by twochickswithasidehustle | Sep 11, 2023 | Uncategorized
Overview
We are seeking a talented individual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement
The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources.
Responsibilities
You will work directly with our client’s membership, insurance adjusters, and attorney’s to:
Recovery Function – Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures
Comply and be knowledgeable of all federal and state laws governing the collection of accounts
Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to account
Negotiate payment arrangements within established guidelines
Investigative Function – Research claims as investigative support for the company to maximize profits of each account worked
Determine if a case has third party liability potential
Work collaboratively with internal and external contacts to determine account liability
Assign file to a Recovery Specialist after detailing investigation claims
Coordinate benefits with no fault and first party auto carriers
Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements
Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client
Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details
Investigative claims and accident details to identify recovery potential
Update internal systems with information obtained and actions taken on account
Ensure proper notification per client guidelines
Effectively work, maintain, and manage a variety of cases with current and accurate notes
Meet department objective standards for Customer Service.
Follow account process to ensure proper investigative steps are taken on each account
Follow client and state guidelines for determining potential for recovery on behalf clients
Develop templates for system training materials based on the training strategy
Deliver specific application training based on use needs analysis
Create and document training materials based on key functionality across the application
Coordinate with product teams to keep training materials current with updated functionality and features
Develop additional system support materials such as user job aids
Qualifications
High School diploma or GED required
Minimum 6 months experience in health insurance industry, medical claims, data entry, or customer service required
Basic knowledge of Microsoft Word and Excel required
Basic computer proficiency required (typing, ability to navigate various websites)
Ability to work independently to meet objectives
Ability to perform well in a team environment
Strong verbal and written communication skills
Ability to be thorough and detailed when speaking over the phone or entering data
Ability to interact with all levels of people both internally and externally in a professional manner
Working knowledge of HIPAA privacy and security rules
Ability to maintain a high level of confidentiality and ethics
Basic knowledge of health insurance coverage and/or terminology preferred
Ability to organize information to be shared to parties as required
Ability to meet deadlines
Bilingual (Spanish & English) a plus
Base compensation ranges from $15.20 to $18.40. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
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Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Cotiviti values its diverse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision
Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)
by twochickswithasidehustle | Sep 11, 2023 | Uncategorized
Job Requisition ID:5158
Position Summary/Position
Under the general supervision of the Claims Oversight Supervisor, the Claims Oversight Auditor – FWA is responsible for auditing IEHP providers, giving feedback for billing process improvement and providing trending information to IEHP internal departments: Provider Services and Contracting. The Auditors will support the Compliance department by auditing providers to ensure the Plan meets Federal and State regulatory and contractual requirements for Fraud, Waste and Abuse.
Major Functions (Duties and Responsibilities)
- Audit claims to ensure providers are billing correctly.
- Provide feedback to Providers for billing process improvement through provider report cards.
- Validate the effective implementation of Corrective Action Plans (CAPs) through future audits to ensure compliance.
- Provide trending information to Provider Services and Contracting through reports and meetings to review data.
- Report any possible FWA to the Compliance department.
- Initiate and expand recovery opportunities by working with the Provider Resolution and Recovery department and the Reconciliation and Reporting department to develop standard audits.
- Promote teamwork and maintain effective working relationships with others throughout the organization.
Supervisory Responsibilities
Leading: Self
Experience Qualifications
Four (4) years auditing claims in a managed care environment including contract and financial DOFR interpretation. Two years (2) claims processing including Medi-Cal and Medicare.
Preferred Experience
Education Qualifications
High school diploma or GED required.
Preferred Education
Bachelor’s degree from an accredited institution preferred.
Professional Certification
Professional Licenses
Drivers License Required
Yes, must have a valid California Driver’s License.
Knowledge Requirement
Knowledge of Medi-Cal and CMS guidelines for claim payments.
Skills Requirement
Strong analytical and problem-solving skills. Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings. Microsoft Office including being able to manipulate large data sets in Excel files. Excellent oral and written communication skills.
Abilities Requirement
Ability to build successful relationships across the organization.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions
Office environment.
