- Molina Healthcare (NE)
- …appropriate modules within the core processing system (QNXT). * Conducts focal healthcare Medical claim audits on samples of processed transactions impacted by ... combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is… more
- Travelers Insurance Company (Phoenix, AZ)
- …for quality claim handling including investigating, evaluating, negotiating, and resolving claims on losses of lesser value and complexity and provide claim ... if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. + Achieve a positive result by returning an injured… more
- CVS Health (Franklin, TN)
- …+ Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. + Documents claim information in the ... timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and… more
- Sedgwick (Columbia, SC)
- …FUNCTIONS and RESPONSIBILITIES** + Proactively and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional ... Workplaces in Financial Services & Insurance General Product and Liability Complex Claim Advisor - Multi-State Licensing Preferred - Hybrid - Sedgwick Offices **ARE… more
- Molina Healthcare (Warren, MI)
- …**Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which ... documentation for denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical… more
- Axis (Chicago, IL)
- …part in the selection process. **Job Description** AXIS is seeking a **_Senior Claims Specialist - Environmental Claims_** to join our North America Claims . ... The candidate should possess the ability to handle primary & excess claims arising from policies issued to AXIS Environmental insureds. This role will be responsible… more
- CVS Health (Tallahassee, FL)
- …non-participating providers. Additionally, they will assist in creating bulletins, newsletters, and claim trainings to improve provider claims issues. as well as ... Field Analyst** works with the grievance and appeal and claims operations department to trend provider claim ...assigned. **Required Qualifications** + 3+ years of experience in medical billing and coding, specifically related to claims… more
- MetLife (Bloomfield, CT)
- …in Healthcare field * Proficient with Microsoft office software * Prior STD and Family Medical Leave Act claims knowledge * Ability to work independently * A ... training. Key Responsibilities: * Manages overall STD block of claims and possible companion claims to include...Federal, State, Local laws * Creates and executes individual claim action plans, serves as point of contact for… more
- Travelers Insurance Company (St. Paul, MN)
- …mail and wage statements. Prints and prepares claim documents for legal and medical reviews. Reports and assigns claims , and transitions closed files to and ... multiple departments to assist with the timely resolution of claims , which may include: Properly documents claim files,...records, and reviews medical bills,… more
- Black & Veatch (Overland Park, KS)
- …corporate claim management processes and procedures. + Manages contract claims and risk issues related to prime agreements and/or subcontract agreements. + ... agreements prior to commitment and provides advice on potential claim issues. + Manages project specific claims ...of health care benefits including but not limited to medical , dental and vision insurances along with disability and… more