Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances Communicates with appropriate parties regarding appeals and grievance issues, implications, and decisions Analyzes and identifies trends for all appeals and grievances May re

Evaluates new and on going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines needs for additional medical information. Determine appropriate benefit calculations and payments. Performs revie

Evaluates new and on going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines need for additional medical information. Performs periodic follow ups to verify continued existence of a disabling condition. Respon

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

Provide expertise and support by reviewing, researching, investigating and auditing problematic claims Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance Responsible for all aspects of quality assurance Extensive work experience with multitasking in multiple functioning processes To work within the es

The SHOW comes alive at MGM Resorts International! Have you ever wondered what it would be like to work in a place full of excitement, diversity, and entertainment? Are you enthusiastic about being a team player in one of the most fascinating industries in the world? At MGM Resorts, we seek individuals like YOU to create unique and show stopping experiences for our guests

Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice

Providence caregivers are not simply valued they're invaluable. Join our team and thrive in our culture of patient focused, whole person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence is calling a Sr. Medical Malpractice Claims Manager Profes

Western Region CBO The Western Region Consolidated Business Office provides business office services including billing, collections, cash posting, pre access management, variance and customer service to our affiliated UHS facilities. We are seeking dynamic and talented individuals to join our team. Job Description Responsible for the maintenance and processing of patient