- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Axis (Alpharetta, GA)
- …available upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… more
- Grant Thornton (Los Angeles, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare systems. This includes areas such as… more
- Point32Health (Canton, MA)
- …contract interpretation in accordance to claims processing guidelines, Point32Health Medical and Payment Policies and established audit protocols. He/she ... (minimum): 5-7 years of related professional healthcare experience including familiarity with medical claims processing. + Preferred: 8-10 years of related work… more
- Providence (MT)
- **Description** ** Senior Claims Manager - Employment Practice Liability \*Remote * Candidates residing in Alaska, Washington, Montana, Oregon, California, Texas ... or New Mexico are encouraged to apply.** The Senior Claims Manager- Employment Practice Liability ("EPL")...- they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused,… more
- CRC Insurance Services, Inc. (Raleigh, NC)
- …following job description:** Responsible for managing and resolving complex insurance claims involving litigation, coverage disputes, and high exposure. This role ... then hire attorney for coverage counsel for coverage analysis. 2. Settle claims within settlement authority, where applicable. 3. Work with adjusters, insureds,… more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- New York State Civil Service (Menands, NY)
- …State NY Zip Code 12204 Duties Description Under the direction of the Senior Workers' Compensation Claims Referee, the duties of the Workers' Compensation ... and evaluates documentary evidence and testimony, both lay and medical , given at hearing; orders medical examinations...Chair.* Performs related duties as required.* Coordinate with the Senior Workers' Compensation Claims Referee in the… more
- Cardinal Health (San Juan, PR)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, ... medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles… more
- American Water (Camden, NJ)
- …package including 401(k),Defined Contribution Plan, Employee Stock Purchase Plan, medical , prescription, dental and vision coverage, plus disability, paid time ... wastewater services to our communities. Effective, efficient, and intelligent insurance claims management, oversight, and forecasting are essential to this mission.… more
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