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Job ResponsibilitiesConfirms coverage of claims by reviewing policies and documents submitted in support of claimsDirects and monitors assignments to experts and outside counsel, ensures effective vendor and litigation management on moderate to high complexity claims including demonstrable savingsAnalyzes coverage and communicates coverage positionsPrepare coverage position letters on matters typically in litigation without assistance of outside coverage counsel.
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Actively engages 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, and fire or fraud investigators, and other experts.
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Ensure Proof of Claims, Motions for Relief, Payment Change Notices, Post Petition Fees and Costs are prepared by counsel, are accurate and all aspects of the bankruptcy are handled according to investor guidelines and timeframes.
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Claims Examiner’s conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes. This role is responsible for the analysis and management of complex workers’ compensation claims.
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Second, the individual will provide advice and counsel on the legal risks and requirements associated with branded prescription pharmaceutical products including the Anti-Kickback Statute, the False Claims Act, the Food, Drug and Cosmetic Act, FDA advertising & promotional regulations, OIG Guidance, the PhRMA Code and the Sunshine Act.
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As a Field Auto Adjuster, you will play a crucial role in our Auto claims handling process by writing estimates directly at customer homes, repair shops, or tow yards. We’ve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection.
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Perform an audit for Medicare claims prior to billing with AICD (automated implantable cardioverter defibrillator)/Pacemakers to ensure Medicare billing criteria is supported. Perform other detailed audits for claims as needed to identify cosmetic and organ transplant codes and charges that need to be separated from other ancillary charges.
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The Claims team is currently seeking an experienced Auto Adjuster to join in their Worcester MA - Richmond, VA - Itasca, IL or Howell, MI office location. Be responsible for some to all aspects of each claim, including informal hearings, arbitrations and small claims litigation and maintaining a high level of productivity, confidentiality, and customer service.
$50,000 - $60,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Ability to drive scientific excellence, understand key technologies, build models, and communicate effectively within R&D.5+ years in FMCG or Consumer HealthcareExperience in Consumer Science/Products Research (qualitative & quantitative research, consumer modelling, upstream/front end consumer need definition AND downstream/product validation and claims substantiation)Excellent analytical skills, including strategic thinking.
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The Medicaid Billing Specialist is responsible for the accurate and timely editing, preparation, submission of electronically and manually processed claims to third party payers in accordance with policies and procedures.
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This position requires the Claims Manager to be in the office located in Richmond, VA full time (this is not a remote position). Preferred skills include: familiarity with ICD-10 codes; medical terminology certification; dental claims processing experience; and knowledge of Basys (system vendor.
$140,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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ESIS , a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.
$99,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Basic understanding of 1st and 3rd party fraud (claims to charge-off timing, chargeback recovery rights, etc.) Partner with claims, policy, strategy, and product teams to deliver data insights and analysis that inform critical decisions and help achieve goals.
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Partner with various departments across the Markel organization, including Legal & Compliance (US and International), Global Security Services, IT, Finance, Claims, Workplace Resources, Audit, and Privacy and Compliance.
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Qualified candidates ideally have prior experience handling fire, water, smoke, and natural disaster claims in the restoration/mitigation industry. Benefits: Pay is up to $24 per hour, based off experience and any IICRC certificationsPaid vacation timeSix paid holidays: New Year's Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day and Christmas DayCompany vehicle provided to lead technicians during work hoursEligible for health, dental, and vision insurance after 30 daysPossibility for overtime hoursResponsibilities:Professionally represent the company’s mission, vision, and values.
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claims job in Richmond, VA
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