The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Content Claims Specialist Field Level I Requisition ID 2024 24911 Job Locations US MA Boston Position Type Regular Full Time Category Claims Business Unit CUS_Loss Adjusting US Excellence In Everything We Touch Position Summary The role of Content Claims Specialists is a multi faceted role, which focuses primarily in the following four key areas of edjuster's content clai

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

The Sr. Claims Auditor utilizes CPT and ICD 10 coding to review physician claims and medical records for coding accuracy. Internal auditing functions focus on "desktop reviews" of claims, design and quality control of future audits, and other auditing related functions. Review clinical notes and claims submitted to verify the appropriateness of codes billed based on servi

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

As a member of our Claims management team supervise claims staff to ensure appropriate claim outcomes through consistent execution of best claims practice. In this role utilize your prior claims and management experience to achieve business plan goals and to ensure compliance with legal statutes, policy provisions and company guidelines while fostering a culture of commun

Fast paced field environment with frequent face to face, customer interaction Ability to traverse ladders, roofs, crawl spaces, and damaged property Typically inspects multiple losses per day requiring car travel between locations Evaluates and settles property related damages (primarily) between $10,000 and $100,000 (aggregate); occasionally handles losses that exceed $1

Handles property/inland marine claims for assigned region with availability to assist as needed in all other regions. Evaluates property related damages of $100,000 (aggregate) and above. Handles complex Business Income losses. Responds to catastrophe claims handling in accordance with company CAT plan. Responsible for all coverage determinations, negotiations, reserving

Job Location Smithfield, RI Smithfield, RI Position Type Full Time   Travel Percentage Occasional Job Shift Daytime Job Category Some Experience Description Position Overview (In office) This position is responsible to review written inquiries related to claims edit determinations that decrease claim reimbursement. This position also reviews inquiries related to denie

Claims Specialist ID 2024 7722 Job Location Location US MA Boston Type Regular Full Time Category/Department Claims Additional Locations US FL Tampa | US FL West Palm Beach | US NY New York Overview About Suffolk Suffolk is a national enterprise that builds, innovates, and invests. Suffolk is an end to end business that provides value throughout the entire project lifecyc

Insurance Coordinator is responsible for proactive management of the insurance authorization process. Supports clinicians by managing insurance authorizations/certifications (initial/ongoing) process. Assists patients with the financial and authorization issues related to their care. Supports all ambulatory PT/OT practice sites. Proactively, effectively and efficiently ma

The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

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

Review assigned accounts by contacting Medicare to ensure timely resolution of accounts. Create updates and document information relating to the financial status of accounts in the hospital billing systems. Contact patients and/or other third party representatives to secure additional information pertaining to reimbursement of accounts. Process rejected/adjusted claims th