19 results for Claims Examiner Analyst Healthcare

Medical Claims Analyst We are in search of a Medical Claims Analyst to join our team! This role offers a remote work schedule and is a contract to permanent employment opportunity. As a Medical Claims Analyst, you will be tasked with processing and verifying patient data, accurately assigning codes to outpatient medical records, and working closely with providers to identify the appropriate care plans for patients. Your responsibilities will also include understanding coding changes that impact coding, compliance, and reimbursement requirements, and educating providers on the appropriate documentation to support all codes captured in the electronic health record. Responsibilities: • Accurately assign CPT-4 and HCPCS codes to outpatient medical records based on documentation.• Verify, modify, and abstract patient data to meet data integrity and organization-specific protocols and requirements.• Stay updated with the coding and classification system(s) revision cycle (ICD-10-CM and MSDRG annually).• Utilize electronic and hard copy resources to assist in accurately assigning coding and classification codes.• Collaborate with providers to identify the appropriate ICD-10, CPT, and HCPCS codes for patient care plans and associated treatment orders.• Educate providers on the appropriate documentation to support all codes captured in the electronic health record.• Work with computerized patient management systems and enter data accurately.• Handle medical billing and follow-up for third party payors.• Perform other related duties as assigned.

Workers Comp Claims Examiner We are looking for a meticulous Workers Compensation Claims Examiner to join our team in Roseville, California. You will be handling and overseeing workers' compensation claims from start to finish, ensuring compliance with legal standards and our internal policies. Your role will require excellent communication skills, problem-solving abilities, and a comprehensive understanding of workers' compensation regulations. Responsibilities:• Analyze and process workers' compensation claims in a timely and efficient manner.• Review medical records, accident reports, and other documentation to establish the validity of claims.• Keep track of ongoing claims to ensure proper case management and resolution.• Confirm that claims comply with regulatory guidelines and state-specific workers' compensation laws.• Document claims, correspondence, and actions taken in detail.• Communicate effectively with claimants, medical professionals, attorneys, and other stakeholders about claim status.• Clearly explain workers’ compensation policies and procedures.• Professionally address questions and concerns, ensuring a positive experience for all parties involved.• Evaluate claim situations and make decisions about approvals, denials, settlements, or escalations based on evidence and policy.• Negotiate settlements and authorize payments within set limits.• Identify potential fraud or discrepancies within claims and report irregularities to the correct departments.• Evaluate risks and recommend strategies for minimizing cases of non-compliance or overpayment.• Collaborate with internal teams, including HR, legal, and finance departments.• Keep up to date with changes in workers' compensation laws and guidelines.• Participate in training programs to enhance claims management skills.

Claims Examiner-Lost Time We are offering a short term contract employment opportunity for a Claims Examiner-Lost Time in New Haven, Connecticut. This role primarily functions in the insurance industry and involves handling all aspects of workers compensation lost time claims. The successful candidate will be expected to maintain strong customer relations throughout the process, from setup to case closure. Responsibilities: • Handling all components of workers compensation lost time claims, from initiation to closure, maintaining strong customer relations throughout. • Thoroughly reviewing claim and policy information to establish a basis for investigation. • Conducting comprehensive investigations, obtaining facts and statements from insured claimants and medical providers. • Evaluating facts gathered through investigations to determine the compensability of the claim. • Informing insureds, claimants, and attorneys of claim denials, when applicable. • Preparing reports on investigations, settlements, denials of claims, and evaluations of involved parties. • Administering statutory medical and indemnity benefits in a timely manner throughout the life of the claim. • Setting reserves for medical, indemnity, and expenses within authority limits and recommending reserve changes to Team Leader. • Regularly reviewing claim status and making recommendations to Team Leader to discuss problems and remedial actions. • Working with attorneys to manage hearings and litigation. • Directing vendors, nurse case managers, and rehabilitation managers on medical management and return to work initiatives. • Complying with customer service requests, including special claims handling procedures, file status notes, and claim reviews. • Filing workers compensation forms and electronic data with states to ensure compliance with statutory regulations. • Maximizing recovery opportunities by referring appropriate claims to subrogation and securing necessary information. • Collaborating with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers, and Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Medical Claims Representative We are looking for a competent Medical Claims Representative to join our team in Los Angeles, California. The Medical Claims Representative will be primarily responsible for monitoring, investigating and analyzing relevant agreements, as well as handling claims payments and maintaining effective communication with various stakeholders. Responsibilities: • Handle the filing and pursuit of claims payments meticulously and efficiently.• Answering inquiries regarding EOBs as well as any other issues pertaining to medical claims• Monitor and analyze healthcare industry trends and developments, and understand their implications on claims.• Investigate potential violations of collective bargaining agreements and take necessary action.• Maintain timely and effective communication with members, agents, attorneys, and company representatives.• Manage workload independently, ensuring all tasks are completed accurately and on time.• Work closely with the legal department to provide information/analysis of associated claims.• Research and analyze various agreements, including member contracts, assumption agreements and distribution agreements.• Handle appeals, benefit functions, billing functions, claim administration, and collection processes effectively.• Maintain a strong focus on customer service, ensuring all queries and issues are resolved promptly and professionally.

