Top Claims Litigation Executive provides legal representation to the organization in insurance claims-related litigation. Provides legal advice to claims personnel. Being a Top Claims Litigation Executive leads a staff of internal attorneys and outside legal counsel. Tries large, complex cases as required and directs claims cases through litigation cycle. Additionally, Top Claims Litigation Executive consults with senior management to resolve issues and decide settlements. Must be admitted into the state bar. Acts as Attorney of Record. Requires a Juris Doctor degree from an accredited law school. Requires admittance to a state bar. Typically reports to top management. The Top Claims Litigation Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Claims Litigation Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Under the supervision of the Manager, the incumbent adjudicates claims and provides phone and/or casino onsite coverage for all member and provider interactions. Accountable for the status of claim age for all group evaluation and daily work flow. Makes adjustments daily to ensure standards are met. High school diploma or GED; one year of college level anatomy or pre-med classes or advanced medical terminology training, including ICD10 and CPT Coding; minimum two to four years’ experience in medical claims processing; word processing and data entry skills; Must have the ability to train employees and familiarity with HIPAA guidelines. Experience with Trizetto QicLink or VBA claims system preferred.
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