UNKNOWN

FEED

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA).

CGS Administrators

Processor, Claims II

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We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

BlueCross BlueShield of South Carolina

Processor, Claims I

PGBA

Utilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers Review open/unpaid claim balances and take required action. " Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.

Mindlance

Office/Administration - Medical Claims Coordinator/Processor

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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: To support and maintain the claims management system for a local office or multiple office locations; and to ensure security access meets established policies within assigned group.

<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.

OSS Coordinator

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FULL_TIME

Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.

HOUR

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>


Allied Universal

SIU Investigator

[AW]-iCims

PART_TIME

SIU Investigator - Part Time

The state Fiscal Accountability Authority offers an exceptional benefits package for FTE positions that includes: Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse and Children. A bachelors degree and claims experience in casualty, bodily injury, workers compensation or property claims or a high school diploma and acceptable equivalent experience.

YEAR

State of South Carolina

Insurance Analyst III - 60015860

Additional duties may be assigned: Knowledge in the following areas: 1) claims handling concepts, practices, and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated analytical, decision making and negotiation skills. As part of a Title procurement process, the knowledge and ability to process, log, track, evaluate, coordinate, and resolve total losses on personal auto, classic vehicles and heavy equipment commercial vehicles/trucks in conjunction with state required forms and documentation.

Athens Administrators

Auto Specialist - Commercial Trucking

Auto Specialists - Commercial Trucking

The role shapes ambiguous examiner workflows into ontology, pipelines, Workshop applications, and AIP agents; sets the technical terms of co-development with Palantir; and enforces the graduation and portability conditions that keep Foundry and AIP an accelerator rather than the permanent claims platform. Partners directly with Casualty business leadership, examiners, and operations to shape problems in the workflow - sitting with users, leaving with a scoped build, and refusing work that would wire new capability onto a process known to be broken.

Principal Forward Deployed Engineer

They will deal directly with claimants and claimant's representatives in routing calls to appropriate DDS staff, sending out correspondences by fax or mail and making outgoing calls to ask investigative questions, such as gathering work history and functional information. All required information must be reviewed in the appropriate systems (i.e., Social Security Administration (SSA) system (DCPS), PCOMM and eView) for completeness and accuracy and documented on the Electronic Worksheet (EWS) when appropriate.

Government of Florida

OPS RECORDS ANALYST - 64801620

Responsibilities range from ensuring the safety of food service, maintaining the integrity of real estate transactions, furthering the transparency of condominium governance, and overseeing the qualifications of licensure that ensure work requiring a skilled professional is performed safely and sufficiently. Background Screening Requirement: The Florida Department of Business and Professional Regulation requires all job applicants, interns, volunteers and contractors to pass a Level 2 background check as per Chapter 435, Florida Statutes which consists of fingerprinting and a check of local, state, and national law enforcement records.

FRAUD INVESTIGATOR / ANALYST III - 79001459 1

Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or. Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.

Cotiviti Holdings Inc. (Inactive)

Senior Investigator Lead Validation (Healthcare FWA)

Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), or Certified Fraud Examiner (CFE). Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.

Investigator Lead Validation (Fraud, Waste & Abuse)

1. 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

Staff Internal Auditor

Position requires advanced knowledge of dental terminology and dental procedure codes; knowledge of common data mining tools, such as Audit Command Language (ACL), SQL Developer and IBM’s Fraud and Abuse Management System (FAMS); strong verbal and written communication skills; strong organizational and analytical skills; ability to manage multiple assignments with competing deadlines; and the ability to resolve complex problems using independent judgment. Position requires a bachelor's degree in accounting, business administration, finance, healthcare administration, information technology, or a related field and three years of experience auditing, utilizing analytical tools and software, dental claims billing or review, or as a dental hygienist.

Delta Dental Plan of Michigan

Special Investigations Unit Investigator

Requesting Information About the AEDT - NYC Local Law 144: Candidates who reside in New York City and are subject to NYC Local Law 144 may request information about the AEDT, including details on the type of data collected, the sources of such data, and our data retention policies. The Manager also leads confidential reviews of suspected misconduct, including false invoicing, procurement abuse, expense reimbursement misuse, vendor misconduct, asset misappropriation, payroll irregularities, and other activities that may expose the organization to financial loss.

FirstService Corp

Financial Risk & Controls Manager

Assists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete a COB claim. Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.

Claims Examiner Jobs in the United States

Processor, Claims II CGS Administrators

Processor, Claims I BlueCross BlueShield of South Carolina

Processor, Claims I PGBA

Processor, Claims II BlueCross BlueShield of South Carolina

Office/Administration - Medical Claims Coordinator/Processor Mindlance

OSS Coordinator Sedgwick Claims Management Services, Inc.

SIU Investigator Allied Universal

SIU Investigator - Part Time Allied Universal

Insurance Analyst III - 60015860 State of South Carolina

Auto Specialist - Commercial Trucking Athens Administrators

Auto Specialists - Commercial Trucking Athens Administrators

Principal Forward Deployed Engineer Sedgwick Claims Management Services, Inc.

OPS RECORDS ANALYST - 64801620 Government of Florida

FRAUD INVESTIGATOR / ANALYST III - 79001459 1 Government of Florida

Senior Investigator Lead Validation (Healthcare FWA) Cotiviti Holdings Inc. (Inactive)

Investigator Lead Validation (Fraud, Waste & Abuse) Cotiviti Holdings Inc. (Inactive)

Staff Internal Auditor Utah County

Special Investigations Unit Investigator Delta Dental Plan of Michigan

Financial Risk & Controls Manager FirstService Corp

Medical Claims COB Processor I Moda Health

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