Medical Claims Representative We are offering a contract to permanent employment opportunity for an Insurance Follow-Up Specialist in FORT WAYNE, Indiana. This role is in the healthcare industry and will involve follow-ups on medical claims. The workplace environment is business casual and requires a high level of interaction with doctor offices. Responsibilities: • Follow-up on insurance claims and patient claims payments. • Provide customer service in relation to medical billing and insurance follow-ups. • Utilize skills in Medical Claims, Medical Billing, and Medical Insurance Billing for efficient execution of tasks. • Manage Insurance Denials and Payer Denials, and handle Medical Appeals. • Leverage expertise in Insurance Follow-up, Claim Denials, Denial Management, and Claim Adjudication. • Interact with doctor offices to resolve any discrepancies or issues related to medical claims.

Insurance Verifier We are seeking a detail-oriented Insurance Verification Specialist who is fluent in both English and Armenian to join our team on a temporary basis, with the opportunity to transition into a contract-to-hire role. The ideal candidate will play a critical role in ensuring that patient insurance coverage is verified accurately and promptly to facilitate efficient billing and processing while providing exceptional customer service.Key Responsibilities:<ul><li>Conduct insurance eligibility and coverage verification for patients, including confirming benefit details, co-pays, deductibles, and authorization requirements.</li><li>Communicate effectively in both English and Armenian to address inquiries from patients, healthcare providers, and insurance companies.</li><li>Perform detailed data entry and maintain accurate records in the company's electronic health record (EHR) or patient management system.</li><li>Handle insurance-related correspondence and proactively resolve discrepancies regarding coverage or claims.</li><li>Collaborate with billing departments and other internal teams to ensure documentation meets necessary compliance standards.</li><li>Assist with follow-ups on pending verifications or authorization requests to support timely patient access to services.</li><li>Stay updated on changes in insurance policies and procedures to ensure accurate communication with patients and stakeholders.</li></ul>

Medical Insurance Authorization Assistant Become a Key Player in Transforming Patient Care in Denver, ColoradoAre you ready to step into a dynamic, fast-paced healthcare environment that prioritizes excellence, teamwork, and patient satisfaction? We are seeking an experienced, detail-oriented Medical Insurance Authorization Specialist to join our dedicated team. This is your opportunity to help people navigate their healthcare journeys while working fully onsite in Denver, Colorado.If you have a background in pharmacy and expertise in insurance authorization processes, we want to hear from you! In this critical and rewarding role, you’ll play an essential part in ensuring patients access life-changing growth hormone therapies and other medical treatments, while improving their overall healthcare experience. Why This Role?<ul><li>Impact: You’ll directly contribute to enhancing patient outcomes by securing key medical authorizations that change lives.</li><li>Growth: Be part of a forward-thinking team in a specialized therapeutic area, where your skills truly make a difference.</li><li>Collaboration: Build meaningful connections with families, medical teams, and insurance providers every single day.</li></ul> Buzz-Worthy Responsibilities✔️ Insurance Authorizations: Spearhead the process of medical necessity submissions and prior authorizations by working hands-on with insurance providers to pave the way for patient care.✔️ Acceleration of Approvals: Own and manage the lifecycle of insurance approvals, including denials and appeals. Navigate challenges with confidence and problem-solving expertise.✔️ Data Precision: Ensure seamless completion of online submissions, paperwork, and accurate record-keeping to maintain compliance and efficiency.✔️ Patient Touchpoints: Empathically communicate with families to share updates, offer reassurance, and guide them through the authorization process.✔️ Team Synergy: Step in where necessary, supporting teammates and ensuring workflow stability during high-priority situations.✔️ High-Impact Correspondence: Handle approximately 20–30 calls daily while maintaining professional email communication across relevant stakeholders.

