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ADAPTED_NOW

The role involves reviewing the claim, performing focused assessments of claimed injuries, reviewing medical records, and potentially rendering a medical opinion based on the record review and completed Compensation & Pension (C&P) exam. Conduct Comprehensive Medical Disability Examinations: Perform thorough and focused medical evaluations of Veterans, including reviewing their medical history, conducting physical examinations, and assessing the impact of disabilities on their daily life and functional abilities.

YEAR

<p>OUR MISSION is to be the partner of choice for government agencies by providing a solid foundation, quality processes, and precise outcomes through rapid recruitment and deployment of personnel services.

OUR VISION is to create a culture by empowering people to be treated as partners in order to create effective solutions in which we can all call OUR SUCCESS.

OUR NAME "Loyalty is willing in that it is freely given, not coerced. It is chosen after personal consideration, not something that one is born into. Loyalty is practical in that it is practiced. It is actively engaged upon, not passively expressed merely as a strong feeling about something. Loyalty is thoroughgoing in that it is not merely a casual interest but a wholehearted commitment to a cause." – Royce </p>

Loyal Source

Examiner Physican Assistant

FEED

We are seeking a skilled and board-certified Family Medicine or Internal Medicine physician to join our team in Littleton, CO for an Independent Medical Examination (IME). · Prepare Reports: Deliver a detailed IME report within an expected turnaround time of 5 days.

Dane Street, LLC

Family Medicine/Internal Medicine - Independent Medical Examiner

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As a Senior Government Consultant I – Program Integrity Specialist, you will play a vital role as a core team member providing expert insights on complex projects for clients, which are primarily state Medicaid and Children’s Health Insurance Program (CHIP) agencies and related state agencies responsible for Medicaid and CHIP fee-for-service and managed care programs. Participate in and lead client projects related to fraud, waste, and abuse prevention; compliance monitoring; risk assessment; and external audit coordination; Coordinate project priorities, client needs, subcontractor/vendor collaboration, deliverable development, workgroup activity, and leadership reporting.

Marsh McLennan

Senior Government Consultant I - Program Integrity Specialist

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Primary Location Fresno, California Facility Name Fresno Orchard Plaza Medical Offices Employee Status: Regular Worker Location: Onsite Schedule Full-time Scheduled Weekly Hours: 40 Shift Day Salary $41.08 - $43.22 / hour. Essential Responsibilities: Create and Maintain Reports: For all medical services related to treatment of industrial injuries or illnesses: Create and maintain complete industrial claim files using internal systems.

HOUR

At Kaiser Permanente, we are relentless in our pursuit of excellence. Driven by our mission to provide the highest quality preventive medicine, we are committed to eliminating health care disparities, and to making lives better through innovation, technology, and research.

Our desire to deliver the best possible care inspires us to promote wellness among our members, communities, and each other. It also fuels our belief that everyone — regardless of circumstance — deserves access to affordable care, which further drives our motivation to expand our reach.

Founded nearly 80 years ago, our unique business model sets us apart — positioning us to drive improvements across the industry and around the world.

Kaiser Permanente

Industrial Report Billing

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Interaction with patients, family members, physicians and their office staff, hospital personnel, employers, funeral homes, various governmental agencies, third party agencies (insurance companies) in person, by telephone, fax or internet. 2. Essential Physical and Cognitive Demands, Manual Dexterity: Describes the physical efforts, manual dexterity and cognitive skills required for the job (i.e., hand/eye coordination, lifting, pulling, walking, concentration, analysis, customer sensitivity, etc.).

Montefiore Nyack Hospital

Patient Access Coordinator

The ideal candidate has recent administrative experience, strong computer skills, and excellent proficiency in Microsoft Excel. We are seeking a detail-oriented Administrative Claims Processor to review, verify, and process claims while ensuring accuracy and compliance with applicable requirements.

Alpha Rae Personnel Inc

Administrative Professional III 14249

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Develop and maintain collaborative and liaison relationships with Blue Cross Blue Shield Association (BCBSA), Blue Cross Blue Shield (BCBS) Plans, HHS OIG, other carriers' anti-fraud professionals, law enforcement and regulatory agencies. May attend webinars and conferences like BCBSA, National Health Care Anti-Fraud Association (NHCAA), and Association of Certified Fraud Examiners (ACFE) to keep apprised of developments in health care fraud.

Premera Blue Cross

Investigator III

Using established guidelines, this role reviews requests from physicians, pharmacies, medical groups, and members for prescription drugs and pharmacy benefits, researches and resolves issues, and collaborates closely with clinical pharmacists and other healthcare professionals to ensure accurate, compliant, and timely processing of pharmacy-related requests. The Pharmacy Technician supports multiple pharmacy operations areas, including formulary management, pharmacy audit and recovery, pharmacy service center, Medicare Part D and Part B, appeals, state health programs pharmacy operations, prior authorization, and oversight and audit support.

Actalent Inc

REMOTE Pharmacy Technician - NY State Resident

Preferred Candidates will possess some of the below attributes: Preference may be given to applicants with one of the following certifications: Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), Certified Information Systems Auditor (CISA), or Certified Management Accountant (CMA). The Auditor's Office also examines the financial books kept by the other county officials to see that accurate and complete records are maintained.

