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The Veterans Claims Examiner (VCE) for the Regional Processing Office (RPO) determines eligibility and entitlement for Veterans benefits under Veteran Readiness and Employment Program (VR&E - Chapter 31.
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A claims examiner must have the ability to interpret and apply laws, rules and regulations as well as evaluate claims from initial report to final determination. Health insurance claims processing experience and insurance regulation knowledge highly preferred.
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A Senior Associate is responsible for analyzing, processing, researching, adjusting and adjudicating claims which will result in a payment or nonpayment of a claim with minimal guidance from the medical team or leadership team.
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Process claims based on contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups’ and company policies and procedures.
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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.
$45.59 - $50.67 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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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5 years' experience processing long term disability claims. The Stable and Mature LTD Claim Examiner will manage an assigned caseload of Long Term Disability cases. Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact.
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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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2 years experience processing long term disability claims. The Claim Examiner II obtains and analyzes information to make claim decisions and payments on Long Term Disability "LTD" and Waiver of Premium "WOP" claims.
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Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) To learn more about the Claim Examiner II position, watch our exclusive employee video.
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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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Supervise claims examiner staff including scheduling and assigning work, reviewing performance, recommending salary increases, promotions or discharges. Strong working knowledge of claims processing standards, CMS claims processing requirements and various Medicare fee schedules.
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Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.
Full-timeExpandApply NowActive JobUpdated 26 days ago - UpvoteDownvoteShare Job
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3-5 years of experience as a claims examiner handling professional and facility claims. Understanding of claims processing rules, managed care benefits, and adjudication.
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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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claims processing examiner jobs
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