- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …+ Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely ... return to work. + Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines. + Knowledgeable and compliant with New York State Workers' Compensation Law, Medical Treatment… more
- CVS Health (Albany, NY)
- …routine nature. + Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc + Maintain department ... established performance metrics at a meets or exceeds expectations level + Work together as a team and apply the Aetna Core Values in day-to-day operations + Creating a Differentiated Service Experience + Demonstrating Service Discipline + Handling Service… more
- Humana (Albany, NY)
- …either the state agency or payer perspective + Detailed understanding of healthcare claims Travel: While this is a remote position, occasional travel to Humana's ... offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range… more
- Actalent (Clayville, NY)
- …+ Reduce and prevent defects in supplied materials and verify defect claims . + Lead cross-functional teams to pursue performance improvements aligned with ... organizational goals. + Mitigate business impact from supplied material defects and manage supplier quality risks. + Submit, review, coach, and accept supplier corrective action requests. + Lead on-site supplier engagements, including performance reviews,… more
- Centene Corporation (New York, NY)
- …to providers that would improve utilization and health care quality. + Reviews claims involving complex, controversial, or unusual or new services in order to ... determine medical necessity and appropriate payment. + Develops alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both… more
- Mohawk Valley Health System (Utica, NY)
- …and uses them as a contact when necessary to resolve outstanding issue on claims . + Determines whether payment from insurance billed is accurate, based on DRG, ... Contracted Rate, Per Diem, or Fee Schedule. Initiates an adjustment, if necessary, to bring account to the correct balance. Demonstrates thorough knowledge of rates for specific payor responsibility and advises management of any trends regarding inappropriate… more
- Walgreens (New Paltz, NY)
- …to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... insurance companies as well as medical providers and participates in 3rd party audit. + Follows-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest alternative medications, and answer… more
- The Arc Mid-Hudson (Lake Katrine, NY)
- …as the primary liaison with the agency's insurance provider, coordinating accident claims and communications with adjusters, repair shops, and body shops as needed. ... + Will lead the accident review committee in coordination with safety risk management. + Will investigate reports from the public of safety hazards or problems with the transport of the people served by The Arc Mid-Hudson and will make appropriate reports… more
- Paychex (Rochester, NY)
- …prescribed guidelines to ensure good customer relations are maintained and customer claims and complaints are resolved fairly, effectively, and in accordance with ... Paychex policies and procedures. Hours of Operation: Monday-Friday, 8am-8pm EST *Schedule to be assigned after training is complete. Responsibilities + Delivers quality service to Paychex clients via phone, email, chat, and other avenues + Develops and… more
- Canon USA & Affiliates (Melville, NY)
- …Funds (APF) - Track budgets - Reconcile sales funds and budgets - Validate claims - Research and resolve chargebacks - Meet with Sales, Product, and Credit groups ... - Communicate with our Dealers/Partners, and internal sales team - Issue credits - Manage all aspects of the assigned accounts **About You: The Skills & Expertise You Bring** - Bachelor's degree in a relevant field (Finance or Accounting) or equivalent… more