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Showing posts with label claims. Show all posts
Showing posts with label claims. Show all posts
Complex Claims Director - Workers Compensation - Liberty Mutual - Elmsford, NY
Advance your career at Liberty Mutual Insurance - A Fortune 100 Company!
Seeking a
Complex Director
manager to join our Workers Compensation team, managing a team of employees. The ideal candidate will bring leadership skills and a superior ability to develop, coach and mentor.
Supervises the day-to-day claims activities for the unit by establishing priorities, scheduling and assigning work, adjusting schedules when necessary to meet completion dates, and assisting others with resolving complex problems while ensuring adherence to service and quality standards.
Analyzes claims files prepared by claims staff, approves payments, and grants authority for settlements when appropriate.
Acts as a technical expert and provides direction in various areas, such as compensability determination, investigation, coverage interpretation, claims reserves, and settlement. Refers issues above authority level to the next level of management.
Uses the objective setting and performance evaluation processes to ensure employees understand the expectations, receive regular feedback, and are appropriately rewarded and developed. Deals decisively with performance and/or conduct issues using the performance management process.
Ensures technical resources are engaged in assignments commensurate with their experience and job title and that direct reports receive a proper orientation, on-going technical training and development opportunities.
Ensures compliance with related legislation, corporate policies, and programs.
Monitors new and emerging exposures and coverage issues and makes recommendations to Regional HO Management regarding same. May periodically conduct desk audits.
Assumes a leadership role with Regional/HO Management and other departments with new business and/or renewal presentations and periodic service calls.
Demonstrates an exceptional ability to capture, extract and analyze data specific to existing and emerging risk.
Can make and implement recommendations related to said analysis.
Involved in the analysis and implementation of
new and revised policies and procedures.
Demonstrates a consistent high level of expertise in complex workers compensation issues and successfully imparts that expertise to direct reports.
Qualifications:
Bachelor's degree, or equivalent work experience plus at least 7-10 years of progressively more responsible claims experience required. Prior management experience desired.
Ability to organize, lead and get work done through others; in depth knowledge of insurance products.
Advanced analytical skills to interpret business information drawn from multiple sources to make critical decisions.
Demonstrated team management skills and abilities.
Effective interpersonal skills needed to create and enhance partnerships with internal and external customers; including verbal and written communications
Benefits:
We recognize that talented people are attracted to companies that provide competitive pay, comprehensive benefits packages and outstanding advancement opportunities. For this reason we offer a Comprehensive Benefits Plan that includes the following:
401K and Company paid pension plan
Medical coverage
Dental coverage
Paid time-off
Pay-for-Performance
Discounts on automobile and homeowner's insurance
Discount fitness memberships
Flexible spending accounts
Tuition reimbursement
Vision care coverage
Work/Life resources
Credit Union membership
Employee and Dependent life insurance
Disability insurance
Accidental death & dismemberment insurance
Coordination of Benefits Claims Analyst - CVS Caremark - Scottsdale, AZ
Coordination of Benefits Claims Analyst more... ?
Job Category: Business Analyst Clinical Licensure Required : N/A Job Type: Full Time Position Summary: Responsible to review & interpret claims data in all adjudication platforms. Perform complex reviews/audits of claim adjustments/recoveries/reconciliations for Medicare Part D plans. Analyze the accuracy of participant's accumulations and financial adjustments. Validate the execution of proper controls/procedures. Work with internal and external partners to resolve Coordination Of Benefits related issues by developing new processes and procedures ensuring that beneficiaries, providers and clients are made financially whole. Work with CMS, federal and states agencies in COB related efforts to ensure proper reimbursement to primary and or secondary payers. Responsible for meeting or exceeding turnaround time standards and quality expectations. Communicate effectively; express thoughts in a clear, concise manner in both individual and group situations.
