335 bill review analyst i jobs found

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a hybrid role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify problems and...

Responsible for receiving and entering medical claims while maintaining accuracy and meeting turnaround requirements. The Setup Analyst provides a higher level skillset, supporting the goals of the Setup department, personal growth, and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Ensure bill is eligible for MCS review Handle / organize bills to be entered in a timely fashion Enter bill proficiently and accurately into internal system Communicate any special handling of each claim Maintains production standards and production requirements Comply with standard protocol for processing problem claims Responsible for high profile clients, including production, QC, communications, etc. Train new employees Function as back-up for filter or filter leads Requires punctual and consistent attendance Must be willing and able to work overtime as required Assist co-workers, supervisor and management in accomplishing...

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 Professional Review Analyst 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 remote role. Candidate must be located in the greater Charlotte, North Carolina Region and able to attend in office training for a minimum of 1 week at start of employment. 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...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description Join Allstate Technology Solutions, a pioneering force committed to revolutionizing the way our employees, agencies, and customers interact digitally. Our mission is to harness cutting-edge technology, innovative product design, and the power of artificial intelligence to create a world‑class customer experience. We aim to redefine the customer experience, ensuring consistency and operational efficiency across all touchpoints and channels. Become a part of our story. At Allstate Technology Solutions, you’ll find a collaborative and...

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 hybrid role.  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...

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...

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 role. 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...

Discover a Career That Empowers You — Join HUB International! At HUB International, we’re more than just an insurance brokerage firm — we’re a thriving community of entrepreneurs driven by purpose and passion. Every day, we help individuals, families, and businesses protect what matters most by providing a broad array of insurance, retirement, and wealth management products and services. But we don’t stop there — we also invest deeply in our people. Here, your career is in your hands. You’ll be empowered to learn, grow, and truly make an impact. Whether you're supporting a local business or helping a national client navigate complex risk, you’ll be backed by the strength of a global firm and the heart of a regional team. As one of the world’s largest insurance brokers — and a proud Stevie Award-winning workplace — HUB offers a unique blend of big-company resources and entrepreneurial spirit. With over 20,000 professionals across 570+ offices in North America, we bring...

Company Details   W. R. Berkley Corporation is comprised of 60+ businesses alongside Berkley Technology Services (BTS) and other shared services groups. Here at Berkley Technology Services, the core of our success is our people. Our teams bring their own unique perspective and experiences which enables us to translate the needs of our business to deliver adaptable, secure solutions while providing an unmat ched user - focused experience. Our tagline “Thoughtful Minds | Empowering Possibilities” was crafted with our own teams in mind. At BTS, our teams thrive i n Berkley’s decentralized model - leveraging the power of being part of a long standing, heritage brand with extensive expertise whi le innovation and being entrepreneurial is encouraged. Internally, we operate as a relatively flat organization valuing communication and feedback. We pride ourselves in an open - door policy where no one is treated differently based...

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 Decision Science Analyst Senior, you will provide decision support for business areas across the association. Staff in this area will be responsible for applying mathematical and statistical techniques and/or innovative /quantitative analytical approaches to draw conclusions and make 'insight to action' recommendations to answer business objectives and drive change. The essence of work performed by the Decision Science Analyst involves gathering, manipulating and synthesizing data (e.g., attributes,...

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 In this pivotal role as a Senior Benefits Advisor for Health & Welfare at USAA, you will take direct stewardship of our comprehensive medical and pharmacy benefit programs. You will cultivate and manage deep engagement with key partners, ensuring the effective design, implementation, and ongoing administration of health and welfare benefits, with a sharp focus on medical and pharmacy offerings. You will play a crucial part in shaping the employee experience related to healthcare benefits, ensuring our...

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 Digital/Technical Product Manager - Intermediate Level the candidate selected for this role will support the discovery, delivery, and ongoing performance of our IVR/IVA experience for all calls coming to USAA. This person will be instrumental in optimizing the member experience across our voice platform. This position offers an opportunity to shape the future of our voice technology by driving the implementation of our product by analyzing performance data and reporting insights to inform optimizations and...

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 We are seeking a dedicated Product Development Director to support the Property and Casualty (P&C) Business Development area. This is a non-people leading director role that will work closely with this team to monitor product performance and data insights.   This role is accountable for developing new products, overseeing and managing the launch and maturation of new products into target strategic markets. Acting as a cross functional expert, this position provides expertise and support for product line...

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 We are currently seeking a talented Business Strategy and Planning Manager at our San Antonio, Texas corporate headquarters location. As a dedicated Business Strategy and Planning Manager, you will prepare high-quality presentations, reports, and briefing materials tailored to diverse executive audiences, including company Presidents and the Chief Legal Officer, ensuring clarity, precision, and alignment with strategic objectives. Conducts strategic analyses of business needs and environmental trends in support of...

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, 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 member value is preserved via risk mitigation. Responsible for prioritizing the Bank agile team backlog to drive business outcomes in service to Member Protection. Acts as ‘voice of the end-user’ to drive accountability with business and technology partners. Brings a data-driven approach to decisions and impediment...

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 Corporate Communications Principal , you will be a key member of the Corporate Communications Leadership Team operating as a strategic communication advisor directly to the Executive Leadership Team and other high-level executives. You will leverage your deep subject matter expertise to lead proactive and strategic communications initiatives and leader communications to drive business goals while aligning with the USAA brand. You will be a strategic communicator that lives the USAA Mission and keeps...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description The Material Damage Claims Adjuster is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. National General seeking an experienced Material Damage (MD) Claims Adjuster, preferably located in the CST or MST time zones. The ideal candidate will possess exceptional communication skills, a strong customer service orientation, keen attention to detail, a metrics-driven mindset with the ability to meet performance goals and strong organizational skills to...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description This job is responsible for investigating and analyzing complex and occasionally highly complex, multi-discipline coverage and claims that have been referred to the special investigation unit (SIU) for potential fraud. This role typically handles a combination of complex attorney represented and unrepresented claims and complex losses and claims involving extra-contractual liability, medical losses in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background...

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 role. 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...