3 claim examiner associate jobs found

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 hybrid position until fully trained. Training will be full-time onsite. 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...

Job Type: Permanent Build a brilliant future with Hiscox   Join our dynamic and forward-thinking Claims team! Here, you’ll be part of an energetic and innovative group, with the chance to help shape insurance products and collaborate with business leaders throughout the organization. Our Complex Claims Specialist-Miscellaneous Professional Liability role is an individual contributor responsible for the handling of mid to high-severity primary Miscellaneous Professional Liability claims for the organization from inception to resolution.  This includes, but is not limited to, insurance agents, property managers, tax preparers, and various consultants. This role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required.  The Role: Adjusts and resolves complex mid to severity claims that include all phases of...

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.   Job Description: The opportunity: The Employee Benefits Internal Specialist, Group Underwriting position supports the Sales Representative with all aspects of the Request for Proposal (RFP) process through to sold case. This position provides key support to assigned Employee Benefit Representatives (EBR)/Small...