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Utilizes clinical expertise, and reviews insurance appeals, prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.
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DOMAIN experience in Healthcare, Hospital, Insurance / Claims, EHR, Clinical Systems Management, Utilization Management systems preferred. If you are a passionate and qualified Technical Product Owner with experience in the health insurance, health provider, or IT industry, please read on.
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Independent Insurance Claims Adjusters Needed Now! Let us help you on your career path as a Licensed Claims Adjuster. At MileHigh Adjusters Houston, our focus is assisting you on your journey to become a Successful Licensed Claims Adjuster.
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WHAT WE ARE SEEKING We have assignments available to help our insurance carrier or Third-Party Administrator (TPA) clients in Property & Casualty (P&C) Commercial Claims Adjuster or Examiner positions.
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Preferred Soarian Financials Experience General Application functionality Reports and Cubes OMS DSS Scheduler UI Builder CRDT BRDT HEP Preferred Technical Skills JavaScript Java SOA concepts (understanding of the use of and implementing web services) TIBCO Constructs (Business Works and Events) SQL/SQL Server (Stored Procedures) XML HL7 Standards X12 (HIPAA EDI) Standards ChristianaCare Offers: Full Medical, Dental, Vision, Life Insurance, etc.
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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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1+ year of experience with Claims Escalation or Insurance Follow Up (Blue Cross Blue Shield/BCBS Commercial Payers experience preferred) The Claims Escalation Specialist (Medical Insurance Follow Up) will perform the daily collections and management of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments.
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We are seeking a Private Investigator in the Merced area who is licensed in California to perform surveillance work on worker's compensation, auto liability, general liability, and long and short-term disability claims.
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Youll serve on the front lines of insurance sales, helping new customers navigate our products, processing claims and inquiries, and developing an ever-growing lead list to secure new business.
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Powered by a passionate team of mental health advocates and healthcare veterans, we welcome private practices to tap into large scale referral, administrative and community support , so that counselors can enjoy the freedom of choosing when, where and who to work with , without the hassle of mundane admin tasks like credentialing, billing and insurance claims.
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Commercial Insurance Account Executive - Limited Remote within New England - Must have Applied EPIC + Massachusetts accounts experience. Apply problem solving techniques to various issues including cancellations, claims, renewal issues, audits, receivables, carrier issues.
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5 plus years of Employer Stop Loss, Managed Care Risk-Based Underwriting or related work experience in health insurance or related industry. We help them overcome obstacleswith a team providing underwriting, risk-management, claims, and stop-loss expertisebacked by strong financials and all supported by exceptional, personalized service.
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Crop insurance experience in claims or compliance or any ag-related experience and background. ProAg has an exciting opportunity for a Crop Insurance Adjuster to join our team. Continuously expand your knowledge of RMA rules and regulations and ProAg procedures for applying all MPCI, Crop Hail, and Federal Crop Insurance regulations.
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Management and execution of a variety of customer service and value-added service requests/inquiries including but not limited to: account activity; policy administration and insurance placement; billing activity; claims administration; coverage/loss analysis; contract review for insurability; review policy forms and endorsements; review audits; identify errors and facilitate corrective actions; Certificates of Insurance; Evidences of Property; and Cancellation/Reinstatements.
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You will work closely with brokers, insurance carriers, and colleagues located throughout the globe to support Fortives global insurance placements, captive insurance strategies, loss mitigation, contractual risk transfer and claims management processes.
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insurance claims jobs in Watertown, SD
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