- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and… more
- Ryder System (Albany, NY)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **SUMMARY** This ... position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling processes… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...services. 25% + Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru… more
- University of Rochester (Rochester, NY)
- …Website link (EPIC Insurance Coverage tab), review payer website, or contact payer representative as to why claims are not paid. + Determines steps necessary ... follow up activity. + Research and calculate under or overpaid claims ; determine final resolution + Review and determine correct follow up. + Contact payer on… more
- ASM Global (New York, NY)
- …brokers and underwriters specializing in entertainment and live events. + Review event contracts, vendor agreements, and talent deals for appropriate ... indemnification, hold harmless, and insurance provisions. 4. Claims Oversight and Coordination + Lead the organization's claims management process by… more
- Highmark Health (Albany, NY)
- …for the implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the… more
- Uniland Development Company (Amherst, NY)
- …responsibilities of this position include managing Uniland's insurance policies and claims processes, assisting with claim and incident resolution and litigation ... pertaining to Uniland's business activities. + Facilitates administration of insurance claims , including builder's risk, liability, and property insurance and other… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …maintain the effectiveness of Quality Systems for managing the batch record review and release process Quality Management Activities supporting all phases of ... compliance. + Manages reports and trends to the Management Representative to help in the preparation of Management reviews...above. + Improves supplier quality performance for batch record review and release process for OAPI GMP release of… more
- 32BJ Benefit Funds (New York, NY)
- …their dependents. The team focuses on leveraging over 10 years of medical claims data, provider data and pricing data (internal and external) to inform improvements ... using Databricks platform. + Support the team's professional development, performance review and the hiring process. + Guide implementation of CI/CD practices… more
- Highmark Health (Albany, NY)
- …and report improper coordination of benefit billing practices through paid clams review . + Participate as pharmacy representative in onsite member appeals ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more