and classify member and provider appeals. Determine eligibility, benefits, and prior activity related to the claims, payment...
and classify member and provider appeals. Determine eligibility, benefits, and prior activity related to the claims, payment...
, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality... assigned severity claims. Provides quality customer service and ensures quality and timely coverage analysis and communication...
needed. Assist participating providers when issues require coordination of various Plan departments (Claims, Care Management, EDI...
and classify member and provider appeals. Determine eligibility, benefits, and prior activity related to the claims, payment...
requirements required Familiarity with health plan pricing, claims administration and benefit designs required Experience... in claims and EDI transactions (837, 835, etc.) required Additional experience/specialized training may be considered in lieu...
/risk share contract parameters. This includes analysis and interpretation of claims submission for superior coding accuracy...
enablement, and claims transformation. This role requires deep industry knowledge and strategic consulting skills to advise..., AI-driven claims automation, and predictive analytics for risk segmentation. Additionally, they will support regulatory advisory...
Management processing To Identify late appeal request and notify to Operations Unit Manager for claims disposition...
. Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator...
, and Paid Parental Leave. Manage STD, LTD, and Workers’ Compensation claims. Distribute wellness information to employees...
, and Paid Parental Leave. Manage STD, LTD, and Workers' Compensation claims. Distribute wellness information to employees...
.” Insurance companies purchase reinsurance from other carriers to protect against the risk of a major claims event. Guy Carpenter... and reinsurance specialist with more than 3,500 professionals in over 60 offices around the world. Guy Carpenter delivers a powerful...
guidelines. The work of DFS includes managing the ACS budget; submission of monthly claims for revenue; processing of payments... PASSport reports direct service contracts statuses and budgets for external stakeholders. Also act as budget support specialist...
others, Beazley’s underwriting control standards, Beazley’s claims control standards, other Beazley standards and customer... thinking Talent developer Conceptual thinking Who We Are: Beazley is a specialist insurance company with over 30 years...
titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder... data Experience rating data and claims material to price coverage Define, restrict, or qualify policy coverage Review...
(FCLA) Fraud Claim Law Specialist (FCLS) Certified Protection Professional (CPP) Associate in Claims (AIC) Chartered...Overview Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied...
(FCLA) Fraud Claim Law Specialist (FCLS) Certified Protection Professional (CPP) Associate in Claims (AIC) Chartered...Overview Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied...
compensation claims process. Supervises the clearance process for employees returning from medical leaves of absence. Minimum.... Certification in Occupational Health Nursing (COHN), Certified Occupational Health Nurse-Specialist (COHN-S), or similar credential...
with Patient Support Specialist (PSS) to identify and eliminate barriers to access for patients enrolled in GPS. Responds to HCP... claims. Takes lead in completing Business Reviews and Claims Reviews for practices. Provides education on specialty...