- State of Massachusetts (Boston, MA)
- …deliver program integrity. *What you'd do:* Lead Claims Examiner/Job Service Representative II , who reports to the Senior Manager of Benefit Operations & ... *Lead Claims Examiner/Job Service Representative II | Department...Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies… more
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager II ** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Los Angeles, CA)
- **Telephonic Nurse Case Manager II ** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the ... therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Wilmington, DE)
- **Nurse Case Manager II ** **Work...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of ... employment, unless an accommodation is granted as required by law. The **Nurse Case Manager I** I is responsible for care management within the scope of… more
- Sutter Health (Burlingame, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and… more
- AO Smith (Lebanon, TN)
- Regional Field Service Manager II Date: Sep 8, 2025 Location(s): Lebanon, TN, US, 37090 Company: A. O. Smith Corporation PRIMARY FUNCTION: Regional field service ... SCOPE OF RESPONSIBILITY: Position reports to the Field Service Engineering Manager SPECIFIC DUTIES/ACCOUNTABILITIES(List in order of importance) + Aligned with… more
- Baylor Scott & White Health (Dallas, TX)
- …Summary** + Under the Safe Choice Claims Manager , the Safe Choice Claims Specialist II reviews, studies, and processes assigned claims within their ... efficient service while protecting the organization's assets. + The Claims Specialist II 's main duty involves using...and coordinate training with HR team. + Work with Claims Manager for improvements in processes to… more
- State of Massachusetts (Boston, MA)
- …or suitability is questionable or difficult to determine. 7. Prepare accurate case notations within claims management system which contain accurate, specific, ... * Claims Examiner/Job Service Representative I| Department of Family...Examiner/Job Service Representative I, who reports to the Senior Manager of Benefit Operations & Program Integrity is based… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Sutter Health (Oakland, CA)
- …**CERTIFICATION & LICENSURE** + RN-Registered Nurse of California Required + Certified Case Manager (CCM) Preferred. **EXPERIENCE** + Minimum of 2 years ... patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely… more
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