- UPMC (Pittsburgh, PA)
- …you passionate about quality and committed to making processes better every day? As a Claims Quality Support Specialist , you'll play a key role in ... ensuring our claims operations meet the highest standards of accuracy, compliance,...improvement, and training expertise to raise the bar on quality performance. If you thrive in a role where… more
- Henderson Brothers Inc. (Pittsburgh, PA)
- Position Details + Job Title: Claims Specialist + Department: Commercial Lines + Division: Risk Control/ Claims + Reports To: Claims Supervisor + ... Contract: No + FLSA status: Exempt Position Description The Claims Specialist will provide heroic claims...for all our customers. Primary Responsibilities & Duties + Support and manage claim process for clients who are/and… more
- Carrington (Coraopolis, PA)
- **Come join our amazing team and work remote from home!** The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses ... upon the date the action occurs. + Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation.… more
- Carrington (Coraopolis, PA)
- **Come join our amazing team and work remote from home!** The Claims Recovery & Loss Analysis Specialist is responsible for performing financial reconciliation ... Respond to and make all corrections identified during the Quality Review Process within 24 hours of receipt. +...to apply the proper decision rationale and provide evidentiary support to complete accurate written summaries. + Research incurred… more
- CVS Health (Harrisburg, PA)
- …both routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations from standard ... protocols, standards, and policies to provide effective and timely support . + Acts as a subject matter expert on.... + Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and… more
- Sedgwick (Harrisburg, PA)
- …medical management of claims ; ensures appropriate recommendations are made on claims . + Consistently achieves appropriate quality audit scores. + Acts as ... Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims… more
- Travelers Insurance Company (Harrisburg, PA)
- …evaluate, reserve, negotiate and resolve the company's most severe and/or complex claims , in multiple jurisdictions, in accordance with Best Practices. Provide ... claim handling and superior customer service on assigned claims , while engaging in indemnity & expense management. Promptly...file exposure is greater than $2 million. + Provide quality customer service and ensure file quality … more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …Drug Safety Monitoring and Reporting as required by the pharmaceutical manufacturers we support . The Specialist ensures that ConnectiveRx operates in a constant ... a call center or claims processing). + Medical call center or medical claims experience preferred. + Quality Control or Quality Assurance experience is… more
- Globus Medical, Inc. (Collegeville, PA)
- …prior authorization, appeals support , detailed claims review, and hotline support . The Patient Access Specialist will be responsible for providing payer ... Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support...customer types. **Essential Functions** **:** + The Patient Access Specialist will adhere to quality of HFX… more
- Oracle (Harrisburg, PA)
- …grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering ... **Job Description** Oracle Clinical AI Assistant (CAA) allows providers and their support staff to focus more on patient care by reducing administrative burden of… more
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