by twochickswithasidehustle | Oct 15, 2023 | Uncategorized
Lead Long Term Disability Claims Specialist
Date Posted: Sep 28, 2023
Location(s): Remote, US, 0
Company: MetLife
Job Location: 100% Virtual
Role Value Proposition:
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The Lead LTD Claims Specialist evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the Lead LTD Claims Specialist will be a technical expert and emerging leader who will be responsible for coaching and mentoring new associates as well as participating in projects to drive continuous improvement and improve the customer experience. The Lead LTD Claims Specialist is the highest-level individual contributor managing claims within the LTD organization. The Lead LTD Claims Specialist is responsible for exercising independent judgment, demonstrating critical thinking skills, exemplary customer service skills as well as effective inventory management skills.
Key Responsibilities:
•Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations while effectively and independently managing an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews. Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination and interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations.
•Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available. Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments.
•Collaborates effectively with both external and internal resources, such as physicians, attorneys, vocational consultants and CPAs, as needed, to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.
•Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and addresses/resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.
•Serves as an extended leadership team member, participates in new hire onboarding including coaching, mentoring and development, providing direct support to Unit Leaders, and partners with the leadership team to meet project goals related to quality, timely claim outcomes, customer service and staff development and provide detailed, balanced feedback to leadership on individual, team, customer or site performance and offers solutions on opportunities identified.
Essential Business Experience and Technical Skills:
Required:
•5+ years of LTD/IDI Insurance Claims experience with excellent customer service skills proven through internal and external customer interactions and prior experience with independent judgement and decision making while relying on the available facts/problem solving/critical thinking while having the ability to effectively manage multiple systems and technology resources/Organizational and time management skills.
Preferred:
•Bachelor’s degree and knowledge of STD/FML, state leave laws, worker’s compensation, ERISA, and Social Security.
Business Category
GCSO
Number of Openings
3
At MetLife, we’re leading the global transformation of an industry we’ve long defined. United in purpose, diverse in perspective, we’re dedicated to making a difference in the lives of our customers.
MetLife:
MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits and asset management to help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.
We are one of the largest institutional investors in the U.S. with $642.4 billion of total assets under management as of March 31, 2021. We are ranked #46 on the Fortune 500 list for 2021. In 2020, we were named to the Dow Jones Sustainability Index (DJSI) for the fifth year in a row. DJSI is a global index to track the leading sustainability-driven companies. We are proud to have been named to Fortune magazine’s 2021 list of the “World’s Most Admired Companies.”
MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.
The wage range for applicants for this position is $50,000.00 to $67,000.00 per year. This role is also eligible for annual short-term incentive compensation. MetLife offers a comprehensive benefits program, including healthcare benefits, life insurance, retirement benefits, parental leave, legal plan services and paid time off. All incentives and benefits are subject to the applicable plan terms.
We want to make it simple for all interested and qualified candidates to apply for employment opportunities with MetLife. For further information about how to request a reasonable accommodation, please click on the Disability Accommodations link below.
MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
MetLife maintains a drug-free workplace.
by twochickswithasidehustle | Oct 15, 2023 | Uncategorized
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Provider Appeals Coordinator is responsible for managing the overall coordination, investigation, documentation and the resolution process of medical claims appeals and ensuring compliance with policies and procedures under company, MassHealth, Commonwealth Care contracts and NCQA standard guidelines.
Our Investment in You:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
The Appeals Coordinator is competent in the following related responsibilities but may not be expected to be responsible for all of the functions simultaneously. The Appeals Coordinator may have a major focus on administrative appeals; while also providing clinical edit claims review support to the dept. Nurse Coordinator.
