- Sedgwick (Lansing, MI)
- …**ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and ... Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Wayne State University (Detroit, MI)
- Risk Management Specialist Wayne State University is searching for an experiencedRisk Management Specialistat its Detroit campus location. Wayne State is a premier, ... society. Essential functions (job duties): Job Purpose The Risk Management Specialist within Enterprise Risk Management & Insurance Programs (ERM) will provide… more
- Sedgwick (Grand Rapids, MI)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Travelers Insurance Company (Lansing, MI)
- …reserve, negotiate and resolve the company's most severe and/or complex claims , in multiple jurisdictions, in accordance with Best Practices. Provide quality ... claim handling and superior customer service on assigned claims , while engaging in indemnity & expense management. Promptly manage claims by completing essential… more
- Molina Healthcare (Grand Rapids, MI)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… 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
- Henry Ford Health System (Troy, MI)
- …workflows, and assisting the supervisor with escalated issues. The CBO Coding Senior Specialist confirms the accuracy and completeness of coding to ensure compliant ... claims are sent to payers. The CBO Coding Senior Specialist works independently to resolve complex diagnostic accounts. The CBO Coding Senior Specialist helps… more
- Molina Healthcare (MI)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Otsuka America Pharmaceutical Inc. (Detroit, MI)
- …innovative products, with a focus on pharmaceutical products to meet unmet medical needs and nutraceutical products for the maintenance of everyday health. In ... its evolved customer engagement model, a Neuroscience Specialist engages healthcare providers (HCPs) using in-person, virtual, and digital tools, offering expertise… more
- LG Energy Solution (Holland, MI)
- …such items as physicians' reports on employee health, workers' compensation insurance claims , medical restrictions on employee work, and the policies and ... Title: Occupational Health Nurse, Specialist (Part Time or Full Time) Reports to:...and manage work-related injuries and illnesses, including Workers' Compensation claims + Manage return to work approval process +… more