UNKNOWN

FEED

The Senior Special Investigative Unit (SIU) Auditor investigates and audits potential healthcare fraud, waste, abuse, and coding irregularities across claims, billing, documentation, and reimbursement. For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

Premera Blue Cross

Senior Special Investigative Unit (SIU) Auditor

sourcestack_via_bold

This role will serve as a trusted advisor to surety carriers, legal counsel, claims professionals, and contractors by delivering financial analysis, investigative accounting, economic damage quantification, and project fund analysis related to bonded construction projects and disputes. MDD, a Davies Company, is seeking a highly experienced Senior Surety Manager to lead complex surety-related forensic accounting engagements within our Construction & Surety practice.

YEAR

Davies Group Ltd

Senior Surety Manager

linkup_via_bold

At the discretion of the Unemployment Insurance Manager, coordinate unemployment insurance hearings for clients: Review determinations with clients, request hearings, review claimants’ files, discuss cases with witnesses, prepare for hearings, represent clients during hearings, and review hearing files at the Department of Labor. · Perform a variety of miscellaneous duties, including reviewing charges against clients' accounts for accuracy; following up on CCC charges for each assigned client; answer incoming calls from the main telephone line; setting up new clients with appropriate forms and a call to introduce themselves and answer any new client questions.

HR One

Human Resource Generalist / Unemployment Claims Processor

Ability to: demonstrate customer service, compassion, respect, courtesy and tact when interacting with others; understand and apply written instructions; communicate information clearly and concisely, compare information and recognize discrepancies; utilize computerized data systems; establish and maintain effective working relationships with others. Skill to: math skills sufficient to add, subtract, multiply, divide and calculate percentages using a calculator; proficient keyboarding skills (typing and 10-key).

HOUR

State of South Dakota

Medical Claims Processor

Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment: Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente''s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente''s policies and procedures. Ordering and photocopying medical records; temporarily cover other desk/functions due to vacation and workload fluctuations; clears designated Health Connect work queues daily, creates patient accounts to register patients and fills in the required KP computerized systems, provides personalized and professional patient/employer/carrier services.

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

OHS Claims Processor I (Bilingual)

The Claims Processor will: Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including: eviction management, property inspection and maintenance, conveyance of title, title delivery, maintenance of HOA, taxes, and property insurance during the GSE REO process File claims for reimbursement of expenses Reconcile claim proceeds File supplemental claims as needed Ensure data accuracy Perform other related duties as required and assigned Demonstrate behaviors which are aligned with the organization's desired culture and values What You'll Bring High School Diploma / GED 1+ years of relevant work experience Default-related experience preferred Demonstrated aptitude for data, reporting, and working with numbers, desired Familiar with GSE and Insurer servicing guidelines Must be highly proficient in Excel and Word Why You Should Join As one of the top mortgage lenders in the country, Pennymac has helped over 4 million lifetime homeowners achieve and sustain their aspirations of home. Compensation: Individual salary may vary based on multiple factors including specific role, geographic location / market data, and skills and experience as defined below: Lower in range - Building skills and experience in the role Mid-range - Experience and skills align with proficiency in the role Higher in range - Experience and skills add value above typical requirements of the role Some roles may be eligible for performance-based compensation and/or stock-based incentives awarded to employees based on company and individual performance.

PennyMac Mortgage Investment Trust

Claims Processor

This position offers a unique opportunity for an experienced RN to move beyond direct patient care and play a key role in protecting benefit integrity while collaborating with clinical, claims, compliance, and investigative teams. In this role, you will leverage your clinical expertise and analytical skills to help detect, prevent, and minimize fraud, waste, and abuse within a long-term care insurance program.

FedPoint

Claims Fraud Clinical Analyst (RN)

clearcompany

CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Claims Processor II (Remote)

This role supports the claims department and requires prior insurance experience, including familiarity with claims billing, processing, and coding, as well as researching and validating claims information. Responsibilities include creating and maintaining reports and spreadsheets related to claims aging, coordination of benefits, precertifications, and other claims activities.

ICONMA, LLC

Claims Processor/Analyst

jobdiva

If you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email EmployeeRelations@luxotticaretail.com. EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions.

EssilorLuxottica

Processor- Claims

ea_via_bold

Specific Skills Needed: Medical Billing, cash application and collection (collection is not calling demanding payment; it's researching why a claim didn't get paid and taking steps necessary to correct the info). 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.

Diversity Nexus

Office/Administration - Medical Claims Coordinator/Processor

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.

