UNKNOWN

FEED

The investigator analyzes claims, encounter, enrollment, medical record, and provider data; conducts interviews, field investigations, and on-site audits, when necessary; prepares detailed investigative reports; and collaborates with compliance, legal, operational stakeholders, regulatory agencies, and law enforcement. Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating, and resolving allegations and indicators of fraud, waste, and abuse (FWA) involving providers, vendors, members, and other parties participating in Elderplan's product lines.

YEAR

Metropolitan Jewish Health System

Fraud Investigator

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FULL_TIME

You will work as part of the BerryDunn Program Integrity team, and work closely with MQD Program Integrity staff, audit and TPL specialists, data analysts, compliance staff, vendor partners, and other workstream members to help identify risks, interpret policy, improve internal controls, escalate issues for leadership, and support recovery efforts. You Will: Conduct detailed reviews of Medicaid claims and related provider, member, eligibility, financial, and operational data to identify, document, and escalate potential fraud, waste, abuse, improper payments, compliance issues, and operational risks.

BerryDunn

Medicaid Program Integrity Senior Consultant

[AW]-iCims

Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust's mission, vision, and values.

HOUR

Amtrust Financial Services Inc

Senior Claim Examiner I, CA

Our employee-founded resource groups create communities within Arrive’s walls, including Women in Logistics, Emerging Professionals, Prisms, Black Logistics Group, Salute and Unidos. The Associate Claims Examiner will professionally communicate with external parties and collaborate with internal teams, while also developing a basic grasp of the transportation industry and business acumen.

Arrive Logistics

Associate Claims Examiner

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The LTD Claims Examiner II investigates, analyzes, and adjudicates long-term disability, voluntary disability, and waiver of premium claims in accordance with insurance policy provisions, internal procedures, and applicable regulations. Consult appropriate medical and risk resources and refer claims to the correct risk level when necessary.

Vets Hired

LTD Claims Examiner II

Manatal

The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate.

AssuranceAmerica Corporation

Casualty Claims Examiner

AIG Warranty delivers a full range of service solutions including warranty management administration, extended service contracts and mobile insurance theft/loss programs, customer service support, service network management, claims processing services, and service contract underwriting. Claims Analysts are responsible for receiving incoming calls and emails from Service Providers needing authorization or payment for repairs on major appliances, consumer electronics, heating and air, or other home systems.

AIG and its member companies form one of the world’s leading insurance organizations. We provide insurance for businesses and individuals, helping individual customers plan for their futures by offering life insurance, travel insurance, product warranty, auto insurance and retirement products. Our commercial clients have come to rely upon our risk expertise and financial strength to help them address some of their most complex challenges – from huge construction projects to protecting themselves from the emerging threats to data security. We offer our people the chance to grow in a dynamic company that values teamwork, fresh perspectives, and a commitment to helping their clients.

American International Group

Warranty Claims Examiner

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Working knowledge of Microsoft Word & Excel is required Strong analytical skills are required to effectively and efficiently analyze information. Excellent verbal and written communication skills to express complex evaluations and resolve claims through a well-planned negotiation strategy.

Core Specialty Insurance Services

Senior Claims Examiner

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Gather and analyse information necessary to make an accurate evaluation of the claim by delivering effective resolution of claims, make decision within established authority levels and identifying settlement issues. As the Healthcare Claims Examiner, you will directly handle Commercial Healthcare Claims including Medical Malpractice and Healthcare facilities across the U.S. Key Accountabilities/Deliverables:

Claims Examiner - Commercial Healthcare

Managing litigation cases related to auto claims disputes, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders. Analyzing and reviewing auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers.

Reserv

Litigation Claims Examiner

Review documents, estimates, policy forms, and determine if and how coverage applies to submitted claims; Authorize payment within scope of authority, effectively resolving claims in a cost-effective manner and ensuring timely issuance of disbursements; referrals to carriers as needed; Write coverage letters detailing coverage positions. Recruiting Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role.

Proctor Loan Protector

Claims Examiner

Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. QUALIFICATIONS REQUIRED: Education/Experience: High School Diploma or GED required; Bachelor's degree in a related field (preferred); one (1) year or more related experience; or an equivalent combination of education and experience.

TRISTAR Insurance Group, Inc

Workers Compensation Claims Examiner I

ADAPTED_NOW

Strong communication and interpersonal skills to effectively interact with claimants, customers, insureds, brokers, attorneys, etc., in a positive manner regarding losses. Contacts, interviews and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.

Georgia Tek Systems

Claims Examiner-Portland, OR

PRIMARY PURPOSE OF THE ROLE To analyze General Liability & Auto BI (Litigated & Non-Litigated), Premises claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring countsSM; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of nearly 15,000 colleagues in some 275 offices located in the U.S., Canada, the U.K and Ireland. Sedgwick facilitates financial and personal health and helps customers and consumers navigate complexity by designing and implementing customized programs based on proven practices and advanced technology that exceed expectations. Sedgwick’s majority shareholder is KKR; Stone Point Capital LLC, La Caisse de dépôt et placement du Québec (CDPQ) and other management investors are minority shareholders.

Sedgwick Claims Management Services, Inc.

Liability Claims Examiner | General Liability & Auto BI (Litigated & Non-Litigated), Premises | License Required | Dedicated Client

Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security-as well as your professional development-to bring peace of mind to you and your family.

American International Group Inc (AIG)

War Hazard Recovery Claims Examiner - Federal Workers Compensation

Responsibilities: To analyze complex or technically difficult general liability 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. Analyzes and processes complex or technically difficult general liability 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.

Iconma LLC

Claims Examiner - Liability

Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses. Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.

To analyze Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Workers Compensation Claims Examiner | NY Jurisdiction | NY Licensing | Remote

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Workers Compensation Claims Examiner - CA | On-Site or Remote

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for the twelfth consecutive year in a row and for the 20th time overall as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

Claims Examiner Jobs in the United States

Fraud Investigator Metropolitan Jewish Health System

Medicaid Program Integrity Senior Consultant BerryDunn

Senior Claim Examiner I, CA Amtrust Financial Services Inc

Associate Claims Examiner Arrive Logistics

LTD Claims Examiner II Vets Hired

Casualty Claims Examiner AssuranceAmerica Corporation

Warranty Claims Examiner American International Group

Senior Claims Examiner Core Specialty Insurance Services

Claims Examiner - Commercial Healthcare Core Specialty Insurance Services

Litigation Claims Examiner Reserv

Claims Examiner Proctor Loan Protector

Workers Compensation Claims Examiner I TRISTAR Insurance Group, Inc

Claims Examiner-Portland, OR Georgia Tek Systems

Liability Claims Examiner | General Liability & Auto BI (Litigated & Non-Litigated), Premises | License Required | Dedicated Client Sedgwick Claims Management Services, Inc.

War Hazard Recovery Claims Examiner - Federal Workers Compensation American International Group Inc (AIG)

Claims Examiner - Liability Iconma LLC

Claims Examiner Iconma LLC

Workers Compensation Claims Examiner | NY Jurisdiction | NY Licensing | Remote Sedgwick Claims Management Services, Inc.

Workers Compensation Claims Examiner - CA | On-Site or Remote Sedgwick Claims Management Services, Inc.

Claims Examiner - Workers'''' Compensation (California) ICW Group

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