- Cedars-Sinai (CA)
- …people throughout Los Angeles and beyond. **Req ID** : 11588 **Working Title** : Claims Examiner - Managed Care **Department** : MNS Managed Care ... **Job Description** The Claims Examiner is responsible for accurately...is a leader in providing high-quality healthcare encompassing primary care , specialized medicine and research. Since 1902, Cedars-Sinai has… more
- New York State Civil Service (Schenectady, NY)
- … Examiner and direct guidance of the Senior Workers' Compensation Examiner within the Office of Operations/ Claims Operations/Capital District, the Workers' ... NY HELP Yes Agency Workers' Compensation Board Title Workers' Compensation Examiner (NY HELPS), WCB Item #4344 Occupational Category No Preference Salary Grade 14… more
- New York State Civil Service (Menands, NY)
- NY HELP Yes Agency Workers' Compensation Board Title Workers' Compensation Examiner (NY HELPS), WCB Item #5113 Occupational Category No Preference Salary Grade 14 ... Code 12204 Duties Description Under the direction of the Senior Workers' Compensation Examiner within the eClaims Unit, the Examiner 's duties will include but… more
- New York State Civil Service (Schenectady, NY)
- NY HELP Yes Agency Workers' Compensation Board Title Workers' Compensation Examiner (NY HELPS), WCB Item #5021 Occupational Category No Preference Salary Grade 14 ... accounts; or experience examining, investigating, processing, or adjusting insurance claims ; or responding to technical questions from policyholders or claimants;Or… more
- Marriott (Bethesda, MD)
- …and assess reserve adequacy to ensure accuracy, reasonableness, and timeliness. * Ensure claims are directly managed in a timely and effective manner, using ... and/or responsibilities. The Senior Director acts as a liaison between claims department and operations promoting service excellence through education, training, and… more
- Sedgwick (Dayton, OH)
- …reports, claim adjustments, provider requests and operational expense check requests. + Queues claims for Managed Care ; transfers payment allocations; and ... Coordinator **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple...logins and the applicable security access for the company's claims management systems by determining the validity for incoming… more
- Prime Therapeutics (Des Moines, IA)
- …Examiner credential preferred. + Bachelor's degree preferred. + Prefer knowledge of managed health care business model and processes, preferably in behavioral ... Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the...for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded… more
- NTT DATA North America (Boston, MA)
- …will be assigned to conduct pre-payment reviews of medical records for healthcare claims in one or more of the following areas: (1) Partial Hospitalization and ... case work, including correspondence, findings, and an investigative chronology Evaluating claims by applying Plan policies and procedures and generally accepted… more
- Air National Guard Units (Flowood, MS)
- …on-the-job experience managing health services activities, including plans and operations, managed care , human resource management, logistics management, patient ... Evacuation Specialists. Performs a variety of duties associated with nursing services/patient care on Aeromedical Evacuation (AE) flights, and on the ground the… more
- Molina Healthcare (Lexington, KY)
- …investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as ... ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all… more