Content Claims Specialist Field Level I Requisition ID 2024 24911 Job Locations US MA Boston Position Type Regular Full Time Category Claims Business Unit CUS_Loss Adjusting US Excellence In Everything We Touch Position Summary The role of Content Claims Specialists is a multi faceted role, which focuses primarily in the following four key areas of edjuster's content clai

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

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

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

As a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance with legal statutes, policy provisions and company guidelines while fostering a culture of commun

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

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

Position is scheduled Thu Sat, Days! In our Adult Community Services program, this position works as a member of a team to provide opportunities for individuals to develop skills to be used on their journey of recovery for personal growth focusing on working with individuals in their pursuits of independence. Position assists with daily living skills including every day d

Weekdays, 1st shift! No weekends! In our Adult Community Services program, this position works as a member of a team to provide opportunities for individuals to develop skills to be used on their journey of recovery for personal growth focusing on working with individuals in their pursuits of independence. Position assists with daily living skills including every day dome

Insurance Coordinator is responsible for proactive management of the insurance authorization process. Supports clinicians by managing insurance authorizations/certifications (initial/ongoing) process. Assists patients with the financial and authorization issues related to their care. Supports all ambulatory PT/OT practice sites. Proactively, effectively and efficiently ma

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

Position is scheduled Tue Sat, Days! In our Adult Community Services program, this position works as a member of a team to provide opportunities for individuals to develop skills to be used on their journey of recovery for personal growth focusing on working with individuals in their pursuits of independence. Position assists with daily living skills including every day d

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

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

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