- Sedgwick (Troy, MI)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles reviews and analyzes management reports and… more
- Sedgwick (Lansing, MI)
- …growth, and inclusion. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE:** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Lansing, MI)
- … claims involving litigation and non-litigated exposures; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability Property Damage | Remote As a Claims … more
- Sedgwick (Negaunee, MI)
- …compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. **ESSENTIAL ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Associate - Workers Compensation - Hybrid - Negaunee, MI or Seven Hills, OH… more
- Sedgwick (Lansing, MI)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner Workers Comp I Remote I SE, Central, NE regions **PRIMARY PURPOSE**… more
- CVS Health (Lansing, MI)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... At CVS Health , we're building a world of health...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… more
- Molina Healthcare (Grand Rapids, MI)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication , QNXT system navigation, and strong analytical acumen. Experience ... compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...or equivalent experience Prior experience in Payment Integrity and/or COB/ Claims roles at a health plan or… more
- CVS Health (Lansing, MI)
- …dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, ... At CVS Health , we're building a world of health...organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Demonstrated ability to… more
- Sedgwick (Lansing, MI)
- …compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. **ESSENTIAL ... FUNCTIONS and RESPONSIBILITIES** + Adjusts medical-only claims and low- to mid-level lost-time workers compensation claims under close supervision. + Supports… more
- Trinity Health (Howell, MI)
- …+ Analytical ability to affective and efficiently resolve registration, insurance and claims processing issues. + Demonstrated knowledge of revenue cycle ... codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement. Verifies insurance eligibility… more