2 senior workers compensation claim representative jobs found

In this role you will apply Underwriting policy, philosophy & procedures to evaluate the acceptability of submitted or existing business. Based on qualifications and experience or the selected candidate, this position can be filled as an Underwriter Specialist or Underwriter Specialist Senior. What You’ll Do As an Underwriter Specialist you will work closely with sales personnel to obtain information needed to properly underwrite, price, and program individual policies and accounts. Additionally you will: Use manuals, established procedures, and information collected works on the more complex underwriting assignments and refer business outside of authority limit Be responsible for underwriting of the more complex, larger accounts and reinsurance placements Evaluate established procedures for effectiveness and recommend change Attend sales meetings to meet and confer with Sales Representatives/Account Managers in pursuing new accounts Train other...

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. 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...