- Molina Healthcare (Columbus, GA)
- …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
- Travelers Insurance Company (San Diego, 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 (Richardson, TX)
- …case resolution. + Review , approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . + Determine Value of ... 1 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… more
- Travelers Insurance Company (Morristown, NJ)
- …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
- Travelers Insurance Company (Hartford, CT)
- …direct supervision, this position is responsible for: Reviewing/evaluating, approving and processing Medical Only claims with: No lost time beyond statutory ... guidelines, medical position statements, etc.). + Coordinate medical treatment as appropriate: + Review , approve...impacted parties. + Identify the need for and engage nurse resource for utilization review when appropriate.… more
- Kellermeyer Bergensons Services (Oceanside, CA)
- …in compliance with all applicable laws and regulations. Processes workers compensation claims and approves claim settlements within defined level of authority. ... are responded to timely and accurately * Approve claim settlements within authority level * Respond to requests...timely and accurate processing and closures of workers' compensation claims * Review open claims … more
- Access Dubuque (Dubuque, IA)
- Claims Processing Representative **Grand River Medical Group** 1 Positions ID: 1405087 Posted On 01/17/2025 **Job Overview** ** Claims Processing ... Position located in Dubuque, IA; telecommuting options available Grand River Medical Group is seeking an experienced Claims Processing Representative… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of claims for payment. This position is ... Nurse Reviewer is responsible for reviewing provider claims appeals, validating coding and medical necessity...Medical and Payment Policy teams. Key Responsibilities: + Review provider claim appeals utilizing sound clinical… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...clinical information and may also provide education on the medical review process. + The Contractor performing… more