- Humana (West Point, NY)
- …beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims , referrals/authorizations, network operations , access to care, ... to correct multifaceted problems relating to eligibility, enrollment, billing, claims , referrals/authorizations, network operations , access to care, Defense… more
- Houston Methodist (Katy, TX)
- …Utilization Review (UR) position is responsible for leading the daily operations of the Utilization Review department to ensure efficient, high-quality, and ... effective work environment. This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal business… more
- Justworks (New York, NY)
- …compensation insurance risks, working closely with the Underwriting, Workers Compensation Operations , Customer Support, Claims and Licensing teams at Justworks. ... you'll fit right in. Department Risk Programs/ Workers Compensation Operations Function Who You Are The Quality Assurance Analyst...renewals, audits, etc. + Review and check accuracy of claims data in the RMIS system to include but… more
- HCA Healthcare (San Antonio, TX)
- …and Board of Trustees. Include the patient's story of harm. Risk Management/ Claims Activities (if not otherwise assigned) - Collaborate with defense legal counsel ... to coordinate the investigation, processing and defense of claims against the facility; records, collects, documents, maintains, and provides to defense attorneys… more
- Sedgwick (Memphis, TN)
- …as appropriate. + Works with project managers, project requestors, operations , business representatives, IT representatives and clients to ensure complete ... combination of education and experience required. Experience in multi-line claims management processes and system requirements strongly preferred. Skills &… more
- USAA (San Antonio, TX)
- …makes us special and impactful. **The Opportunity** **Join our dynamic Reinsurance Operations team in the Life Actuarial department as a Reinsurance Analyst II!** ... opportunity to play a vital role in supporting reinsurance processes, from claims processing and treaty administration to financial reporting and audit support.… more
- Elevance Health (Indianapolis, IN)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing… more
- Snapsheet (Chicago, IL)
- …Remote Job Type: Full-time Job Department: Estimating About Snapsheet : Snapsheet is claims technology the way it should be: purposeful, precise, and designed to ... in to our core systems and processes across cloud-based claims management, virtual vehicle appraisals, and elite loss and...in Auto Total Loss, you will oversee the day-to-day operations and success of our "Total Loss" team. Understanding… more
- The Hertz Corporation (Oklahoma City, OK)
- …Day in the Life:** The Recovery Specialist is responsible for managing claims including billing, collections, and adjustments. This role partners with internal Sales ... and Operations teams and works with customers and insurance carriers to resolve claims over the phone and through email. We expect the starting wage to be around… more
- BlueCross BlueShield of North Carolina (NC)
- …liaison with other key departments (Medical Management, Network Management, Data Analytics, Claims & Enrollment Operations ) to develop, monitor, and update ... respective roles, responsibilities, and strategies related to claims payment integrity activities. **Fraud Detection and Prevention:** + Work closely with analytics… more