Claims Examiner

... medical review process (i.e. bed downgrades, change to observation status, alternative setting, etc.) Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner, and to ensure appropriate reimbursement in the Claims adjudication system Follows and maintains compliance with regulatory agency requirements and participate in continues quality improvement activities Attends all required trainings and management-identified meetings in person. In certain circumstances, the employee may be allowed to conference in, at the discretion of the ...

... medical review process (i.e. bed downgrades, change to observation status, alternative setting, etc.) Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner, and to ensure appropriate reimbursement in the Claims adjudication system Follows and maintains compliance with regulatory agency requirements and participate in continues quality improvement activities Attends all required trainings and management-identified meetings in person. In certain circumstances, the employee may be allowed to conference in, at the discretion of the ...

... compensation claims to determine benefits ... work with high exposure claims involving litigation ... ongoing adjudication of claims within service ... identify subrogation of claims and negotiate ... compensation claims by investigating and ... on the claim; manages claims through well-developed ... settlement of claims within designated ... appropriate reserves to claims; manages reserve ... and cost effective claims resolution. Coordinates ... reduce overall cost of claims for our clients. ... offsets. Reports claims to the excess carrier; ... properly documented and claims coding is correct. ... (5) years of claims management experience ... 2+years of relevant WC claims experience Nesco ...

... and resolve claims for all Medi-Cal ... and processes claims and claims worksheets. ... Routes and tracks claims requiring review by ... Examiner II is distinguished from Claims ... and resolves pended claims for Medi-Cal types: ... coverage, and batch claims within established ... standards. Completes claims from the Batch Error ... Pass Report. Routes claims to appropriate PHC ... up and completes claims once response to ... and procedures, PHC Claims Operating ... pended claims. Generates claims ... to the Medi-Cal Claims Supervisor. Reviews ... time frame. Supports Claims Departments needs ... trends of pending claims that are increasing ... billing and/or claims examining experience ... skills. Knowledge of claims processing and/or ...

... research, and resolve claims for all Medi-Cal claim ... letters. Routes and tracks claims requiring review by other ... and resolves pended claims for Medi-Cal types: ... other coverage, and batch claims within established ... standards. Completes claims from the Batch Error Report ... Batch Pass Report. Routes claims to appropriate PHC ... Follows up and completes claims once response to request ... and procedures, PHC Claims Operating Instruction ... resolving pended claims. Generates claims correspondence as ... and reports to the Medi-Cal Claims Supervisor. Reviews all ... time frame. Supports Claims Departments needs for ... prior experience examining claims in an automated ...

... The Senior Claims Examiner handles all aspects of claims notices and files related to workers compensation and accompanying coverages, including but not limited to claims and coverage analysis, liability and ... change. Key functions include but are not limited to: Adjusting all aspects of claims and loss notices, including but not limited to claims and coverage analysis, liability and damages analysis, reserve setting, ... analysis and reporting and coverage litigation. Attend mediations, settlement conferences, trials and other claims-related travel as needed or required. Support the marketing, risk management, finance and actuarial ...

... compensation claims to determine benefits ... work with high exposure claims involving litigation and ... ongoing adjudication of claims within service ... identify subrogation of claims and negotiate ... compensation claims by investigating and ... on the claim; manages claims through well-developed ... Negotiates settlement of claims within designated ... appropriate reserves to claims; manages reserve adequacy ... timely and cost effective claims resolution. Coordinates ... to reduce overall cost of claims for our clients. Manages ... Medicare offsets. Reports claims to the excess carrier; ... properly documented and claims coding is correct. Refers ... Five (5) years of claims management experience or ...

... compensation claims to determine benefits ... work with high exposure claims involving litigation ... ongoing adjudication of claims within service ... identify subrogation of claims and negotiate ... compensation claims by investigating and ... on the claim; manages claims through well-developed ... settlement of claims within designated ... appropriate reserves to claims; manages reserve ... and cost effective claims resolution. Coordinates ... reduce overall cost of claims for our clients. ... offsets. Reports claims to the excess carrier; ... properly documented and claims coding is correct. ... (5) years of claims management experience ... 2+years of relevant WC claims experience EEO: ...

Posting Description: Participant Accident Claims Examiner / Health Insurance K&K Insurance is a leading provider of specialty coverage ... motorsports, and events. As a Claims Examiner, you will report directly to the Manager of Claims working in the challenging and ... of insurance. The Claims Examiner handles all assigned claims to a conclusion. Handles a high volume of claims and maintains Customer ... Obtain information necessary for claim to be established in the claims system Investigate to verify that injury occurred while claimant ... the payment of medical claim Process/move and maintain claims within the claims workflow and archival systems Skills and experience that ...

P&C Commercial Claims Adjuster - Carrier or TPA - REMOTE Put your Insurance Experience to work FROM HOME! At Wahve, we value significant insurance experience and want to revolutionize the way people think about phasing ... carrier or Third-Party Administrator (TPA) clients in Property & Casualty (P&C) Commercial Claims Adjuster or Examiner positions. Responsibilities include: Handle General Liability / Bodily Injury, Property, ... Garage/Garagekeepers Legal Liability or Umbrella claims. Knowledge of any/all these lines is acceptable. Set-up claim in claims management system. Properly document claims files. Review police reports, legal and medical ...

... large loss, complex claims promptly and equitably ... on moderate-to-difficult claims. Reviews coverages, ... and settles claims utilizing claims best practices. ... if coverages apply to claims submitted. Manages all ... activity on complex claims. Directs the discovery and ... legal counsel. Analyzes claims activity and prepares ... of authority, settling claims in the most cost effective ... of disbursements. Settles claims promptly and equitably and ... drafts in payments for claims within authority limits. ... procedures. Analyzes claims activities and prepares ... experience. Technical claims investigations/settling ... 4-8 years experience in Claims or similar organization. ...

... terminations of employment if necessary. Conducts ongoing training with office staff; e.g., leasing paperwork, workplace safety, and any other type of training that may be needed daily. SAFETY Reports all liability and community incidents to the corporate office immediately. Ensures that all workers' compensation claims are reported and proper paperwork is completed. The property manager will complete any pertinent safety checklists with the maintenance staff. ADMINISTRATIVE/OFFICE Ensures that lease files are complete and that completion of leases is being executed properly. Approves in writing all leases on the property. Responsible for ...

JOB SUMMARY: The primary responsibilities of the Insurance Specialist are: ensure that payments received from the insurance companies are posted correctly to the patient accounts; ensure that denials and unpaid or partially paid claims are thoroughly researched; to provide specialized assistance to our patients and clinical staff using their knowledge base of a particular insurance; to provide excellent patient service.

... a synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals ...

... terminations of employment if necessary. Conducts on-going training with office staff; e.g., leasing paperwork, workplace safety, and any other type of training that may be needed daily. SAFETY Reports all liability and community incidents to the corporate office immediately. Ensures that all workers' compensation claims are reported and proper paperwork is completed. The property manager will complete any pertinent safety checklists with maintenance staff. ADMINISTRATIVE/OFFICE Ensures that lease files are complete and that completion of leases is being executed properly. Approves in writing all leases on the property. Responsible for ...

... a synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals ...

... systems to find missing information as applicable; coordinate with other departments to resolve issues when needed Accurately document and process customer claims in appropriate systems Lead fact-finding discussions to determine the best options for the customer Utilize knowledge base and training to accurately answer ... Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application ...