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Claims Examiner WC - NJ & MD Jurisdictions. Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. To analyze workers compensation 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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Contract role for Claims Examiner –Remote f or our client. Claims Examiner –Remote- Garden City, NY. Confer with legal counsel on claims requiring litigation. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
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Claims processing experience required. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
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Claims Examiner –Remote- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
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To review all estimates and supporting documentation submitted by contractors/adjusters, using Xactimate, Symbility, and other estimating applications; to ensure estimates follow client and regulatory requirements and meet Sedgwick Repair Solutions’ guidelines while replacing a field adjuster if needed, and to serve as a subject matter expert on property restoration scope.
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We have Contract role for Claims Examiner –Remote f or our client Garden City, NY. Please let me know if you or any of your friends would be interested in this position. Resolve complex, severe exposure claims, using high service oriented file handling.
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The Senior Claims Examiner will play a pivotal role in managing and adjudicating complex insurance claims, ensuring accuracy, efficiency, and adherence to company policies and regulatory guidelines.
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Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. Pay and process claims within designated authority level.
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To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Bhakti Lakhote at email address. Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Bhakti Lakhote at email address.
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Proficiency in analytical, document management, and database query software. Adjuster license in New York State is Required. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
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Designation as a Certified Fraud Examiner. Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data. Duties Description The Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) seeks forensic accountant/auditors (FAA) for its Civil Enforcement Division in Pearl River (Rockland County) or New York City. FAAs support the Unit by working in partnership with its attorneys, detectives, data analysts, nurses, and legal support analysts to conduct complex, long-term healthcare fraud investigations.
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Must be in EST or CST Time Zone. Contact or interview claimants, doctors, medical specialists, or employers to get additional information. Location: Garden City, NY (Remote) General knowledge of state and national laws and regulations.
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The Opportunity As a dedicated injury examiner, you will adjust complex bodily injury claims and UIM claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations.
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Workers Compensation Claims Adjuster | Orange, CA. Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. Education & Licensing: 4 years of claims management experience or equivalent combination of education and experience required.
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Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor.
Starting at $40,851.44 - $88,511.46 a year depends on education, experienceFull-timeRemoteExpandApply NowActive JobUpdated Today
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