Claims Specialist
Found in: Appcast US C2 - 2 weeks ago
- The Claims Specialist will be responsible for reviewing claims processed by the outside vendor, including resolving provider appeals/disputes. Performs root cause analysis for all provider projects to identify areas for provider education and/or system (re)configuration. Initiates and follows through with resolution of all pended claims, (re)pricing, returned or refund checks and the development of provider and facility compensation grids. Provides feedback or suggestions to enhance current processes or systems.
- Reviews and investigates claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations
- Compiles claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner
- Investigates suspense conditions to determine if the system or procedural changes would enhance claim workflow
- Communicates and follows up with a variety of internal and external sources, including but not limited to providers, members, attorneys, regulatory agencies, and other carriers on any claim related matters
- Analyzes patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions
Experience:
Eight or more years of insurance experience within a healthcare or managed care setting (preferred)
Claims adjudication experience
Knowledge of MLTC/ Medicaid/Medicaid benefit
Knowledge of Member (Subscriber) enrollment & billing
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Claims Specialist
2 weeks ago
New York, United States RSC Solutions Full time- The Claims Specialist will be responsible for reviewing claims processed by the outside vendor, including resolving provider appeals/disputes. Performs root cause analysis for all provider projects to identify areas for provider education and/or system (re)configuration. Initiates and follows through with resolution of all pended claims, (re)pricing,...
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Claims Specialist
2 weeks ago
New York, United States RSC Solutions Full time- The Claims Specialist will be responsible for reviewing claims processed by the outside vendor, including resolving provider appeals/disputes. Performs root cause analysis for all provider projects to identify areas for provider education and/or system (re)configuration. Initiates and follows through with resolution of all pended claims, (re)pricing,...
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Claims Specialist
Found in: Appcast Linkedin GBL C2 - 3 weeks ago
New York, United States Labaton Keller Sucharow LLP Full timeClaim Specialist Job DescriptionFLSA Status: Non-ExemptReports to: ADR Case Manager Summary: We are seeking a Claim Specialist with 1-2 years of experience. Comfortability with technology and platforms required. JOB RESPONSIBILITIESFormat documents and communications for clients;Liaise between third party vendor and Labaton Sucharow;Review documents...
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Claims Specialist
12 hours ago
New York, United States AXIS Capital Holdings Limited Full timeThis is your opportunity to join AXIS Capital a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders Claims Specialist, Claims, Specialist, General Liability, Insurance
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Claims Specialist
1 week ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a plaintiff law firm. This opportunity is full time and hybrid out of New York, NY.Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
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Claims Specialist
Found in: Appcast US C2 - 2 weeks ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a plaintiff law firm. This opportunity is full time and hybrid out of New York, NY.Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
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Claims Specialist
Found in: Appcast Linkedin GBL C2 - 2 weeks ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a plaintiff law firm. This opportunity is full time and hybrid out of New York, NY.Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
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Claims Specialist
Found in: Appcast Linkedin GBL C2 - 3 days ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a great plaintiff law firm. This opportunity is full time and hybrid out of New York, NY. Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
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Claims Specialist
Found in: Appcast US C2 - 3 days ago
New York, United States LHH Full timeLHH Recruitment Solutions is seeking a Claims Specialist for a great plaintiff law firm. This opportunity is full time and hybrid out of New York, NY. Hours: 9:30am - 5:30pm, overtime when necessaryResponsibilitiesFormat documents and communications for clients; review documents (release/document verification) for production to defense counsel for quality...
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Professional Lines Claims Specialist
2 weeks ago
New York, United States Insure National, LLC Full timeJob DescriptionJob DescriptionWe are actively looking to hire a Professional Lines Claims Specialist to join our team!If you have any of the following experience, apply today! Requirements: 5+ years casualty claims experience GL/AL claims experience required Bachelor's Degree Required Organizational and Communication skills required $90,000 +Hybrid...
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Settlement Claims Specialist
1 week ago
New York, United States Labaton Keller Sucharow Llp Full timeClaim Specialist Job Description FLSA Status: Non-Exempt Reports to: ADR Case Manager Summary: We are seeking a Claim Specialist with 1-2 years of experience. Comfortability with technology and platforms required. JOB RESPONSIBILITIES Format documents and communications for clients; Liaise between third party vendor and Labaton Sucharow; Review documents...
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Claims Adjudication Specialist
Found in: Talent US C2 - 2 weeks ago
New York, United States MetroPlusHealth Full timePosition 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...
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Claims Supervisor
10 hours ago
New York, United States NYC Health Hospitals Full timeMetroPlusHealth 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...
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Claims Supervisor
3 days ago
New York, United States MetroPlusHealth Full timeJob DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health +...
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Claims Supervisor
4 days ago
New York, United States MetroPlusHealth Full timeEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth provides the highest...
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Claims Specialist I
4 days ago
New York, United States Nationwide Full timeIf you’re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything...
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Claims Specialist Executive
2 days ago
New York, United States Hexaware Technologies Full timeRemote work opportunity in US Education: Mandatory: Has atleast completed 2 years College Degree Responsibilities: Complete Patient Registrations Process registration including confirming insurance and patient information Update patient information as necessary, document current health insurance information and review/update patient demographics Research...
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No-Fault Claims Assistant
4 days ago
New York, United States Abrams Fensterman Full timeJob DescriptionJob DescriptionSalary: $45k-$55kNo-Fault Data Entry Claims AssistantOur legal team is committed to providing each client with quality counsel, innovative solutions, and personalized service. Founded in 2000, the firm offers the legal expertise of its 115+ attorneys, who have accumulated experience and problem-solving skills over decades of...
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Temp - Sr. GL Claims Specialist (Construction & Construction Defect) | Remote
Found in: Talent US C2 - 8 hours ago
New York, United States The Jonus Group Full timeJob Description : Our client is seeking to add a Senior General Liability Claims Specialist that would have the ability to work remotely. This is a contract position. Responsibilities include moderate to complex Commercial General Liability Claimsthroughout the United States. Contractor would be required to investigateclaims via telephone, written...
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Claims Quality Analyst
3 days ago
New York, United States MetroPlusHealth Full timeJob DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health +...