Claims Reimbursement Specialist
4 days ago
We are seeking a highly skilled Claims Reimbursement Specialist to join our team at TEKsystems. As a Claims Reimbursement Specialist, you will be responsible for systematically analyzing and auditing claims for overpayments and applying billing rules to determine the appropriate party to refund.
Key Responsibilities- Analyze and audit claims for overpayments and apply billing rules to determine the appropriate party to refund.
- Research and analyze the status of insurance refunds and communicate professionally with insurance companies regarding the status of requests, paid/pending claims, and the rebilling of unpaid claims.
- Determine and submit appropriate documentation for refund approvals and follow guidelines as outlined in FPBO policies and procedures or instructions provided.
- Ensure that registration data is accurate and updated, utilizing all available data resources as determined by FPBO and transfer any claims that require charge corrections to the assigned party.
- Provide on-line documentation per account and perform proactive follow-up using Tickler List.
- Through careful research and interpretation, determine the financial responsibility of refund balance.
- Work rejected refund requests on a daily basis.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Ability to work in a fast-paced environment and meet deadlines.
- Knowledge of healthcare reimbursement and billing rules.
- Experience with claims processing and reimbursement systems.
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Reimbursement Specialist
7 days ago
San Bernardino, California, United States TEKsystems Full timeJob DescriptionKey Responsibilities:• Perform weekly work queue assignments to ensure timely and accurate processing of financial claims.• Systematically analyze and audit financial data to identify overpayments and apply billing rules to determine the appropriate party for refunds.• Research and resolve misapplied, undistributed, and incentive...
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Workers Compensation Claims Adjuster
5 days ago
San Bernardino, California, United States Amtec Enterprise Full timeJob Title: Workers Compensation Claims AdjusterJob Summary:Amtec Enterprise is seeking a highly skilled Workers Compensation Claims Adjuster to join our team. As a Workers Compensation Claims Adjuster, you will be responsible for processing a wide variety of worker's compensation claims, including complex or sensitive cases.Key Responsibilities:Claims...
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Compensation Claims Specialist
6 days ago
San Bernardino, California, United States Staffmark Group Full timeJob SummaryWe are seeking a highly skilled Workers' Compensation Claims Adjuster to join our team at Staffmark Group. As a key member of our risk management team, you will be responsible for reviewing and processing workers' compensation claims, ensuring compliance with industry regulations and company policies.Key ResponsibilitiesClaims Review and...
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Insurance Claims Specialist
1 week ago
San Diego, California, United States CorVel Corporation Full timePosition Overview: The Auto/PD Liability Claims Specialist plays a crucial role in overseeing both intricate and straightforward Auto and General Liability claims. This position operates within designated authority limits to achieve optimal results for CorVel Corporation and its clientele. Core Responsibilities:Evaluate and assess claims to verify policy...
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Claims Management Specialist
1 week ago
San Diego, California, United States CorVel Corporation Full timePosition Overview: The Auto/PD Liability Claims Specialist plays a crucial role in overseeing both intricate and straightforward Auto and General Liability claims. This position operates within designated authority to secure optimal results for CorVel Corporation and its clientele. Key Responsibilities:Evaluate and process claims, ensuring policy coverage is...
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Healthcare Claims Evaluator
2 weeks ago
San Francisco, California, United States San Francisco Health Plan Full timeJoin Our Team as a Claims Processing SpecialistMake a positive impact in the community with San Francisco Health Plan. We are currently looking for a dedicated Claims Processing Specialist to join our team.Role Overview:The Claims Processing Specialist plays a crucial role in the management of claims processing, adjudication, and investigative tasks. This...
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Claims Management Specialist
1 week ago
San Diego, California, United States Intercare Insurance Full timeJob OverviewPosition Summary: The Claims Management Specialist plays a crucial role in overseeing and resolving a portfolio of workers' compensation claims. This position reports directly to the Claims Supervisor and is responsible for managing complex cases while adhering to company policies and regulatory requirements.Key Responsibilities:Conduct thorough...
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Property Field Inspection Claims Specialist
1 week ago
San Mateo, California, United States State Farm Mutual Automobile Insurance Company Full timeJob SummaryWe are seeking a highly skilled Property Field Inspection Claims Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...
