Claims Jobs - Remote Work From Home & Flexible
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10 days agoCollaborate with CX to provide customer service, guidance, and education to policyholders through every step of theclaimsprocess. Review veterinary bills for accuracy and to determine whether coverage applies forclaimedcosts. Investigateclaimsto...
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New!TodayResearch and find solutions to deniedclaims. Complete outbound calls to insurance carrier supervisors to investigate denial reasons. Resubmitclaimswith errors, utilizing knowledge of CMS 1500 forms and a broad understanding of data, coding, and...
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New!6 days agoTheClaimsLeader develops strategies to achieve employee performance levels and the expert execution ofclaimprocesses. The individual monitors staffing levels and workloads, provides coaching and mentoring, and participates in performance reviews.
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30+ days agoUses proprietary software tools to access and reviewclaimdocuments, enterclaimdecisions, and create escalations when needed. Utilizes documented team processes to ensure compliance with departmental standards.
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25 days agoAbility to conduct multiple types of complexclaimsinvestigations. Daily submission of updates regarding work performed on each case. Ability to manage time. Maintain a sufficient level of client billable hours. Write and record detailed statements.
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30+ days agoLooking for aClaimsAdjuster to adjudicateclaimsin accordance with best practice guidelines and regulatory requirements from FNOL through to resolution. You will be an ambassador of our customer centeredclaimsjourney and will maintain clear lines...
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9 days agoEfficiently investigateclaims, evaluate contract language, and identify appropriate coverage where applicable. Diligently manage file diaries that moveclaims及时解决。提供优质的customer service to members and partners...
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30+ days agoTheclaimsauditor will be responsible for coordinating and completing audits as well as compiling and reporting results and trends accurately, appropriately, and timely. Applicants must have 5 years of comprehensive experience with the processing or...
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9 days agoHandle the intake of severe cyber events, including the coordination with breach counsel, forensic investigators and other vendors.Evaluate full pending ofclaimsin affiliation with the posting and recommending accurate reserves. Maintain documentation.
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9 days agoReview incoming new matters to advise of complexity; Investigate and research theclaimin order to determine whether coverage exists; Reviewing and handling requests for letters of indemnity with undertaking; Drafting coverage letters.
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30+ days agoConduct quantitative and qualitativeclaimfile audits on insurance partners on such topics as, but not limited toclaimpredictive modeling accuracy, reserve analysis, litigation prevention/ management, fraud and subrogation. Strategize and support...
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New!5 days agoReviewclaimsubmissions to confirm required documents have been received; verify medical codes, eligibility, other insurance, authorizations, and account benefit plans. Follows established policies and procedures to pay, pend for additional...
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30+ days agoThis job is responsible for demonstrating proficiency in first party estimating, investigation, evaluation and negotiation at the most reasonable cost. Satisfy customer needs and ensure file quality. Applying and explaining applicable coverage to all...
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30+ days agoManages and oversees the integrity of theclaimsmanagement process, ensuring that all daily operations adheres to the rules, regulations, and contractual requirements of CMS, CO DOI, contracted and non-contracted providers. Ensures the contractual...
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30+ days agoAs aClaimsSupervisor, you are responsible for leading and inspiring a team of high performing and highly engaged professionals that work to ensure a quality patient experience.ClaimsSupport handles all communication, paperwork, and negotiations...
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New!6 days agoTheClaimsAnalyst works on the full range ofclaims, correspondence, quality assurance and escalations to ensure the satisfaction of the goals and priorities of the team. Years of experience: 1 year.
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12 days agoReceives and reviews insuranceclaimsand related documents. Maintains electronicclaimfiles in accordance with procedures. Presentsclaimpackets and explainsclaimhandling procedures to clients. Gathers information and documents needed forclaim...
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New!YesterdayAs a team member, you will work closely with insurance payers to ensure that payment for applicable care is coordinated accurately and efficiently. You will also be a part of our larger Member Success team, collaborating with colleagues from diverse...
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30+ days agoOurClaimsAssociates are responsible for handling assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members; research billing issues to determine the possible...
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30+ days agoHandle assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members. Research billing issues to determine the possible cause of the error and assist withclaims...
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15 days agoSecure and analyzeclaiminformation to make and approve disability decisions and payments on disabilityclaims. Develop, apply and approve appropriateclaim和残疾管理策略以确保职业mpt and accurate payment and liability...
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30+ days agoReviewclaimssubmitted by providers and submitclaimsto insurance payers. Review electronicclaimsfrom insurance payers and post payments. Troubleshoot and resolve deniedclaimsby contacting insurance companies via phone and contacting clients...
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30+ days agoSeniorClaimsAnalyst is responsible for the accurate review, input and adjudication of specialists, ancillary, and electronicclaimsin accordance with outside regulations, internal production standards, & contractual obligations of the organization.
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30+ days agoYour role would be to investigate and adjust workers' compensationclaimswith the highest potential exposure. We take an extremely aggressive and pro-active approach inclaimsadjusting and are looking for the person who not only knows their...
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New!3 days agoManage a high volume ofclaimfiles from beginning to end. Resolve and document autoclaimsas 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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13 days agoUnder direct supervision, analyze information/documentation received to determine how to proceed with aclaimreview & determine methods of obtaining additional information from alternative sources.Reviewclaimsand outside sources used in the review.
