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Contributes to Risk Adjustment Data Validation (RADV) audit coding review, including analysis of claims data to ensure chart acquisition is complete and documentation is comprehensive; applies CMS coding guidelines to validate audited condition(s); assists with review and ranking of charts for submission.
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Maintenance of credentialing and provider data management systems, including the Counsel of Affordable Quality Healthcare (CAQH), Credentialing Systems, SPayer, Symplr and proprietary claims system and Power BI Tool.
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If you are interested in the exciting, high paying and rewarding career of an Independent Claims Adjuster, apply now; and we will send you an immediate email with more details. Our focus is to assist you by training you for Success as a Licensed Independent Claims Adjuster.
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The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.
$56,860 - $91,580 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders.
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Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accidental and weather-related claims for homeowners, commercial properties, and large losses.
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Job Summary – The Network Reimbursement Analyst creates claims and reimbursement related analytics for fee-for-service and value-based contracting as well as oversees inpatient, outpatient and professional rates changes annually.
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Our Legal department is looking for a Staff Attorney to provide legal research and provide legal advice on legal related issues and matters that may involve Investments, Agency, Claims, Policy Service, Underwriting, general Corporate matters, and all other areas of the Company as needed.
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Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.
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Proficient knowledge of billing and medical claims processing. Responsibilities Reviews, processes, and reconciles specialized or complex insurance claims. To generate specialized reports on insurance claims and resolves problem/issues within the reports.
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Previous experience in adjusting workers' compensation claims is essential. Assess and monitor subrogation claims for resolution. Provide notices of qualifying claims to excess/reinsurance carriers.
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Processes insurance claims, follow-ups and payments daily and maintains insurance log. As a Consumer Loan Specialist, you will be a key team member in the branch. Philanthropic support for charities such as Juvenile Diabetes Research Foundation and the American Cancer Society.
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Desired: 4 years of college or equivalent courses; Experience as Operations Coordinator, Lead or Supervisor; Experience in managing a vehicle warranty claims program; ASE Certified; Experience and knowledge of DOT regulations.
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Maintains the Sales Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and identifying shrink and damages.
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Duties may include but are not limited to core revenue cycle functions such as, billing, claims filing, data entry, charge entry, insurance follow up, denial management, payment posting, customer service, registration, scheduling, prior authorization, and billing records review.
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claims job in Jackson, MS
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