Review, process and identify medical claims based on standard operating procedures on CPS. Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates). Review and apply member benefit plans and provider contracts, Pricing,

Provide legal advice to UnitedHealthcare Payment Integrity regarding payment strategy and policy development Provide legal advice to Special Investigations Unit regarding fraud, waste, and abuse and related issues Advise on the implementation of federal and/or state legal/regulatory requirements impacting the health care industry (particularly in the topics specified abov

The claims auditor will be responsible for coordinating and completing audits as well as compiling and reporting results and trends accurately, appropriately, and timely. ESSENTIAL FUNCTIONS Logging/Tracking all Claims/Tasks to be audited Audit for accuracy as well as workflow compliance; Release of appropriate claims using established workflows Assist with all audit prog

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. This

The Government & Third Party Liability Appeal Lead/Trainer provides leadership and oversight to the Revenue Cycle employees to ensure an overall high level of quality, efficiency, and productivity, while affirming all departmental goals are satisfactorily met. Maintains a physically, mentally, and environmentally safe work environment for all employees. Provides a positiv

The Claims Advocate plays an essential role in mitigating BBSI's risk related to workers' compensation claims. This role requires exceptional business and customer service acumen and significant experience in workers' compensation claims, including claims handling. This role will coordinate the essential duties related to the claims advocacy program. Duties and related is

Clinical Investigator starting approx. July 2023 UCSF Division of General Internal Medicine at San Francisco General Hospital The Department of Medicine at the University of California San Francisco (UCSF) is recruiting for a Clinical Investigator (MD/DO or PhD/DrPH/ScD trained) to join the faculty as an Assistant, Associate, or Full Professor in the Division of General I

Investigate all non standard claim problems (25%) Investigates for COB and determine the primary payer (25%) Investigate and process adjustment requests (25%) Adjust claim payments resulting from duplicate payments, incorrect payee, etc. Recover expended funds for managed care plans System documentation of investigation results Training of Coordination of Benefits claim p

Title Claims Customer Service Advocate II Location Columbia, SC, 29229 Duration 6 months assignment Shift Mon Fri 8 4 30p Note Training 6 weeks onsite. No option for Remote. Top 2 4 PREFERRED/NICE TO HAVE skill sets/qualities Medical background, office experience, customer service, previous call center experience Please provide a few sentences describing what a typical da

The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Inspiring healthier lives through Water Your Way. At Primo Water, we are committed to empowering associates to live our shared values and provide opportunities for our associates to grow and celebrate being part of a winning team. Our comprehensive benefits package empowers you to maximize your money, live a healthy life, and grow personally and professionally. We call it

The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Claims Clerk Job Locations US OH Columbus Requisition ID 2024 17767 # of Openings 1 Category (Portal Searching) Administrative/Clerical Position Type (Portal Searching) Regular Full Time Overview The Claims Clerk will review insurance claims forms and documents for accuracy and completion and obtain missing information as necessary. Determines claims coverage by examining

Claims Adjuster II Job Locations US AZ Scottsdale Requisition ID 2024 16659 Category Claims Workers Compensation Position Type Regular Full Time Overview AmTrust has an immediate need for a Workers' Compensation Claims Adjuster II. Responsible for the prompt and efficient examination, investigation and settlement or declination of insurance claims through effective resear

Senior Claims Examiner Workers Compensation Requisition ID 2024 24861 Job Locations US LA New Orleans Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on