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Coordinate casualty claims (Work Comp, GL, Auto, Inn Keepers liability insurance, Garage Keepers liability insurance) processing including maintenance of all files, monitoring, auditing, and overseeing third-party administrative claims, reviewing, and approving reserve and reserve changes within their authority, pursue quick and efficient file closures and overall services to ensure that all claims are administered according to company policy and carrier requirements.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses' analysis. Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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As directed, the Analyst/Sr. Analyst will perform a number of insurance and risk management activities that support the various business lines within PPL which include: insurance program renewals for property and casualty lines, captive insurance management, claims, contract reviews for a wide variety of risks, management of the surety bonding program, certificates of insurance processing, and involvement in any project that requires corporate insurance assistance.
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Troubleshoot existing and/or potential problems in the claims processing process and contract management modeling system recommending changes as appropriate. Ensures timely and accurate processing of adjustments and denials from payers.
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5 years of work experience in pricing or financial analysis using large data sets and complex SQL queries, including 3 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare, and/or related field.
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Act as subject matter expert for benefit plan and claims processing. Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Act as subject matter expert for benefit plan and claims processing.
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Strong analytical skills, knowledge of health plan operations including medical management, enrollment, claims, EDI transaction processing, knowledge of Medicare and Medicaid plans, financial reconciliation and IT/ Data systems knowledge.
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With HealthRules Payer, our integrated solutions suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration capabilities, a unique to industry configuration and promotion application, and home and host processing support available on both public and private clouds.
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Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs.
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Tagged as: business technology, claims processing, commercial auto, data, Executive, insurance operations, management, operations, policy administration, premium collectino, private passenger auto, product management, project management, underwriting.
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Provide strategic goals for insurance operations including business technology, policy administration, claims processing, premium collection, and reconciliation of data. Assist staff, board companies, consumers and producers with complex automobile insurance regulatory requirements, coverage issues, claims, underwriting and residual market issues.
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Benefit and Claims configuration experience (benefits, supplier contracts, claims processing rules). Understanding of healthcare benefits and how they impact claims adjudication.
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This role also requires knowledge of health plan operations including Medicare and Medicaid plans, claims processing, EDI transaction processing, enrollment, financial reconciliation, and IT systems knowledge.
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Good to have knowledge on Guidewire Policy and Claims databases. Must have knowledge on the data mapping, basic data cleaning and processing tasks to ensure data quality and data accuracy.
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Your primary responsibilities will include processing orders, communicating with internal salespeople and representative agencies, and handling warranty claims. Your primary responsibilities will include processing orders, communicating with internal salespeople and representative agencies, and handling warranty claims.
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claims processing jobs in Lincoln, RI
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