24 bill review analyst i jobs found in Folsom, CA

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify problems...

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify problems and find effective...

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned     KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify...

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 position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: 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 case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Provider Relations Specialist assists providers via phone and email with bill review questions and requests of varying complexity. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and professionally with providers and other stakeholders via phone and email Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review Navigate 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...

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...

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 position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: 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 case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of the Claims Department and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgement of the claim Determines the validity and compensability of the claim Establishes reserves and authorizes payments within established reserving authority limits 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 necessary Additional duties as assigned   KNOWLEDGE & SKILLS: Excellent customer service skills Excellent written and verbal communication skills Fast learner; develops knowledge and understanding of...

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 position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: 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 case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of claims department and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgement of the claim Determines the validity and compensability of the claim Establishes reserves and authorizes payments within established reserving authority limits 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 necessary Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent Customer Service Skills Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and...

Description Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers an exciting opening for a Workers Compensation Claims Specialist within the West Region!   As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements, and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. You may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Depending on your overall skills and experience, you may be considered as a Claims Specialist II,...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Software Quality Assurance Engineer 2 with extensive software QA technical expertise to join our dynamic QA team. This individual will design, develop, and maintain test scripts and automation Frameworks. The ideal candidate should have strong experience in Selenium/Python, Playwright/TestScript and C Sharp , along with a deep understanding of UI, API and Database automation environments.   KEY RESPONSIBILITIES Design, develop, and maintain automation for various applications – UI, API and Databases. Review in detail, test plans and test cases to transform them into automation regressions. Collaborate with QA team members and other stakeholders to understand test requirements and implement automation. Implement best practices for DevOps and CI/CD pipelines, ensuring smooth and automated deployments across environments. Participate in automation code reviews, providing...

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Underwriting Compensation Overview The hourly salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual hourly rate for this position will be determined by a number of factors, including the scope,...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a mid-level Technical Product Owner in its Walnut Creek Office. The TPO 2 will be responsible for owning the delivery of complex IT products and solutions from concept to deployment and will work closely with technical teams to translate high-level business requirements into detailed technical specifications aligning with the organization's strategic goals, while leveraging technical expertise and product management experience to enhance product delivery, improve team efficiency, and support the product's vision and roadmap. Area of Focus: Marketing KEY RESPONSIBILITIES   PRODUCT BACKLOG OWNERSHIP & REFINEMENT Takes full ownership of managing, grooming, and prioritizing the product backlog in alignment with business objectives. Writes detailed, clear, and actionable user stories and epics, incorporating technical requirements and constraints. Collaborates with...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Software Engineer 2. This individual will need extensive technical expertise to join our dynamic development team. Responsibilities include designing, developing, and maintaining software solutions in a hybrid development environment, encompassing on-premises, cloud, and hybrid infrastructures. The ideal candidate should have strong experience with C#, .NET, and React, along with a deep understanding of modern development practices across various environments.   ESSENTIAL RESPONSIBILITIES Design, develop, and maintain software solutions using C#, .NET, and React in on-premise, cloud, and hybrid environments. Collaborate with product managers, architects, and other developers to gather and translate business requirements into technical specifications. Contribute to the architectural design of systems, ensuring scalability, performance, security, and maintainability. Build...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a mid-level DevOps Engineer. This individual supports the selection, design, implementation, and ongoing operation of the infrastructure environment and resources both on premises and in the Azure cloud. This involves collaborating with other infrastructure staff, development staff, and/or consultants in developing, configuring, maintaining, supporting and optimizing infrastructure systems.   Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status.   ESSENTIAL RESPONSIBILITIES Participates in defining infrastructure system roadmap and the development of long-term strategies to manage and scale the services provided by the Infrastructure Platform Administration team.  Develops, implements, and maintains infrastructure systems configurations, procedures, and associated training plans.  Prepares,...

As our business continues to grow, we are expanding our capabilities in harnessing cutting-edge AI advancements. We seek a highly motivated problem solver who thrives in addressing complex challenges with innovative solutions. This team is dedicated to adapting the latest AI technologies to drive value for our business. You'll be joining a small, focused, and fast paced team that plays a critical role within a broader organization of excellence. If you're eager to be at the forefront of AI innovation and ready for impactful work, we want to hear from you. This team and this position are physically located in our downtown San Francisco, CA office. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:   Develop, maintain, and enhance complex software systems leveraging state-of-the-art AI models.   Conduct requirements analysis, software design, peer reviews, and maintain thorough documentation.   Implement software engineering best practices including iterative...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description The Investigative Specialist will work through interesting and unique claims files to verify the validity of the claims. They will also be responsible for investigating and confirming the facts of loss for basic to advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. This position supports our West Coast claims team. The ideal candidate will be located in the Pacific Time Zone; however, candidates outside the Pacific Time Zone may be considered if they are able to work Pacific Time Zone hours. Every claim...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. Every claim presents a new challenge. This role is ideal for someone who enjoys problem-solving, analyzing information, and making confident decisions while supporting customers and internal partners. Key Responsibilities • Applies increased experience in the Adjuster II level or a rotation into a specialty position (Coverage, Investigation Specialist, Total Loss, Initial Handler,...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description National General Insurance is currently hiring an Attorney-Represented Bodily Injury Claims Adjuster. The ideal candidate will be based in one of the following Pacific time zone states: California, Nevada, Oregon, Arizona, and possess experience in handling homeowner, commercial, or auto liability claims. Candidates must be able to work 8am--5pm Pacific time zone hours. Litigation experience may be necessary for this role. The ideal candidate will possess strong analytical skills, excellent attention to detail, and the ability to effectively manage and negotiate claims. Responsible for investigating and...