by twochickswithasidehustle | Sep 2, 2024 | Uncategorized
Date: Aug 30, 2024
Location:
Remote, Remote, US
Requisition ID: 10904
Description:
Role Description: The Claims Examiner evaluates insurance claims to determine whether their validity and how much compensation should be paid to the policyholder. The Claims Examiner is responsible for reviewing all aspects of the claim, including reviewing policy coverage, damages, and supporting documentation provided by the policyholder.
Roles & Responsibilities
- Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions.
- Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information.
- Ensure that claims processing aligns with the company’s insurance policies and relevant regulatory requirements.
- Conduct investigations, when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts.
- Analyze policy coverage to determine the extent of liability and benefits payable to claimants.
- Evaluate the extent of loss or damage and determine the appropriate settlement amount.
- Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates.
- Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing.
- Maintain accurate and organized claim files and records.
- Stay updated on industry regulations and maintain compliance with legal requirements.
- Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders.
- Strive for high efficiency and accuracy in claims processing, minimizing errors and delays.
- Stay informed about industry trends, insurance products, and evolving claims management best practices.
- Generate and submit regular reports on claims processing status and trends.
- Perform other duties as assigned.
by twochickswithasidehustle | Sep 2, 2024 | Uncategorized
Job Details
Description
Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO discounts
- Position requires knowledge of the Fee Schedule and the operation of the computer terminal
- May consult reference materials in the auditing process
- Requires regular and consistent attendance
- Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Additional duties as assigned
PRODUCTION REQUIREMENTS:
- Based upon situation or state specific issues meet 98% accuracy, 10,000+ keystrokes per hour
KNOWLEDGE & SKILLS:
- Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules
- Knowledge of CPT/ICD/HCPS coding
- Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred
- Strong interpersonal skills and commitment to customer service
- Able to work collaboratively and independently
- Able to identify problems and find creative, effective solutions
- Able to balance multiple priorities
- Excellent verbal and written communication skills
- Highly developed organizational abilities as well as time management skills
- Must be proficient in Microsoft applications
EDUCATION & EXPERIENCE:
- High school diploma or equivalent
- 1-2 years of data entry experience
- Experience with Medical Bill Review preferred
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $18.36 – $29.63 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
by twochickswithasidehustle | Sep 2, 2024 | Uncategorized
Job Description
Administrative Assistant
$18-$20/hr
Contract Duration: 5 months
Remote (within EST/CST)
Must Haves:
- 1+ data entry experience
- Experience in a financial aid office (understanding of financial aid rules)
- Ability and willingness to use personal equipment
Preferred:
- Higher education industry experience
Job Description: Responsible for certifying private educational loans and keying processing information for federal PLUS loans in the PeopleSoft student information system (SIS). This role includes
- Refund processing
- Data entry
- Query review to support financial aid processing
The staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly, never provide banking information during the application process and always double check the email address of the recruiter to ensure it’s from @planet-pro.com – and not a domain with an alternative extension like .net, .org or .jobs. Candidate safety is a top priority at Planet Professional.
Planet Professional and The Planet Group of Companies are equal opportunity employers. It is our practice not to discriminate against any employee or applicant based on any criteria, condition or basis protected by laws or regulations in the locations where we do business. All qualified applicants are encouraged to apply. We celebrate diversity and are committed to providing an environment of mutual respect. We believe that diversity, equity and inclusion enable us to better meet our mission and values while serving our clients across the globe. If you have a disability or handicap and would like us to accommodate you in any reasonable way, please inform your recruiter, or contact us, so that we can discuss the appropriate alternatives available.
by twochickswithasidehustle | Aug 28, 2024 | Uncategorized
$33.65/hr
Remote
Analyze complex or technically difficult workers’ compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Analyzes and processes complex or technically difficult workers’ compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Negotiates settlement of claims within designated authority.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Prepares necessary state fillings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
QUALIFICATIONS
Bachelor’s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
5 years of claims management experience or equivalent combination of education and experience required
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Pay Details: $33.65 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.
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