Coordinates and... [+] More

Coordinates and directs activities involving claims against company for shortages in or damaged property, accidental death or injury to people or employees, and private property damages. Heads activities of workers investigating claims to ascertain validity of claims and extent of company liability.

Handles claims for which company is liable, and presents claims to head office for settlement, or negotiates settlement with claimant and authorizes payment. Reviews employee accident reports to determine compensation program under which accidents are covered, and doctor reports for type of injury and length of time disabled. Authorizes payment of disability compensation according to State or Federal acts. Contacts medical personnel to ascertain need for extension of payments beyond specified recovery date. Negotiates with people having valid claims against company or death or injury to effect out-of-court settlement and refers cases that cannot be settled to legal department. Represents company at industrial accident or compensation board hearings to present company position on accident liability. May testify at court hearings to present evidence on company liability from investigation documents. [-] Less

Coordinates and... [+] More

Coordinates and directs activities involving claims against company for shortages in or damaged property, accidental death or injury to people or employees, and private property damages. Heads activities of workers investigating claims to ascertain validity of claims and extent of company liability.

Handles claims for which company is liable, and presents claims to head office for settlement, or negotiates settlement with claimant and authorizes payment. Reviews employee accident reports to determine compensation program under which accidents are covered, and doctor reports for type of injury and length of time disabled. Authorizes payment of disability compensation according to State or Federal acts. Contacts medical personnel to ascertain need for extension of payments beyond specified recovery date. Negotiates with people having valid claims against company or death or injury to effect out-of-court settlement and refers cases that cannot be settled to legal department. Represents company at industrial accident or compensation board hearings to present company position on accident liability. May testify at court hearings to present evidence on company liability from investigation documents. [-] Less

Coordinates and... [+] More

Coordinates and directs activities involving claims against company for shortages in or damaged property, accidental death or injury to people or employees, and private property damages. Heads activities of workers investigating claims to ascertain validity of claims and extent of company liability.

Handles claims for which company is liable, and presents claims to head office for settlement, or negotiates settlement with claimant and authorizes payment. Reviews employee accident reports to determine compensation program under which accidents are covered, and doctor reports for type of injury and length of time disabled. Authorizes payment of disability compensation according to State or Federal acts. Contacts medical personnel to ascertain need for extension of payments beyond specified recovery date. Negotiates with people having valid claims against company or death or injury to effect out-of-court settlement and refers cases that cannot be settled to legal department. Represents company at industrial accident or compensation board hearings to present company position on accident liability. May testify at court hearings to present evidence on company liability from investigation documents. [-] Less

Oversees and directs the management of... [+] More

Oversees and directs the management of the claims function to include review and approval of claims. Directs the implementation and ongoing maintenance of claims handling systems, policies, and procedures. Typically requires a college degree and five or more years of claims management experience.

Monitors departmental operations to ensure compliance with regulatory agencies as well as contractual obligations. Performs regular data analysis of claims payment reports to identify variances so that areas of focus may be identified and resources may be appropriately deployed. Provides support on complex claims issues. Prepares and manages the departmental budget and manages expenses. Hires, develops, and motivates a qualified claims processing staff. [-] Less

Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically... [+] More

Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically requires a college degree in a related field and an in-depth understanding of claims auditing.

Provides oversight of departmental training and auditing activities. Monitors departmental operations to ensure compliance with regulatory agencies and contractual obligations. Develops strategic initiatives and transforms initiatives into action plans. Hires, trains, and motivates a qualified management staff. Oversees the development of training programs that are targeted toward error reduction and decision quality in claims processing. Analyzes audit and training reports to determine department effectiveness. [-] Less

Supervises and facilitates the coordination and scheduling of all external claims audits conducted by customers, audit firms, external vendors, and regulators. Assists in the preparation of audits and management of the audit process.

Notifies appropriate parties of the audit and schedules... [+] More

Supervises and facilitates the coordination and scheduling of all external claims audits conducted by customers, audit firms, external vendors, and regulators. Assists in the preparation of audits and management of the audit process.

