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Interface and coordinate activities between QIC project directors/medical directors and adjudication team, client and project end user (i.e. health plans or health plan enrollees). Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
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A successful Senior Analyst will ensure a high level of quality and accuracy through benefit configuration, test execution and validation efforts while serving as a subject matter expert on benefits and claim adjudication system coding setup.
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PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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Builds strong, trusting team relationships within the Operations Department and across the organization, System Support, Development Support, DBA/SQL, Client Services and Quality Assurance to maintain client satisfaction.
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To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
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Ensures appropriate levels of service and operational support to assigned clients by understanding and championing clients' operating requirements throughout the organization, including client business model, targeted markets, benefit design objectives, pharmacy network composition, overall claims adjudication expectations, reimbursement methodologies, metrics, and reporting tools.
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Interface and coordinate activities between QIC project directors/medical directors and adjudication team, client and project end user (i.e. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
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PRIMARY PURPOSE : To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
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Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution.
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PRIMARY PURPOSE OF THE ROLE: To analyze high-level General Liability claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
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Communicate on complex or sensitive issues or draft such responses for supervisor or team lead. Create and maintain standardized decision letter language consistent with CMS guidance for all QIC projects.
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To analyze Workers Compensation Claims claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
$95,000 - $102,000 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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PRIMARY PURPOSE : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims within the teams including frequent diaries on complex or high exposure claims.
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PRIMARY PURPOSE OF THE ROLE: To analyze complex, high-level Auto & General Liability (BI & PD) claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
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