- Highmark Health (Albany, NY)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... data including, but not limited to: medical/surgical physician and institutional claims and encounters, clinical data, prescription drug data, membership data,… more
- Prestige Employee Administrators (Melville, NY)
- …for workers' compensation risk exposure, including industry classification, loss history, claims trends, and safety programs. + Pricing & Quoting: Develop and ... + Collaboration: Work with internal teams (Sales, Risk, HR, Finance, Claims ) to evaluate new business opportunities and provide underwriting guidance during… more
- Centene Corporation (New York, NY)
- …to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review, hospital readmission review ... adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues. + Provide regular reports...and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be… more
- Travelers Insurance Company (New York, NY)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... Will You Do?** + Follow operational policies to analyze, investigate, and resolve BSI claims of varying levels of severity with limited supervision from claims … more
- Family and Children's Association (Mineola, NY)
- …plans and the management of employee leaves of absence, workers' compensation claims , unemployment insurance, and short-term disability claims . This role also ... invoices, and payroll to resolve discrepancies. + Administer unemployment insurance claims + Support and manage short-term disability, workers' compensation, and… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …for developing, improving and continuing the process billing of medical claims for specialty pharmacy facilities. Needs to communicate financial and clinical ... tasks. Establish, manage, and communicate the process of billing medical claims for specialty facilities. **Responsibilities** **Job Duties:** + Manages the existing… more
- Danaher Corporation (New York, NY)
- …governed multi-modal datasets (text, tabular, device logs, lab results, EHR/ claims ), develop and validate production-grade RAG, fine-tuned LLMs, and task-specific ... will have the opportunity to: + Conduct RWE analytics of EHR/ claims /registries/device telemetry to drive biomarker discovery and development. + Communicate impact… more
- MTA (Brooklyn, NY)
- …A Baccalaureate Degree from an accredited college in Business Administration or a related field of study and ten (10) years of relevant experience, of which five (5) ... administration. + Leading internal investigations related to questionable or fraudulent claims . + Overseeing the TPA and monitoring service level agreements and… more
- City of New York (New York, NY)
- …financial documentation to support revenue plans; preparing and submitting revenue claims ; preparing financial reports to various New York State departments, the ... - Oversee Revenue Analysts to ensure accurate analysis of claims data, claim submissions and reports are processed timely...college or university with a specialization in an appropriate field of physical, biological or environmental science or in… more
- CDM Smith (Buffalo, NY)
- …expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs ... in regular FEMA meetings by providing updates on work status and may evaluate claims and make recommendations to FEMA as to whether the claim is eligible. Assists… more