Notifies appropriate parties of the audit and schedules entrance and exit conferences. Develops tools to assist staff in effectively coordinating audits and holds staff meetings as needed. Reviews customer contracts for audit rights, and prepares necessary audit confidentiality agreements and Par Plan addendum agreements. Supervises the obtaining and reviewing of claim samples and documentation. Ensure all HIPAA requirements applicable to the job are met. Directs and oversees analysis of requested data in order to minimize organization's risks. Ensures data integrity. Assures that auditors have a positive experience. Reviews findings and responses for adequacy and appropriateness. Reviews draft and final audit reports from auditors. Prepares responses to report findings. May travel to other claims audit locations as needed. [-] Less

Oversees claims management to ensure timely, accurate handling of claims, quality claims services, and appropriate resolution of claim discrepancies. Supervises claims staff.

Manages, reviews, and resolves claims, including determining course of action, developing arguments and addressing claimants' rebuttals, conducting preliminary negotiations,... [+] More

Oversees claims management to ensure timely, accurate handling of claims, quality claims services, and appropriate resolution of claim discrepancies. Supervises claims staff.

Manages, reviews, and resolves claims, including determining course of action, developing arguments and addressing claimants' rebuttals, conducting preliminary negotiations, and preparing and issuing notices to claimants and other third-parties. Manages administrative, financial, accounting, and reporting functions for claims. Assists in overall case resolution strategies, settlements, and litigation support. Authorizes appropriate payment or refers claims to investigators for further review. Analyzes and identifies trends and provides reports as necessary. Provides input for forecasting and planning activities. Generates risk analysis reports for management. Monitors and participates in quality control and reviews. Manages and monitors all high-exposure and complex files. Oversees operational management of the Claims Department, including overall productivity, efficiency, and accuracy. Provides expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims. Directs claims staff hiring, oversight, coaching, and training. [-] Less

Supervises employees engaged in claims auditing and training. Implements claim auditing department policies, practices, and procedures to ensure identification of claims processing errors. Typically requires prior experience as a Claims Processor or Adjudicator and an in-depth understanding of claims auditing.

Supervises... [+] More

Supervises employees engaged in claims auditing and training. Implements claim auditing department policies, practices, and procedures to ensure identification of claims processing errors. Typically requires prior experience as a Claims Processor or Adjudicator and an in-depth understanding of claims auditing.

Supervises auditing activities by monitoring weekly backlogs, distributing audit assignments based on work loads, and reviewing and responding to audit inquiries. Responds to error rebuttals from Claims Processors or Adjudicators. Assists in hiring, training, coaching, and evaluating performance of assigned staff. Contributes to the development of training programs that are targeted toward error reduction and decision quality in claims processing. Monitors training programs to evaluate effectiveness. [-] Less

Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years... [+] More

Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years of claims examining/auditing experience may be required to fulfill the requirements of this position.

Ensures evaluation of all claims through determination of types and amounts of benefit payable. Ensures/oversees documenting of provider claims/billing forms to support payment/decisions. Ensures claims processing is consistent with applicable policies, procedures, and department guidelines. Supervises maintenance of claims records. Reviews appeals and complaints that Examiners are unable to resolve. Analyzes and approves insurance claims. Conducts personal interviews with claimants to explain procedure for filing claims. Submits statement of claim liabilities to actuarial department for review. Informs departmental supervisors on claims status. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports, and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. May participate in the specialized training and handling of complex claim situations and projects requiring advanced claim knowledge and experience, as delegated by Claims Manager and/or Director. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. [-] Less

Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims. This position typically requires four years of experience in claims processing or auditing.

Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims.... [+] More

Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims. This position typically requires four years of experience in claims processing or auditing.

Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims. Provides training and development, communicates policies and procedures, and monitors work production quantity and quality. Reviews and resolves complex claims issues that cannot be resolved by subordinates and releases high dollar claims as needed. Ensures that all claims are processed according to the terms of the plan contract and applicable policies, procedures and department guidelines. Oversees documentation of claims and billing forms to support claim decision, payment or denial. In addition to supervisory skills, must have knowledge of discipline equal to or exceeding that of direct reports. Typically supervises more than 8 Claims Adjudicators. Tracks and monitors claims volume and age of inventory. Submits statement of claim liabilities to accounting for review. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. Monitors the work flow process to ensure that work is distributed appropriately. This position typically requires four years of experience in claims processing or auditing. May be called upon to manage unit(s) in the absence of the Claims Manager. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. [-] Less