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Senior Claims Examination Specialist
2 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type: Full-TimeSalary Range: $65,220.24 USD to $109,989.53 USDLocation: Remote options available for qualified candidates.The Senior Claims Examination Specialist is responsible for managing a portfolio of moderate to complex claims, ensuring exceptional service delivery to...
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Claims Processing Specialist
2 weeks ago
San Diego, California, United States American Specialty Health Incorporated Full timeCompany OverviewAmerican Specialty Health Incorporated is on the lookout for a dedicated Claims Examiner to operate within a dynamic production environment. This role is pivotal in ensuring the precise examination, entry, and adjudication of claims, adhering to regulations, ASH standards, and the contractual commitments of the organization. The Claims...
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Healthcare Collections Specialist
1 week ago
San Bernardino, California, United States Hire Writing, LLC Full timeJob OverviewThe Healthcare Collections Specialist plays a crucial role in the effective management of outstanding payments from patients, insurance providers, and other financial entities. This position requires collaboration with the billing department to ensure all claims are diligently pursued, payments are secured, and any billing or payment-related...
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San Diego, California, United States Sedgwick Full timeAbout the RoleWe are seeking a highly skilled and experienced Claims Adjuster Workers Compensation Specialist to join our team at Sedgwick. As a key member of our team, you will be responsible for analyzing and managing workers compensation claims to ensure accurate and timely benefits are provided to our clients.Key ResponsibilitiesAnalyze and manage...
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Senior Claims Examination Specialist
2 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type: Full-TimeSalary Range: $65,220.24 USD to $109,989.53 USDLocation: Remote/Hybrid options available for qualified candidates.The Senior Claims Examination Specialist is responsible for managing a diverse portfolio of claims, ensuring exceptional service delivery to...
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Claims Processing Specialist in Medical Billing
2 weeks ago
San Ramon, California, United States California Dermatology Care Full timeJob OverviewA leading full-service dermatology practice is seeking a skilled candidate for the role of Claims Processing Specialist focused on insurance claims management and payment posting. The ideal candidate will possess a dynamic personality, integrity, a quick learning ability, and strong multitasking skills. Interested applicants should provide a...
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Senior Claims Evaluation Specialist
2 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type: Full-TimeSalary Range: $65,220.24 USD to $109,989.53 USDLocation: Remote/Hybrid options available for qualified candidates.The Senior Claims Evaluation Specialist is responsible for managing a diverse portfolio of claims, focusing on delivering exceptional service to...
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Senior Claims Assessment Specialist
2 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type : Full-TimeSalary Range : $65,220.24 USD to $109,989.53 USDLocation : Remote or Hybrid options availableAt ICW Group, we are committed to fostering an inclusive environment where innovative minds can thrive. We seek individuals who are eager to adapt, grow, and...
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Senior Claims Management Specialist
2 weeks ago
San Diego, California, United States ICW Group Full timeAre you seeking a role that offers more than just employment? At ICW Group, we value innovative individuals who adapt, grow, and deliver exceptional results. We foster a dynamic work environment that encourages creativity and collaboration, aiming to provide the best insurance experience possible. ICW Group, headquartered in San Diego with various regional...
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Senior Claims Examination Specialist
1 week ago
San Diego, California, United States ICW Group Full timeAre you seeking a fulfilling career where your contributions are valued? At ICW Group, we prioritize innovation and adaptability in our workforce. We foster a dynamic work environment that encourages creativity and collaboration to deliver exceptional solutions. Our mission is to provide an unparalleled insurance experience. ICW Group, headquartered in San...
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Healthcare Accounts Receivable Specialist
2 weeks ago
San Bernardino, California, United States TEKsystems Full timeJob OverviewPosition Summary:The Healthcare Accounts Receivable Specialist is responsible for managing the collection of outstanding accounts and billing across various insurance providers and entities. This role involves thorough analysis and auditing of accounts to ensure accurate balances, appropriate follow-up, and full reimbursement.Key...
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Claims Support Specialist
6 days ago
San Diego, California, United States Mitchell Full time**Job Summary**We are seeking a highly skilled and customer-focused individual to join our team as a Customer Service Support 1 at Mitchell. As a key member of our organization, you will be responsible for providing exceptional customer service and support to our clients.**Key Responsibilities:**Provide claims support, including status updates, documenting...