114 professional review specialist ii 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...

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...

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   Position: AVP, Team Manager – GL BI and PD Reporting to: Claims Director, Property & Casualty         Band: II Location: Atlanta, Boston, Chicago, Hartford, New York, Scottsdale Flexibility: Permanent Travel: Hybrid   About Hiscox USA: Hiscox USA underwrites small- to mid-market commercial risks through brokers, other insurers and distribution partners and directly to businesses. In 2023, gross written premiums for the segment will represent over $1bn. Approximately 50% of the portfolio comprises small commercial business sold either online or through intermediaries, and the remaining 50% represents traditionally traded business intermediated through broking partners for Property and Casualty and Specialty Lines, including Professional Liability, Cyber, Technology and Media & Entertainment. Hiscox USA has built the digital business through ongoing investment in the brand, technology...

If you’re passionate about being part of a dynamic organization that enables a Fortune 100 company with nearly $70 billion in annual sales to drive innovation and adopt new technologies that deliver business results, then Nationwide’s Technology team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This role will work a hybrid schedule coming into the Columbus, Ohio, Des Moines, Iowa, or Scottsdale, Arizona office 2 days (Tuesday & Thursday) per week. Remote internal associates may also be considered. The successful candidate will focus on internal development within Technology Operations supported tools and possesses some of the following competencies: General understanding of IT Service Management processes and best practices (Event, Incident, Problem, Change, Configuration Management,...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This is a field-based role on the National Catastrophe Response Team. This position is responsible for managing property claims in response to catastrophic events across the country. As a field-based adjuster, you will be deployed to areas impacted by large-scale disasters—such as hurricanes, tornadoes, floods, or other major events—to assess damages, support policyholders, and help communities begin the recovery process.  The role requires extensive travel (up to...

Position Title Credit Products Specialist II - Franchise Finance Location Nationwide, MI 48098 Job Summary The Credit Products Specialist II – Franchise Finance plays a key role in structuring and underwriting complex commercial credit transactions while managing an assigned loan portfolio within a specialized vertical or region. This position is responsible for independently analyzing credit risk, negotiating loan terms, and providing strategic recommendations to relationship and credit teams. By proactively monitoring portfolio performance and identifying emerging risks, this role ensures sound credit decisions and long-term client success. The position also supports the professional development of junior team members by sharing expertise and best practices. Job Responsibilities: JOB RESPONSIBILITIES Credit Structuring & Underwriting : Lead underwriting efforts for complex loan requests, assessing creditworthiness and recommending risk-mitigating...

The Float 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 role is available for both remote and hybrid work arrangements. 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...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This is a fully remote position. The ideal qualifications for candidates applying for this role include: 3–5+ years workers’ compensation claims experience, with strong lost-time and litigation handling Experience in Illinois, New Jersey, and Pennsylvania preferred Proven ability to independently manage a full caseload, including reserves, settlements, and claim strategy Strong communicator with experience collaborating across claimants,...

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...

Position Title Credit Products Specialist II - Counterparty and Insurance   Location Charlotte, NC 28202   Job Summary The Credit Products Specialist II –Counterparty and Insurance plays a key role in structuring and underwriting complex commercial credit transactions while managing an assigned loan portfolio within a specialized vertical or region. This position is responsible for independently analyzing credit risk, negotiating loan terms, and providing strategic recommendations to relationship and credit teams. By proactively monitoring portfolio performance and identifying emerging risks, this role ensures sound credit decisions and long-term client success. The position also supports the professional development of junior team members by sharing expertise and best practices.   Job Responsibilities: JOB RESPONSIBILITIES Credit Structuring & Underwriting : Lead underwriting efforts for complex loan requests, assessing creditworthiness and recommending...

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...

At Arbella, we’re focused on people. We work hard to attract and retain the best. That means providing a great work environment, encouraging work/life balance, offering flexible work arrangements, competitive salaries and exceptional benefits packages. We invest in our employees and encourage them to grow so that we, too, can grow as a company. Other perks include: • On-site gym and fitness classes and one-on-one personal training • On-site nurse, nutritional counseling, and mental health resources • Full-service cafeterias • Free shuttle service to Quincy Adams T Station • Tuition assistance programs • Opportunities to get involved: Arbella Activities Committee, Diversity and Inclusion Council, and more • A company committed to community: volunteer opportunities, employee-led community efforts, and the Arbella Insurance Foundation • Robust training, mentorship, and professional/personal development programs • Colleagues who genuinely care about each other Arbella...

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 hybrid 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 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 hybrid role. 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 Collaborates with team members on more complex or problematic...

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 role. 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...

Overview Position Summary:   If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors.  The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers.   Geo-Salary...

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   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 hybrid 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...

Description At Liberty, you'll thrive in a hybrid setting that fosters in-person collaboration, innovation and growth. This approach optimizes both remote and in-person interactions, enabling you to connect and ideate with your team and deepen valuable relationships across the company, while still enjoying the flexibility of remote work for focused tasks and projects.   The Workers Compensation Claims Specialist works within a Claims Team under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts.   We are open to filling this position as...