The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare providers, health plans, billing companies, and members on inquiries related to claims, eligibility, and authorization. Education, Training and Experience Required: High School Diploma or equivalent, 1 ...
Confirms coverage of claims by reviewing policies and documents submitted in support of claims. This position will be responsible for the resolution of moderate to high complexity and moderate to high exposure claims which can be subject to disputes that must be resolved in mediation or litigation. ...
Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Works close...
Communicating with claimants, employers and various medical professionals through phone and e-mail to gather necessary claim information, managing the claim process from the initial request to the return to work. Collaborating with fellow case managers, nurse case managers, and consulting physicians...
Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or *** Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and compa...
Confirms coverage of claims by reviewing policies and documents submitted in support of claims. This position will be responsible for the investigation and resolution of lower to medium complexity and lower to medium exposure claims. These claims will consist of non-litigated and litigated matters. ...
Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company p...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies...
The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare providers, health plans, billing companies, and members on inquiries related to claims, eligibility, and authorization. Education, Training and Experience Required: High School Diploma or equivalent, 1 ...
The Property Claims Field Adjuster will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle minor to moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Compa...
The Claim Representative is accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards. Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and with...
Job Description The Claims Specialist is responsible for accuracy of claims submission, benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM and IFMG, claim follow-up, ...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
Investigates and maintains claims:Reviews and evaluates coverage and/or liability. Works toward the resolution of claims files, and attends arbitrations, mediations, depositions or trials as necessary. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handl...
The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and...
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determ...
Working under minimal supervision, the Member Experience Specialist – Claims contributes to Wawanesa’s goal of delivering an exceptional and consistent claims service experience by enhancing relationships with members through tracking and trending feedback utilizing various data sources. Works colla...
Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Zenith is a team of Workers’ Compensation Specialists com...
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determ...
The Claims Resolution Specialist will be the first line of contact for Health providers and will assist providers with questions related to the payment of claims and resolution of claims payment issues. Seeking a highly motivated an experienced - Claims Resolution Specialist (Customer Service) to jo...