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Claims Examiner - Workers Compensation. 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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Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
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Manages the litigation process; ensures timely and cost effective claims resolution. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
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Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
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Ensures claim files are properly documented and claims coding is correct. Five (5) years of claims management experience or equivalent combination of education and experience required. Negotiates settlement of claims within designated authority.
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CERTIFICATIONS/LICENSES : One or more of the following preferred: Active license in good standing to practice law in one or more jurisdictions; Certified Fraud Examiner (ACFE); Certified Insurance Fraud Investigator (CIFI); Chartered Property Casualty Underwriter (CPCU); Self-Insurance Certification (Claims/SIP.
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The AVP, Sr. Claims Examiner handles all aspects of claims notices and files related to professional liability and accompanying coverages, including but not limited to claims and coverage analysis, liability and damages analysis, reserve setting, reporting, reinsurance analysis and reporting, and travel.
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Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions.
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Coordinates vendor referrals for additional investigation and/or litigation management. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
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Claims Examiner - Liability. 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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Certified Financial Crimes Specialist (CF) Certified Fraud Examiner (CFE) preferred. 10+ years of Back Office (REG E claims, Return Item Processing, Check Adjustments, ACH Exceptions and Cash Vault and Research, etc.
$85,000 - $115,000 a yearFull-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Registered Nurse (RN), Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), or Accredited Health Care Fraud Investigator (AHFI) preferred. Experience with relevant technology, such as background check systems, claims processing platforms, data mining and fraud detection software.
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Develop and maintain collaborative and liaison relationships with Blue Cross Blue Shield Association (BCBSA), Blue Cross Blue Shield (BCBS) Plans, HHS OIG, other carriers' anti-fraud professionals, law enforcement, and regulatory agencies.
$65,500 - $106,100 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The auto liability claims department is looking for an experienced Claims Examiner to handle moderate complexity auto claims within our organization. Evaluate, negotiate, and settle assigned property damage or bodily injury claims within authority granted, or seek authority for those claims in excess of authority.
$70,000 - $100,000 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Accredited Healthcare Fraud Investigator (AHFI), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI), Certified Financial Crimes Investigator (CFCI), Certified Fraud Examiner (CFE), and Certified in Healthcare Compliance (CHC) Certifications.
$73,100 - $166,000 a yearFull-timeExpandApply NowActive JobUpdated 19 days ago
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