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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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This position is for an Auto Estimator, handling claims resulting in property damage to vehicles. Claims Appraiser - Auto Estimatics. You may be the first point of contact to meet with our insureds, explain coverage, estimate vehicle damage, and help them through the claims process while providing Remarkable® service.
$68,787.06 - $99,038.28 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Jonus Group is seeking a skilled California Workers Compensation Claims Adjuster to join our TPA client's dynamic team. 3+ years of experience as a Workers Compensation Claims Adjuster handling California Indemnity claims.
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Collaborate with the Director of Payment Integrity to identify opportunities for financial recoveries and to ensure integrity of claims payments. Working knowledge of claims processing, correspondence and CRM platforms and adjudication strategies Demonstrated Experience with claims testing/auditing/QA.
$150,000 - $170,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution.
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Collaborating across disciplines and business units, including: the office of general counsel overseeing errors & omissions issues arising from claims handling, the Brandywine (run-off) team, the Bermuda claims team and in-house coverage counsel team.
$128,500 - $215,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Management Coordinator is responsible for all utilization management activities for assigned cases from admission through discharge, including peer reviews and appeals, in accordance with the Utilization Review Plan, for patient population ages 5 years through 21 years, with significant behavioral health needs and Autism Spectrum Disorders or other developmental disorders.
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Assist project teams with setup/utilization of BIM, Revit, Navisworks and 3D Modeling Software. Proficiency with at least one of the following: Revit Architecture, Revit Structure, Revit MEP or Civil 3D.
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Responsible for data and report generation of providers as well as regulatory agencies, as needed for Utilization Management activities. Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues.
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Assist clients with the completion and filing of victim compensation claims with the State Office of Victim Services. The Domestic Violence Victim Advocate is a part of the Crime Victims Assistance Bureau (CVAB) within the Special Victims Division, reporting directly to Adrianna Barona, immediate supervisor, under the overarching authority of the Chief of CVAB.
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QualificationsEstimating knowledge using CoreLogic and/or Xactimate is required, along with the ability to navigate within Corelogic suites and guidewire claims handling platforms. Collaborates and consults with our Inland Marine/Builders Risk Underwriting and Engineering partners to determine liability and identify risk conditions to drive continuous improvement toward claims handling and risk management excellence.
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Must have experience in: payment integrity, fraud detection, claims analysis. Performance Monitoring: measure the effectiveness of fraud detection algorithms and claims management solutions, and iterate on product improvements based on data-driven insights.
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Sponsorship not Offered for this Role Responsibilities As AVP, Claim Manager, you will be responsible for product quality, and performance of the liability claims professionals on your team and supporting the VP Claims Manager.
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claims utilization jobs Company: Metroplus Health Plan in Bronx, NY
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