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Processes or adjust medical insurance claims in accordance with policies and procedures. Lead Medical Claims Specialist. Knowledge of medical insurance practices including enrollment, payment terms related to insurance premiums and out of pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort.
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QualificationsAdvanced knowledge of Commercial Casualty insurance, claims investigation, coverage evaluation, loss assessment, reserving, insurance legal & regulatory environment, claims processes, applications/systems and procedures, medical terminology, and finance.
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Travel to satellite offices based on need and perform reminder calls, insurance verification, and batch reconciliation. Practice a culture of safety to reduce or prevent risk of injury, claims, loss or liability by utilizing the Risk Management and Infection Control Plan.
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We are committed to rewarding individual and team efforts through our total rewards philosophy which includes competitive pay plus incentive compensation, a company-sponsored pension plan, 401(k) savings plan with matching employer contribution, a choice of medical, prescription drug, dental, vision, and life insurance programs, as well as skills development training with tuition reimbursement.
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Facilitating completion of outage management system (OMS) follow-up requests, inspection and maintenance repairs, streetlight installation and replacement, claims, Transmission priority repairs, aerial patrol findings, and Job & Contracting (J&C) projects.
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Follows up on outstanding payments due on all types of open medical insurance claims, i.e., managed care and commercial. Responds to requests from internal departments regarding the proper coding, billing, and processing of medical insurance claims.
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High School diploma and at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience.
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The individual is responsible for conducting a comprehensive review of the insurance denial and working with the Clinical Denials Nurses and Coding Denials Specialists to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely manner.
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We're looking for a dedicated medical claims coordinator to join our team and play a vital role in ensuring seamless coordination of care for injured workers. Are you passionate about providing support and assistance to individuals navigating workers' compensation claims.
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Along with some Specialty Claims (sexual abuse, molestation, human trafficking, etc. Achieves goals for a top-tier customer experience, employee engagement, loss cost accuracy and reserving, and consistent, quality claims handling practices.
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Offering a competitive, guaranteed salary, productivity and non-productivity incentives as well as a comprehensive benefits package that includes a group claims made malpractice insurance policy with no tail, paid vacation, sick pay, CME reimbursement, medical, dental, life, vision and disability insurance, retirement plan, health care and dependent care spending accounts, child care discounts, tuition reimbursement, free fitness center membership and an employee assistance program.
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BenefitsWe have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more.
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This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate, and following up on all denials to ensure reprocessing and payment in a timely manner.
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Evaluates claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Identifies wage loss expenses and wage exposures on medical claims.
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Description Liberty Mutual has an immediate opening for a Complex Claims Unit Manager role, to support our Commercial Casualty Excess Coverage and Specialized Claims Unit. In this role, you will manage the Casualty Environmental Claims team, which handles Primary and Excess Casualty environmental matters (including PFAS, and other emerging risks, etc.
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medical insurance claims jobs
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