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As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complex/large medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.
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Availability for conversation with client Medical Directors, assisting in auditing cases where necessary, and reviewing areas of dispute in more complex cases. The successful candidate will have multiple state licenses, past Medical Director experience, understand Workers’ Compensation laws throughout the US, and know various state Workers’ Compensation treatment guidelines.
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Research and answer complex questions regarding CPT, ICD-9, HCPC and other codes, fee schedules, PPO applications, and other technical matters. Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areas.
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The Florida Trial Attorney provides effective legal representation, either personally or by retaining and supervising outside counsel that handles moderately complex litigation involving either the corporation and/or it’s insured within established corporate guidelines and the applicable code of professional responsibility.
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Our client is expanding their presence in Arizona and seeking to add a Senior Workers Compensation Claims Specialist to their team. Handle moderate to complex workers compensation claims with minimal supervision and guidance from the manager.
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About the position The Project Director/Construction Executive is responsible to provide overall strategies, leadership, and management of multiple, less complex regional or national projects from start to finish, including staffing, managing project budget, scheduling, quality control, problem resolution, job coordination and communication, job invoicing/payments and client satisfaction activities.
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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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Claims Examiner - Workers Compensation. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Coordinates vendor referrals for additional investigation and/or litigation management.
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Manage sales planning for self and for team to drive sales, and achieve designated goals, client experience and financial results. Prioritize client needs and introduce services of other Fifth Third Bank employees, i.e. loans, estate planning, deposits.
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Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
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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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PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
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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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NOTE : Credit security clearance, confirmed via a background credit check, is required for this position. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
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