- Travelers Insurance Company (Cleveland, OH)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Sedgwick (Columbus, OH)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of all ... claims to ensure information substantiates disability. + Provides clear...change the duties of the position at any time. \# nurse #casemanagementspecialist Sedgwick is an Equal Opportunity Employer and… more
- Sedgwick (Columbus, OH)
- …treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug interactions, health and safety concerns, and ... team on difficult cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate clinical options, and… more
- Sedgwick (Columbus, OH)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Crisis Care Triage **This nurse will need to be on call every Saturday 6am until Monday 6am each ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Elevance Health (Mason, OH)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a minimum of… more
- Medical Mutual of Ohio (OH)
- …and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of ... planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS...utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy, encounter, and quality measurement data. + Advanced… more
- CVS Health (Columbus, OH)
- …Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/ Claims Research Medicaid team. Extensive claims research on ... in accordance with contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …backgrounds (eg licensed therapists, clinical psychologists, behavioral health specialists, Nurse Practitioners and Physician Assistants in behavioral health, etc.) ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Morley (Columbus, OH)
- …queues are time sensitive **_Nice to Have_** + Experience in medical claims reimbursements or medical billing + Conversant in health insurance industry terminology ... + Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help...Patient advocacy: Free 24/7 help with benefit questions and claims issues + Family, financial and estate guidance (will)… more
- Sedgwick (Cincinnati, OH)
- …selected to advance to the next round, a recruiter will be in touch. \# nurse #fieldcasemanager #CRC #CDMS Sedgwick is an Equal Opportunity Employer and a Drug-Free ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more