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New! YesterdayAppeal the denials or reduction of reimbursements by the stop loss carrier. Communicate appropriately funding information and requirements to clients. Assemble weekly or daily funding request information for clients. Handle releasing payments to...
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New! YesterdayResponsible for compiling and analyzing claims data and perform related duties including tracking trends, noting patterns, and detecting any irregularities as it relates to aged Accounts receivable and claims processing trends.
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New! YesterdayReview and process living life insurance claims. Investigate claims. Evaluate investigation results and authorize payments. Summarize, when necessary, to substantiate reason for payment or denial of claim. Monitor the course of claims' investigations...
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New! YesterdayResearch/rectify third-party denials/edits, requests for information and other related correspondence. Process a variety of Third Party Administrator (TPA) payments. Willingness to learn different claim platforms within eviCore and also client claims...
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New! YesterdayReview all medical insurance claims for resolution and payment. Resolve any incoming inquiries or payment denials from insurance providers for payment. Research, compile, and respond to documentation requests from insurance carriers in a timely basis.
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FeaturedNew! YesterdayWe now seek action-oriented, problem-solving and self-motivated individuals to join us and showcase their customer service and related data entry skills as part of our healthcare team. You may be involved in claims adjudication and/or provider...
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New! YesterdayHandles investigation regarding all aspects of the most complex auto claims (coverage, liability and damages) with the exercise discretion and independence within increased level of authority. Applies advanced understanding of insurance policies...
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New! YesterdayInitiates auto and homeowner claims by obtaining preliminary loss information from agents, insureds and third parties. Provide customers with an explanation of the claim process. May authorize services such as roadside assistance and rental cars.
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New! YesterdayLead the day-to-day claims activities, including claims actions, emails, and payments. Own the assessment and approval of new claims and complicated cases, whenever, within the authority. Build rapport with customers to speed up claim s resolution and...
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New! 2 days agoWorks with claims leaders and independently to identify & provide data support to recognize opportunities. Collaborates with other departments in Claims & other divisions of the company (Product, U/W, IT Domain Teams, etc.) on implementing solutions.
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New! 2 days agoProvides technical guidance on unusual or complex claim cases. Troubleshoots and resolves complex claims. Makes decisions under conditions of uncertainty, sometimes with incomplete information, that produce effective end results. May oversee...
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FeaturedNew! 3 days agoDocument claim paid dates and notifications for EOB and IDN audit tracking in Excel. Pull requested correspondence samples from vendor site. Edit and review current strategic partner custom projects. Sort mail, document returned mail, and stuff letters.
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New! 3 days agoDemonstrate sound estimating fundamentals in order to create estimates of damages on 1st and 3rd party material damage losses. Demonstrate basic understanding of the content of all policy types written by the company. Negotiates settlements, makes...
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New! 4 days agoImplement reporting and reconciliation workflows and document processes. Responsible for experience studies and medical trend studies. Responsible for running queries and providing required analysis in order to understand related drivers (such as...
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New! 4 days agoDevelop the knowledge and skills needed to conduct thorough investigations, make determinations regarding eligibility for our customers, provide ongoing leave administration, and communicate decisions and status updates.
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FeaturedNew! 4 days agoPerform research on various computer systems and document customer information regarding current status, payment expectations, notes of conversations and other relevant information. Use mail, email and phones to contact customers to discuss, negotiate...
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New! 4 days agoResponsible for determining covered failures by reviewing vehicle service agreements, determining the need for inspection, interpreting policy coverage, and researching all facts, for multiple product lines; including but not limited to automobiles...
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FeaturedNew! 4 days agoThis is a challenging role with serious impact. You'll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You'll also need to effectively draft correspondence that...
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FeaturedNew! 4 days agoLead and manage a team of inventory specialists. Provide expertise claims support for all related aspects of claim system processes and claim business processing rules. Ensure data integrity, data security and process optimization by identifying trends.
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FeaturedNew! 4 days agoMakes timely and appropriate contacts, determines and completes appropriate level of investigation to make determination of coverage, assess liability and determine damages. Takes a recorded statement from all parties involved in the claim.
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FeaturedNew! 4 days agoInteract with customers to gather support data to ensure invoice accuracy and also work through specific billing discrepancies. Provide input to policies, systems, methods and procedures for the effective management and control of the premium billing...
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New! 5 days agoObtains information from involved parties to evaluate facts of loss, including law enforcement reports, witness interviews, initial treatment medical records, to determine liability. Reviews coverage & claims process with customers. Sets reserves.
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New! 5 days agoMaintains file information to ensure accurate record of claims; continually reviews & monitors progress and expense of claims in pending. Settles and authorizes payment with claimants.Identify and escalate files with more significant indemnity exposure.
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New! 5 days agoResponsible for making accurate decisions on assigned claims through proactive case management according to the plan provisions, state and federal guidelines, and established protocols. This position consults with other team members, and the...
