Senior Health Claims Examiner

Job Opportunity:We are seeking a highly skilled professional to fill the position of Insurance Claims Examiner. This role is ideal for individuals with strong analytical and problem-solving skills, as well as excellent communication abilities.The successful candidate will be responsible for investigating and resolving insurance claims in a fair and timely...

Job TitleHealth Claims Supervisor: A Key Role in Insurance OperationsThis role is responsible for ensuring the timely and accurate adjudication of insurance claims. Key ResponsibilitiesThe Health Claims Supervisor will be responsible for:

1. Properly adjudicate reimbursement claims on outpatient, inpatient benefits of policyholders on a health policy.2. Accurately determine if a medical condition is a covered benefit based on the policy provisions, terms, and conditions.3. Adjudicate reimbursement claims in accordance with the different processes within defined authority limit and escalate to...

Key Responsibilities:1. Process claims document and index to appropriate claims files in the system.2. Responsible for FNOL (First Notice of Loss)/ new claim files creation and registration in the system including policy verification/ upload of policy documents and determination of appropriate coverage.3. Ensures loss reserves are set and maintained with...

Job OverviewA senior fraud investigator will conduct regular reviews and analysis of merchant fraud patterns, suggesting rule changes to improve fraud detection and prevention rates.Key Responsibilities:Conduct thorough investigations into complex cases and escalations, managing case closures to maintain operations and ensure timely completion in line with...

Job Title: Clinical Claims Training ExpertWe are seeking a highly skilled Clinical Claims Training Expert to join our team. As a key member of our organization, you will be responsible for delivering comprehensive end-to-end claims process training to new hires and existing claims examiners.The primary goal of this role is to ensure that all staff members...

Claims Leadership OpportunityA visionary leader is sought to oversee the claims management process for a prominent insurance company. The ideal candidate will possess strong leadership skills, excellent problem-solving abilities, and a customer-centric mindset.This role offers a unique chance to lead a high-performing team and drive operational excellence in...

Claims Specialist RoleThe Claims Associate plays a vital role in ensuring seamless claim processing and streamlining the claims management process.This position requires strong organizational skills, attention to detail, effective communication, and proficiency in handling multiple tasks simultaneously.The ideal candidate will possess excellent time...

Job Title: Senior Manager of Claims OperationsJob Summary:We are seeking an experienced Senior Manager of Claims Operations to lead our claims management team. The ideal candidate will have a proven track record of managing complex claims processes, ensuring timely and effective resolution of claims.Key Responsibilities:Manage the end-to-end claims process,...

Job DescriptionWe are seeking a Claims Resolution Specialist to join our team. This role involves reviewing, researching and resolving claims for health plans, commercial customers and government entities.As a Claims Resolution Specialist, you will be responsible for analyzing and identifying trends and providing reports as necessary. You will also ensure...