- Mount Sinai Health System (New York, NY)
- …to Directors for potential legal intervention, and assisting in the escalation of claims that may require involvement from insurance carriers or legal entities. The ... cycle management, with a strong understanding of both hospital and professional claims processes. ? Previous experience in a role that involved analyzing contracts,… more
- Robert Half Legal (New York, NY)
- Description We are seeking a Claims Technical Specialist to oversee the examination, evaluation, and processing of complex claims estimates and paid claims ... policy terms and conditions in alignment with the client's Claims Philosophy. This role supports the claims ...with laws, regulations, and best practices. + Deliver superior claim outcomes through exceptional customer care and responsiveness. +… more
- Molina Healthcare (Buffalo, NY)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to… more
- Highmark Health (Albany, NY)
- …requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- MetLife (Oriskany, NY)
- …office for meetings Key Responsibilities: * Effectively manage a team of STD Claim Specialists in a fast-paced environment to ensure individual and team performance ... indicators and delivering on customer commitments through quality and timely claim determinations including compliance with ERISA and other state and regulatory… more
- UNUM (Albany, NY)
- …Physical Medicine and Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across ... and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal… more
- Sedgwick (Albany, NY)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… 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
- MTA (Brooklyn, NY)
- …reduce overall costs. Some of the major responsibilities include supervising the TPA's claims management and medical provider networks as well as coordinating ... claims to ensure rapid closure while maintaining the required claim information in the claims database to ensure information is up to date and organized. +… more
- Guidehouse (New York, NY)
- …edits such as: + Correct Coding Initiatives (CCI) + Medically Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, ... third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and...and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims . +… more