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Preferred experience may include insurance loss control, underwriting or claims; commercial building construction, compliance or other property inspections; fire safety and industrial safety occupations.
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Trains and validates process execution related to inventory movement functions to include TIME, claims, omni channel fulfillment and inventory adjustments. Effectively network with retail and government resources to identify, investigate, and address organized retail crime activities inclusive to case resolution and prosecution.
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Randstad in partnership with The Hanover Insurance Group is actively seeking Claims Service Representatives to join their Claims Customer Service Center on a temp to perm basis, remotely within the CST, MST, or PST time zones.
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Detection, investigation, and documentation of Organized Retail Crime, and other violations of law and/or company policy. Conducts MES sweeps, Fitting Room checks and safety certifications as the needs of the business dictate.
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Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims. Bachelors degree or 4 years WC claims experience. Knowledge of medical terminology involved in complex claims.
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Ensure accuracy of all insurance claims, including but not limited to third party insurance, private insurance companies, Medicare, or Medicaid. Comply with State and Federal drug laws as regulated by the State Board of Pharmacy, HIPAA, the Drug Enforcement Agency and the Food and Drug Administration.
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Familiarity/expertise in pharmaceutical data sets, such as prescriber-plan data, patient-level data, transactional claims, EMR/EHR data, SPP Hub data, diagnostic data, etc., is a big plus. Relevant experience on tools such as MS Excel, R, SQL, Python, Tableau, and PowerBI.
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The Reimbursement Specialist is charged with coordinating the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. The Reimbursement Specialist is responsible for prioritizing and managing to resolution denied claims with government and third party payers.
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As our Assistant Risk Manager, you'll have direct ownership of responsibilities related to managing the company's insurance database, insurance policy, incidents/claims, safety, loss control, and other general responsibilities.
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Industry Knowledge : Prior experience in physical damage claims, total loss claims handling, or salvage operations preferred. Pilgrim Insurance is looking for a driven Administrative Claims Specialist to play a pivotal role in our claims team, coordinating the processing of automobile titles, and providing technical support to our claims organization.
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As a Claim Analyst IV, you will be responsible for handling all aspects of multi-line, financial lines claims from inceptio Analyst, Claims Analyst, Team Manager, Financial, Technology, Benefits.
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To enhance program Utilize Insurance Broker resources to provide 3rd party audits with development of action plans for improvement based on audit results Utilize TPA audit findings to develop process improvement strategies and action plans Support business development team in modeling insurance and claims projections for bidding opportunities and participate in RFP efforts Additional Statements Drug and alcohol screening: Employment contingent upon passing pre-employment drug and alcohol screen.
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What you'll do: Under general supervision, is responsible for a variety of office/clerical tasks relating to claims processing; contacts patients and responsible parties to resolve past-due accounts; investigates account status and initiates collection.
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Expertise with health plan claims and benefits administration software. Expertise with health plan claims and benefits administration software. Strong Medicaid/Medicare knowledge (NY State Medicaid specifically would be a huge advantage for this opening.
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Learn and access the electronic MassHealth system to research information necessary to respond to questions related to MassHealth eligibility, third party insurance, prior approval, and claims.
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claims job in Tewksbury, MA
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