- NTT DATA North America (Decatur, IL)
- …for NTT DATA Services and for the people who work here. NTT DATA seeks a ** Claims Examiner ** on a **project** basis to work **remote, from home** . This is ... role. **Must have TPA experience or GBAS experience** The Claims Processor reports to the Regional Claims ...The Claims Processor reports to the Regional Claims Manager, Employee Benefits Division. This position is responsible… more
- Sedgwick (Springfield, IL)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner , Bodily Injury (Auto) **PRIMARY PURPOSE** : To analyze and ... process complex auto and bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.… more
- Intermountain Health (Springfield, IL)
- **Job Description:** The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims , in a timely and ... to and supports the corporation's quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely… more
- Sedgwick (Springfield, IL)
- …Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing ... to advance to the next round, a recruiter will be in touch. \#claimsexaminer # claims _As required by law, Sedgwick provides a reasonable range of compensation for… more
- Prime Therapeutics (Springfield, IL)
- …and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively ... compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with… more
- Travelers Insurance Company (Naperville, IL)
- …a team of professional accountants to quantify the financial aspects of customer claims to ensure current, accurate, and complete information. You will leverage your ... and approve insured accounting records and financial statements for property insurance claims typically involving losses up to $5 Million+. + Counsels Property, Auto… more
- Prime Therapeutics (Springfield, IL)
- … claims processing environment **Preferred Qualifications** + Certified Fraud Examiner or Accredited Health Care Fraud Investigator + National Pharmacy Technician ... and client initiatives; engage in cross functional analysis of medical and pharmacy claims ; lead FWA investigations for federal employee program + Stay current on… more
- Highmark Health (Springfield, IL)
- …**Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) ... (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have… more
- Abbott (Abbott Park, IL)
- …federal healthcare program laws, including the Anti-Kickback Statue, Stark Law, False Claims Act and CMS regulations. + Proficiency in audit methodologies, risk ... Public Accountant (CPA), Certified Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE) + Experience using data visualization tools such as Tableau… more