited ... updates/changes to member enrollment, provider contract, provider demographic information, claim processing guidelines and/or system configuration requirements.… more
- Highmark Health (Albany, NY)
- …and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, ... **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health… more
- Sedgwick (Rochester, NY)
- …asbestos) by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate ... + Calculates and assigns timely and appropriate reserves to claims ; monitors reserve adequacy throughout claim life....depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client;… more