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Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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We aim to provide comprehensive insurance solutions, use enhanced data and technology to make more informed decisions and rely on a field-based underwriting, claims and loss control model to be closer to our customers and brokers.
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Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
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Prefers specific knowledge of claims processing and customer service systems (NASCO adjustment and pend processing, UPS, UCSW, Research Station, Cognos, and Image). Requires knowledge of health insurance operations (i.e. claims, enrollment, underwriting, etc.
$102,795 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
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Let us help you on your career path as a Licensed Claims Adjuster. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster.
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Responsibilities The primary purpose of the Inpatient Coding Data Quality Auditor/Educator is to ensure the consistent processing of claims and collection of data to optimize DRG reimbursement and produce quality data that accurately reflects the severity and intensity of hospital inpatient services.
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Claims under Gallagher Bassett Services. Building Professional Acumen - Learning about our Risk Management, Benefits, Wholesale and Claims businesses. Claims under Gallagher Bassett Services.
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Support Sr. Contract Administrator with change orders proposals, change orders, and claims Determine merit, evaluating and estimating level of effort for hours and costs, negotiating with the contractor and writing up Findings of Facts and Records of Negotiation.
$194,500 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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NET, C#, SQL Server, Oracle, Apache Spark, GitHub, AWS Cloud, Openshift, Team Foundation Server (TFS), Jenkins, UDeploy, Scaled Agile (SAFe) Framework, sprint planning, and experience in healthcare claims and benefits domains.
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Responsibilities: Experience with billing Part B claims, review and handle denials. Experience in New York Pharmacy billing claims. Must correctly resubmit claims to get them processed.
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Handling insurance claims and medical billing using appropriate coding systems (medical billers and coders). Operating equipment like X-rays, MRIs, or ultrasound machines (radiology technicians, sonographers.
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As a senior field claims adjuster on our Home & Property team, you'll manage the coverage and damage analysis of property claims. Handling claims from start to finish, you'll support customer needs while ensuring swift resolution.
$112,200 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers' compensation claims.
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Review hospital incident reports and refer potential liability claims to insurance carrier as appropriate. Provide Risk Management educational training to Hospital staff/employed/ independent practitioners as part of the Hospitals orientation process deemed appropriate for risk management Administration of tracking documentation addressing (i) subpoenas, (ii) medical malpractice and other litigation claims and (iii) lost and personal belongings, including reimbursement for such items.
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claims job Company: Metroplus Health Plan in Clifton, NJ
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