The Sr. Claims Auditor utilizes CPT and ICD 10 coding to review physician claims and medical records for coding accuracy. Internal auditing functions focus on "desktop reviews" of claims, design and quality control of future audits, and other auditing related functions. Review clinical notes and claims submitted to verify the appropriateness of codes billed based on servi

Senior Claims Analyst, GL New York Labor Law Full time Remote & Hybrid Opportunities Available It's an exciting time to join Rockville Rockville, a wholly owned subsidiary of the RiverStone Group, is a growing third party claim administrator, setting a new standard of service excellence in the insurance services industry. We handle diverse claims with unique and interesti

Claims Specialist ID 2024 7722 Job Location Location US MA Boston Type Regular Full Time Category/Department Claims Additional Locations US FL Tampa | US FL West Palm Beach | US NY New York Overview About Suffolk Suffolk is a national enterprise that builds, innovates, and invests. Suffolk is an end to end business that provides value throughout the entire project lifecyc

Handles property/inland marine claims for assigned region with availability to assist as needed in all other regions. Evaluates property related damages of $100,000 (aggregate) and above. Handles complex Business Income losses. Responds to catastrophe claims handling in accordance with company CAT plan. Responsible for all coverage determinations, negotiations, reserving

Reporting to a Manager , Assumed Claims , this role handles assumed claims of severity and complexity, including resolution of coverage and liability issues, claim evaluation, esta blishment of adequate reserves, c laim resolution , transaction processing, and implementation of strategic initiatives. Essential Functions Handles moderate to complex assumed claims (and thos

Claims Analyst, CD Full time Hybrid & Remote Opportunities Available It's an exciting time to join Rockville Rockville, a wholly owned subsidiary of the RiverStone Group, is a growing third party claim administrator, setting a new standard of service excellence in the insurance services industry. We handle diverse claims with unique and interesting problems to conquer, pr

Review loss notices; confirm and interpret policy coverages; establish adequate reserves; and investigate and handle claims involving primary and excess coverages Responsible for assignment to and control of work of defense counsel, assignment of expert witnesses, and interfacing with peer carriers, including design and execution of defense and indemnity contracts, evalua

Reporting to the Manager of Case Management and working under the direction of the Case Managers (CM) and Social Work (SW) staffs, the Case Management Associate provides support to Case Managers and Clinical Social Workers with routine and regulatory clinical and administrative functions. Key Responsibilities Provides administrative support related to the discharge proces

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

Review assigned accounts by contacting Medicare to ensure timely resolution of accounts. Create updates and document information relating to the financial status of accounts in the hospital billing systems. Contact patients and/or other third party representatives to secure additional information pertaining to reimbursement of accounts. Process rejected/adjusted claims th

Vaco Boston has partnered with our client to help fill a Claim Adjuster role. Responsibilities Inspect property and physical damage Analyze complex information from different sources Examine claim liability Prepare and process claim reports Consult with specialists (e.g. physicians, engineers) Calculate benefits and payments Negotiate settlements with claimants Examine po

Provide claims handling on complex/latent claims in compliance with claims handling procedures, client SLA and within agreed authority levels, including accurately capturing and updating claims data/information in compliance with best practices. Apply knowledge and judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law, determ

Provide claims handling on complex/latent claims in compliance with claims handling procedures, client SLA and within agreed authority levels, including accurately capturing and updating claims data/information in compliance with best practices. Apply knowledge and judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law, determ

As a not for profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a manage