Maintains the Provider Appeals process and workflow toward process improvement; provider satisfaction and claims payment accuracy under MassHealth, Commonwealth Care contract requirements and NCQA accreditation guidelines where applicable
Establishes and ensures workflow continuity with the Plan in the areas of Claims Processing; Provider Servicing and Health Services
Responsible for the preparation and research of data and records required to assure timely processing of administrative appeals in compliance with company guidelines
Produces administrative appeals reports for management and nurse review, as well as ad hoc reports
Ensures the quality and organization of administrative appeal documentation
Provides claims review and interpretation of appropriateness of administrative appeal
Coordinates management of provider appeals with other departments and tracks through resolution
Ensures continuous improvement of the administrative appeals process and establishment of related workflows as needed in response to Plan policy and procedure or claims processing changes
Responds to, documents, investigates and facilitates the resolution of provider administrative appeals, including the writing, review, and approval of resolution letters
Identifies and communicates trends
Works with other departments to create and implement improvement plans
Qualifications:
Education:
Bachelor’s degree in Health Care Administration, related field or, an equivalent combination of education, training and experience is required
Certification in Medical Coding (CPC Certification) preferred
Experience:
2 or more years’ experience working in a managed care organization required
Experience with claims processing and appeals required
Knowledge of Medical Coding, Medical terminology, CPT‚ ICD9‚ and HCPCS codes required
Project Management experience highly desirable
Competencies, Skills, and Attributes:
Demonstrated ability to successfully plan, organize and manage projects within a managed care organization
Strong working knowledge of Microsoft Office products required
Detail oriented, excellent verbal and written communication skills essential
Ability to work in both team and independent settings at all levels of the organization
Good customer service skills essential
Experience working with diverse populations preferred
Knowledge of health care terminology helpful
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization
A strong working knowledge of Microsoft Office products
Demonstrated ability to successfully plan, organize and manage projects
Detail oriented, excellent proof reading and editing skills
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
by twochickswithasidehustle | Oct 15, 2023 | Uncategorized
About iRhythm:
iRhythm is a leading digital healthcare company focused on the way cardiac arrhythmias are clinically diagnosed by combining our wearable bio sensing technology with powerful cloud-based data analytics and Artificial Intelligence capabilities. Our goal is to be the leading provider of ambulatory ECG monitoring for patients at risk for arrhythmias. iRhythm’s continuous ambulatory monitoring has already put over 4 million patients and their doctors on a shorter path to what they both need – answers.
About this role:
iRhythm is seeking a Data Privacy Specialist to join our growing Global Privacy Compliance Team. The Data Privacy Specialist will be responsible for supporting the implementation of operational aspects of the global privacy compliance strategy and managing some day-to-day privacy operations activities, including data subject rights requests, incident process and review, and training. Our ideal teammate has a desire to grow professionally and a commitment to being a compliance business partner. This role will be a part of a fast-paced, results-driven environment that fosters diversity and engagement, employee growth and career development.
Key Responsibilities
Assist with the implementation of One Trust Data Privacy compliance platform, and manage the ongoing daily business needs;
Manage personal data requests (including medical records and billing reports) & associated documentation, including collaboration with relevant business function team members;
Undertake Data Privacy Incident triage and management, investigations & documentation; escalate as per policy;
Assist with the completion and ongoing maintenance of organizational Records of Processing Activity (RoPAs);
Provide Data Privacy guidance and support to routine customer, patient and colleague questions, and escalate where appropriate;
Assist in the development and maintenance of Data Privacy training materials and business unit specific training, including Data Privacy training plans. Monitor employee compliance with required training;
Conduct ad hoc training sessions for employees on the importance of data privacy and how to maintain compliance with data privacy policies and procedures;
Provide support with audits, both internal and external;
Provide vendor contracting support to internal Procurement team;
Manage and update Data Privacy documentation as required, including policies, SOPs and DOPs;
Support audit teams, as requested, to conduct privacy related audit projects;
Assist in conducting data privacy risk and impact assessments (e.g. DPIAs);
Assist with conducting monitoring plans for Data Privacy risks, in line with iRhythm’s privacy compliance program; and
Assist with Data Protection Officer (DPO) reports and ensure accountability is managed appropriately.
Other related duties as may be assigned.
About you:
Bachelor’s degree is required.
At least 2 years professional experience is required; Experience in compliance function, healthcare, medical device or legal environment is preferred.
Experience with data privacy management platforms, such as OneTrust is desirable.
Experience with data privacy operations and documentation, including RoPAs. DPIAs, data subject requests, etc is desirable.
Strong analytical skills to identify patterns and trends, as well as potential threats and mitigation measures, are essential.
