Under the leadership of Patient Financial Services (PFS) management, the Account Specialist II is responsible for accounts receivable through claim follow up, cash collection, and denial management for services rendered by Cook Childrens Medical Center (CCMC). This positon requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies,

Accurately process professional claims. Responsible for editing and adjusting of claims per the EDI daily audit report. Analyze and adjudicate claims to ensure accurate payment Interpret Fee for Service (FFS) and capitated provider contracts Review claims on a periodic basis Meet Department Quality of 98.50% or better on a weekly and monthly basis. Meet production standar

include, but are not limited to Opening, stamping, reviewing, and assigning mail to appropriate claim folders Reporting claims to insurers when appropriate Responding to TPA emails regarding intake inquiries Downloading video and putting in corresponding claim folders Fielding phone calls and voicemails and responding to accordingly or directing to the appropriate person t

include Liability Incident Reporting Evaluation Coordinate with operations on accident reporting, video review and follow up investigation Manage escalation of Critical Incident Reports Claim Coordination and Operations Support Review TPA files for proper set up, coding and diary Conference calls with claim adjusters for ongoing strategies Reserve/settlement authority with

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

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 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

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees. This position is eligible to work from home in TX, OK, KS, NE, SD, ND, NM, AZ, CO, UT, WY, MT, NV, CA, OR, ID

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

At Dearborn Group, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary This Position Is Responsi

Position will report directly to the Claims Manager and will assist in the administration of the company's claims program to include the reporting, processing of claims as well as coordination with TPA on open active claims as needed. Will also assist with general duties within the Risk Management department as assigned. Essential Duties/Responsibilities Claim administrat

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

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

Complex Claims Adjuster Lawyers Professional Liability Job Locations US United States Requisition ID 2024 16359 Category Claims Specialty Lines Position Type Regular Full Time Overview Amtrust Financial Services, a fast growing commercial insurance company, is seeking a Complex /Specialty Adjuster. This position can be located in one of our claims offices with the possibi

include but are not limited to Cultivate and maintain professional and proactive communication level with clients, production staff, Project Managers and other associates Establish and monitor broking strategy and growth goals with key carrier partners Identify opportunities and develop proprietary and/or preferred terms and conditions with key carrier partners Identify o