Insurance Verifier We are seeking a detail-oriented and experienced Insurance Verifier to join our team. In this position, you will play a key role in ensuring the accuracy and completeness of insurance information, facilitating smooth operations for our healthcare services. This is an excellent opportunity for professionals familiar with insurance authorization processes and proficient in using EPIC software. Responsibilities:<ul><li>Verify patient insurance information and ensure accuracy in the system.</li><li>Understand and navigate procedures for HMO, PPO, and Medicare Outpatient services requiring prior authorizations, including knowledge of capitation requirements.</li><li>Collaborate with various departments to resolve insurance eligibility and authorization issues.</li><li>Maintain accurate and organized records of verifications and authorizations.</li><li>Adhere to compliance policies and ensure all work aligns with applicable regulations.</li><li>Provide excellent customer service to patients and internal stakeholders.</li></ul>

Medical Claims Representative Great Opportunity to work with a well-known TPA insurance company in Fort Wayne, IN. This is a temporary to permanent position. Position Purpose: This position examines, enters and accurately adjudicates medical, dental, vision, HRA, FLEX, or STD claims based upon coverage, policy and procedural guidelines. May be assigned multiple clients with several lines of coverage.Primary Responsibilities:To perform this job successfully, the individual must be able to perform each essential duty satisfactorily (the requirements listed below are representative of the knowledge, skill and/or ability needed). Reliable, consistent and predictable performance of the following job duties is required:<ol><li>Enters paper claims into a proprietary claim adjudication system.</li><li>Adjudicates both paper and electronic claims with 99% accuracy for payment dollars and claim coding following an extensive on-the-job training class.</li><li>Maintains strict first-in/first-out for claims adjudication.</li><li>Follows office procedures for follow-up on claims needing additional information by reviewing the Holding for Information Report for each assigned client on a monthly basis.</li><li>Adjudicates prescription claims not automatically adjudicated by the claim adjudication system.</li><li>Interprets COB and Medicare worksheets as needed on assigned clients.</li><li>Batches adjudicated claims according to client preference or schedule.</li><li>Reports to clients on a weekly basis the total of all claims processed for that client, requesting the funding or requesting that funding be transferred to Pro-Claim.</li><li>Communicates with brokers, agents and clients regarding high dollar cost claims and SPEC claimants.</li></ol>Critical Required Skills:<ol><li>Must be able to work well independently and in a team atmosphere.</li><li>Ability to maintain a departmental accuracy standard of 99%.</li><li>Detail oriented.</li><li>Ability to manage multiple priorities that change from day-to-day and week-to-week in a fast-paced environment.</li><li>Ability to understand system calculations in order to determine if claims are adjudicating accurately.</li><li>Ability to manually process claims in the claims adjudication system if necessary.</li><li>Must understand complicated benefit designs.</li><li>Ability to self-manage, prioritize and meet specific production deadlines.</li><li>Computer experience, including Word, Excel, and Outlook.</li><li>Accurate 10-key and/or data entry skills.</li></ol>

Medical Claims Representative We are on the lookout for a dedicated Medical Claims Representative based in Rancho Cordova, California. As a Medical Claims Representative, your primary role will be to review and process claims from out-of-group providers, ensuring compliance with company policies, health plan contracts, and other relevant regulations. This opportunity offers a long-term contract employment in the healthcare industry. Responsibilities: • Review and process claims from Out of Group providers, adhering to written criteria, policies, and procedures. • Determine the appropriateness of claims for payment, considering factors such as eligibility, benefits, authorizations, coding, and contracted payment terms. • Stay up-to-date with changes in contracts annually and apply the correct terms to the claims. • If a claim is not appropriate for payment, ensure that the denial is correctly executed in the system for the letter to print accurately. • Consistently meet internal, external, and governmental timeliness standards. • Maintain the discretion to pay or deny medical services using the department's policy guidelines. • Handle sensitive and confidential information with discretion and professionalism. • Refer claims and documentation that do not meet our department policy guidelines to the UM department as needed. • Maintain communication with Eligibility, Member Services, UM, providers, the Health Plans, and any applicable staff as required. • Ensure the achievement of production and quality standards. • Work independently on assigned tasks and activities, based on established policies and procedures.

