Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Conducts audits of highly complex accounts substantiating accuracy of policy classifications.
Develops proper premium basis on risks adhering to strict time deadlines.
Conducts interviews with the insured to obtain information regarding the insured's operations and business model.
CNA strives to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. They are focused on success, individually and collectively and pride themselves on promoting a culture that challenges and engages people.
Conduct in-depth analysis of claim payments, identifying trends and patterns for cost avoidance through internal and external collaboration.
Ensure medical claims comply with guidelines, contracts, and standards while detecting billing inefficiencies and recommending corrective actions.
Provide data-driven recommendations to management on payment-affecting issues, supporting necessary system and policy updates and provider education.
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.
Investigate and determine whether medical insurance claims are recoverable from a liable third party.
Communicate and negotiate with healthcare plan members, insurance adjusters, and attorneys.
Utilize computer systems to accurately document collected information.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. With over 85 health plans and 270 million lives represented, we bring together a configurable, AI-powered platform along with expertise.
Prepare documentation, review claim history, and investigate requests.
Utilize available resources to investigate claim situations for cases.
Follow-up with responsible departments and delegated entities to ensure compliance.
Centivo is an innovative health plan for self-funded employers, aiming to provide affordable, high-quality healthcare. They work with employers ranging in size from 51 employees to Fortune 500 companies and are headquartered in Buffalo, NY with offices in New York City and Buffalo.
Investigate complex Homeowners/Commercial claims to confirm facts and cause of loss.
Compare investigation facts against policy to determine coverage of claim.
Assess and determine extent of damages, document with photos, measurements, repair estimate.
Mercury has been helping people reduce risk and overcome unexpected events for over 60 years. They are a team that encourages growth, fun, and collaboration, embracing diverse perspectives and offering competitive compensation and benefits.
Lead integrated risk and controls audits across claims operations, reserving, payments, and insurance data quality
Plan and execute internal audits of P&C insurance operations
Assess and challenge end-to-end control environments
They are a platform that uses AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They shortlist the top-fitting candidates and share directly with the hiring company.
Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims.
Liberty Mutual provides insurance products and services. They aim to create a workplace where everyone feels valued and supported, offering comprehensive benefits and professional development opportunities to foster an inclusive culture where employees can thrive.
Investigate, evaluate, analyze, negotiate, and settle residential property claims.
Maintain ongoing communication and status updates to customers until file closure.
Determine appropriate settlement amount based on independent judgment and estimates.
Max Insurance is an insurance carrier focused on providing customer experiences to Canadians. They are looking for smart, motivated claims professionals to join their energetic and rapidly growing team where they emphasize flexibility & benefits.
Perform complex manual reconciliations between Product Activation logs, Salesforce records, and Billing Systems.
Investigate "Master Account" views to determine if products created in the accounts are currently billing or not.
Process and validate portions of a 7-8 million-line database, and record discrepancies where system integrations failed.
Coderoad is a software development company that provides end-to-end software development services. They offer opportunities to work on real-world projects in a supportive environment, focusing on staff augmentation, dedicated IT teams, and general software engineering.
Investigate and resolve Homeowners claims of moderate complexity in a prompt and efficient manner.
Use imagery and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting.
Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate.
Mercury Insurance has been helping people reduce risk and overcome unexpected events for more than 60 years. They are one team with a common goal to help others, having a diverse perspectives where everyone is included, to serve customers from all walks of life.
Review, analyze, and process moderately complex to complex workers compensation claims.
Make decisions about liability/compensability and negotiate settlements.
Manage an inventory of commercial property/casualty claims.
Liberty Mutual is a fast-growing company that consistently outpaces the industry in year-over-year growth. They offer comprehensive benefits, flexible workplace options, and professional development in an inclusive environment where everyone can thrive.