- Highmark Health (Albany, NY)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... claim rejection and the proper action to complete the...effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of… more
- Robert Half Legal (New York, NY)
- …alignment with the client's Claims Philosophy. This role supports the claims function in specific insurance classes to drive operational efficiency, ... Description We are seeking a Claims Technical Specialist to oversee the examination, evaluation,..., including fact, liability, and loss investigations, and interpret insurance contracts effectively. + Evaluate and negotiate resolution of… more
- Sedgwick (Albany, NY)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Marine Team Lead **PRIMARY PURPOSE** **:** To supervise the activities of the ... adjuster department; to assign caseload of claims to adjusters and to ensure customer...Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
- Philadelphia Insurance Companies (New York, NY)
- …District of Columbia, and write all major lines of Commercial Property and Casualty Insurance . We provide unique insurance and risk management tools from our ... underwriters and loss prevention engineers and fair and timely claim settlement from a skilled team of claim...professionals. We work with major brokers and leading independent insurance agents throughout the United States to serve the… more
- Raphael and Associates (New York, NY)
- …Adjuster to apply their knowledge of negligence theories while investigating Liability claims . This position provides an opportunity for the right candidate to ... : + End to end management of liability field claims according to client guidelines and state requirements. +...to provide superior reports so that proper evaluations of claim values can be made. + Appropriately represent the… more
- Highmark Health (Albany, NY)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- MetLife (Oriskany, NY)
- …and technology resources Preferred: * Bachelor's degree * 7+ years of STD Insurance Claims experience * knowledge of STD, group disability, Workers Compensation, ... office for meetings Key Responsibilities: * Effectively manage a team of STD Claim Specialists in a fast-paced environment to ensure individual and team performance… more
- Sedgwick (Albany, NY)
- …smaller and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims… more
- MTA (Brooklyn, NY)
- …workers' compensation claims to ensure rapid closure while maintaining the required claim information in the claims database to ensure information is up to ... (Case Management), is responsible for effective management of worker compensation claims for their assigned area of responsibility. This person supports the… more