Medical Claims Representative We are offering an employment opportunity for a Medical Claims Representative in the Financial Services industry, located in Bakersfield, California. The role involves processing and managing medical claims with a strong focus on customer service. Responsibilities: • Operate computer systems to input claims data information accurately.• Adhere to the established quality and production standards in claims processing.• Handle inbound calls from healthcare providers and health plans, providing exceptional customer service.• Adjudicate physician claims in a precise and timely manner.• Ensure compliance with accuracy standards for claims, pends, and tasks.• Conduct timely follow-ups on inquiries received and log all incoming calls and emails correctly.• Effectively use software such as Allscripts, Cerner Technologies, EHR SYSTEM, Epic Clinical, Epic Software for claims administration.• Apply knowledge of medical claims, ICD, CPT Codes, ICD Codes, Medical Insurance, and Medicare in daily tasks.• Participate in other duties as required, maintaining the integrity of the overall claim administration process.• Understand and implement billing functions, benefit functions, and collection processes as part of the role.

Property Damage Claims Specialist We are seeking a Property Damage Claims Specialist to join our team in Allentown, Pennsylvania. In this role, you will handle customer property damage claims related to our electric service operations. You will oversee the claim from initial receipt to final determination and settlement, ensuring all actions comply with state regulations and company policy. This role offers a long term contract employment opportunity and operates in a hybrid mode, with three days on-site and two days working from home. Responsibilities: • Handle customer property damage claims resulting from our service operations • Oversee the entire claims process, from receipt to final determination and settlement • Ensure all actions comply with state regulations and our company's policy • Maintain accurate and timely records of all claims • Provide quality customer service and handle escalated calls when necessary • Maintain confidentiality regarding claims decisions and rationale • Analyze claims to ensure appropriate losses are paid for each event • Assist in determining liability for damage claims • Maintain tracking records of all accepted and denied claims • Handle other duties and projects as assigned.

100% Remote CA Barred Insurance Coverage Opinion Atty Firm seeks Coverage Opinion Writing Attorney (No Litigation) This Attorney opening involves working closely with insurers to provide expert advice and analysis on insurance coverage matters. The ideal attorney will have a deep understanding of various insurance policies and be adept at drafting comprehensive coverage opinions. Key Responsibilities:<ul><li>Collaborate with insurers to provide advice on insurance coverage and interpret policies.</li><li>Analyze various types of insurance policies across an array of industries.</li><li>Draft detailed coverage opinions based on policy analysis and contract interpretation.</li><li>Maintain effective communication with clients and internal team members.</li></ul> Billable hour target: 1850/year Can work 100% remote in US (PST work hours) Perks of Firm:<ol><li>Established for over 30 years</li><li>Multiple offices with large firm resources</li><li>Women-owned firm</li></ol>

Claims Representative We are in search of a Claims Representative to join our team in INDIANAPOLIS, Indiana. In this role, you'll be tasked with a variety of responsibilities, all revolving around the processing and management of claims. This role is pivotal within our organization, as it entails dealing with multiple programs simultaneously and the ability to adapt and apply feedback in a dynamic work environment. We are offering a contract to permanent employment opportunity. Responsibilities: • Manage and process customer claims in a timely and accurate manner • Conduct thorough audits on all claims to ensure accuracy and compliance • Utilize multiple software programs to handle and track claims • Implement feedback received from supervisors and peers to improve work efficiency • Maintain a flexible mindset to adapt to changing work environments and schedules • Handle calculations related to claims processing and payout • Keep track and update the status of claims regularly • Ensure high attendance and punctuality to maintain workflow efficiency • Use emotional intelligence to handle sensitive claims and customer interactions • Maintain a comprehensive database of claims and their respective statuses.

Reinsurance Claims Specialist We are offering a contract to permanent employment opportunity for a meticulous Reinsurance Claims Specialist in the insurance industry, based in Boston, Massachusetts. As a Reinsurance Claims Specialist, you will play a crucial role in managing and processing reinsurance claims, ensuring adherence to contract stipulations, and performing comprehensive claims analysis. You will also be required to liaise with internal teams, such as finance and accounting, to cater to data management and reporting requirements. Responsibilities • Ensure the precision of client claim submissions, confirm coverage as per contract terms, and authenticate the receipt of all necessary supporting documents. • Efficiently process and record claims in the claims management system. • Carry out in-depth claims analysis, including the reconciliation of inception-to-date claim balances and tracking of aggregate deductibles and/or reinstatement premium calculations as applicable. • Generate and analyze reports to competently manage the claims portfolio. • Work in collaboration with finance and accounting teams to fulfill data-related needs. • Use your knowledge of treaties/bordereau and understanding of reinsurance contract language to effectively handle reinsurance claims. • Utilize your experience with casualty lines of insurance, specifically environmental and/or asbestos, to manage a diverse claims portfolio.

