Claims Auditing and Adjudication Professional

Job OverviewMaintain regulatory and contractual standards by assisting Claims Operations in various functions. Participate in claims auditing, adjudication, adjusting, investigation/analyzing and other special projects as needed.Key responsibilities include adjudicating assigned claims, adhering to deadlines, analyzing claims based on contracts, and...

Job DescriptionAs a Claims Operations Generalist at MedPOINT Management, you will play a critical role in ensuring compliance with regulatory and contractual standards. You will assist in various functions, including claims auditing, adjudication, adjusting, investigation/analyzing, and other special projects as needed.Main Duties and ResponsibilitiesAssist...

Job TitleClaims Operations GeneralistAbout the RoleWe are seeking a highly skilled Claims Operations Generalist to join our team at MedPOINT Management. As a Claims Operations Generalist, you will be responsible for assisting in various functions to maintain compliance with regulatory and contractual standards.Key ResponsibilitiesAssist in claims auditing,...

About the Role:We are seeking a skilled Claims Audit Specialist to join our team at MedPOINT Management. As a key member of our recovery services team, you will be responsible for reviewing and disputing capitation deductions received from various health plans. Your expertise will also be required to analyze retro eligibility term reports, identify...

About UsL.A. Care Health Plan is a mission-driven, not-for-profit health insurer that serves the most vulnerable members of Los Angeles County.Job SummaryWe are seeking a highly skilled and detail-oriented Claims Data Entry Specialist II to join our team.Estimated Salary: $58,000 - $80,000 per yearThe Claims Data Entry Specialist II will be responsible for...

Job OverviewArgo Group is a leader in specialty insurance with a culture that values respect, equality, wellness, and opportunity. We're an innovative organization that's agile and impactful in our industry.Our collaborative workplace is designed to ensure all employees feel comfortable bringing their whole selves to work, confident in respectful treatment,...

Job DescriptionThe Claims Data Entry Clerk II is responsible for the timely and accurate data entry of claims and other documents. This includes keying claims for all lines of business, including complex claims, and data entry of claims in the Core adjudication system. The ideal candidate should have a strong understanding of administrative processes and a...

About the JobWe are seeking a highly skilled and detail-oriented Claims Data Entry Specialist II to join our team at L.A. Care Health Plan.Estimated Salary: $52,000 - $70,000 per yearThe Claims Data Entry Specialist II will be responsible for accurately and efficiently entering claims data into our Core adjudication system.Job DescriptionEnter claims data...

Job OverviewArgo Group is a leading underwriter of specialty insurance products in the property and casualty market. We are committed to delivering collaborative solutions for niche markets, working with independent agents, wholesale brokers, and retail brokerage partners.We are seeking a highly capable Workers' Compensation Claims Adjuster to join our team....

About the RoleWe are seeking a highly skilled Workers' Compensation Claims Examiner to join our team at Argo Group. In this role, you will be responsible for adjudicating workers' compensation claims with technical complexity.Company OverviewArgo Group is a leading specialty insurance company that offers a range of innovative products and services. We pride...

Job Description:Key Responsibilities:Review and adjust medical claims to ensure accuracy and compliance with regulatory requirements.Research and resolve issues related to claims processing.Collaborate with internal teams to facilitate efficient claim resolution.Maintain accurate records and reports to track claim status and performance metrics.Stay...

Job Description:L.A. Care Health Plan is seeking a highly organized and detail-oriented Data Entry Clerk to join our team. As a Claims Data Entry Clerk, you will be responsible for accurately and efficiently entering claims data into our Core adjudication system.About the Role:Enter claims data into the Core adjudication system with high accuracy and...

About This OpportunityWe are seeking a Medical Claims Review Expert to join our team at MedPOINT Management. As a Risk Claims Adjuster Specialist, you will be responsible for reviewing and adjusting hospital risk claims in accordance with regulatory guidelines.Responsibilities:Review and adjudicate web portal inquiries.Assist Providers and other Departments...

Consultative Search Group seeks a Financial Audit Professional to join their team in the dynamic music industry.Job SummaryWe are looking for an experienced audit professional with expertise in royalty compliance procedures to perform thorough audits of record labels and publishers on behalf of our diverse client base. The ideal candidate will have a strong...

**Job Overview:**Sedgwick Claims Management Services is seeking a detail-oriented Insurance Claims Analyst Trainee to join our team. In this role, you will work closely with experienced claims professionals to analyze workers compensation, general liability, or disability claims.As an Insurance Claims Analyst Trainee at Sedgwick, you will have the...

**Job Description:**Sedgwick Claims Management Services is seeking a highly skilled General Liability and Disability Claims Specialist to join our team. In this role, you will work closely with our claims professionals to analyze general liability and disability claims.As a General Liability and Disability Claims Specialist, you will apply your knowledge of...

Job OverviewWe are seeking a skilled Risk Management Professional to join our team at MedPOINT Management.This role is responsible for ensuring the accuracy and efficiency of claims processing, in accordance with regulatory requirements and company policies.The ideal candidate will have experience working with automated claims adjudication systems and...

Job Title: Medical Claims AuditorAbout the Role:This position is responsible for reviewing claims paid in Shared and Dual Risk Pools, monitoring and maintaining files audited, submitting disputes to outside entities, and ensuring accuracy and integrity of Hospital claims paid by MPM.Key Responsibilities:• Review, track, and analyze Risk Pool Summaries•...

Job Description:The Hospital Claim Reviewer plays a critical role in ensuring the accuracy and integrity of Hospital claims paid by MPM. This position involves reviewing claims paid in Shared and Dual Risk Pools, monitoring and maintaining files audited, submitting disputes to outside entities, and collaborating with cross-functional teams to resolve issues...

Join Our TeamWe are seeking a highly motivated Claims Management Professional to join our team at Regal Medical Group in Southern California. In this role, you will be responsible for managing the entire claims process, from initial receipt to final resolution. This includes researching and resolving complex claims issues, as well as presenting learning...