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W orkers Compensation Self-Insurance Program : Direct the administration of first-party workers' compensation claims, including reporting, investigation, analysis, litigation management, and resolution.
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In collaboration with the WCA, TPA, and Associate Administrator, helps create, implement, and drive initiatives to lower OSHA recordable injuries, WC claims, and associated WC costs. Works closely with the injured worker, WCA, TPA, Medical Providers, and any other assigned Case Managers to manage and settle or close claims.
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This role will partner with the Contracting team, CIN team and the Clinical teams on evaluating VBC shared savings/risk contracts, incentive programs and distribution, incentive funds flow, calculating and modeling projected financial risk performance (such as risk corridor scenarios, stoploss/reinsurance, feasibility, and scenario analyses.
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Position Overview: To manage complex and high-dollar reinsurance claims through various lines of coverage (Workers’ Compensation, Liability, Property etc.) · Perform timely and accurate processing of claims related to multiple lines of coverage (such as Property, Workers’ Compensation, Liability, Cyber, etc.
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Qualifications:Minimum of 1 year experience as a workers compensation claims adjuster. As a Work Comp Adjuster, you will be responsible for investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
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Strong knowledge of risk management, commercial property and casualty insurance, claims, health and safety, business continuity, real estate/property management, and environmental issues.
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Participates in the policy and procedure development, maintains internal and external relationships (wholesalers, Covered Entities, and third-party administrator [TPA] vendors) as needed, 340B rules/guidance surveillance, assist in 340B off site audits as necessary, contract management/implementation, reporting/analyzing, and program enhancement/ optimization projects including annual budgeting.
$65,000 - $95,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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At least 1 professional security management or risk management certification: Certified Information Systems Security Professional (CISSP), Certified Information Security Manager (CISM), Certified Informations Systems Auditor (CISA), Certified Risk & Information Systems Control (CRISC), Certified Information Privacy Professional (CIPP) or Open FAIR Certified.
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Work collaboratively with other members of the corporate legal teams, risk management and claims teams and partners. Deep insurance background (5+ years of insurance focus), either in claims, underwriting, or insurance product developmentLicensed to practice law in at least one jurisdiction; licensed or eligible to become licensed to practice law as in-house counsel in the State of Colorado or Commonwealth of Pennsylvania.
$143,000 - $169,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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RCIS offers a wide range of private product coverages, including a diverse selection of named-peril options, supplemental and stand-alone insurance products as well as federal crop insurance plans through the United States Department of Agriculture's Risk Management Agency.
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Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
$25.97 - $46.68 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Overview Gallagher Bassett is the premier provider of global claims, loss control, and risk management consulting services, dedicated to exceptional customer service and demonstrably superior outcomes.
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This position Director, Technology & Cyber Risk will play a high-impact role in enhancing the organizations cybersecurity and technology risk posture. The first-line CISO has operational responsibilities and reports to the CIO. The second-line Chief Tech Risk Officer (CTRO) and the Technology Risk Management (TRM) organization have broader responsibilities for cybersecurity but also reliability, software quality, resilience, and other technology risks.
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3+ years of experience in HEDIS record collection and risk adjustment (coding). Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
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You will assess the risk for various commercial insurance lines of business that can include Property, General Liability, Workers Compensation, Auto/Fleet, Products Liability, Inland Marine and Builders Risk. Tools or Items You Must Provide:·Windows-based PC with an image/document scanner·Digital camera·High speed internet access·Measuring device such as: laser, 100 ft.
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tpa compensation claims risk jobs Company: Deloitte
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