Claims Admin Support Spec Int We are offering an exciting opportunity in the industry for a Claims Admin Support Specialist in Maitland, Florida. In this role, you will be performing a variety of clerical duties, interacting with multiple internal and external contacts, and providing support to our team. Responsibilities: • Interact professionally with customers, vendors, medical providers, attorneys, and law enforcement agencies over phone and mail. • Provide diligent customer service and follow up on inquiries. • Screen and direct telephone calls to appropriate departments or individuals. • Maintain and update office supplies inventory. • Operate and maintain office equipment including fax, printing, and copying machines. • Coordinate document maintenance activities, such as creating, retrieving, and copying documents. • Receive and direct visitors, resolving routine inquiries where possible. • Distribute incoming mail from USPS, FedEx, and other delivery companies. • Coordinate office shredding activities. • Conduct research and reporting tasks as requested by leadership. • Travel occasionally to support business needs. • Perform various other support duties as needed, including setting up meetings and coordinating record retention.

UT-LGR-9113-Contract Administrator II-ADV We are seeking a Contract Administrator II to join our team in Miramar, FL. In this role, you will be functioning as the primary liaison for contracting matters, ensuring compliance with the agreed terms and conditions, company policies, and financial objectives. You'll be working closely with various internal departments, as well as with our government and commercial customers. Responsibilities: • Develop and maintain a cooperative relationship with our large aerospace manufacturer customer, managing the contractual aspects.• Promptly review incoming paperwork, ensuring units are inducted within 24 hours of receipt, and appropriately manage non-product components.• Collaborate with the customer for quote approvals, resolving overdue accounts receivable issues, and obtaining necessary information to process units.• Ensure contractual obligations and requirements are adequately disseminated.• Cooperate with International Trade Compliance to ensure all import/export regulations are adhered to.• Comprehend and support internal financial goals, including milestones, progress payments, payment terms, and cash collection.• Coordinate hardware demand with the customer and the demand management team.• Use your skills in Microsoft Excel, SAP R/3, and Microsoft PowerPoint to manage and analyze data.• Ensure compliance with all company policies and regulations, using your knowledge in Compliance, Finance, and Engineering.• Use your Leadership Skills to guide the team and contribute to Operations and Training.

Claims Admin Support Spec Int We are offering a contract for a permanent employment opportunity for a Claims Admin Support Specialist in Maitland, Florida. This role primarily involves performing standardized clerical duties under direct supervision. The job function is within the industry and requires a person skilled in customer service, office functions, and leadership. Responsibilities: • Engage in regular interaction with multiple internal and external contacts such as customers, vendors, medical providers, attorneys, and law enforcement agencies through phone and mail. • Efficiently screen and direct telephone calls to appropriate departments or personnel. • Responsible for maintaining and updating office supplies inventory. • Operate and maintain office equipment, including fax, printing, and copying machines. • Coordinate document shredding activities with the designated vendor. • Handle document maintenance tasks such as creating, retrieving, and delivering files, and copying documents. • Compose routine correspondence as required. • Receive and direct visitors, resolving routine inquiries when possible. • Open, sort, and distribute mail from USPS, FedEx, and other delivery companies. • Perform various support duties, including setting up meetings and coordinating record retention. • Occasional travel may be required as part of the role. • Conduct research, reporting, and additional searches as requested by leadership.

UT-LGR-9113-Contract Administrator II-MST We are offering a contract to hire employment opportunity for a REMOTE Contract Administrator II role in the Aerospace industry. This remote position involves working closely with the Supply Chain Contracts team, managing a comprehensive portfolio of allocated supplier contracts, and coordinating with business partners on contract matters. Responsibilities:• Coordinate with business partners on supply chain contract matters• Manage a comprehensive portfolio of allocated supplier contracts• Communicate with supply chain leadership to develop and execute contracts• Provide guidance to stakeholders on allocated projects• Draft, generate, negotiate, interpret, and manage complex contract documents for allocated suppliers• Perform analysis and prepare reports to ensure contracts are within negotiated and agreed-upon parameters• Negotiate supplier contracts with stakeholders to achieve business favorable terms• Review contractual terms and conditions for their acceptability and assess the risk and impact• Utilize legal resources and other subject matter experts to recognize and address all levels of risk through the development of unique contract terms• Monitor contract status, risk mitigation, and contingency plans, and brief management and other functional areas• Identify opportunities to streamline workflow and improve quality of work product• Track and report key functional metrics• Represent the organization on legal issues related to allocated contracts• Maintain historical legal records.