- Sedgwick (Dublin, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... EST **PRIMARY PURPOSE OF THE ROLE:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims application… more
- Sedgwick (Blue Ash, OH)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... professional needs. **PRIMARY PURPOSE** **:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims … more
- ICW Group (Sacramento, CA)
- …and workflows for Audit & Compliance program. + Works closely with training specialist and claims management staff to correct deficiencies and address technical ... purpose of this job is to supervise functions of claims internal controls and to monitor team activities with...quality, adherence to IT security guidelines, profitability and other risk -related metrics for self and members of the team.… more
- The Cigna Group (Bloomfield, CT)
- …in ICD-10-CM medical diagnosis coding * Familiarity with CMS regulations for Risk Adjustment programs helpful. * Medical claims , billing, or inpatient ... code accuracy and compliance in support of the HHS' Risk Adjustment (RA) program and Risk Adjustment...other scoring instrument, as defined per policy. * Performs claims matching and auditing, as required, identifying missing or… more
- Houston Methodist (Houston, TX)
- …+ Conducts risk -based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes applicable ... position include serving as subject matter expert, performing complex and high risk -based and baseline compliance reviews, and identifying potential risk areas… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Remote Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE At Polaris Pharmacy Services, we're more ... it most, we invite you to grow with us. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy … more
- AIG (Miami, FL)
- …effectively cross-sell the company's offerings. + Collaborate with engineering and technical specialist to identify and understand risk exposures. + Negotiate ... reports. + Strong understanding of actuarial methods in support of pricing risk , claims and reserving practices. + Advanced working knowledge of local & global… more
- AON (St. Peter, MN)
- …Captive Insurance Companies, Insurance-Linked Securities Vehicles, Special Purpose Vehicles and Specialist Rated Reinsurance Companies. This is a hybrid role with ... of capital gains and losses. + Review of all claims and reconciliation of claims bordereaux. +...incorporated cell companies, especially for the transfer of longevity risk for pension funds. Skills and experience that will… more
- Insight Global (Cincinnati, OH)
- …develop and support various projects, coordinate and design studies to support product claims , and ensure all product claims comply with global regulations. ... to consumer data focus groups to gather insights. The specialist will also conduct update meetings to ensure team...to ensure team alignment and write defensives about product claims . Preferred candidates will have the ability to assess… more
- Newtown Savings Bank (Newtown, CT)
- …This position is responsible for the daily activities of the Account Resolution Specialist (s). Ensure adherence to The Fair Debt Collection Practice Act. Assist the ... Account Resolution Specialist (s) with difficult or complex accounts and situations, utilizing...of Directors on a monthly basis. + Prepare monthly Risk Rating Downgrade Report and quarterly Risk … more