Claims Review jobs

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Subrogation Claims Representative
Great West Casualty Company - 7 reviews - Bloomington, IN 47404
2 years legal, claims, or insurance experience preferred. Knowledge of how to read a claim file and an insurance policy to gather information....
Monarch Shores - 8 reviews - San Juan Capistrano, CA 92675
Identifies incorrect claims and assists with correction of these claims. The Insurance Claims Specialist is responsible for review and follow up of a client’s...
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Sr Cargo Claims Tech Specialist
FM Global - 38 reviews - Parsippany, NJ
When a loss is settled, he/she presents the claim with his/her recommendations for payment to the Claims Manager for final review and approval....

Medical Review Nurse

Broadpath - 18 reviews - United States
Navigate claims systems and imaging software simultaneously to review both pre-payment and post-payment claims....

Medicare Medical Review Nurse

NCI Information Systems, Inc. - Anaheim, CA
Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to...

QM Nurse Consultant

Aetna - 1,663 reviews - Dallas, TX 75201 (City Center District area)
Technical - Aetna Applications/EDI Claim Lookup/1-3 Years/End User. Click here to review the benefits associated with this position....

Medical Review Nurse (RN) - Indianapolis, IN

RepuCare - 5 reviews - Indianapolis, IN 46204
Working with medical directors in interpreting appropriateness of care and accurate claims payment. Conducting pre-certification, inpatient, retrospective, out...

Utilization Management Nurse Reviewer-Care Authorizations

Medical Mutual of Ohio - 52 reviews - Strongsville, OH 44136  +1 location
Manages initial, concurrent and retrospective review of cases, including appeals. Provides educational assistance to providers and physicians regarding covered...

Complex Claim Specialist - Remote Florida

The Main Street America Group - 2 reviews - Jacksonville, FL 32246 (Sandalwood area)
Conducts claims investigations, determines coverage and liability, and negotiates (settle, authorize or deny payment) to conclusion the claim within authority...

Grievance/Appeals Analyst II - MO, IN, KY, OH, WI

Anthem, Inc. - 1,664 reviews - Ohio, MO
Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to...

Claim Rep, Trainee - Outside

Travelers - 699 reviews - Chantilly, VA  +8 locations
Claim Rep Trainee Outside Prop Works closely with Unit Manager or mentor to promptly resolve assigned claim....

Utilization Review Nurse

Medix - 53 reviews - El Segundo, CA
Performs reviews as needed on other related Care Management processes including retrospective and prospective review of referrals and appeals review....

Disability Nurse Reviewer/Clinical Consultant

Aetna - 1,663 reviews - Plantation, FL 33317
Escalates claim review to a Manager level if appropriate action has not been taken after medical recommendations....
Claims Officer, ATL
Claims Officer, ATL (E&S Property). Participates in the claims audit process. Liberty Mutual Insurance has an excellent claims opportunity available ....
Research & Resolution Associate/Medical Billing
Omni Eye Specialists - Denver, CO
Review each payer’s specific guidelines (rates, filing/appeal deadlines, forms, etc.). Ensure that all claims with monthly-predetermined balances are completed...
Sponsored by Eyecare Services Partners

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