Essential Job Functions: -Work with CMS, federal and states agencies in COB related efforts to ensure proper reimbursement to primary and or secondary payers. -Effectively plan, prioritize, organize time and workload -Effectively present information and respond to questions from internal and external personnel. -Accurately research and adjudicate claims in order to arrive at expected outcome -Perform complex reviews/audits of claim adjustments/recoveries/reconciliations for Medicare Part D plans -Work with internal and external partners to resolve Coordination Of Benefits related issues by developing new processes and procedures ensuring that beneficiaries, providers and clients are made financially whole.
Required Qualifications: -Excellent written and verbal communication skills -Well organized with the ability to effectively handle multiple priorities - Ownership and results driven - Attention to detail - Able to handle high volume receipts within defined turnaround times coupled with excellent quality - Expert proficiency in Microsoft Office Excel - Working knowledge of accounting principles - Ability to effectively work within a team - Flexible in adapting to change - Demonstrated ability to analyze data and determine conclusions - Ability to learn and apply increasingly complex concepts, policies and procedures - Ability to effectively plan, prioritize, organize time and workload - Ability to work successfully in a deadline-oriented environment Preferred Qualifications: 3+ years relevant experience. Previous Coordination of Benefits/Medicare Secondary Payer Experience, Pharmacy, Healthcare preferred Education: Bachelor's Degree or equivalent work experience required Business Overview: CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nations largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units Minute Clinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. turnaround BETS_ARC_Setter BACH_6df36a in times research personnel
Disability Claims Representative Trainee - Phoenix - Liberty Mutual - Phoenix, AZ
Disability Claims Representative Trainee - Phoenix
-
31297
Description
Launch your career at Liberty Mutual - A Fortune 100 Company!
Have an investigative nature? Like to understand all the details and contributing factors before you make decisions? Like helping people resolve questions? Claims might just be right for you.
If you join our Group Benefits claims team, Liberty Mutual starts you off right with a comprehensive training program, one-on-one mentoring, and on-the-job training. ...
Healthcare Claims Appeals Auditor Representative - Wausau, ... - UnitedHealth Group - Wausau, WI
Healthcare Claims Appeals Auditor Representative - Wausau, WI more... ?
October 19, 2011 (last updated 3 hours 17 min ago)
October 19, 2011 (last updated 3 hours 17 min ago)
Position Description:Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals. Position Responsibilities:
* Maintains a good understanding and interpretation of plan language of all plan benefits for assigned customer accounts including all product lines.
* Reviews appeals based on priority basis by completion of expected turnaround time and in compliance with DOL regulations to avoid penalties/fines.
* Completes a backend Quality Review by checking specific Plan language, verifying benefit information and reviewing bill copy for accuracy of Patient, Date of Service, dollar amount, CPT codes, and Provider name.
* Reviews all documentation in specific system applications.
* Recognizes when to refer claims to our compliance and/or legal department that have potential to become a legal/financial risk.
* Recognizes concerns involving medical judgment issues and refers to Registered RN and determines what additional medical documentation is necessary and requests such information prior to referral. Makes the appeal determination and generates a resolution letter and finalizes all documents related to an appeal review by closing out the database entries.
* Makes sure the letter has all the correct information to be DOL and HIPAA compliant by including specific wording to Appeal Levels, number of days to file, and where to file as outlined in each of the specific Plans.
* Maintains operations by following policies and procedures according to DOL and HIPAA regulations. Maintains customer confidence and protects operations by keeping information confidential.
* Provides the very best customer service to claimants, customers, providers of service and internal personnel concerning appeal reviews.
* Communicates with appropriate parties regarding appeals issues, implications and decisions.
* Analyzes and identifies trends for appeals and may research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
* Production and quality standards must be met on a daily and monthly basis
UnitedHealthcare Employer & Individual is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare Employer & Individual, what you do matters. It*s that simple...and it*s that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Regardless of your role at UnitedHealthcare Employer & Individual, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
trend, analyst, claims customer service, call center
Clinical Supervisor Dearborn, MI 11/10/2011 Sorry, I could not read the content fromt this page.
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