- UPMC (Pittsburgh, PA)
- …(NCD) or Local Coverage Determination (LCD). + Evaluate referrals from Pharmacy Benefit Manager (PBM) by analyzing medical and pharmacy claims and associated ... to identify potential clinical care issues; prepayment review of claims , and prepayment review of unlisted codes. Claims...Staff and document as appropriate in the SIU FWA Case Management Database. + Assist in the development and… more
- The Hartford (Seattle, WA)
- …and expense exposure of assigned claims . They will report to a Property Major Case Manager and operate in a team environment that will develop and share ... exposure of assigned claims . They will report to a Property Major Case Manager and operate in a team environment that will develop and share business… more
- University of Southern California (Alhambra, CA)
- …Collector Appeal Specialist is responsible for accurately processing inpatient and out-patient claims to third party payers and private pays, following all mandated ... guidelines are met; provided quality control checks on paper and electronic claims ; process tracers, denial and related correspondence; initiate appeals; compose and… more
- Travelers Insurance Company (Redlands, CA)
- …Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager . + Performs administrative functions such as ... this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim… more
- LA Care Health Plan (Los Angeles, CA)
- …Social Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Accredited Case Manager ... clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating… more
- State of Colorado (Denver, CO)
- …from inception through hearings and appeals, including fully contested claims , challenges to specific disability and medical benefits, penalty allegations, ... Workers' Compensation Division, state agencies, and the State's third party- claims administrator, regarding workers' compensation law, liability exposure, and… more
- Advanced Orthopedics and Sports Medicine Institute (Freehold, NJ)
- …and confirming NY claims are open and active for treatment, completes case manager screen and documents all insurance information necessary. Assist with ... full time The Workers Compensation Support Coordinator will assist the Nurse Case Manager to maintain an efficient patient flow through registration and initial… more
- LATICRETE International (Bethany, CT)
- …Compensation claims through WC provider. + Manages Workers compensation case and coordinates with Payroll to ensure accurate comp/benefits. + Assesses company ... vendor payments/accounting. The Benefits Specialist works closely with the Manager , Human Resources, external vendors/consultants, and employees. ESSENTIAL DUTIES… more
- Hawaiian Electric (Honolulu, HI)
- …various litigation matters including commercial, contract, personal injury, and property damage claims , from case inception to judgment and appeals; advising ... matters including commercial, contract, personal injury, and property damage claims , from case inception to judgment and...and working on all aspects of litigation matters from case inception to judgment and appeals. Role: Manager… more
- Elevance Health (Chicago, IL)
- …Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including ... case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients.… more
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