Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. verify pricing, prior authorizations, applicable benefits) Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, st

Work From Home (WFH) This is a WFH position. The applicant must live within a one (1) hour radius of Dallas/Fort Worth and be available to come to the office for equipment pickup exchange, office meetings, and training, etc. Additional details in regard to WFH shall be discussed as part of the interview process. Shift 8 hour flex shift between 6am to 6pm Monday through Fr

The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Additional Information The Member Advocate will serve as a Liaison between the Members and Cook Children's Health Plan (CCHP). The Member Advocate will help Members and their Legally Authorized Representatives (LARs) navigate through the complexities of the healthcare system. The Member Advocate will guide and educate Members on their benefits, Member Rights & Responsibil

The Claims Examiner Senior is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements. Responsibilities Meet and/ or exceed claims processing production requirements Maintain statistical accuracy of 98%, and financial accuracy of 98% Correct DoD error report as needed, respond

Providence caregivers are not simply valued they're invaluable. Join our team and thrive in our culture of patient focused, whole person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence is calling a Sr. Medical Malpractice Claims Manager Profes

Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics to select the best benefit plan o

Bachelor's or Associate's degree preferred or equivalent business/industry experience Insurance industry designation(s)/certification(s) preferred Demonstrated proficiency with Microsoft Office products and claims related software programs including Xactimate and XactAnalysis. Strong communication skills Experience in conflict resolution and problem solving Working knowle

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the Claims Settlement Specialist must understand (1) the procedures bi

Provide executive level administrative support to the Internal Audit team. The position requires a dependable, detail oriented individual with the ability to work in a high paced environment while planning and scheduling tasks and ensuring efficient, accurate and timely completion. Will be required to Interact with all levels of management. Maintain the security of confid

Claim Examiner Workers Compensation Requisition ID 2024 25201 Job Locations US TX Dallas Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary Investigate, evaluate, negotiate, and settle moderate difficulty type claims; takes appropriate action to achieve results that have a positive impact on profitab

Commercial Property Complex Adjuster Job Locations US United States | US NJ TBD Requisition ID 2024 16664 Category Claims Property Position Type Regular Full Time Overview A Commercial Property General Adjuster is responsible for investigating, evaluating, and resolving large and complex property claims involving commercial buildings, equipment, and inventory. The adjuste

TMC Bonham Hospital is a 25 bed critical access hospital that includes both primary care and specialty physicians. The Critical Access Hospital, offering both inpatient and outpatient services along with 24 hour emergency services. The Critical Access Hospital (CAH) Program was established to assure access to healthcare services for rural residents. The program provides r

Responsible for performing all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for the tracking of concerns, complaints and issues raised by network providers, and results reporting. Facilitates resolution of all complaints/issues raised by network providers relate

Loss Investigation Specialist Seasonal Requisition ID 2024 24507 Job Locations US TX Dallas Position Type Commissioned Hourly Category Claims Business Unit CUS_Loss Adjusting US Excellence In Everything We Touch Position Summary Under direct supervision, this position will support the loss investigation process and report obtained information in a timely and efficient man