6 claims examiner associate jobs found

The 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.   This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager   Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: 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...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Associate | West Hills, CA (Onsite) Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? A stable and consistent work environment in an office setting. Career development and promotional growth opportunities through increasing responsibilities. A diverse and comprehensive benefits package to take care of your mental, physical, financial and...

SUMMARY:     Workers Compensation Defense Attorney needed for in-house litigation position, working under the direction of the General Counsel.  This attorney will work defending litigated Workers’ Compensation claims before the WCAB and hearing locations, primarily in and surrounding Los Angeles, CA, and will handle a full caseload from initial status conference through trial. This attorney will conduct research where necessary, examine records, conducts investigations, attends depositions, consult with witnesses, insured(s), legal assistants, and/or personnel.  Participate in negotiations on behalf of the Company including settlements.   Claims Focus:  This position will provide  state specific legal representation before courts, arbitration panels and/or administrative bodies.  Serve in an advisory capacity to company and employees.  Prepare legal pleadings, motions, memorandums, trial briefs, etc. Conduct research where necessary, examine records, attend...

Job Description TITLE:                          Senior Property Adjuster DEPARTMENT :            EMA Loss Adjusting REPORTS TO:               Claims Manager STATUS:                       Regular, Full-Time, Exempt This is a field position in the Los Angeles, CA market. SUMMARY OF JOB PURPOSE :  The Senior Property Adjuster effectively determines and communicates the extent of loss or damage associated with commercial property claims in a variety of business classes. The Senior Property Adjuster is typically assigned loss or damage assessments in a moderate cost range, based on incumbent’s experience and demonstrated ability for handling larger or more complex claims. PRIMARY JOB RESPONSIBILITIES : Investigates insurance claims in any of a variety of settings, including, but not limited to, retail establishments, private or public office buildings, commercial habilitation, hospitality, corporate facilities, transportation sites, manufacturing sites,...

Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description Business Title(s):   Senior Commercial General Liability Bodily Injury Claims Adjuster   Employment Type:   Full-Time   FLSA Status:   Exempt   Location:   In-Office     Summary:    We are looking for a highly capable Senior Commercial General Liability Bodily Injury Claims Adjuster to join our team and work from any   one of   the our   offices in Albany, Chicago, Los Angeles, New York City, Omaha, Richmond (VA),...

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned   KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines Proficient in Microsoft Office applications Technical...