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New! 5 days agoResponsible for investigating and confirming the facts of loss for basic to advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority.
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New! 5 days agoResponsible for investigating and confirming the facts of loss for basic to advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority.
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New! 5 days agoResponsible for investigating and confirming the facts of loss for basic to advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority.
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New! 5 days agoInvestigate, secure and analyze information pertaining to employees' eligibility status, medical condition, occupational or employer requirements, contractual obligations and statutory regulations. Two years of general office and customer service...
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New! 5 days agoLead U.S. launch engagement with customers as relates to health economics and reimbursement. Create training and deliver education programs to sales force, physicians, medical directors, billing personnel, distributors, and other external stakeholders...
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New! 6 days agoBuild/Analyze/Manipulate statistical models. Uses statistical models and analytics to build and deliver presentations to business leaders that are supported by the analysis. Maintains forecasts for the following time frames; Monthly forecast for 5 years;
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New! 6 days agoReview claims and underwriting files for proper disclosure of past medical history, exclusions, riders, endorsements; administer policy enhancements, premium waiver and other policy benefits. Make decisions on claim benefit eligibility determination...
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New! 6 days agoReview claims and underwriting files for proper disclosure of past medical history, exclusions, riders, endorsements; administer policy enhancements, premium waiver and other policy benefits. Document the claim file to ensure an accurate record of...
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New! 6 days agoThe Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. The Team Leader works with external customers to enhance the overall...
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FeaturedNew! 6 days agoSupervises day-to day activities and priorities of claims staff including the management of claims assignments and ongoing guidance of specialty claim files. Ensures execution of claim handling strategies; including appropriate determination of...
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New! 6 days agoThis job is responsible for investigating moderately complex and occasionally complex claims when an attorney is representing the injured 3rd party which may include: Injury Casualty Soft Tissue (ICST) and represented- moderate or major claims.
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1 week agoSpend your day handling claims virtually from home. Handle escalated claims files that have complex contents or additional living expense damages. Conduct a thorough coverage investigation of the loss and ensure the policy was applied correctly. Use...
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Featured1 week agoDirectly handles a consistent workload of coverage litigation files, with the lead, senior or managing coverage litigation attorney(s), on Intact s behalf. Responsible for all phases of litigation and efficient resolution of litigation of some...
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1 week agoReviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees. Investigates and evaluates complex coverage issues to determine applicable coverage, partnering with Coverage Counsel...
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1 week agoManage a high volume of moderate losses and/or complex claim activity. Investigate, adjust and settle claims of moderate to high complexity within a pre- determined authority level. Represents the Company on complex or escalated claim files with a...
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1 week agoManage insurance AR portfolios for multiple clients. Manage a volume of approx. 200 claims per day. Follow-up on all outstanding AR in a timely and efficient manner using assigned reports. Respond appropriately to payor denials via written/verbal...
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1 week agoRespond to electronically and phone summited claim losses and first notice of loss calls from claimants, insureds and other parties. Respond to calls on established claims in a polite, professional and empathetic manner and determine appropriate...
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1 week agoRespond to electronically and phone summited claim losses and first notice of loss calls from claimants, insureds, and other parties. Respond to calls on established claims in a polite, professional, and empathetic manner. 1 year of experience. Hybrid.
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1 week agoProvides customer service support, via the telephone to policyholders, agents and brokers regarding organizational products and practice by providing prompt, efficient, accurate and high quality customer service in a courteous and professional manner.
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1 week agoOptimize testing and monitoring activities to ensure the quality of the systems and processes supporting the company's operation. Become an SME on all lines of business (Medicare, Medicaid and stay current with regulatory guidelines) through the course...
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1 week agoEvaluates & authorizes disposition of complex DI claims. Analyzes & recommends disposition of contestable and complex claims where liability is questionable. Initiates and manages claim investigations and coordinates field and external investigations.
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1 week agoResolve routine, complex, and unique questions/issues. Ensure facilitation of first call resolution and customer satisfaction on all transactions handled. Employ probing questions and actively listen to customer issues or questions, showing interest.
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8 days agoAnalyze complex or technically difficult workers' compensation claims to determine benefits due. Work with high exposure claims involving litigation and rehabilitation. Ensure ongoing adjudication of claims within service expectations, industry best...
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8 days agoIdentify exposures related to loss and determine coverage. Make liability decisions, analyze aggravating factors and potential for shared responsibility, and set up subrogation. Manage outside counsel through litigation process. Use knowledge of state...
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8 days agoManage a high volume of claim files from beginning to end. Resolve and document auto claims as quickly and accurately as possible. Interview all involved in an accident to determine coverage and liability decisions. Validate damage is consistent with...
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10 days agoManaging and evaluating individual and team performance, while taking appropriate action to meet or exceed performance standards, Ensuring claims processing is consistent with applicable policies, procedures and department guidelines. 2+ years of...
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