- Humana (Richmond, VA)
- …to Provider Claims Manager and support development of systems issue resolution + Convene billing forums with selected provider associations to share billing ... community and help us put health first** The Provider Claims Educator reports to the Claims Education...claims systems, adjudication, submission processes, coding, and/or dispute resolution **Work at Home Criteria** To ensure Home or… more
- Magellan Health Services (Albuquerque, NM)
- …abandonment rate, talk time). Comfortable adapting to change. General Job Information Title Claims Resolution Specialist Grade 20 Work Experience - Required ... detailed quality and professionalism. + Assists with claim dispute resolution through research and facilitating the ...all pertinent information is recorded both for ease of resolution by the Claims Department and service… more
- University of Rochester (Rochester, NY)
- …expertise of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative II is responsible for working across ... research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all… more
- Travelers Insurance Company (Houston, TX)
- …and execute a strategic file management plan that achieves optimal file resolution , including as appropriate: research and recommendation of counsel; litigation ... and enthusiastic team player with extensive industry experience to join our Strategic Resolution Group Claim team as a Major Case Specialist handling complex toxic… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **Position Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...role will also be responsible for timely review and research , as necessary on all new and revised coding… more
- New York State Civil Service (Albany, NY)
- …New York Title Property-Casualty Insurance Claims Administrator (Risk Managment Claims Analyst) Occupational Category Other Professional Careers Salary Grade ... carriers, insurance broker contact(s), and others as necessary. * Facilitate the resolution of property and/or builders' risk insurance claims in conjunction… more
- Travelers Insurance Company (Houston, TX)
- …of junior employees. **What Will You Do?** + In the handling large exposure claims , your responsibilities may include: + Coverage Research and Analysis - ... and execute a strategic file management plan that achieves optimal file resolution , including as appropriate: research and recommendation of counsel; litigation… more
- FM (Waltham, MA)
- …and resolution of complex coverage issues. Interprets and executes claims policies and procedures. + Provides direction and feedback to direct reports ... business operations by drawing upon state-of-the-art loss-prevention engineering and research ; risk management skills and support services; tailored risk transfer… more
- NTT DATA North America (MO)
- …the timelines to complete compliance training of NTT Data/Client * Work independently to research , review and act on the claims * Prioritize work and adjudicate ... the candidate will be responsible for:** + Processing of Professional and Hospital claim forms files by provider +...98.5% PA and 99.75% FA. * Timely response and resolution of claims received via emails as… more
- UCLA Health (Los Angeles, CA)
- …fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claims + Experience processing complex institutional ... timely data entry, and the review and adjudication of professional , ancillary, and institutional claims for services...and turn-around requirements. This role requires the ability to research and resolve complex claim issues as well as… more