- ZOLL Medical Corporation (Pittsburgh, PA)
- …companies to facilitate the reprocessing of denied, incorrectly paid and unprocessed claims to result in a favorable return. Essential Functions + Provides ... workflow processes to ensure timely follow up on assigned claims + Contact patients, physician offices and insurance companies...to payer after making necessary edits on HCFA 1500 claim forms + Write appeals to insurance companies to… more
- Robert Half Legal (New York, NY)
- Description We are seeking a Claims Technical Specialist to oversee the examination, evaluation, and processing of complex claims estimates and paid claims ... policy terms and conditions in alignment with the client's Claims Philosophy. This role supports the claims ...settlement, and fair resolution of disputes in line with company guidelines. The selected candidate will manage the complete… more
- Highmark Health (Denver, CO)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... ** Company :** Highmark Inc. **Job Description :** **JOB...and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES**… more
- Trinity Health (Davenport, IA)
- …of the revenue cycle process for an assigned PBS location. Documents claims billed, paid, settled, and follow-up in appropriate system(s). Identifies and escalates ... objective of maximizing reimbursement for services rendered and ensuring claims are paid or settled in a timely and...or settled in a timely and accurate manner. Researches claim rejections, make corrections, take corrective actions, and/or refer… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
- Sedgwick (Irving, TX)
- …naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes ... physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability plan; to make… more
- Sedgwick (Eden Prairie, MN)
- …under ADA, state, and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims or makes a recommendation ... Drive Eden Prairie, MN 55344 **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and procedures pursuant… more
- NJM Insurance (Hammonton, NJ)
- NJM Insurance Group (NJM), a top-rated insurance company , is looking for a Personal Injury Protection Representative who has excellent communication skills as well ... make a determination as to coverage and course of action. + Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals.… more
- Raphael and Associates (New York, NY)
- …30+ lbs.) Company Overview: Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally ... Adjuster to apply their knowledge of negligence theories while investigating Liability claims . This position provides an opportunity for the right candidate to… more
- Sedgwick (Salem, OR)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more