Manage the provider data ticketing queue, ensuring timely resolution of requests.
Partner with team members to obtain required data elements and validate completeness.
Identify and implement opportunities to streamline provider data structure and workflows.
Curana Health is committed to radically improving the health, happiness, and dignity of older adults. They serve 200,000+ seniors in 1,500+ communities across 32 states, with over 1,000 clinicians, care coordinators, analysts and professionals.
Lead the resolution of complex financial and benefits billing escalations to ensure accurate member financial tracking.
Perform root-cause analysis on multi-system issues, coordinate corrective actions, and reconcile claims data across platforms.
Act as the primary bridge between internal and external teams to clarify issues and expedite resolutions while communicating clearly with members.
Maven Clinic is the world's largest virtual clinic for women and families, providing clinical, emotional, and financial support through its digital platform across fertility, maternity, parenting, and menopause care. It is an award-winning, mission-driven company trusted by over 2,000 employers and health plans, with a culture recognized for innovation and as a great place to work.
Supports Medical Policy Directors (MPD) through various aspects of the New Policy processes.
Performs multi-faceted data and report analytics to provide accurate client or policy information.
Researches and examines client questions and drafts accurate responses.
Cotiviti provides payment accuracy and analytics-driven healthcare solutions. They have a large team, and cultivate an inclusive and equitable environment for all employees.
Analyzes and answers inquiries regarding pharmacy claims adjudication.
Adjudicates pharmacy claims and processes pharmacy claims for payment.
Performs varied activities and moderately complex administrative/operational/customer support assignments.
Humana is committed to helping people live healthy lives, creating personalized experiences, and working collaboratively. They offer medical, dental, and vision benefits, a 401(k) retirement savings plan, and paid time off.
Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually. The Coherenauts who succeed here are empathetic teammates who are candid, kind, caring, and embody their core values and principles.
Responsible for performance, development, and coaching of staff.
Work with claims team and external attorneys to review coverages and resolve claims.
Partner with underwriting managers to provide excellent customer service.
Liberty Mutual is committed to delivering exceptional service and making a meaningful difference for customers. They strive to be the most trusted global brand and the best place to work, focusing on profitability and scale.
Investigates claims using internal and external resources, analyzing reports and researching past claim activity to make damage and loss assessments.
Determines policy coverage through analysis of investigation data and policy terms, establishes claim reserves, and negotiates settlements within authority limits.
Maintains accurate claim file documentation throughout the life cycle of cases and alerts leadership to potential fraud or subrogation issues.
Liberty Mutual is a diversified global insurer and the third-largest property and casualty insurer in the United States. The company fosters an inclusive culture where everyone feels valued and can thrive, supported by comprehensive benefits and a commitment to professional development within a large corporate environment.
Monitor client inventory in Machinify and client systems, perform requirements gathering, and implement processes to resolve client issues.
Enter, track, and follow up on tickets to ensure timely resolution for client production issues and support internal Operations teams through regular meetings.
Support client invoicing and reconciliation processes, generate client reporting, and act as a liaison between clients and internal IT/Operations teams.
Machinify is a healthcare intelligence company that specializes in AI-powered solutions for payment integrity and cost management across the healthcare payment continuum. The company is a digital-first organization with a culture that empowers employees to do their best work in a flexible and trusting environment.
Prepare and file mortgage insurance claims, reconciling advances and validating supporting documents.
Maintain clear records and reports for management, assist with updating workstations, and track claim payments.
Conduct research, manage a task queue, and communicate effectively to work independently and meet deadlines.
LoanCare is a leading full-service mortgage loan subservicer for banks, credit unions, and other financial institutions, supporting over 1.8 million loans. Backed by Fortune 500 company Fidelity National Financial, it offers a culture built on integrity, innovation, and collaboration, providing resources for employee growth and flexibility.
Coordinate responses to service escalations, including investigation and documentation.
Perform root cause analysis of service escalations to identify improvement opportunities.
Assist in identifying and developing Operations Reporting and Underwriting manuals.
Fetch is dedicated to helping pets live their healthiest and happiest lives through comprehensive insurance coverage. They are a high-growth Warburg Pincus portfolio company with over 350 pet-loving employees shaping the future of pet health and wellness.
Proactively resolve production concerns and assist the management team with balancing and assigning work daily.
Use reporting resources to deliver the most up-to-date data for the CV management team.
Maintain job aids and training documents; serve as an SME for process workflows on key clients.
Cotiviti provides healthcare solutions and analytics to its clients. They focus on improving healthcare outcomes and reducing costs through data-driven insights. The company is an equal opportunity employer that values its employees and offers a comprehensive benefits package.
Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Accountable to meet and maintain established department production and quality standards.
Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.
Analyze Auto Bodily Injury and Property Damage claims on behalf of clients to determine benefits due.
Ensure ongoing adjudication of claims within service expectations and industry best practices.
Negotiate settlement of claims within designated authority and communicate claim activity with the claimant and the client.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.
Make outgoing calls for messages received regarding new claims
Enter new claim information into the client website
ClaimsPro LP is an international programs group that handles a variety of claims including auto physical damage and property damage. They are Canada's largest privately owned provider of insurance services empowering employees with the tools and technology to provide clients with the highest quality of service.
Performs advanced level work related to denial management.
Processes and follows up on all appeal types, at an expert level, to all payers.
Takes actionable steps to resolve open claims, including refiling or appealing claims, or resolving manual tasks.
US Anesthesia Partners is a company that provides anesthesia services. They provide equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, or disability.
Report, oversee, monitor, and investigate insurance claims across all jurisdictions.
Partner with insurance carriers to mitigate loss by evaluating and implementing tools.
Develop, implement, and improve scalable processes and training to build a best-in-class claims function.
Instawork's AI-powered labor marketplace helps local businesses scale and enables global technology companies to push the frontiers of robotics and AI. They connect more than 7M skilled workers with local restaurants, hotels, warehouses, stadiums, and more.
Collaborate with internal and external partners to improve data quality, streamline concept development, and optimize workflows.
Translate business needs into analysis by providing healthcare business knowledge with data, technical, and analytical expertise.
Perform data analysis and ensure implementation meets client and business requirements, functioning as a consultant to translate information needs into specifications.
TREND Health Partners is a tech-enabled payment integrity company facilitating collaboration between payers and providers to reduce waste and improve healthcare access. It is a dynamic and growing organization that promotes a collaborative and innovative work environment.
Review, investigate, and manage PIP claims from initial notice through resolution.
Analyze medical records, treatment plans, billing submissions, and police reports.
Evaluate claim validity and determine exposure based on applicable state PIP regulations and policy guidelines.
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Investigates claims to determine coverage, analyze policy provisions and draft coverage position letters.
Establishes liability, verifies damages, and resolves claims within authority, recommending case value and resolution strategy.
Works with defense counsel, manages litigated files, and identifies/handles suspicious claims and claims with subrogation potential.
Liberty Mutual strives to create a workplace where everyone feels valued and supported. They welcome diverse perspectives, embedding inclusion in their culture to foster an environment where individuals can thrive and make a meaningful impact.