- The County of Los Angeles (Los Angeles, CA)
- …as directed for medical care evaluation studies. + Works with Professional Standards Review Organization representative to orient new staff to Federal laws and ... in the supervision* of nursing staff engaged in utilization review activities. -AND- 2 . Current certification issued...to view correspondence. Los Angeles County will not consider claims of not viewing or receiving notifications to be… more
- CRC Insurance Services, Inc. (TX)
- …**Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates General ... to determine the extent of exposure to the insured and all financial partners. 2 . Countrywide Litigation Management providing world class claims service to our… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and… more
- USAA (Los Angeles, CA)
- …to ensure compliance with laws, regulations, and policy provisions. + Review claims /suppliers for fraud indicators and refers to Special ... require face-to-face interactions with members and third parties. + Review facts of loss and vehicle damage to determine...inspection. + May serve as a subject matter expert representative for disputed claims or trials. Serves… more
- Access Dubuque (Dubuque, IA)
- …and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract ... authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated ...or equivalent combination of education and experience required. Two ( 2 ) years of claims supervisory experience preferred.… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...services. 25% + Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru… more
- University of Rochester (Rochester, NY)
- …Website link (EPIC Insurance Coverage tab), review payer website, or contact payer representative as to why claims are not paid. + Determines steps necessary ... RTP are required. + Remote location must be within 2 hours of RTP and within New York State....up activity. + Research and calculate under or overpaid claims ; determine final resolution + Review and… more
- USAA (San Diego, CA)
- …to field provider method of inspection. + May serve as a subject matter expert representative for disputed claims or trials. Serves as a resource to team members ... responsible for the investigation, negotiation, evaluation and appraisal of vehicle damage claims for both repairable and total loss vehicles to ensure estimate… more
- Cognizant (Dallas, TX)
- …primary focus will be supporting traditional risk management functions such as claims management, insurance, renewal process, safety, contract review and ... d)Coordinating such coverages between CTS entities, brokers and insurers around the world 2 .Manage certain claims arising under these policies by: a)Working with… more
- State of Massachusetts (Boston, MA)
- …work, available for work and looking for a job. The Job Service Representative I performs customer service and issue resolution by assisting employers or claimants ... information by conducting research and verifying information in order to mitigate fraud. Review and complete not 30x weekly benefit amount determinations. Review … more