4 siu field investigator jobs found

SUMMARY:   The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision. Primarily responsible for the investigation and management of workers’ compensation claims. Conducts one point contact on the managed claims, determines compensability of claims, manages the medical treatment program, and confirms the claimant’s disability will not exceed waiting period timelines.  This includes calling and discussing potential claim activity and work-related injuries with policyholders, and claimants, providers, attorneys, agents, and state agencies, when necessary.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Investigates workers’ compensation claims including a mandatory contact to the employer within the required time frame with additional contacts to the employee or provider, as necessary.   Inform medical providers of billing address and billing...

Perform technology functions to include but not limited to business and systems analysis, application development and process improvement. Serve as a liaison between the business area and the IT organization when needed. Identify, document and communicate system and process changes necessary to improve system and operational performance measures.  Possess an in-depth knowledge of line of business while contributing to the identification, analysis and recommendation of technical process improvement initiatives. Design, create and implement technical solutions. Support complex business processes. Conduct data gathering and analysis to understand business strategy requirements. Provide direction for short and long-term planning sessions and provide direction to ensure understanding of business goals and direction. Evaluate ongoing department activity and propose new tools or technologies Assist in the business process redesign and documentation as needed for new technology....

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. 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 in compliance with all state regulatory requirements. Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling....

Department Preferences Technical Experience Minimum 3 years SQL experience required Minimum 1 year python experience preferred 1 year Databricks preferred Data analysis experience 3 years healthcare experience required Risk Adjustment experience preferred   Responsible for planning, organizing, directing, implementation, and leading department assignments.  Position operates within broad objectives to ensure optimum utilization of manpower and budget.  Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements. Leads in the research, analysis, identification and evaluation of data from assigned problems to evaluate existing and potential trends and issues. Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research...