II. Essential Responsibilities Set up, research, review and process non contestable claims within established productivity and quality standards. Review company records to confirm insurance coverage. Review all beneficiary and title changes and collateral assignments for correctness and generate appropriate correspondence in accordance with state insurance regulations req

Job Description Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient's need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other h

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisio

Under the supervision of the Director of Compliance, the analyst will manage, develop, implement and monitor policies, procedures, processes, training, corrective action plans and overall operations to ensure compliance with federal and state laws and regulations affecting the Medical System and its Affiliates. Additionally, the Analyst will work collectively with Affilia