6 provider relations specialist jobs found in West Des Moines, IA

Job Description: Join our growing team as a Sr. Liability Claims Specialist, Supervisor , at Creative Risk Solutions, where you’ll lead a high-performing group of adjusters and ensure exceptional claims handling from start to finish. This role offers the opportunity to drive operational excellence while supporting clients with complex liability exposures. Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. Essential Responsibilities: Adjudicate claims as needed, investigate, negotiate settlements, and maintain accurate documentation. Monitor claims, especially in litigation, ensuring timely responses and adherence to "Best Practices for Claims." Research and respond to...

Job Description: Join our growing team as a Sr. Liability Claims Specialist, Supervisor , at Creative Risk Solutions, where you’ll lead a high-performing group of adjusters and ensure exceptional claims handling from start to finish. This role offers the opportunity to drive operational excellence while supporting clients with complex liability exposures. Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. Essential Responsibilities: Adjudicate claims as needed, investigate, negotiate settlements, and maintain accurate documentation. Monitor claims, especially in litigation, ensuring timely responses and adherence to "Best Practices for Claims." Research and respond to...

Join a growing team of Medicare specialists and healthcare professionals dedicated to delivering high-quality Medicare compliance solutions. The Medicare Medical Coordinator plays a key role in supporting Medicare lien resolution, medical cost projections, and Medicare Set-Aside services. This position works closely with Certified Nurse Medicare Specialists and Nurse Life Care Planners to ensure accuracy, quality, and exceptional client service. This is an excellent opportunity for an organized and detail-oriented professional with medical terminology knowledge who enjoys working in a collaborative, fast-paced environment where their contributions directly impact client outcomes.   Essential Functions & Responsibilities Proofread, format, and quality-review medical reports, cost projections, and client correspondence for accuracy and consistency. Assist in the preparation of Medicare-related documentation, including lien and medical cost projection support...

Job Description: We are looking to add a Sr. Workers’ Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states . This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement.   Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions...

Job Description: We are looking to add a Sr. Workers’ Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states . This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement.   Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions...

The Quality Assurance Specialist participates in all assigned activities to assist the Medicare Services team to ensure team compliance. The QA Specialist will work closely with all other team members completing activities such as file audits, training manual updates, document formatting, and work flow management assistance. This position is temporarily remote during pandemic. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for team file reviews Responsible for updating team training modules in SharePoint Responsible for team outcome tracking in Excel Responsible for tracking unit Medicare pricing in Excel May assist Medicare Services VP with daily work flow May assist Medicare Services VP with daily invoicing May assist Medicare Service VP with marketing documents and customer outreach Requires punctual and consistent attendance Maintain HIPAA compliance in all aspects of communications Comply with all safety rules...