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A SIU / Claims investigator must possess strong computer and internet skills, as well as strong verbal and written communication skills. The Special Investigations Unit (SIU/Claims) Field Investigator conducts recorded statements / interviews, accident scene investigations, online research, and witness canvassing.
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Candidates must have a terminal degree such as a MD, DO or equivalent, PhD, EdD. Demonstrated leadership experience in assessment and faculty development. Reporting to the Vice Dean for Medical Education and working in collaboration with other Associate and Assistant Deans, the Associate Dean for Assessment and Faculty Development will provide strategic direction for assessment and faculty development initiatives across the continuum, from UME to GME to CPD. The candidate will also have a commitment to diversity, equity, and inclusion in academic medicine.
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Additionally, the Liability Claims Supervisor directs the Claims Specialist and represents MTS in court on litigated claims. Negotiates settlements of bodily-injury and property-damage claims with claimants, attorneys and insurance carriers with approval and authority from Manager of Risk & Claims, General Counsel or the MTS Board of Directors.
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Work with BMS disability and worker’s compensation insurance providers in case managing occupational and non-occupational injuries and illnesses, and short- and long-term disability claims. Family care services such as adoption and surrogacy reimbursement, fertility/infertility benefits, support for traveling mothers, and child, elder and pet care resources.
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SKILLS: A SIU / Claims investigator must possess strong computer and internet skills, as well as strong verbal and written communication skills. Ethos is looking to hire a part time, experienced Insurance SIU / Claims Field Investigator in the San Diego, CA area.
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Reviews claims filed against MTS and MTS accident reports involving potential third‑party liability and adjusts third‑party liability claims in an efficient and cost‑effective manner. Possess an associate's or bachelor's degree from an accredited university in risk management or related field, with at least five years of recent and extensive public agency liability claims administration experience with accident investigation or loss control.
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The primary focus of UC San Diego's workers' compensation claims case management program is to design, develop and implement loss control initiatives. This position is independently responsible for the administration and management of more than 500 (of approximately 1000 total claims) incident reports, claims case management for more than 225 (of approximately 475 total open claims) workers' compensation claims and the proper identification and administration of CAL-OSHA recordable and reportable injuries for the UC San Diego campus.
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Responsibilities include; facilitation of transitional return to work assignments for injured employees, and case management of workers' compensation claims. The primary focus of the Incident Reporting Program is tri-fold: 1) ensure accurate and timely reporting of workers' compensation claims per Title 8, California Code of Regulations, Subdivision 14001, 2) ensure accurate and timely recording and reporting of CAL-OSHA injury claims per CAL-OSHA regulations, and 3) assist in the operation of loss prevention initiatives by identifying, trending and analyzing work-related injuries and illnesses.
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Study Design and Implementation: Design real-world evidence studies protocols, develop statistical analysis plans, and conduct statistical analyses of medical payer claims data. The qualified candidate will be able to successfully support and manage health economic analyses (e.g., cost effectiveness and budget impact models), conduct retrospective analyses of payer claims data, create health economic value tools and dashboards, synthesize existing evidence, and support international health technology assessments (HTAs) and health care reimbursement submissions.
$91,400 - $152,300 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The Auditor will analyze and assess Sharp’s potential risks using SHC’s billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc.
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This ideal candidate should be able to work with Mitchell product management, engineers and data scientist in a consultative and collaborative way to build machine learning services and products that enable claims automation.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses' analysis. Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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Key responsibilities will include claims payment and remittance, network management, provider credentialing, data exchange and reporting and quality oversight. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
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If so, we are looking for a Full or Part-time Materials Engineer/Materials Scientist with broad design and manufacturing expertise to join our national Materials Science practice group to provide investigation, analysis, reports, and testimony where technical and scientific answers are needed to help resolve civil and criminal litigation and insurance claims.
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Job Responsibilities· Provide counsel and litigation strategies for clients in both transportation matters (including catastrophic loss, personal injury, cargo claims, products liability, and research and advice regarding regulatory compliance) and commercial litigation matters (including contract-related claims, real estate disputes, landlord/tenant issues, breach of fiduciary duty claims, fraud and misrepresentation claims, unjust enrichment claims, partnership disputes.
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edd claims jobs in San Diego, CA
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