Claims Specialist

About the Role:The Claims Resolution Specialist will be accountable for coordinating with insurers, policyholders, and stakeholders to resolve claims promptly. This role involves investigating and evaluating claims, gathering supporting materials, and approving or rejecting claims based on thorough analysis and policy terms.

Job DescriptionWe are seeking a skilled Healthcare Claims Specialist to join our team. As a Healthcare Claims Specialist, you will be responsible for reviewing, researching, investigating, negotiating and resolving all types of claims, as well as recovery and resolution for health plans, commercial customers, and government entities.Key...

Job DescriptionWe are seeking a highly skilled Claims Decision Specialist to join our team. In this role, you will be responsible for accurately adjudicating reimbursement claims on outpatient and inpatient benefits of policyholders.Responsibilities:Claims Adjudication: Properly evaluate and determine the validity of claims based on policy provisions, terms,...

The role of a Claims Resolution Specialist involves verifying the compensability of insurance claims and ensuring that all required documents are in order. This includes reviewing parts for comparative assessment and negotiating claim settlements. The specialist must also update loss reserves in the system, perform proper tagging of claim costs, and review...

The RoleWe are seeking a Claims Specialist for our Employee Benefits division who will be responsible for handling the end-to-end processing of claims, providing guidance, instruction, and direction to team members to achieve team objectives.This position will focus on medical claims as well as other insurance lines under Employee Benefits. The ideal...

Our company is seeking a Claims Resolution Specialist to resolve Short Term Disability claims promptly and fairly. This role demands exceptional analytical, interpersonal, and problem-solving skills, as well as the ability to maintain confidentiality.Responsibilities include:Reviewing claim information, making phone calls, and resolving claims.Applying...

**Job Overview**ActiveOne Health is seeking a highly skilled Medical Claims Specialist to join our team. As a key member of our health insurance processing team, you will be responsible for the timely and accurate processing of medical claims.Key Responsibilities:Analyze medical information and perform data entry to ensure claim accuracyReview and...

About the RoleThe Claims Decision Specialist will play a crucial role in ensuring that health claims are processed efficiently and accurately. This position requires strong analytical and communication skills, as well as the ability to work independently and as part of a team.Key Responsibilities:Review and analyze health claims to determine coverage and...

Job SummaryWe are seeking a skilled Claims Specialist to join our team. The successful candidate will be responsible for processing claims, maintaining accurate records, and communicating with claimants. This is an exciting opportunity for individuals looking to develop their career in the insurance industry.ResponsibilitiesReviews and evaluates claims,...

Job OverviewWe are seeking an experienced Insurance Claim Triage Specialist to join our team at Eteam Workforce Private Corporation. In this role, you will be responsible for managing the entire claims process, from receiving and verifying claims documents to creating transmittals and sending acknowledgments to members.Key Responsibilities:Triaging claims...

Job SummaryEteam Workforce Private Corporation is seeking a highly skilled Medical Claims Specialist to join our team. In this role, you will be responsible for assessing and adjudicating hospitalization claims of insured members, analyzing medical documents, and ensuring seamless health customer journeys.Main ResponsibilitiesAssess and adjudicate real-time...

At Pioneer Your Insurance, we are looking for a skilled Insurance Claim Specialist to join our team.About the RoleThis is a challenging and rewarding position that requires strong analytical skills, attention to detail, and effective communication abilities.The successful candidate will be responsible for processing, reviewing, and recommending claims for...

TASQ Staffing Solutions is seeking a skilled Customer Claims Specialist to join our team. As a key member of our organization, you will be responsible for processing Short Term Disability claims with expertise and accuracy.Requirements:Bachelor's/Associates degree or equivalent experience in customer-facing roles.Minimum 2 years of customer service...

Job SummaryWe are seeking a skilled Healthcare Claims Specialist to join our team. In this role, you will be responsible for preparing and processing PhilHealth claims for submission, ensuring all necessary documents are complete and accurate.You will verify patient information details for compliance with PhilHealth guidelines and submit claims to the...

Company Overview">JOB MATCHMAKER is a leading provider of healthcare services, dedicated to delivering exceptional quality and care to our clients. As a Claims Processor, you will play a vital role in ensuring the accuracy and efficiency of our claims processing system.

Job DescriptionThis Claims Resolution Specialist - Medical Insurance role involves ensuring accurate and timely adjudication of insurance claims, as well as communicating with members and providers to resolve any issues or concerns.Key ResponsibilitiesAdjudicate insurance claims in accordance with relevant policies and procedures.Ensure accurate and complete...

Role SummaryWe're looking for a Professional Claims Investigator to join our team. As a Healthcare Claims Resolution Specialist, you'll be responsible for reviewing, researching, investigating, negotiating, and resolving claims for health plans, commercial customers, and government entities.Responsibilities:Provide claims support, including research,...

Claims Resolution at OptumWe're seeking a skilled Healthcare Claims Resolution Specialist to join our team. In this challenging role, you'll review, research, investigate, negotiate, and resolve claims for health plans, commercial customers, and government entities.Responsibilities:Provide expertise in claims resolution, including research, negotiation, and...

About the RoleWe are seeking a highly organized and detail-oriented Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for accurately adjudicating insurance claims and ensuring timely payment of invoices from providers.Key ResponsibilitiesAdjudicate insurance claims in accordance with relevant policies...

Open to PHRN or Non PHRN'sShift Schedule: Night Shift ScheduleWork Setup: OnsiteRequirements:Bachelor's/Associates degree, with 2+ years of customer-facing work experience preferred.Short Term Disability Claim Processing Experience reviewing and gathering information, making phone calls, and making the actual claim decision - at least 1 year or more of...