12 claims examiner jobs found

Pay rate: $20.00 to $38.50/hr. Description: Remote all across US. CA experience is mandatory. Working hours will be PST in case candidate is non local to CA. PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims;...

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely* from anywhere...

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely* from anywhere...

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely* from anywhere...

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely* from anywhere...

Medical Billing - PenPay - New Flight Research Remote / Work-From-Home Starting Pay: $17.00 Job Summary Payor Discovery New Flight Research Representative is responsible for management of assigned accounts that may fall anywhere in the revenue cycle of the claim. Successful candidates will possess a strong customer service background with an emphasis on telephone communications and will be a compassionate and professional voice for the company. Essential Functions/Duties Examines the patient record and/or researches all avenues in order to gather information Supports process improvements to assure quality and timely documentation Follows billing process, makes necessary contacts to assure maximum reimbursement Works closely with all billing and support service groups Performs all other duties as assigned Maintain a working knowledge of industry standards Ability to utilize critical thinking skills to locate/identify insurance and validate coverage...

**Employment Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE = Work Remote Position** **=** **(Pay Range: $34.0638-$51.0961)** Responsible for reviewing all post-billed denials (inclusive of clinical denials) for medical necessity and appealing them based upon clinical expertise and clinical judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves as part of a team of clinical payment resolution colleagues at an assigned PBS location responsible for identifying and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers, in addition to promoting departmental awareness of clinical best practices. The position will report directly to the Supervisor Clinical / Coding Payment Resolution. **ESSENTIAL...

Overview: This position ensures the legal, operational, and risk management compliance of the Bank at a high level of complexity and ability. Facilitates the security and integrity of Bank activities through the expert identification of risks, inefficiencies, and compliance issues. Provides guidance to business leaders and associate teams through knowledge of new and existing laws that impact enterprise activities. Leads the review of business processes, procedures, and activities for risks and inefficiencies. Assists internal and external audits. Develops and implements new, compliant policies as appropriate. Serves as a liaison between corporate, legal, and division teams to identify and resolve complex issues. Assists management with special projects and initiatives that foster an understanding of and compliance with applicable regulations, rules, and standards. May provide leadership to less experienced associates in the work group. Responsibilities: Compliance...

Overview: This position ensures the legal, operational, and risk management compliance of the Bank. Maintains an expert knowledge of new and existing laws that impact enterprise activities in order to recommend necessary changes. Reviews business processes, procedures, and activities for risks and inefficiencies. Assists internal and external audits. Develops and implements new, compliant policies as appropriate. Serves as a liaison between corporate, legal, and division teams to identify and resolve complex issues. Facilitates the security and integrity of Bank activities by ensuring compliance with all applicable rules, regulations, and standards. Responsibilities: Compliance Improvement - Analyzes external laws and regulations as well as internal processes and systems. Aids the development and revision of policies, procedures, services, products, and systems that ensure regulatory compliance. Fosters understanding and proper implementation of necessary changes in impacted...

Overview: This position ensures the legal, operational, and risk management compliance of the Bank. Maintains an expert knowledge of new and existing laws that impact enterprise activities in order to recommend necessary changes. Reviews business processes, procedures, and activities for risks and inefficiencies. Assists internal and external audits. Develops and implements new, compliant policies as appropriate. Serves as a liaison between corporate, legal, and division teams to identify and resolve complex issues. Facilitates the security and integrity of Bank activities by ensuring compliance with all applicable rules, regulations, and standards. Responsibilities: Compliance Improvement - Analyzes external laws and regulations as well as internal processes and systems. Aids the development and revision of policies, procedures, services, products, and systems that ensure regulatory compliance. Fosters understanding and proper implementation of necessary changes in impacted...

Job Description S UMMARY The UX Researcher enables Advance Auto Parts devices and systems to make informed decisions based on sound mixed-method research and analytics. We are looking for an experienced and motivated UX Researcher to join our growing team and raise the bar on how we gather and apply customer insights at Advance Auto Parts. This role is responsible for developing and applying research methods to answer challenging questions and collaborating closely with a diverse set of highly skilled cross-functional partners. While other duties may be assigned, the E SSENTIAL D UTIES & R ESPONSIBILITIES include the following: Work closely with the design and product management teams throughout the development lifecycle to define, measure and communicate UX research findings and guidelines around the various customer experience solutions evaluated, maintaining a high bar for execution. End-to-end ownership with all aspects of the UX research lifecycle...

Don’t miss this amazing 100% remote opportunity where you will be part of a team-oriented work culture where you are invested in to ensure success within the company. Our company provides a work/life balance for all employees as well as an excellent benefits package including 12 paid Holidays! Fidelity Bank  is searching for experienced  Client Experience Specialist  in the  Des Moines, IA  area! If you have proven experience in a customer service call center, we want to hear from you! As a member of the team, you can expect: Top Compensation:  Starting pay between $38,000 -$50,000 depending on your experience! Day Time Schedule -  Monday through Friday - 8:15am to 5:00pm with a rotational Saturday schedule working 9:00am to 1:00pm Excellent Benefits:  Medical, dental, vision, life, short- and long-term disability, HSA, 401(k) with company match, and more! Referral Incentive Plan, up to $1,000 a year. Opportunities for Advancement! Culture:...