- Travelers Insurance Company (Lansing, MI)
- …Provide quality claim handling and superior customer service on assigned claims , while engaging in indemnity & expense management. Promptly manage claims ... management and evaluation of some of the Company's severe and complex liability claims by providing claim handling guidance, recommendations and strategies to… more
- CVS Health (Lansing, MI)
- …improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims . You will be a key link in providing our ... each and every day. **Job Summary** Reviews and adjudicates claims in accordance with claim processing guidelines....computer applications at one time. **Preferred qualifications** - Prior medical claim processing experience is a plus.… more
- Sedgwick (Lansing, MI)
- …to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation received ... medical management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and… more
- Wayne State University (Detroit, MI)
- …Essential Functions Administer, organize, and manage all Phases of Worker's Compensation Claims (from initial filing to claim closure). This entails the ... Risk Management Specialist Wayne State University is searching for an...authorization of payments for medical treatment invoices and the investigation of injuries including… more
- Henry Ford Health System (Detroit, MI)
- …+ Submit third party claim forms (ie UB04 or 1500) through the claims editing software. Understands the claim editing process and resolving the edits based ... of patient financial, insurance and demographic patient information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials… more
- Molina Healthcare (Grand Rapids, MI)
- …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
- Trinity Health (Ann Arbor, MI)
- …Type:** Part time **Shift:** Day Shift **Description:** **Pharmacy Tech Specialist - Home Infusion** **Department:** Home Infusion **Location:** Trinity Health ... drug inventory. Performs all job functions of the Pharmacy Technician Specialist as needed/appropriate for the Home Infusion Pharmacy department. Performs pharmacy… more
- Guidehouse (Detroit, MI)
- …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
- Sedgwick (Lansing, MI)
- …Fortune Best Workplaces in Financial Services & Insurance (Remote) EDI Support Specialist - Casualty **PRIMARY PURPOSE** **:** To identify, research, resolve, and ... of related experience to include two (2) years of workers' compensation or claims related experience and three (3) years of EDI technical experience including… more
- Sedgwick (Grand Rapids, MI)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance ADA Accommodation Specialist **PRIMARY PURPOSE** : To enhance the ADA process for claimants ... requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation requests; and to approve and/or negotiate… more