of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources... disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement...
fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources... Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan...
and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data... audits) EDUCATION & EXPERIENCE: Associate’s degree or equivalent experience CPC or CPC-A required Previous experience...
fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources... disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement...
fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources... disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement...
quantity of claims required for the auditing of each examiner. Audits and authorizes payment of claims over examiner's limits...'s degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two...
quantity of claims required for the auditing of each examiner. Audits and authorizes payment of claims over examiner's limits...'s degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two...
quantity of claims required for the auditing of each examiner. Audits and authorizes payment of claims over examiner's limits...'s degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two...
in Financial Services & Insurance OSS Coordinator PRIMARY PURPOSE: To support and maintain the claims management system.... ESSENTIAL FUNCTIONS and RESPONSIBILITIES Completes examiner update reports, claim adjustments, provider requests...
& RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner... and timelines (must maintain a score of 98% or higher on performance audits) EDUCATION & EXPERIENCE: Associate’s degree...
to other appropriate internal teams as needed. Supports the provider escalation project team to resolve claims and payment issues... within established service level agreements, WellCare best practice and quality standards. Applies a comprehensive knowledge of claims...