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Close coordination/contact with all VP Claims Leaders as it relates to ensuring proper staffing across. Strong Property Insurance claims background both personal and commercial lines. distribution capabilities, exceptional financial strength, underwriting excellence, superior claims.
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Consult on all pharmacy benefit programs to increase sales and revenue for Keenan core business (healthcare, schools, municipalities, commercial, TPA, COE), Keenan Pharmacy legacy Marketing Partners, Keenan Pharmacy acquisitions and AP offices across the country.
$100,000 - $125,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Ability to obtain Property Deeds / Corporate Business search about premises liability claims. Knowledge of No-Fault applications, filing of claims/procedures, deadlines. Ability to set up property damage claims.
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Under the direction of the Superintendent for the Department of Financial Services (DFS), the Executive Deputy Superintendent for the Consumer Protection and Financial Enforcement Division (CPFED) oversees the following Business Units: Enforcement, the Consumer Examination Unit, the Consumer Assistance Unit, the Holocaust Claims Processing Office, the Criminal Investigations Bureau, and the Frauds Bureau.
Starting at $162,868 - $201,711 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Assists in compliance reviews of internal and Third Party Administrator's ("TPA") claims processing policies and procedures. Minimum of 3 years related claims and/or auditing experience requiredExperience working in a TPA or HMO or managed care environment preferredKnowledge of Medicare and Medicaid claims requiredPrior training and knowledge of DRG, ICD9 and CPT4 requiredProficient PC skills, including Microsoft Windows requiredKnowledge of HIPAA guidelines required.
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Develop and foster relationships with reinsurance brokers and reinsurance markets to facilitate placements, execution of contract wording, timely claims payments and gain market intelligence. Work with Underwriting, Finance, Actuarial and Claims to gather data to assist in reinsurance submission preparation (data to be provided to a broker who will prepare submissions.
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This role reports to the SVP & Chief Legal Officer and works closely with the VP, Claims Counsel as well. The Senior Surety Claims Counsel is responsible for reviewing, investigating, resolving, and negotiating performance bond defaults, payment bond claims, subdivision, and commercial bond claims.
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Interfaces with the HRA/TDC on-site Professional Liability Investigators: reporting potential claims as well as cases of concern by preparation of preliminary reports, and determination of priority of investigation given risk management assessment.
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Works to ensure the company's compliance with pharmaceutical laws including the Anti-Kickback Statute, False Claims Act, PhRMA Code and FDA regulatory guidelines. The Associate Senior Counsel, Legal Operations - Commercial reports to the Assistant General Counsel, Legal Operations - Commercial and will be primarily responsible for providing counsel specific to the company's pharmaceutical regulatory needs, including sales and marketing, scientific exchange and other medical activities, monitoring, co-promotions, and FDA standards for a variety of pipeline and in-line assets.
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The RoleSenior Claims Specialists at Willis Towers Watson drive proactive adoption of risk mitigation strategies and positive outcomes for clients who experience losses. Advocate for timely, optimal resolution of claims, including escalation/negotiation with claim service providers on disputed claims.
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Try and/or arbitrate cases and prepares motions in liminie and summary documents Draft post-trial motions Prepare for and participate in appeals Provide legal opinions to claims clients Investigate and pursue subrogation litigation as appropriate Manages projects.
$82,000 - $146,125 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years. Overview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.
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Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (e.g., Facets, QNXT, etc.) Seven (7) years of medical claims investigation or data mining, 5 years in a leadership role.
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JD degree and 7+ years of legal practice including a minimum of 4 years focused on providing counsel to the pharmaceutical industry. Strong knowledge of FDA regulatory and fraud and abuse law. A global pharmaceutical company located in NorthNJ seeks an Associate Senior Counsel, Legal Operations - Commercial who will be responsible for providing counsel specific to the company's pharmaceutical regulatory needs.
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Deep background in medical billing, coding, or auditing of insurance claims and medical records. Clear documentation of inconsistencies with claims billed vs health plan payments. You will be responsible for reviewing and analyzing medical claims, patient medical records, and automatic claim audit results to help train our machines that will deliver automated audit results.
$60,000 - $70,000 a yearFull-timeExpandApply NowActive JobUpdated Today
claims tpa jobs Company: Metroplus Health Plan in Newark, NJ
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