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Responsible for checking the accuracy and completion of claim forms and attachments; reviews company records to determine coverage. Obtains missing information by calling or writing to the insured using standard scripts or form letters. Calculates amount of claim. Submits claims within assigned limits, for payment. Qualifications Minimum Requirements 1 years claims examiner experience Critical Ski
Posted 1 day ago
When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life (a Life & Specialty Ventures Company) is always ready. At USAble Life, we strive to have a positive impact in the lives of others, especially our employees. We are a diverse group of individuals working together to go the extra mile. Bring your talents and expertise to join our team, and you&rs
Posted 3 days ago
Supervisor, Medical Management (Non Clinical) (1113875) Position Purpose Supervise the day to day operations of the medical review unit Oversee changes to medical review unit functions and performance in relation to company mission, philosophy objectives and policies Assist senior management with budgets and forecast for strategic planning and key initiatives. Balance current and future needs effe
Posted 5 days ago
Grievance & Appeals Coordinator I (1114217) Position Purpose Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain f
Posted 5 days ago
Program Specialist I Social Work LPN or RN (1113783) Position Purpose Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program an
Posted 20 days ago
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 25 days ago
Health Net
- Little Rock, AR
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 28 days ago
Health Net
- Little Rock, AR
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 1 month ago
Health Net
- Little Rock, AR
Define and monitor the member's progress towards meeting his/her identified goals. Attend all team meetings for the member to discuss the member's current state including, but not limited to their satisfaction with services and support staff, goal progress and development, incidents, behaviors and medications. Maintain required documentation in accordance with agency and funding source requirement
Posted 2 months ago
Claims Representative II Homeowners Little Rock, Arkansas (19846) Join our Team! The Automobile Club of Missouri is seeking a Claims Representative II. This position is based in Little Rock, Arkansas and handles Homeowner claims involving property lines of insurance written in compliance with all regulatory and statutory requirements. The primary functions include inspection, investigation, evalua
Posted 2 months ago
ESIS Sr. WC Claims Rep (317725) The Senior Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. MAJOR DUTIES & RESPONSIBILITIES Duties include but are not limited to Under limited supervision, receives assignments and reviews claim and policy information to provide background for i
Posted 8 months ago
ESIS Sr. WC Claims Rep (317725) The Senior Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. MAJOR DUTIES & RESPONSIBILITIES Duties include but are not limited to Under limited supervision, receives assignments and reviews claim and policy information to provide background for i
Posted 8 months ago
At Abbott, we're committed to helping people live their best possible life through the power of health. For more than 125 years, we've brought new products and technologies to the world in nutrition, diagnostics, medical devices and branded generic pharmaceuticals that create more possibilities for more people at all stages of life. Today, 99,000 of us are working to help people live not just long
Posted 1 day ago
Arvest Bank
- Little Rock, AR
Under the close direction of the assigned manager, the Title Agent 1 will search and review the chain of title and related matters on less complex files affecting a particular parcel of real property in preparation of determining the condition of title for the purpose of issuing a title commitment, report or policy. When the Title Agent produces the title commitment, they will determine the condit
Posted 5 days ago
The Engineer, Professional Engineer is responsible for conducting engineering studies, developing design drawings and/or specifications, and performing related administrative duties. This position is governed by state and federal law and agency policy. Typical Functions Inspects sites to verify compliance with plans, specifications, and state and federal regulations during all phases of constructi
Posted 6 days ago
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