Utah County Government

Staff Internal Auditor

GDIT's Federal Health Division is hiring a Healthcare Coding Expert to support the Centers for Medicare and Medicaid (CMS), you will be trusted to identify trends in the data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members (Partner) and the Trusted Third Party (TTP). To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available.

GD Information Technology

Healthcare Coding Expert (certified professional coder)

We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).

<h2>Leaders in health care solutions for those most in need</h2>
<p>AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than&nbsp;5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing&nbsp;<a href="http://www.amerihealthcaritas.com/corporate/innovation.aspx" target="_self">innovative solutions</a> that help improve health outcomes while&nbsp;<a href="http://www.amerihealthcaritas.com/who-we-serve/government/cost-savings.aspx" target="_self">reducing costs</a>.</p>
<h3>Our mission, our goal</h3>
<p>Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.</p>

AmeriHealth Caritas

Investigator Sr

Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred. Investigates files by using appropriate field, computer and telephone investigative techniques and provides appropriate documentation of actions in a thorough timely manner.

Military, Veterans and Diverse Job Seekers

SIU Investigator

In order to be considered for this position, you must meet ALL the following minimum qualifications: Four years of recent (within last ten years) full-time investigative experience which included: 1.) conducting fact finding; 2.) collecting and preserving evidence according to the rules of evidence; 3.) examining records; 4.) locating and interviewing witnesses to verify or disprove claims of suspected law violations; 5.) and writing investigation reports sufficient for use at administrative hearings or in court. In this role, you will have the opportunity to work on a team of seven investigators to investigate potential violations of legal requirements related to charitable organizations and solicitations, identify appropriate resolutions of matters under investigation, and provide support to other investigators and attorneys in connection with Section investigations and enforcement actions.

State of Oregon

Investigator 3 - Charitable Activities Section

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. POSITION SUMMARY: Under minimal supervision, oversees the daily operations of a workers' compensation claims unit, ensuring timely, accurate, and high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures.

TRISTAR Insurance Group, Inc

Workers Compensation Supervisor

Provide and/or manage classroom and behind the wheel instruction according to corporate and client specifications in all aspects of vehicle operation in the course of passenger transportation, including defensive driving, service area familiarization, passenger loading, unloading and securement, proper manifest documentation, use of on-board equipment, accident and emergency procedures, dispatch and radio communications, and passenger sensitivity. Review all vehicular, passenger and employee accidents/incidents for determination of cause and preventability, identifying potential trends to be addressed in future training efforts as well as ensuring that retraining and safety points are assessed according to company policy.

MV Transportation Inc

Assistant Training and Safety Manager

The Clinical Pharmacist reviews claims in real time, recommends therapeutic interchanges and other clinical savings opportunities, runs Pulse's cost containment programs, produces client reporting, and is part of the team that communicates directly with members, prescribers, and clients, including at quarterly business reviews. Recommend therapeutic interchanges, generic and biosimilar alternatives, and other lower-net-cost options that maintain or improve clinical outcomes, and coordinate with prescribers and members to put changes in place.

ReviveHealth

Clinical Pharmacist (Pulse PBM)

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. 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.

<p>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.</p>

Sedgwick Claims Management Services, Inc.

Claims Examiner I Workers Compensation I CA experience

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.

Claims Examiner | Riverside, CA or Ontario, CA

The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure. Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf .

Prime Healthcare Services Inc

Claims Examiner

Answer verbal and written inquires and customer service queued calls on Group claims from insureds, group policy holders, agents, physicians, hospital attorneys, Workers' Compensation Board, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff. Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices and Social Security application procedures strongly preferred.

Claims Examiner Jobs in the United States

Examiner Physican Assistant Loyal Source

Family Medicine/Internal Medicine - Independent Medical Examiner Dane Street, LLC

Senior Government Consultant I - Program Integrity Specialist Marsh McLennan

Industrial Report Billing Kaiser Permanente

Patient Access Coordinator Montefiore Nyack Hospital

Administrative Professional III 14249 Alpha Rae Personnel Inc

Investigator III Premera Blue Cross

REMOTE Pharmacy Technician - NY State Resident Actalent Inc

Staff Internal Auditor Utah County Government

Healthcare Coding Expert (certified professional coder) GD Information Technology

Investigator Sr AmeriHealth Caritas

SIU Investigator Military, Veterans and Diverse Job Seekers

Investigator 3 - Charitable Activities Section State of Oregon

Workers Compensation Supervisor TRISTAR Insurance Group, Inc

Assistant Training and Safety Manager MV Transportation Inc

Clinical Pharmacist (Pulse PBM) ReviveHealth

Claims Examiner I Workers Compensation I CA experience Sedgwick Claims Management Services, Inc.

Claims Examiner | Riverside, CA or Ontario, CA Sedgwick Claims Management Services, Inc.

Claims Examiner Prime Healthcare Services Inc

Life & DI Claims Examiner I Renaissance Life & Health Insurance Company of America

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