Adjuster Salary at 1099 Pro Inc BETA

Claims Casualty Adjuster Job Summary The Claims Casualty Adjuster handles low to moderate-complexity claims involving material damage, property, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation and negotiation of low to moderate-complexity claims in compliance with established company technical and customer service Best Practices. Under moderate supervision, works within specific limits of authority to resolve claims with well-defined procedures. Job Duties Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address common coverage issues. Conduct phone and/or field investigations to determine liability and damages. May at

Job Description Job Description The Hospital Claims Adjuster is responsible for the adjusting of hospital risk claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospitals/IPAs. Research, reviews, and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff. Duties and Responsibilities · Accurately review all incoming adjustment requests to verify necessary information is available. · Meets production and accuracy standards established by claims management. · Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims. · Coordinate resolution of claims issues with other Departments. · Assist Providers and other Departments in claims research. · Review and adjudicate web portal inquiries. · Assist in training claims personnel when issues are identified. · Promote a spirit of coopera

Job Description Job Description POSITION SUMMARY The Risk Adjustment Coder- Admin is responsible for Risk Adjustment HCC coding management and training both internally and externally to ensure that physicians, office staff and health plan representatives are working together effectively to achieve goals. Reports to Director of IPA Administration. RESPONSIBILITIES-DUTIES Review medical record information to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) Audit provider documentation of CPT, ICD-9 and ICD-10 codes to ensure adherence with coding and CMS Risk Adjustment guidelines Evaluate HCC auditing processes and provide analyses and recommendations to improve overall provider documentation and coding Responsible for ongoing provider education on HCC Support and participate in process and quality improvement initiatives Meet productivity and quality standards Review Comprehensive Annual We

Your Role The Risk Adjustment Provider Partnership team supports all functions within the risk adjustment program, working with cross-functional teams at Blue Shield and Provider Groups. The Risk Adjustment Consultant, reporting to the Manager, will work with operational and clinical leaders to improve recapture rates, understand clinical suspects, and monitor documentation and coding accuracy. They will also implement Blue Shield Programs that ensure diagnoses are coded according to CMS and risk adjustment guidelines. The ideal candidate has strong customer service, project management, organizational, and analytical skills, is a self-starter, and pays high attention to detail. They may assemble project teams, assign and monitor work, and provide guidance and leadership. Your Work In this role, you will: Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods Train lower-level staff on how

Job Description Job Description Summary The claims adjuster is responsible for the adjusting of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff. Duties and Responsibilities · Accurately review all incoming adjustment requests to verify necessary information is available. · Meets production standards of 20-100 claims as established by claims management. · Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims. · Coordinate resolution of claims issues with other Departments. · Assist Providers and other Departments in claims research. · Review and adjudicate web portal inquiries. · Assist in training claims personnel when issues are identified. · Promote a spirit of cooperation and understa

Claims Senior Auto Adjuster The Claims Senior Auto Adjuster supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, claims resolution and negotiation strategies of moderate complexity claims in compliance with established company technical and customer service best Practices. Under limited supervision, works within specific limits and authority to resolve claims with well-defined procedures. Job Duties Communicate and interact with a variety of individuals including insureds and claimants. Verify and explain benefits, coverages, fault, and claims process either verbally or in writing which complies with regulatory and statutory requirements. Recognize and appropriately address moderate-complexity co

Claims Senior Casualty Adjuster Job Summary The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims. Job Duties Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses. Communicate and interact with a variety of individuals including insureds an

Claims Senior Casualty Adjuster Job Summary The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims. Job Duties Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses. Communicate and interact with a variety of individuals including insureds an