Medical Claims Review Specialist

Overview: We are seeking a highly organized and detail-oriented Claims Specialist to join our team. As a Claims Specialist, you will be responsible for processing and managing insurance claims, ensuring accuracy and compliance with relevant regulations and policies. This is a vital role in our organization, as you will play a key part in facilitating the...

POSITION TITLE Claims Review Coordinator REPORTS TO Assistant Manager, Claims & Appeals JOB SUMMARY The Claims Review Coordinator is responsible for the investigation, documentation and resolution of denied claims in compliance with State/Federal law, rules, and guidelines. The Claims Review Coordinator will perform research and utilize extensive claims...

Responsible for comprehensive review, analysis, negotiation, and recommendations for resolution of design and construction claims. - Also responsible for developing and implementing claims avoidance strategies and claims mitigation measures. - Responsible for managing a team of claims specialists. Pay: $237,714.20 - $282,285.71 per year Work setting: -...

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Senior Claims Specialist - Claims Processing Mission Hills , California ReqID: 261029 Job Category: Claims Schedule: Full time Work Location: Facey Sepulveda Annex-Mission Hills Shift: Day Description The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate...

Required: Ability to operate PC-based software programs or automated database management systems. Strong communication skills with excellent analytical and problem solving skills. Ability to self-manage in a fast-paced, detail-oriented environment. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to...

**Description** The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and...

Description Responsible for processing medical claims. Resolves complex, difficult or non-routine claims requiring special handling in accordance with established policy guidelines. Reviews and authorizes payment and final disposition of claims requiring adjustment and claims benefit determination for reinsurance qualification. Handles complex, difficult or...

Job DescriptionJob DescriptionThe Senior EDI Claims Specialist is responsible for overseeing the retrieval, processing, validation, and posting of electronic claim data files into MPM’s core system, EZ-CAP®. Serving as a subject matter expert, the Senior EDI Claims Specialist will support the EDI Claims Team through training, monitoring of workflows,...

Job Description This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine hospital and professional audits, complex audits on individual or...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Required Skills & Experience Extensive knowledge of medical terminology, ICD9, ICD10, and CPT codes. Extensive knowledge of Plan benefits, group insurance, and Medicare principals. Knowledge of Coordination of Benefits rules. Considerable knowledge of basic math. Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

The Senior Claims Specialist will work in a collaborative environment to investigate and settle claims promptly and equitably while building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams. In this role you will have the opportunity to use creative thinking to overcome obstacles...

Job DescriptionJob Description Summary:Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with...

Large Loss Claims Specialist - ConstructionLos Angeles, CA, Atlanta, GA, Dallas, TX, Exton, PA, Chicago, IL, NYC, NY or Hartford, CTAt AXA XL, we deliver on our claims promise by having the best systems, the best people and the best partnerships in place. That's where our Construction Defect Claims team comes in. Construction Defect claims can be very...

ESIS, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk management needs. With 70 years of experience, and offerings in both the U.S....

Job DescriptionJob DescriptionPosition Title – Claims Adjuster - Workers CompensationAddress – Remote CA Pay -- $51.43/HRStart date – ASAPHours – 8a-5p Contract Type – contract to possible hireVaccine Requirement – covid vax required Required Skills & Education: •    5+ years of claims management experience specifically in workers...

Overview of the Role: The Claims Auditor is responsible for reviewing claims processed by examiners based on provider and health plan contractual agreements and claims processing guidelines. Follows all internal processes and procedures to ensure claims audit activities are handled in accordance with departmental and company policies and procedures....