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Ensures accurate reporting and meets regularly with finance to ensure compliance while closely monitoring claims information including emerging trends and large claims by alerting finance and appropriate HR Business partner.
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MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Strong knowledge of key laws and regulations impacting the pharmaceutical industry including the PhRMA Code; Federal Food, Drug, Cosmetic Act; Anti-Kickback Statute; False Claims Act, OIG/DOJ Guidance; Foreign Corrupt Practices Act; and federal and state transparency and disclosure laws.
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The Payment Policy and Reimbursement Analyst ensures claim payment integrity through the accurate application of industry pricing and coding by internal and external administration of claims editing and pricing of HNE claims as well as supporting the payment policy development and maintenance process.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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You will report to the Claims Manager – TPA Liability. Effective teamwork/collaboration skills in order to effectively collaborative with Regional Practice Leads, Claim Legal, TPA and clients to produce desired outcomes, as well as with other internal and external stakeholders such as, brokers, actuarial, reinsurance and business partners to communicate regarding claim results, experience and trends.
$182,000 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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We collaborate with others within the enterprise by providing legal advice to assist with drafting auto insurance policies, by explaining or by educating our internal business areas about auto insurance policies, and by reviewing auto claims-related legislation as well as appellate briefs in insurance coverage-related litigation.
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Get exposure to civil law, including legal assistance (estate planning, family law, tax matters); tort claims (represent interests of the U.S. in tort issues such as Federal Tort Claims Act/Military Claims Act); labor law (arbitration and equal opportunity); and contract law (legal review of multi-billion dollar contracts of military technologies and supplies.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Respond to workers’ compensation claims for the Boston and New York office, in consultation with Sr. HR Manager. Respond to workers’ compensation claims for the Boston and New York office, in consultation with Sr. HR Manager.
Full-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Ensure that the TPA manages the claims diligently, partners with Risk Management and Legal (internal and external), and employs best practices to control claim costs. You will lead strategy on complex bodily injury auto claims, handling pre-litigation disputes and resolving litigated claims with cross-functional partners.
$142,800 a yearFull-timeExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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There are 36 Career Returnee roles right now ranging from Underwriter or Senior Underwriter - Engineering & Construction, Business Analyst/Data Analyst, Investment Analyst Graduate, Treasury Officer, Claims Analyst, Compliance Specialist and more.
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Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Reviewer reports to the Casualty Department Manager.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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EQ offers a comprehensive product set, including transfer agency services, cap table management, equity compensation services, proxy solicitation and advisory services, private company solutions and bankruptcy claims administration services.
$150,000 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Independently advising and coordinating within OCC on legal issues related to disaster preparedness, response, recovery, and mitigation; flood insurance and floodplain management; procurement, contracts, grants, finance, and financial management; property, environmental and historic preservation; claims, freedom of information, privacy, ethics, training and education, and personnel matters and administrative procedures.
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OGC addresses myriad legal issues, including: compliance and risk management, litigation strategy, municipal finance and pension investment transactions and disclosures, agency audits, settlements of claims brought on behalf of and against the City, employee discipline, records access, public policy, and proposed federal, state, and local legislation.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Lead the ideation, development, and enhancement of product features aimed at automating customer service processes (e.g., claims triaging, AI chatbot, substitution evaluation, inventory management, risk-based claims approval & denial.
$200,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago
claims tpa jobs Company: Metroplus Health Plan in Newark, NJ
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