- Molina Healthcare (Bowling Green, KY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Rising Medical Solutions (Chicago, IL)
- …With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, ... business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse ...in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus… more
- Travelers Insurance Company (Irvine, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Travelers Insurance Company (Melville, NY)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... **What Is the Opportunity?** This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
- Metropolitan Council (St. Paul, MN)
- …+ Participate in bi-annual claims meetings with internal departments. + Review medical , legal, and miscellaneous invoices to determine if reasonable and ... to our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical -only Workers'… more
- Lincoln Financial Group (Columbia, SC)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What...and consulting physicians to make appropriate, ethical, and timely claim determinations. * Reviewing complex medical records… more
- Lincoln Financial Group (San Diego, CA)
- …for conducting initial and ongoing interviews with claimants, obtaining and reviewing medical records, and making timely and ethical claim determinations. You'll ... are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims ...managers, and consulting physicians to make appropriate and timely claim determinations. + Reviewing complex medical records… more
- Travelers Insurance Company (Buffalo, NY)
- …Network per jurisdictional guidelines. + Research medical information to support the claim review process. + Occasional contact with provider to ensure the ... you do and where you do it. **Job Category** Claim , Nurse - Medical Case...Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *SUMMARY:* We are currently seeking an*RCM Representative Senior*to join our*Third-Party Claims - HB & PB *team. This full-time role will primarily work remotely… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more