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View salary and benefits informationThe Provider Claims Process and Controls Analyst recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Being a Provider Claims Process and Controls Analyst responds to questions from medical staff and communicates details about policy and guidelines. Establishes the proper codes to use for claims processing. In addition, Provider Claims Process and Controls Analyst r more...
Directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements. Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Provides expert guidance and consultation to staff on the most complex claims. Requires a bachelor's degree. Typically more...
Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Work is generally independent and collaborative in nature. Contributes to moderately comp more...
Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Work is highly independent. May assume a team lead role for the work group. A specialist more...
Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Works autonomously. Goals are generally communicated in "solution" or project goal terms. more...
Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Verifies coverage eligibility. Calculates settlement amounts according to guidelines. Processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. Typically requires 3-5 years of related experience. more...
Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the v more...
Manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Typically requires a bachelor's degree. Typically reports to a director or head of a department. Manages subordinate staff in the day-to-day performance of their jobs.True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority fo more...
Plans and directs all aspects of an organization's insurance claims function. Responsible for managing and implementing claims programs for all lines of insurance. Directs the review and settlement of complex or high dollar claims. Develops procedures and policies to enhance and improve the processing, investigation, and settlement of claims. Ensures legal examinations are made when appropriate. Requires a bachelor's degree. Typically reports to top management. Manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Appr more...
Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the v more...
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