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Under general supervision, with latitude for independent initiative and judgment, the analyst will assist in a broad range of analytical, administrative and research support tasks for the Customer Claims unit.
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As a Claim Account Manager – US Mid-Market for the Americas Claims team, you will be responsible for claim account management functions for customers in our growing US Mid-Market business unit, helping to sell AXA XL Claims value in the marketplace and managing claims-related service issues for our customers, Third Party Administrator (“TPA”) and key distribution partners.
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Analyze healthcare data, including claims data, electronic health records/ electronic medical records (EHR/EMR), registries, and physician/patient surveys, to assess treatment effectiveness, cost-effectiveness, and patient outcomes.
$140,000 - $160,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collaborates with Claims, Operations, IT, Vendor Management, Vendor Compliance and the Vendor Delegation Oversight Sub-committee to ensure regulatory requirements are met by delegates and FDRs.
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Experienced in several of the following domains: biomedical informatics, outcomes and health services research, clinical trials, clinical decision support, population health and claims analytics, quality metrics and reporting, data security, privacy and regulatory compliance, and data governance.
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Participating in indirect tax projects, including sales and use tax refund claims. Participating in indirect tax projects, including sales and use tax refund claims. ACT Consulting has an immediate need for a State and Local Transaction Tax Accountant located in New York, NY with our direct client.
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Partner with and collaborate across functions on analytics and strategic initiatives, including, but not limited to, Underwriting, Actuarial, Reinsurance, Claims, and Operations. Experience with and exposure to various operational disciplines (underwriting, claims, IT, etc.
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With 98% of cyber insurance claims in the past five years coming from small and mid-size businesses with revenue under $2B, providing an integrated solution to help manage risk is more critical than ever.
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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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Qualifications Estimating 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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Demonstrated knowledge of SAP/OPUS, claims, supply chains, Customs & Border Patrol (CBP) and compliance/FMC/PGA s. · Evaluate and process insurance claims if required. Demonstrated knowledge of SAP/OPUS, claims, supply chains, Customs & Border Patrol (CBP) and compliance/FMC/PGA s.
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EDI Software Developer (BizTalk)
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Conduct a thorough investigation of all claims and retain outside surveyors, adjusters, experts, defense counsel, coverage counsel, as needed, based on the severity of the claim, and the facts presented.
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Reviews and analyzes Physician/Allied Health/GME applications for initial appointment and reappointment and credentialing documents including clinical education/training, board certification and eligibility, licensure, accreditation, work history, liability insurance and malpractice claims history.
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Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts.
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claims adjudication jobs Company: Metroplus Health Plan in Queens, NY
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