9 claims team lead workers compensation jobs found in Fort Worth

The CareIQ Intake Specialist provides administrative customer service assistance to claimants, providers, and claims management by receiving and entering new ancillary healthcare referrals. Utilizing proprietary systems and knowledge from training, a CareIQ Intake Specialist will provide excellent telephonic and written customer service to both inbound and outbound customers. A CareIQ Intake Specialist operates with a high focus on accuracy and urgency to ensure that service orders are received quickly in alignment with the claimant and customer needs. This is a remote position but for continuity of business, candidate must live and work in the Central or Eastern Time Zone with a schedule of Monday - Friday, 2:30PM - 11:00PM EST. ESSENTIAL FUNCTIONS & RESPONSIBILITES: Provides quality and friendly telephonic customer service in an inbound and outbound high-volume call-center environment Completes accurate data entry and review Able to learn and operate corporate...

CERIS is seeking a Certified Coder. The CERIS Certified Coder reverse code previously coded medical bills to determine coding accuracy. This is a remote role.  ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determine validity and compensability of the claim using CorVel proprietary programs Make recommendations to referring office Communicate claim status with referring office Read and comprehend all medical reports Adhere to client and carrier guidelines and participate in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties/responsibilities as assigned Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance   KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and understanding of claims...

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.  Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits. Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. Utilize applicable tools and resources to complete internal audits and/or appeals. Timely completion of internal audits and/or appeals. Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and...

Position Summary:   The Senior Vice President of Production Development acts as a strategic partner to high profile clients and works directly with the CEO and Managing Directors to aid in growing and maintaining their books of business. The Senior Vice President of Production Development drives accountability for execution of account strategies through the delegation of tasks and empowering account managers and other service team members. Supervisory Responsibilities:   None Essential Tasks: Responsibilities related to Existing Accounts Help gather exposure updates and applications for renewals Track and ensure service timeline items are completed Manage daily task tracker of ongoing follow up items Verify renewals are booked and items issued (COI, auto ID cards, etc.) Track claims submitted to the claims department and aid with quality control Aid in marketing strategy for renewals Help evaluate incumbent and alternative markets Track account details:...

Overview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.   Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company’s success is grounded in our core values:  accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!...

The Policy and Payment Integrity Manager oversees the PPI team and assists with implementation of policies to perform reviews conducted by CERIS, including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation. This role manages   members of the PPI team, developing team strengths and improving weaknesses, identifying team goals, and evaluating team progress. The Policy and Payment Integrity Manager provides trend analysis of internal auditing of claims for accuracy related to pre- and post-payment claims, targeted claims, high dollar claims, and any other claim or record that requires quality review. The role assists with development of internal quality assurance measures based on client policy and industry guidelines. The manager also aids in researching and implementing best practices related to (CMS) payment policies, healthcare policies, client, state, and/or policy initiatives. This is a remote role.   ESSENTIAL...

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.  Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits. Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. Utilize applicable tools and resources to complete internal audits and/or appeals. Timely completion of internal audits and/or appeals. Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and...

JOB SUMMARY: The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...