- Sedgwick (Columbus, OH)
- … Specialist **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex ... and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to… more
- Zurich NA (Columbus, OH)
- Litigated Claims Specialist , Workers Comp (IN or...within the coverage. + Work to have a timely resolution to claims by developing case strategy; ... 124155 Zurich North America is seeking a sharp, solutions-driven Workers' Compensation Litigated Claims Specialist II to join our high-performing team. This is… more
- USAA (Cincinnati, OH)
- …+ Partners with vendors and internal business partners to facilitate complex claims resolution . May also involve external regulatory coordination to ensure ... us special and impactful. **The Opportunity** As a dedicated Property Adjuster Specialist , you will work within established guidelines and framework to investigate,… more
- Travelers Insurance Company (Cleveland, OH)
- …or their legal representatives. + Recognizes and implements alternate means of resolution . + Manages litigated claims . Develops litigation plan with staff ... resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Molina Healthcare (Columbus, OH)
- …for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with ... Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from… more
- Elevance Health (Mason, OH)
- …defining our innovative role in the industry. **Pharmacy Quality Assurance Specialist ** **Location:** This role requires associates to be in-office **1** day ... law._ **Schedule: Monday - Friday; 8:00am-5:00pm** The **Pharmacy Quality Assurance Specialist ** is responsible for evaluating the quality of services and… more
- Molina Healthcare (Cleveland, OH)
- …and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of Provider No Surprises Act cases to ensure that internal ... and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine...Provider No Surprises Act outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates… more
- Molina Healthcare (Cleveland, OH)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... areas of responsibility (eg, Provider Services/Provider Inquiry Research & Resolution , Provider Contracting/Provider Relationship Management). + Provides timely, accurate… more
- Highmark Health (Columbus, OH)
- …relationships hold the key to uncovering society's most complex challenges? Do you see medical records not just as disparate facts, but as a vast, dynamic network of ... work will directly impact millions of lives. As our Lead Graph Intelligence specialist , you will be the spearhead of cutting-edge research projects. This means… more
- Highmark Health (Columbus, OH)
- …cases of the change or problems and takes appropriate steps to effect resolution . (10%) + Reviews and interprets medical information, classifies that information ... related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding,… more