- Elevance Health (Louisville, KY)
- … processing** workflows and systems preferred. + Experience in **payment integrity** or ** claims recovery** functions within a health insurance or managed care ... to verify the accuracy of billed services and ensure claims were submitted and processed appropriately. The analyst will...and that the provider was expecting payment. + Review claim details to determine claim validity before… more
- State of Massachusetts (Boston, MA)
- The Department of Unemployment Assistance (DUA) administers the Unemployment Insurance (UI) program which provides temporary income assistance to Massachusetts ... not 30x weekly benefit amount determinations. Review wages/earnings and issues on current claim to determine claimant eligibility on the new claim . Determine… more
- Zelis (St. Petersburg, FL)
- …DRG validation. They will be responsible for reviewing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence to proper coding and ... billing, analyzing inpatient DRG claims based on industry standard inpatient coding guidelines, and...Chief Medical Officer in managing disputes related to clinical claim reviews. This position is a production-based role with… more
- Lithia & Driveway (Medford, OR)
- …and by the TPA + Serve as a primary point of contact for insurance carriers, claim adjusters, and internal stakeholders, providing timely updates and responses ... teams, external partners, and store leadership to ensure smooth claims resolution + Manage Certificates of Insurance ...collection, and denial letter drafting + Participate in regular claim reviews with the TPA to support action plans… more
- USAA (Boston, MA)
- …guidelines and framework, investigate, evaluate, negotiate, and settle complex property insurance claims . You will confirm/analyze coverage, recognize liability ... claims outcomes. + Maintains accurate, thorough, and current claim file documentation throughout the claims process....prepare claims estimates to manage complex property insurance claims . + Supports workload surges and… more
- USAA (San Antonio, TX)
- …defined guidelines and framework, investigate, evaluate, negotiate and settle complex property insurance claims presented by or against our members. You will ... claims outcomes. + Maintain accurate, thorough, and current claim file documentation throughout the claims process.... claims estimates to manage moderate complexity property insurance claims . + Apply working knowledge of… more
- Samsung SDS America (Plano, TX)
- …maintaining strong client relationships Claims Management & Resolution + Analyze claims data to determine claim validity, coverage, and/or liability for ... claims , including demand letters, settlement agreements, and releases + Manage claims litigation strategy, including settlements and insurance coverage, and… more
- WestCare Foundation (Dandridge, TN)
- …a plus. + Knowledge: Strong understanding of medical billing and coding procedures, insurance claim submission, and payer requirements. + Attention to Detail: ... Claim Preparation & Submission: Prepare and submit accurate and timely medical claims to insurance companies, government programs, and other payers. + Charge… more
- USAA (Philadelphia, PA)
- …defined guidelines and framework, investigate, evaluate, negotiate and settle complex property insurance claims presented by or against our members. You will ... claims outcomes. + Maintains accurate, thorough, and current claim file documentation throughout the claims process.... claims estimates to manage moderate complexity property insurance claims . + Applies working knowledge of… more
- Sedgwick (Salem, OR)
- …and review new claims and maintain data integrity in the claims system. + Conduct claim file activities including evaluations, investigations, litigation ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr. Adjuster - Multiline (Remote in Portland, OR)...your adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more