Claims Compliance Remediation Claims Analyst

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...

Job DescriptionJob DescriptionKey Responsibilities:Personally investigate and/or supervise outsourced investigations of CGL insurance claims and lawsuits, both bodily injury and property damage, arising out of construction projects in the greater New York City metropolitan area within New York State. Obtain necessary information from every possible source,...

We are looking for experienced adjusters to handle daily claims for our carriers in Nebraska. A Daily Claims Adjuster determines and communicates the extent of loss or damage associated with commercial/residential claims, assisting the insurer in fulfilling its obligation to policyholders and helping to safeguard the insurer’s reputation and...

Job DescriptionJob DescriptionOur client, an insurance provider, is searching for a  Director of Claims Quality. This is a permanent role where employees are required onsite 2 days per week. The full job description is as follows: Location: NYC (2 days per week onsite)Job Type: permanent About the role:The Director of Claims Quality has responsibility for...

CHUBB NORTH AMERICA CLAIMS - QUALITY ASSURANCE & COMPLIANCE LEAD KEY OBJECTIVE This individual is responsible for the North America (NA) Claims Quality Assurance and Claims Compliance function. The individual will lead a team of Quality Assurance and Compliance professionals and will manage and implement effective Quality Assurance and Compliance programs....

CHUBB NORTH AMERICA CLAIMS - QUALITY ASSURANCE & COMPLIANCE LEAD KEY OBJECTIVE This individual is responsible for the North America (NA) Claims Quality Assurance and Claims Compliance function. The individual will lead a team of Quality Assurance and Compliance professionals and will manage and implement effective Quality Assurance and Compliance programs....

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned...

A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight...

TITLE- Guidewire Claim Center Business Analyst Hybrid schedule - Purchase, NY; New York, NY; Florham Park, NJ; Conshohocken, PA; Charlotte, NC contract ROLE SUMMARY Business Analyst for Guidewire ClaimCenter Application to support project and other initiatives. The Business Analyst will be responsible for creating business and functional requirements...

RLI is hiring a Claim Director to focus on complex Casualty and New York Labor Law claims.  Main duties will include: -Handle New York Casualty GL and excess large loss claims proactively to achieve optimum payout results by resolving claims fairly, expeditiously and economically. -Assess coverage issues on claims and issue appropriate coverage...

Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. - Resolve complex, severe exposure claims, using high service oriented file handling. - Pay and process claims within designated authority level. - Examine claims investigated by insurance adjusters, further investigating questionable...

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...

Review and adjust medical claims, process provider refunds, handle customer inquiries, and ensure compliance with company practices. Requires 2+ years of medical claim processing experience and strong communication and organizational skills.

Do you have experience as a medical claims examiner and looking for the next step in your career? Are you looking to work for a company that makes a difference in your community? APEX Placement and Consulting has partnered with a local company in Ossining, NY looking to add an experienced Senior Claims Examiner to their already amazing team! This person...

Job DescriptionJob DescriptionJob Description:A property and casualty client is seeking a Head of Casualty Claims Operations. This professional is responsible for managing and optimizing the performance of all casualty claims units. This leader will drive the execution of strategies that align with corporate objectives and ensure efficient and effective...

Position Overview This position is responsible for the data entry and system adjudication of provider claims including but not limited to professional, ancillary and facility claims. The position is responsible for the end-to-end processing of claims. Job Description Process claims involving medical and/or surgical services; screens for complete...

Department: Claim Advocacy & ConsultingJob SummaryResponsible for providing high level support, including technical knowledge to the claim consulting team in the daily advocacy and consulting service to the commercial insurance lines division’s customers. Provide prompt and courteous service to customers, team members and insurance companies regarding...

Department: Claim Advocacy & ConsultingJob SummaryResponsible for providing high level support, including technical knowledge to the claim consulting team in the daily advocacy and consulting service to the commercial insurance lines division’s customers. Provide prompt and courteous service to customers, team members and insurance companies regarding...

Our client is seeking to add a temporary Workers Compensation adjuster to their team. The ideal candidate will have experience handling lost time claims in the New York jurisdiction, from inception to close.Required Qualifications:3+ years handling Lost Time Workers Compensation claimsExperience handling claims in LitigationActive NY Adjusters...

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...