239 bill review analyst ii jobs found

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...

Overview The Medical Bill Review Support Analyst supports the Medical Management department's key goals of enhancing cost containment. Provides strategic and technical bill review to assist claim offices and adjusters. Accomplishes Managed Care objectives by working processes; planning and evaluating adjuster activities and Medical bill review activities.  Technical abilities and industry-specific knowledge to review Workers Compensation medical bills.   *This role is hybrid out of our Dallas, TX office* Responsibilities Plan, execute, and oversee bill audits related to state fee disputes. Assist in the development of fee dispute processes, including overall management and monitoring programs. Perform fee dispute reviews and submit relevant formwork related to re-pricing and network vendors. Review and audit bills to verify correct billing practices and contractual rates. Ongoing development of cost...

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...

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...

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 Examiner adjusting position, collaborating with vendors, and/or virtually inspecting and estimating losses damaged by fire, water, weather, or other unexpected events.  The Property Claims Examiner will 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 Information An in-person interview may be required...

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 Business Advisor Senior, you will advise stakeholders by providing business planning guidance to include research, development, planning and implementation of procedures and processes to increase business viability and ensure compliance and/or product competitiveness and profitable growth. Develops and implements solutions to influence business decisions for relevant line(s) of business. Develops best in practice solutions to complex business challenges. Identifies opportunities to change, enhance, or...

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, 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 As a dedicated Bank Credit Risk Analyst Senior, you will have a strong background in credit risk strategy development for deposit and consumer credit portfolios to optimize profitable growth within risk appetite. You will own operational and compliance risk inherent in credit strategy. Additionally, you will track and monitor credit strategy performance as well as external factors impacting the credit risk exposure for bank portfolio products within the risk taxonomy.   Credit Risk Analyst Seniors use quantitative...

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 does not qualify for employer-sponsored work authorization.  Nationwide does not participate in the Stem OPT Extension program. Nationwide’s Technology Service Desk is an inbound call center supporting 25,000 plus associates/contractors and 100,000 plus agents. We provide break fix and troubleshooting support for passwords, network, connectivity, hardware, software, and mobile apps, etc. Our group is comprised of approximately 60 associates in Columbus and remote work from anywhere locations....

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...

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 hybrid 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...

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. 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...

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. Candidate must reside in California. 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...

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 .   The Hanover is seeking a Benefits Analyst II to play a key role in delivering a competitive, employee‑focused benefits experience. In close partnership with Human Resources leadership, this position supports the design, administration, and ongoing enhancement of our health, welfare, and retirement programs—ensuring these offerings align with business strategy and support employees throughout their careers. Success in this role requires strong attention to detail, sound judgment, and a consistent sense of urgency to deliver accurate, timely solutions in a fast‑paced environment. At The Hanover, we recognize that the way we work continues to evolve. We are committed to flexibility and empowerment...

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 .   The Hanover is seeking a Benefits Analyst II to play a key role in delivering a competitive, employee‑focused benefits experience. In close partnership with Human Resources leadership, this position supports the design, administration, and ongoing enhancement of our health, welfare, and retirement programs—ensuring these offerings align with business strategy and support employees throughout their careers. Success in this role requires strong attention to detail, sound judgment, and a consistent sense of urgency to deliver accurate, timely solutions in a fast‑paced environment. At The Hanover, we recognize that the way we work continues to evolve. We are committed to flexibility and empowerment...

The Solution Owner I supports the Personal Lines function/portfolio within the Strategic Alignment & Execution (SA&E) department. A successful candidate for this position will work collaboratively with business stakeholders, SO team members, and delivery teams to analyze and provide solutions to business goals. In this role, the SO will support alignment of strategy with business processes and initiatives, design of the product or solution to achieve strategic outcomes to achieve business outcomes by collaborating with delivery teams. Essential Duties & Responsibilities: Responsible for assessing business problems, consulting industry best practices, and offering creative solutions. Responsible for engaging stakeholders to understand the strategy, actions, initiatives and expected business outcomes and seek guidance regarding product features from SMEs, Business Process Leaders, Compliance, Legal, and other stakeholders. Ability to align solution...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   ***This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy. *** Claim Specialist – Bodily Injury – The Auto Club Group Reports to: Casualty Claim Manager II What you will do: (Primary Duties & Responsibilities) ACG is seeking a prospective Claim Specialist to work under minimal supervision.  In this position, you will: Handle highly complex new and reassigned auto and homeowner bodily injury liability claims. Adhere to ACG claim handling procedures, processes and guidelines. Complete...

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 The Collateralized Loan Obligation (CLO) Reporting Consultant II is primarily responsible for Bank Loan and Allstate Investment Management Company (AIMCO) trade settlement, report generation, analysis, and validation, as well as the AIMCO monthly/payment reports and post-payment date reporting. This role is also responsible for ensuring Collateralized Loan Obligation (CLO) calculations are accurate. It is critical for the CLO Reporting Consultant II keeps constant lines of communication open with various internal and external groups in...

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...