92 payment integrity analyst ii jobs found

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...

The CA Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage. This role aims to achieve optimal outcomes for both CorVel and our clients. The Senior Liability Claims Specialist handles litigated files and works with delegated authority, adhering to company best practices. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Investigates claims and handles Auto and/or General Liability claims Establishes reserves and authorizes payments within 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 Collaborates with team members on more complex or problematic claims as necessary Additional duties as assigned...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity USAA is looking for a talented, Bank Agile Product Owner Senior to work in Digital Servicing! As a Bank Agile Product Owner Senior you will work directly with the Bank Agile team to prioritize work to derive business outcomes while delivering on business commitments and ensuring the voice of the customer is strongly...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity We are seeking a detail-oriented Fraud Strategy Analyst II with a strong background in debit card transactions to join our team. In this role, you will be responsible for developing and implementing effective strategies to detect, prevent, and mitigate fraud. You will analyze transaction data, identify emerging fraud patterns,...

The WC 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   Workers’ Compensation  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...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Workers’ Compensation   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 position handling future medical claims. Candidates must hold a California self-insurance certification and must reside in California. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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 lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and...

The Indemnity 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 hybrid position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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 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 necessary...

The   Claims Specialist manages within company best practices low to mid Auto and/or General Liability claims, including bodily injury and property damage 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 auto and general liability 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 auto and general liability 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 necessary...

The Workers’ Compensation Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims under close supervision, supporting the goals of the Claims Department and of CorVel.  This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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 claims...

The Liability Claims Specialist manages non-complex and non-problematic Liability claims under direct supervision of a senior claims professional. This role aims to achieve optimal outcomes for both CorVel and our clients. The Liability Claims Specialist handles litigated files and works with delegated limited authority, adhering to company best practices. This is a remote role. Candidate residing in the Mid-Atlantic Region is preferred. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Manages non-complex and non-problematic medical only claims and minor lost-time liability claims under close supervision 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 Communicates claim status with the customer, claimant, and client Adheres to client and carrier guidelines and participates in claims review as needed...

The WC 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 hybrid position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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...

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 170 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 Technology Compensation Overview The annual base 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 salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program,...

The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collects supporting data and analyzes information to make decisions regarding accuracy of billing Appropriately documents work and final conclusions in designated computer program Understanding of Surgical Implants Meets department's expectations and standards  Additional duties as assigned   KNOWLEDGE & SKILLS: Understanding of Itemization Review for designated clients Understanding of CERIS systems and Data Base informatics Understanding of HIPAA regulations Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly Demonstrated leadership skills; ability to work with Leadership Team(s) within a positive team...

The WC 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 role is available for both remote and hybrid work arrangements. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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...

The   Claims Specialist manages within company best practices low to mid Auto and/or General Liability claims, including bodily injury and property damage 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 auto and general liability 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 auto and general liability 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 necessary...

The   Claims Specialist manages within company best practices low to mid Auto and/or General Liability claims, including bodily injury and property damage 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 auto and general liability 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 auto and general liability 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 necessary...

The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage. This role aims to achieve optimal outcomes for both CorVel and our clients. The Senior Liability Claims Specialist handles litigated files and works with delegated authority, adhering to company best practices. This is a remote position but candidate must reside in East Coast or Midwest. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Investigates claims and handles Auto and/or General Liability claims Establishes reserves and authorizes payments within 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 Collaborates with team members on more complex or problematic claims as...