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Coordinate with Compliance/Regulatory on DOH/DFS complaints and audit results, ensuring timely resolution. Collaborate with the Director of Payment Integrity to identify opportunities for financial recoveries and to ensure integrity of claims payments.
$170,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Working knowledge of claims processing, correspondence and CRM platforms and adjudication strategies Demonstrated Experience with claims testing/auditing/QA Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
$170,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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As a Team Leader, you will be responsible for product quality, and performance of the liability claims professionals on your team and supporting the VP Claims Manager. You may be responsible for maintaining a minor caseload, as determined to be appropriate by the VP Claims Manager.
$230,000ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Our forensic accounting experts apply their understanding of industry, accounting, finance, and economics to address complex issues that arise in dispute resolution in areas such as forensic and fraud investigations, commercial damages, bankruptcies, intellectual property, insurance claims, and business valuations.
$75,000 - $100,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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You’ll provide advice covering solvency, economic capital, risk management, mergers and acquisitions, company restructuring and risk control, financial modelling, underwriting, new legislation, and the efficiency of claims or reporting processes.
$40.75 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Extensive hands-on experience working with large datasets using tools like AWS SageMaker, Python, R, and SQL. Strong knowledge of various pharmaceutical data sources, including patient claims data from IQVIA/SHA, sales force activity data, physician prescription data, and real-world evidence data such as MarketScan and Optum claims.
$215,000 a yearFull-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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As a Workers' Compensation Defense Attorney, you will represent the Insurance Firm in various workers' compensation claims, developing effective strategies to minimize liabilities and protect their interests.
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The Customer Service Representative provides assistance to passengers and crew throughout the different stages of travel through our Jet Aviation FBOs. This position serves as the main point of contact for service requests, inquiries, suggestions, and complaints.
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In this role you’llOversee the execution of intricate projects within CLX, ensuring alignment with business goals and timely project completionBuild and maintain strong relationships with key stakeholders, including executive leaders and Product partners, to drive strategic initiatives for operational excellenceSupport comprehensive financial analysis and forecasting activities, contributing to the financial strategy of claims experience operations.
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JOB DESCRIPTION :Essential Duties & Responsibilities:Performs a combination of duties in accordance with departmental guidelines:Manages an inventory of the most complex and high exposure Lawyers Professional Liability Claims by following company protocols to manage and oversee all aspects of the claim handling, including coverage determinations, investigations, and resolution strategies which may include pursuit of risk transfer, extensive negotiations and complex litigation management.
Full-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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Leading clients through various processes, including making working capital improvements, bankruptcy preparation, liquidation analysis, credit agreement negotiations, and claims processing. Professional certifications such as Certified Turnaround Professional (CTP), Certified Insolvency and Restructuring Advisor (CIRA), Certified Public Accountant (CPA), or Chartered Financial Analyst (CFA) preferred.
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The Claims Examiner continually explores ways to apply claim’s best practices to business challenges. The Claims Examiner is responsible for. Auto claims handling experience. Timely and effectively investigate and evaluate claims while managing outside adjusters and legal counsel.
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Verify finished dietary supplements against label claims minimally on an annual basis or as requested by client (Material Conformance) Lead the COA qualification plan for identity testing, composition, strength, purity and contaminants such as heavy metals and pesticides for all ingredients used in dietary supplements (Material Conformance.
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4 years experience with Guidewire Cloud Claims migration. 4 years of experience working in one of the following sub service areas: Insurance Products, Underwriting, Claims, Billing & Payments, Policy Administration or Distribution.
$208,250 a yearFull-timeExpandApply NowActive JobUpdated Today
claims complaints jobs Company: Metroplus Health Plan in Rego Park, NY
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