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New!YesterdayAs a team member, you will work closely with insurance payers to ensure that payment for applicable care is coordinated accurately and efficiently. You will also be a part of our larger Member Success team, collaborating with colleagues from diverse...
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9 days agoAnalyzeclaims确定需要额外的调查。德al / communicated directly with 3rd parties and customers in the investigation, negotiation and conclusion of Fidelity Bondclaimsin accordance with established procedures. Ensure...
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23 days agoAs aClaimsDirector, you will provide leadership and direction to a group of front-line managers and their direct reports. You will manage will oversee and ensure the fair, ethical, and timely management of complexclaimsfor your assigned area(s) of...
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30+ days agoManage to conclusion all reported & outstandingclaims& incidents in all areas of operation. Summarize & make recommendation on each newly reportedclaimto determine if it should be self-handled, assigned to outside counsel & reported to the insurance.
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30+ days agoServes as a customer service representative for theclaimdepartment by promptly and professionally addressing customer questions and concerns, which may include: Triage and route callers to the appropriate department; Answersclaim地位和付款…
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11 days agoClaimhandling responsibilities will include the following: reviewing assignedclaims, contacting the insured and other affected parties, setting expectations for the remainder of theclaim, and initiating documentation in theclaimhandling system.
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30+ days agoClaimsAdjuster license required and will be obtained during training. Investigate and adjustclaimsaccording to applicable laws and policy provisions. Conductclaiminvestigations including but not limited to recorded statements, securing public...
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New!YesterdayProficient with the rules, regulations, amendments and Guidelines of CMS for executingclaimsprocessing. Must be able to verify thatclaimsare paid in accordance with correct contractual provisions, regulatory guidelines and all company and...
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New!2 days agoUnder the direction of the Manager of Revenue Cycle Management, the MedicalClaimsSpecialist (AR Manager) is responsible for the complete, accurate, and timely processing of all designatedclaims, reviewing and responding to daily correspondence from...
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Featured12 days agoEnsures execution of properclaimhandling strategies; including appropriate determination of coverage, liability, andclaimresolution. Ensures proper reserving to achieve compliance with corporate policy. Makes decisions on recommendations forclaim...
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16 days agoTheClaimsSpecialist will play a critical role in ensuring qualityclaimfile management, service level agreements are met, and regulatory requirements are satisfied all while helping to create and provide an industry leading customerclaims...
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FeaturedNew!TodayYou will be responsible for analyzing complex or technically difficult workers compensationclaimsto determine the benefits owed. Additionally, you will handle high exposureclaimsinvolving litigation and rehabilitation, ensuring thatclaimsare...
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16 days agoTheClaimsSpecialist will play a critical role in ensuring qualityclaimfile management, service level agreements are met, and regulatory requirements are satisfied all while helping to create and provide an industry leading customerclaimsexperience.
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17 days agoYou will work closely with customer productclaimsto deliver efficient closure while providing an outstanding personal touch and WOW-level service. Your engagement with customers goes above and beyond to deliver an industry-leading customer experience.
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23 days agoAs a First Party PropertyClaimsAdjuster, you will review property damageclaiminformation from the Outside Adjuster, complete the investigation, and resolve theclaim. Minimum of 1 year of property or industry equivalent experience.
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New!6 days agoCreate reports to assess quality and efficiency within theclaims团队。开发和现在报告关键火蚁超人ce Indicators (KPIs). Leverage data to highlight areas needing improvement. Utilize data to prepare Cost/Benefit analysis for potential...
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30+ days agoResponsible for overseeing theClaimsaudit team within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC, DHCS, CMS and other accreditation or regulatory requirements including delegation...
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16 days agoBe responsible for ensuringclaimsare handled in accordance with established guidelines and service instructions. Ensures timely completion of file reviews, calibration sessions and analysis reports. Identifyclaim-handling trends by applying...
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30+ days agoResponsible for ensuringclaimsare handled in accordance with established guidelines and service instructions. Ensures timely completion of file reviews, calibration sessions and analysis reports. Identifyclaimhandling trends by applying industry...
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30+ days agoInvestigates and evaluates moderately complex auto and casualtyclaims. Documentsclaimactivities, reserve analysis, summaries of reports. Identifies, investigates, and pursues opportunities for recovery. Handles litigated files of low complexity.
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30+ days agoGathers facts by conducting interviews with all involved parties and considers all the elements of theclaimprior to issuing a decision. Decides the outcome ofclaimsusing sound judgment and applying established policy, procedures, regulations...
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26 days agoManages a personal caseload ofclaims, which may include litigation, to ensure the proper adjudication or settlement of thoseclaims, and they are handled according to Company policies and procedures, within the Company's contractual and legal liability.
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26 days agoReviews employee work quality and interactions with customers through conducting ride-alongs or sit-alongs and file reviews. Defines, analyzes, and tracks department, section, and/or unit measures. Analyzes unit reports and supports business unit goals.
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13 days agoEvaluate and analyze documentation forclaimpayments or denials according to the policy/certificate provisions and state regulations, with limited authority limits. Under direct supervision, analyze information/documentation received to determine...
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