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Receives general supervision from the Workers' Compensation Manager and functional supervision from a Senior Claims Examiner. DISTINGUISHING CHARACTERISTICS: Differs from Workers' Compensation Clerk in that Claims Examiner performs journey-level Workers' Compensation claims adjustment work while Workers' Compensation Clerk performs specialized clerical duties in support of the District Workers' Compensation program.
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The Senior Claims Examiner will work on special projects related to provider and plan documents, system upgrades, implementing initiatives to improve claims processing, and turnaround times.
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As an Auto Claims Examiner, you will be responsible for accurately assessing and processing auto insurance claims. As they continue to expand our operations, we are seeking an experienced and detail-oriented Claims Examiner with expertise in assessing auto damage to join our team.
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Keywords:Tucson AZ Jobs, Bilingual Claims Examiner, English, Spanish, ICD10, CPT, HCPCS, HIPAA Regulations, In-Patient Coding, In-Patient Billing, Electronic Health Records, EHR, Excel, Data Entry, Claims Processing, Medical, Healthcare, Arizona Recruiters, Information Technology Jobs, IT Jobs, Arizona Recruiting.
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Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.
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NaphCare, Inc. has an excellent opportunity for a Sr. Claims Adjudicator (Claims Examiner Tier II, Claims Analyst Tier II) to join our team at the Corporate Headquarters in Birmingham, Alabama.
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The Sr. Claims Adjudicator will be responsible for reviewing medical claims for accuracy and completeness, analyzing complex CCI and CMS edits, making determinations on claims based on established policies and procedures and processing claims for payment.
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Review, edits and determine the validity of unclaimed property claims. Experience processing unclaimed property requests. Research and generate claims based on written correspondence and telephone inquiries.
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Assures claim processing and payment procedures for death, cancer, ordinary/industrial accident and health and total and permanent disability claims according to company procedures and meets the appropriate state regulations.
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The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
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This Senior Claims Examiner is responsible for reviewing, processing, investigating, evaluating, negotiating and the settling of assigned property damage or bodily injury claims with the authority level generally up to $100,000.00.
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This may include derivatives, alternative investments securities lending and tactical asset allocations, IT processes, claims processing, reinsurance, and Electronic Data Processing (EDP) access and application controls.
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The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCF1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
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Knowledge of compliance issues as they relate to claims processing. Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment.
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Job Description Responsibilities Job Summary: The Claims Examiner is detail-oriented and will be responsible for reviewing and adjudicating health insurance claims for all products and all lines of business, including but limited to Medicare, Self-Funded, Fully Insured, ensuring accuracy compliance with policies and regulations and timely settlements.
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