12 legal jobs found in DeWitt, NY

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 role.   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...

The New England Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides technical and jurisdictional guidance to claims...

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 Team Lead | New York Jurisdiction | Dedicated Client We are seeking a highly motivated and experienced Workers' Compensation Claims professionals to join our team. The ideal candidate will have at least 5 years of claims handling experience, with a strong background in New York jurisdictional regulations and processes. Supervisory experience preferred. This position is responsible for supervising multiple teams of workers'...

The Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a Remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Expectation that Senior Claims Specialist maintain independent NY adjuster license as a casualty or general adjuster.  Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the...

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.  This is a remote role.    ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as...

The Professional Review Supervisor is responsible for the supervision of all operations within their designated department. This position functions as a member of the Bill Review Department leadership team, ensuring optimum team performance by providing exemplary support and assistance to achieve the organizational goals of excellent customer service of the bill review department and of CorVel. This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Directs a team of employees in their day-to-day operations and the quality of services provided, focusing on production, timeliness and quality bill review performance Establishes employee performance goals and follow-up to ensure employees are achieving goals, providing encouragement, training and counseling as needed Evaluates and maintains appropriate staffing levels to ensure all work product is completed within internal and external customer turn-around time expectations Has ongoing responsibility for...

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 role.   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...

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as...

The Administrative Assistant performs diverse administrative responsibilities for various levels of staff within the company. This position coordinates various projects and prepares reports and information which may be of a highly confidential and critical nature, supporting the goals of local management, and of CorVel. This is an On-Site role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Answers telephones. Handles inquiries appropriately May open, read, prioritize, route and distribute incoming mail or other materials May coordinate and maintain scheduling and event calendars, including travel dates and arrangements, appointments with customers, meetings and conference calls Organizes and maintains document storage May create and prepare presentations, memos, reports, correspondence and miscellaneous projects May schedule travel, meetings and other events, along with monitoring calendars and room reservations May assist in basic accounting functions...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Northern NJ and NYC area. Work from home, and on the road.  As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to discuss the current treatment plan...

Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent, timely delivery of our quality services. This is a hybrid role reporting to our Syracuse, NY office. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and professionally with callers and via email. Maneuver in the bill review application to obtain accurate information for the callers. Understand CorVel EORs as well as client-specific nuances. Answer basic to complex State WC fee schedule and/or billing questions on processed medical bills covering regular as well as facility bill types Understand and be able to properly explain provider contracted rates, carve-outs and special LOAs applied to medical bills Requires regular and...

We’re thrilled that you are interested in joining us here at the Amynta Group! As a member of Oryx Insurance Brokerage, Inc claims team, utilize knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex construction nature in order to achieve appropriate outcomes. In this position you will administer and resolve Workers Compensation claims in a timely manner in accordance with legal statues, policy provisions and carrier guidelines. Responsibilities: Promptly investigate all assigned claims with minimal supervision, including those of a more complex Construction nature. Determine coverage, compensability, potential for subrogation recovery, and other offsets  (when applicable). Alert Supervisor and carriers Special Investigations Unit to potentially suspect claims. Ensure timely denial or payment of benefits in accordance with jurisdictional requirements. Establish appropriate reserves with documented...