- MetLife (Warwick, RI)
- …in the lives of our customers and our communities. The Lead LTD Claims Specialist manages a caseload of long term disability insurance claims in accordance with plan ... service standards. In this role, the Lead LTD Claims Specialist will be a technical expert and emerging leader...thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. * Serves as… more
- Sutherland Global Services (Providence, RI)
- …phone, email, or online + Providing ongoing appropriate collection activity on appeals + Requesting additional information from Patients, Medical Records, and others ... as needed + Communicating with insurance plans and researching health plans for benefits and types of coverage + Reviewing contracts and identifying billing or coding issues and requesting re-bills, secondary billing, or corrected bills as needed. + Handling… more
- Prime Therapeutics (Providence, RI)
- …+ Review & present recommended credentialing decisions for pharmacy provider appeals and terminations to Prime's Credentialing Committee for final determination + ... Qualifications** + PBM or pharmacy experience + Certified Provider Credentialing Specialist (CPCS) + Certified Professional Medical Services Management (CPMSM) +… more