Physical Requirements
Keyboarding: Traditional – FREQUENTLY
Keyboarding: Other – FREQUENTLY
Use of computer mouse – FREQUENTLY
Hearing: One-on-One – FREQUENTLY
Hearing: In a group – FREQUENTLY
Hearing: Over the Telephone/Cell Phone – FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls – FREQUENTLY
Turning/rotation of wrist or hand – FREQUENTLY
Communicate: Information/ideas verbally – FREQUENTLY
Alternate Sit/Stand or Walk at Will – FREQUENTLY
Near Visual Acuity – FREQUENTLY
Sitting – FREQUENTLY
Lighting – CONSTANTLY
Indoors – CONSTANTLY
Perform complex and varied tasks – FREQUENTLY
Develop and maintain positive work relationships – CONSTANTLY
Regular contacts: co-workers, supervisor – FREQUENTLY
Decision-making – FREQUENTLY
Lead/Influence Others – FREQUENTLY
Work review – FREQUENTLY
Rapid Pace of work – FREQUENTLY
Control of work pace – FREQUENTLY
Problem Solving – FREQUENTLY
Memory – FREQUENTLY
Understand and follow direction – FREQUENTLY
Regular and reliable attendance – CONSTANTLY
A reasonable salary expectation is between $57,948.80 – $73,860.80, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.
by twochickswithasidehustle | Sep 11, 2023 | Uncategorized
- Job Information:
- Job Description:
- The “Chat Moderator” position is a part-time, remote, and flexible position that entails moderating the chat of the official Discord of The Mayeaux Foundation. This can include but is not limited to: 1) Deleting messages made by users that violate the rules of the Discord server. 2) Banning users that have multiple and repeat violations of the rules of the Discord server. 3) Muting users that have violated the rules of the Discord server. 4) Investigating reports made by users about violations of the rules of the Discord server.
- Pay Rate:
- The Pay Rate for this position is $12.50 per hour.
- The Pay Cycle is Weekly starting from Monday and ending on Sunday.
- Qualifications:
- Must be 18 years of age or older.
- Must have a High School Diploma or GED.
- Company Information:
- Equal Opportunity Employer Disclosure:
- No matter how you identify in this crazy world, The Mayeaux Foundation, will forever stand for fair and equal hiring practices and opportunities. The Mayeaux Foundation does not (will not) discriminate race, religion, ethnicity, sexual orientation, gender and sex identity. Come join us and help build a community that is worth lasting.
- About the Company:
- We, The Mayeaux Foundation, are a company based in Castle Rock, Colorado and we strive and stand for equality while managing our company. Our company offers services such as computer programming courses on a variety of programming languages. We plan on launching our own social media app and bank account.
by twochickswithasidehustle | Sep 11, 2023 | Uncategorized
JOB DESCRIPTION
Come join our amazing team and work remote from home!
The Vendor Management Specialist will be responsible for maintaining an existing network of third-party legal vendors, their company portfolios, building the relationship with such vendors and monitoring their continued compliance. Perform all duties in accordance with the company’s policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay range for this position is $24.00 – $26.00 per hour.
What you’ll do:
Review and assess large volume of documentation to complete vendor review in accordance with regulatory compliance and internal policy.
Setup new legal vendors in accordance with the company’s rules and guidelines through a formalized process, ensure ongoing compliance through evaluating and reviewing vendor’s policies and procedures and other required documentations.
Be the first point of contact for vendors and provide updates and on-going communication by running status reports and communicating with vendors through various means to follow up on required compliance items.
Update internal system of record with most up to date records upon receipt.
Manage the vendor ongoing reviews and annual contract obligations.
Gather data for potential new service providers for onboarding consideration.
Monitor and track documents needed from third-party vendors to ensure compliance.
Contact third-party vendors by various means for required documents as needed.
Escalate matters to leadership team timely if unable to resolve issues.
Responsible for all tasks related to the ongoing oversight of an assigned pool of legal vendors and escalating any identified risks, material change in business operations, or privacy issues.
Process marketing and mortgage lending vendor invoices as needed.
Perform other duties and special projects as assigned.
What you’ll need:
High School Diploma or equivalent work experience; and/or some college preferred.
One or more years of mortgage servicing, auditing, finance, compliance or vendor management work experience.
Experience with Loan Origination and Loan Servicing Systems is a plus.
Proficient in MS office, in particular Word, Outlook, Excel and Visio.
Our Company:
Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you’ll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: www.carringtonmortgage.com.
What We Offer:
Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed.
Access to several fitness, restaurant, retail (and more!) discounts through our employee portal.
Customized training programs to help you advance your career.
Employee referral bonuses so you’ll get paid to help Carrington and Vylla grow.
Educational Reimbursement.
Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org.
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