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Confirms and evaluates coverage and/or liability on medium to complex exposure cases. Secures and analyzes necessary information (i.e. expert reports, policies, appraisals, releases, statement, and other necessary documentation) in the investigation of claims. Works toward the resolution of claims, and may attend arbitrations, mediations, depositions, or trials as necessary. Affects settlements an
Posted 1 day ago
Investigates and maintains workers' compensation claims. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, appraisals, releases, statements or other documents) in the investigation of claims. Works toward the resolution of claims files, and attends arbitrations, mediations or trials as necessary. May affect settlements/reserves within prescrib
Posted 1 day ago
Quality Claims Auditor This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems &
Posted 1 day ago
Responsible for the operations of one or more claims processing units, including timely and proper adjudication of claims in accordance with contractual benefits. Responsible for providing leadership and direction to employees. Directs the processing of insurance claims to meet operation, financial, and service requirements. Develops and executes strategic and operational business plans for the de
Posted 1 day ago
Quality Claims Auditor This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems &
Posted 1 day ago
Business Consulting Includes analysis/evaluation of business and/or system process and functional requirements, development of business cases, client support during system development and implementation, development and maintenance of service level agreements. Develops relationships with upstream and downstream business partners. Develops/maintains and changes business processes, and understands t
Posted 1 day ago
Performs full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals. Ensures pre authorizations are complete, information includes data pertinent to medical service and/or care received. Uses knowledge of Service Agreements and benefits in or Knowledge of different KP markets within the CO region. Actively seeks information to underst
Posted 1 day ago
Quality Claims Auditor This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems &
Posted 1 day ago
Quality Claims Auditor This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems &
Posted 1 day ago
American Family Insurance - Corporate Headquarters
- Denver, CO
The Catastrophe Property Claim Field Adjuster position supports the Claim Division goal of ensuring customer service industry leadership and partners with agency to deliver seamless claim service across multiple states. An experienced adjuster who has achieved mastery in and performs all areas of property, commercial and farm ranch claim adjustment activities with the highest degree of competency
Posted 1 day ago
American Family Insurance - Corporate Headquarters
- Denver, CO
The Physical Damage and Certified Repair Program Claim Desk Adjuster position supports the Claims Operations division goal of ensuring customer service industry leadership and partners with agency to deliver seamless claim service. An experienced adjuster who can work on moderately complex physical damage claims, including those dealing with Certified Repair Shops, that primarily do not require on
Posted 1 day ago
Position Description Position Description 1. This adjuster will be in direct contact with various AIG Commercial Property and Energy policyholders. 2. The adjuster will be assigned claims within their assigned territory, including National Accounts. 3. The adjuster will investigate, adjust and conclude a minimum of 8 claims per month. 4. The adjuster will have settlement authority up to $350,000
Posted 1 day ago
The responsibilities of the Claims Specialist are to ensure that appropriate data elements have been captured from the provider billing for reimbursement related to non emergency transportation. This may involve keyboard data entry and/or verification of data submitted electronically from providers for authorized transportation of Medicaid and/or Medicare patients. Essential Duties and Responsibi
Posted 1 day ago
Quality Claims Auditor This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data entered information & by auditing service related information & invoice adjudication/payment for compliance w/ contract terms & Department/Regional policy & procedures. The auditor must be thoroughly familiar w/ outside medical systems &
Posted 1 day ago
Responsible for the operations of one or more claims processing units, including timely and proper adjudication of claims in accordance with contractual benefits. Responsible for providing leadership and direction to employees. Directs the processing of insurance claims to meet operation, financial, and service requirements. Develops and executes strategic and operational business plans for the de
Posted 1 day ago
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