Claims Reviewer Salary at Verus BETA

Job Type Full-time Description The Claims Reviewer I is responsible for the initial review and proper labeling of claimant documents pertaining to mass tort cases involving asbestos and talc. This role involves reviewing and capturing data from specific types of supporting documents and contacting claimants via email and/or phone to verify demographic information. Additionally, the Claims Reviewer I provides administrative support to the Operations department, following instructions and pre-established guidelines under immediate supervision in a collaborative team environment. Primary Responsibilities 1. Perform data entry of limited types of documentation submitted for various projects. 2. Review limited types of documentation submitted for various projects. 3. Process and label newly submitted documentation to Pre-Processing following established procedures. 4. Maintain acceptable levels of productivity and accuracy. 5. Handle general clerical tasks such as photocopying, faxing, mail

Job Description Job Description SUMMARY The Claims Reviewer I is responsible for the initial review and proper labeling of claimant documents pertaining to mass tort cases involving asbestos and talc. This role involves reviewing and capturing data from specific types of supporting documents and contacting claimants via email and/or phone to verify demographic information. Additionally, the Claims Reviewer I provides administrative support to the Operations department, following instructions and pre-established guidelines under immediate supervision in a collaborative team environment. PRIMARY RESPONSIBILITIES Perform data entry of limited types of documentation submitted for various projects. Review limited types of documentation submitted for various projects. Process and label newly submitted documentation to Pre-Processing following established procedures. Maintain acceptable levels of productivity and accuracy. Handle general clerical tasks such as photocopying, faxing, mailing, s

OBJECTIVE: To ensure that all charges, claims and/or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients. ESSENTIAL DUTIES AND RESPPONSIBILITIES: Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components. Follow clams from submission to payment using EMR analytics, reports, payer portals and other resources as necessary Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner Review payer EOBs for a complete understanding of payments and assignment to patient responsibility. Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of

JOB SUMMARY: The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day-to-day operations of CommunityCare’s medical claim review program. The supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to Medical Review staff including analysis, problem solving, and decision making of complex claim reviews. Identifies medical necessity and/or quality issues for further evaluation. Oversees triage of pended and/or high dollar claims. Collaborates with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business. Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned. Proactively conducts rou

Seeking a candidate to fill position for UM Nurse Reviewer. Candidate must have a managed care background, knowledge of Medicare and Medi-Cal and knowledge of health plan and CMS guidelines. Candidate must also have the ability to review and make determination of requests for clinical services. Excellent computer skills and the ability to type at least 45 WPM. Claims review experience is a plus and bilingual is a plus. Summary of Job Duties include: review requests for clinical care appropriateness, defer potential denials to MD and other duties as assigned. High School Diploma, Licensed Vocational Nurse (LVN)

The CRST Project Supervisor specific duties and responsibilities include: + Assist Claim Review Support Team Project Manager in all aspects of Claim Review Support Team management. + Coordinate tasks and responsibilities of the 14+ team members on the Claim Review Support Team, including: + Identify daily team priorities and communicate expectations of priorities to team members. This involves monitoring various claim statuses or queues and identifying claims assignable within the Special Masters guidance. + Determine individual team member capacity and reassign members to high priority tasks, while maintaining coverage of other CRST tasks. + Serve as the VCF point of contact for the DOJ Public Safety Officer Benefits (PSOB) program data validation requests. Coordinate with the CMS team for report generation, review validation match report, compile newly validated data, and retrieve identified Eligibility Determination Letters for submission to the PSOB. + Coordinate with the CMS team

WWC Global is seeking multiple Claims Reviewers for a potential contract to support disaster relief. This position involves receiving, evaluating, and processing claims for compensatory damages for injuries resulting from the Hermit's Peak/Calf Canyon fires. The role requires meticulous attention to detail and adherence to FEMA guidelines. Claims reviewers will objectively review, investigate, process, and evaluate third-party claims. Specific responsibilities include but are not limited to: Provide technical assistance and expertise in support of the Hermit's Peak/Calf Canyon Claims Office (Claims Office), by receiving, evaluating, and processing claims for compensatory damages for injuries from the Hermit's Peak/Calf Canyon Fire. Communicate directly with claimants and/or claimant representatives to expedite claim processing, as requested by FEMA Navigators. Collaborate with local, state, and federal officials to identify eligible response, recovery, and mitigation activities. Advise

We are seeking Medical Claims Reviewers to assist the Air Force Security Assistance and Training (AFSAT) Squadron in monitoring the welfare of U.S. Air Force-sponsored international students. Selected individuals will perform medical claims review activities, receive and process treatment requests, and provide guidance to treatment facilities. Primary Responsibilities Perform medical claim review activities in support of Security Assistance and Security Cooperation training programs. Receive, track, and verify medical, dental, and pharmacy pre-authorizations and claims for International Military Students (IMS) and their dependents. Verify that the International Classification of Diseases (ICD) codes on the claims comply with treatment diagnosis using most recent ICD guidance, advocate for reduced treatment costs and provide claims to AFSAT/FMF for processing. Provide validation/return of treatment requests to facilities and resolve discrepancies. Provide guidance to treatment facilitie