406 provider relations specialist jobs found

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* The Workforce Accommodations Specialist will work closely with the employee, healthcare provider and employer to explore accommodations that will assist the employee in performing the essential functions of their job. The Specialist reviews complex medical information for temporary and permanent accommodation requests; and works with the client to identify reasonable accommodations under the ADAAA, state law, PWFA and/or client requirements.     Duties and Responsibilities: Conduct thorough and confidential assessments of accommodation requests, including reviewing medical documentation and engaging in an interactive process with employees and their supervisors/HR Partners. Serve as the primary point of contact for employees with disabilities, providing guidance and support in requesting and implementing reasonable accommodations. Manage a caseload of open accommodation...

Position Summary:   The Employee Response Center (ERC) Benefits and Claims Specialist is a key role in the Financial Services Day 2-ERC Department at Higginbotham. The roles is responsible for ensuring a thorough knowledge of claims, research tools, and resources to serve employees and employers effectively. This role is centered around evaluating and reviewing claims with precision and accuracy. The individual must be meticulous to determine the claims’ validity and ensure that insurance carriers’ payments are made per policy terms and regulatory requirements. The ERC Benefits and Claims Specialist will also support as backup to the ERC Benefits Specialists, take employee calls, and respond to emails and texts as needed during non-peak and peak times. Supervisory Responsibilities:   None Essential Tasks: Maintaining documentation, spreadsheets, products, and services as requirements change Serving as a subject matter expert on reviewing and assessing insurance...

Investigate and resolve litigated claims in an efficient and accurate manner- negotiate settlements, and communicate effectively with policyholders, vendors, and other stakeholders. What You’ll Do: As a Claims Representative Specialist on our PL – Litigation team, you'll provide prompt claims investigation, evaluation, and settlement or denial of litigated claims. In addition, you will: Verify coverages through investigation and reviewing policy terms, conditions, and language. This may require working with coverage counsel in filing declaratory/summary judgements. Evaluate liability by taking recorded statements from involved parties and witnesses and reviewing police reports accident scene photos and other pertinent evidence. Negotiate claims settlements with claimants and their legal representation within assigned authority limits. Comply with industry regulations, legal requirements, and internal policies through thorough documentation of all decisions correspondence...

National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences...

The salary range for this job posting is $43,950.00 - $70,319.00 annually + bonus + benefits. Pay Type: Hourly The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. Encova Insurance is seeking a Billing and Payment Specialist to work a flexible hybrid role from our Columbus, Ohio location. This role will report to the Director, Treasury Operations. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral...

The salary range for this job posting is $43,950.00 - $70,319.00 annually + bonus + benefits. Pay Type: Hourly The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. Encova Insurance is seeking a Billing and Payment Specialist to work a flexible hybrid role from our Charleston, WV location. This role will report to the Director, Treasury Operations. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral...

Position Summary The Retirement Benefits Specialist performs technical and administrative duties associated with the processing and verification of participants' retirement benefit inquiries and applications in accordance with Company policies, regulatory requirements, and plan guidelines.   "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."   Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s). Scans applications and all relevant documents into appropriate system. Processes retirement benefit applications; verifies the accuracy and completeness of information, researches or investigates past service, related credits, and insurance deductions. Responds to inquiries from participants, beneficiaries, and union representatives, directly or indirectly, regarding retirement benefits. Determines benefit eligibility and requests necessary documentation from...

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.   Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.   Our field team members are located in every state in which we operate.   Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best. Essential Job Functions and Responsibilities Assists in developing and maintaining actuarial models to support risk assessment and pricing strategies. Analyzes datasets to identify trends and...

National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences...

National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences...

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 As a dedicated Property Adjuster Specialist , you will work within established guidelines and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes coverage, recognize liability exposure and negotiate equitable settlements...

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 remote position, but will require approximately 30%-40% travel, including overnight travel. The ideal candidate is an experienced property claims leader who can effectively balance operational performance, technical excellence, customer experience, and associate development across a geographic territory. The preferred location for this position is Texas or west of Texas, including: Washington, Oregon, California, Nevada, Arizona, Utah, Idaho,...

SUMMARY The Senior Commercial Insurance Field Underwriting Specialist (internal title: Senior Business Development Specialist) drives profitable growth, retention, and agency engagement for Accident Fund Commercial Markets Small Business across Western to Mid-Michigan. This field-based role develops and manages independent agency relationships, evaluates and underwrites complex commercial insurance risks within assigned authority, and identifies new business opportunities. Working closely with internal partners, the specialist delivers responsive solutions, supports territory strategy, and serves as a key market representative through regular agency visits and business development activities. ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Evaluates prospective and existing accounts for eligibility, insurability, exposure, and pricing; prepares quotations and accepts or declines business within assigned underwriting...

Plans and delivers safety/risk management services to insured customers and internal associates. We are currently seeking a risk control professional that is technically proficient, self-motivated and results driven to fill an open position within our East Shared Services division. You will conduct comprehensive safety and risk management assessments, provide our Underwriting teams with a strong analytical opinion of risk to support our goal of profitable growth within variety of middle to large premium market segment for Dealerships, Construction, Manufacturing, Wholesale Trade, Retail, Commercial Real Estate and Service industries.  In addition, the successful candidate will develop close relationships with our agents and policyholders, conducting selected safety seminars and training, to build the value-added service that Sentry is known for.   The ideal candidate's preferred location would be in or around the Hartford, CT area. We are searching for an individual who is...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Middle Market department is seeking a Senior Sales Underwriter to join our growing team for our Central/Western Michigan territory .   This is a Full-time, Exempt role.   This is a Hybrid position.     Position Overview/Summary: Responsible for identifying, soliciting, underwriting and selling new and renewal Middle Market accounts that drive profitable growth and align with Industry Segments, appetite and mix goals. Apply advanced technical, sales and analytical skills to provide insurance solutions that help Hanover’s customers manage risk. Demonstrates a thorough understanding of Hanover’s strategies and appetites and will use internal and external data to make...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Middle Market department is seeking a Senior Sales Underwriter to join our growing team for our Central/Western Michigan territory .   This is a Full-time, Exempt role.   This is a Hybrid position.     Position Overview/Summary: Responsible for identifying, soliciting, underwriting and selling new and renewal Middle Market accounts that drive profitable growth and align with Industry Segments, appetite and mix goals. Apply advanced technical, sales and analytical skills to provide insurance solutions that help Hanover’s customers manage risk. Demonstrates a thorough understanding of Hanover’s strategies and appetites and will use internal and external data to make...