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

Oversee the management and auditing of all claims within assigned area of responsibility throughout the process from notice of loss to payment Communicate with agents, claimants, field staff and other key stakeholders around claim status, disputed claims, product documents, escalated questions and problems and general information requests Manage a field claims team by set

Distribute and direct losses and claim tracking for defined territory or agency base to support delivery of effective customer service and claim resolution and ensure team alignment with business goals Accurately document, process and transmit loss information in order to determine potential damages associated with difficult and complex claims Provide overflow support to

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

As a leader in the insurance and financial services industry, we hire the best employees to serve our customers. When you join our team, you can feel good knowing you are helping our customers recover from the unexpected. Our Team Managers are committed to leading and developing our employees to ensure they provide the best service for our customers. Responsible for first

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

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

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

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

Promptly respond to customer inquiries Take detailed notes with regards to warranty issues Verify warranty status and coverage by examining records, and explain provision and exclusions Develop, write and process warranties with accuracy Handle warranty requests in compliance with both company standards and legal requirements Develop accurate estimates and explain estimat

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

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

This position requires the ability to work independently researching and reviewing inquiries from members and providers. Also requires knowledge of benefit interpretation, claims reviews, CPT and ICD coding. Responsible for analyzing, researching, and managing appeal/grievance inventories from members and providers. Respond to inquiries using verbal and written forms of c

The Senior Member Advocate is a vital role in ensuring service excellence to Zelis clients and their members. The Senior Member Advocate is proficient in and supports all Preservice Outreach, Balance Bill Resolution, and No Surprises Act assignment categories. This position requires the ability to act independently within the scope of assigned duties and responsibilities

Senior Claims Examiner Workers Compensation Requisition ID 2024 24938 Job Locations US TX Dallas | US Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary GREAT WORK FROM HOME OPPORTUNITY! Offers Monthly Performance Incentive! Generous Employee Referral Bonus Program! Candidates must have experience in