Excellent communication skills to work effectively with other members of the Privacy, IT and Legal teams are essential.
What’s in it for you:
This is a full-time position with competitive compensation package, excellent benefits including medical, dental, and vision insurance (all of which start on your first day), paid holidays, and PTO!
iRhythm also provides additional benefits including 401K (with company match), an Employee Stock Purchase Plan, paid parental leave, pet insurance discount, Cultural Committee/Charity events, and so much more!
FLSA Status: Exempt
As a part of our core values, we ensure a diverse and inclusive workforce. We welcome and celebrate people of all backgrounds, experiences, skills, and perspectives. iRhythm Technologies, Inc. is an Equal Opportunity Employer (M/F/V/D). We will consider for employment all qualified applicants with arrest and conviction records in accordance with all applicable laws.
Make iRhythm your path forward.
LI-SB1
LI-Remote
Actual compensation may vary depending on job-related factors including knowledge, skills, experience, and work location.
Estimated Pay Range
$71,600—$104,100 USD
by twochickswithasidehustle | Oct 15, 2023 | Uncategorized
Train AI Chatbots, earn money. It’s that simple.
Are you interested in helping to train AI models to become better writers?
Help train cutting-edge AI chatbots on Remotasks! Earn up to an equivalent of $15 per hour while working remotely and choosing your own hours.
Click “Start earning today!” to join thousands of others building the future of AI!
Details
– You can start right away on our website – onboard in less than an hour!
– Earn money for short writing and evaluation assignments, up to an equivalent of $15 or even $20 per hour based on your skill and consistency.
Hours are flexible – work whenever you’d like!
NOTE: This opportunity is only available to proficient English speakers in the following states and territories in the United States: Alabama, Delaware, Florida, Georgia, Guam, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Montana, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
by twochickswithasidehustle | Oct 15, 2023 | Uncategorized
Compensation: Competitive hourly rate
Location: Anywhere, remote
Employment Type: Part time or full time
Do you want to reach and make a positive impact on millions of people?
Do you love crafting email campaigns and push notifications that convert?
Are you excited about the idea of taking on a 200,000+ person email list?
Hiring deadline: Ongoing
This job might be for you if you:
- like being able to set your own hours and work from home
- don’t like drumming up new business or chasing down clients
- like exercising your creativity and experimentation
- like having responsibility
- like working collaboratively
- like having a dependable, reliable stream of work
- want to make the world a better place
- are comfortable with a fast-changing environment.
You should NOT take this job if you:
- are looking for another client to add to your list of clients
- have a strong need/desire for in-person social interaction at work
- like following instructions and being told what to do
- don’t like needing to come up with ideas
- are not comfortable in a fast-changing environment
- don’t have a real interest or experience in online education.
- don’t have experience with email marketing.
ABOUT US
FluentU is an online education company that helps people learn languages with real-world videos, including movie trailers, music videos, news and inspiring talks. We have a popular website, iOS app, and Android app. Founded in 2011, we’re a profitable, stable company with long-term focus, and we’re proudly self-funded.
We get millions of visitors per month on our website and have hundreds of thousands of people on our email list.
This is a unique opportunity to be the primary person behind our email list and mobile push strategy.
JOB DESCRIPTION
As our email marketer, you would be responsible for:
- Writing emails and mobile push notifications
- Setting up funnels
- Conceiving of landing pages and offers that convert
- Managing holiday/seasonal promotions
- Increasing email opt-ins
- Conversion rate optimization
- Setting up marketing automation
- Analyzing campaign performance
You do NOT need to be able to design or code (other team members will handle that).
You would work closely with the founder of FluentU (https://www.linkedin.com/in/alancpark/).
HOW WE WORK
We’re a 100% distributed/remote team. Here’s a little bit more about how we work:
QUALIFICATIONS
Our ideal candidate:
- has several years of email marketing experience
- has a quantitative and analytical bent
- loves experimenting and is results oriented
- has a bias for action
- is a fast learner who is willing to put in the work to figure it out
- writes and speaks English like a native speaker
- is terrific at written communication
- has a deep interest in language learning or online education
- is able to work a minimum of 20 hours per week
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