- Elevance Health (Chicago, IL)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Provider Auditor II** is responsible for… more
- Elevance Health (Chicago, IL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible for… more
- Humana (Springfield, IL)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- City of Chicago (Chicago, IL)
- …participate in settlement negotiations. The workers' compensation defense work involves analyzing claims and medical records, writing motions and draft opinions, ... Torts attorneys have an intensive discovery and motion practice, retain and depose medical and other experts, engage in hearings and jury trials, and make… more
- CVS Health (Springfield, IL)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns ... Excel, PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior experience in… more
- Nestle (Schaumburg, IL)
- …other health care agencies and third party administrators for worker's compensation claims + Maintain confidential medical records to include pre-employment ... CPR and AED use **SKILLS & EXPERIENCE:** + Experience with Workers' Compensation claims management + Experience with OSHA recordkeeping and maintaining OSHA logs +… more
- Evolent (Springfield, IL)
- …of 1 years of experience in technical quality assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable ... experience with Testing, Writing Test cases, Test Plans, and good understanding on what needs to be tested + Demonstrable experience in verbal and written communication with domain teams and program leadership + Demonstrable experience working concurrent… more
- Sedgwick (Springfield, IL)
- …new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff. ... combination of education and experience required to include five (5) years medical case management, two (2) years clinical experience, two (2) years providing… more
- Datavant (Springfield, IL)
- …+ Experience in the following fields would be beneficial: Data Entry, Medical Records, Health Care, Insurance Claims Processing and Proof Reading/Editing ... role will be performed Remote - WFH + Processing medical records along with by taking calls from patients,...calls from patients, insurance companies, and attorneys to provide medical records status + Documenting information on multiple platforms… more
- Canon USA & Affiliates (Springfield, IL)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more