<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 Nurse Practitioner

Examiner Physician Assistant

Interviews applicants, including Spanish-speaking applicants, for financial assistance programs; Reviews certification form to determine that the information is complete and consistent; when necessary, asks applicant appropriate questions and makes necessary additions and/or corrections to the form; Evaluates applicant's financial eligibility for assistance and may determine initial categorical eligibility; Prepares and computes budget for the applicant; Advises applicant of the eligibility determination, the amount of assistance and when the first grant can be expected; Informs the applicant about the program under which she/he is eligible, and any documentation or additional information which may be needed; Explains the validation process to the applicant; Advises the applicant about his/her duty to keep the agency informed of any change that may affect eligibility; Informs applicant about the range of services in the agency and may refer applicant to social services section or other specialists, such as resources, housing, employment, legal, medical, etc; Makes re-determinations of financial eligibility; Recommends emergency grants as needed; May be required to make field visits to obtain collateral verification to determine eligibility and make referrals to Special Investigations Unit if appropriate. Under the supervision of a technical or administrative supervisor, an employee in this class determines financial eligibility for programs administered by the Department of Social Services and recommends amounts of assistance in accordance with established policies and procedures.

Suffolk County, NY

Social Services Examiner I-Spanish Speaking-Help Program

Benefits: We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. Operating along the Eastern half of the United States, our Home Office is based in Central New York, with Regional Office locations in NYC, Dallas and Charlotte.

Utica National Insurance Group

Quality Assurance Examiner - General Liability / E&O

Education/Experience: Level 5: Bachelor's degree (B.A.) from four-year college or university; or four to six years related experience and/or training; or equivalent combination of education and experience. Sets or recommends reserves based on results of claim investigation by examining legal pleadings, claims reports and other similar claim precedents to determine extent of coverage and liability.

Frankenmuth Insurance

Litigation Examiner

Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes. Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.

Dane Street, LLC

Dentistry- Independent Medical Examiner (Ime)

Orthopedic Surgery- Independent Medical Examiner (Ime)

Dentistry- Independent Medical Examiner (IME)

Interviews applicants for financial assistance programs; Reviews certification form to determine that the information is complete and consistent; when necessary, asks applicant appropriate questions and makes necessary additions and/or corrections to the form; Evaluates applicant's financial eligibility for assistance; may determine initial categorical eligibility; Prepares and computes budget for the applicant; Advises applicant of the eligibility determination, the amount of assistance and when the first grant can be expected; Informs applicants about the program under which they are eligible, and any documentation or additional information which may be needed; Explains the validation process to the applicant; Advises applicants about their duties to keep the agency informed of any change which may affect eligibility; Informs applicant about the range of services in the agency and may refer applicant to social services section or other specialists, such as resources, housing, employment, legal, medical, etc; Makes redeterminations of financial eligibility; Recommends emergency grants as needed; Makes field visits to obtain collateral verification of information to be used in determining eligibility for Public Assistance; provides eligibility workers with information obtained in field reviews. Under the supervision of a technical or administrative supervisor, an employee in this class determines financial eligibility for programs administered by the Department of Social Services, and recommends amounts of assistance in accordance with established policies and procedures.

Claims Examiner Jobs in the United States

Senior Special Investigative Unit (SIU) Auditor Premera Blue Cross

Senior Surety Manager Davies Group Ltd

Human Resource Generalist / Unemployment Claims Processor HR One

Medical Claims Processor State of South Dakota

OHS Claims Processor I (Bilingual) Kaiser Permanente

Claims Processor PennyMac Mortgage Investment Trust

Claims Fraud Clinical Analyst (RN) FedPoint

Claims Processor II (Remote) Blue Cross and Blue Shield Association

Claims Processor/Analyst ICONMA, LLC

Processor- Claims EssilorLuxottica

Office/Administration - Medical Claims Coordinator/Processor Diversity Nexus

Examiner Nurse Practitioner Loyal Source

Examiner Physician Assistant Loyal Source

Social Services Examiner I-Spanish Speaking-Help Program Suffolk County, NY

Quality Assurance Examiner - General Liability / E&O Utica National Insurance Group

Litigation Examiner Frankenmuth Insurance

Dentistry- Independent Medical Examiner (Ime) Dane Street, LLC

Orthopedic Surgery- Independent Medical Examiner (Ime) Dane Street, LLC

Dentistry- Independent Medical Examiner (IME) Dane Street, LLC

Social Services Examiner I-Help Program Suffolk County, NY

Similar Job Searches

See More Jobs

Stand out to leading employers.