Claims Audit Specialist

**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 Medical Claims Recovery Specialist to join our team at MedPOINT Management. The successful candidate will research and identify complex overpayments on previously processed claims for multiple product lines, assist in DOFR implementation projects, and review claim refunds and capitation deductions from various...

Job OverviewProsum is seeking a highly skilled Insurance Billing and Claims Specialist to join our team. This role plays a crucial part in ensuring seamless billing processes, maintaining compliance with industry guidelines, and fostering exceptional relationships with clients.Key ResponsibilitiesReview and resolve claim edits in the billing scrubber for...

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,...

Key ResponsibilitiesThe Investigative Claims Specialist will be responsible for:Conducting thorough investigations into questionable insurance claims, including recorded statements and interviews of claimants, witnesses, and employers.Providing timely status updates to case managers and clients.Maintaining accurate and detailed documentation of claim...

We are seeking a Liability Claims Specialist to join our team at JBA International.Job DescriptionThe ideal candidate will have experience in negotiation / reduction of liens with medical providers and third-party payers upon resolution of injured party's claim. Additionally, they will be responsible for preparing client disbursement agreements, compiling...

Job OverviewElite Sourcing LLC is partnering with a leading law firm to seek a skilled Compensation Claims Specialist. This role involves representing clients in workers' compensation matters, providing expert legal counsel and support throughout the claims process.

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 SummaryA Healthcare Claims Specialist is needed at MedPOINT Management to resolve medical claims efficiently and accurately. The ideal candidate will have strong analytical and communication skills.About the Role:Review and adjust medical claims according to established guidelines and protocols.Work collaboratively with healthcare providers and insurance...

Key ResponsibilitiesThe ideal candidate will be responsible for adjudicating claims assigned by leadership, adhering to deadlines, analyzing claims based on contracts, and troubleshooting EZ CAP System configurations to identify potential issues.

Job OverviewAs a Liability Claim Specialist at JBA International, you will play a crucial role in the negotiation and settlement of medical liens. Your primary responsibility will be to reduce liens with medical providers and third-party payers upon resolution of injured parties' claims.The ideal candidate will have excellent negotiation skills, a strong...

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...

Role OverviewWe are seeking an experienced Claims Management Specialist to join our team at Ascendion. As a Claims Management Specialist, you will be responsible for managing all aspects of personal injury cases, from intake to resolution. This includes gathering and reviewing medical records, coordinating with medical providers and insurance adjusters, and...

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...

Job OverviewJBA International is seeking a skilled Claims Investigation Specialist to join our team.About the Position:Draft and respond to written and phone communication with insurance providersRequest and file medical recordsThe ideal candidate will have experience with personal injury claims and processes, as well as strong analytical skills.Salary 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 OverviewMedPOINT Management is a leading provider of IPA services. We're committed to delivering exceptional value to our Members and Providers through our dedicated teams and innovative solutions.In this role, you'll have the opportunity to work closely with our IPA department to ensure seamless communication and resolution of issues. Your expertise...

We are seeking an experienced Compensation Claims Specialist to oversee and negotiate bodily injury claims for Plaintiffs' side cases in the Mid-Wilshire area. As a key member of our team, you will be responsible for negotiating personal injury cases against insurance companies, supervising a team, and reviewing demand packages.Our ideal candidate will have...

About the Role:We are looking for a skilled Claims Analyst Specialist to join our team at MedPOINT Management. The successful candidate will possess expertise in healthcare financial recovery, medical claims analysis, and process improvement.Main Responsibilities:Review and analyze retro eligibility term reports to identify potential overpayments.Develop and...

We are seeking a skilled Dental Claims Specialist to join our team at the Dental Office in Los Angeles, CA. As a key member of our front office team, you will be responsible for managing patient accounts, collecting and posting payments from insurance companies, and monitoring dental claim reports.The ideal candidate will have experience with Dentrix...