Average Salary for Jobs with Claim Settlement Policies Skills

Directs the activities of an organization's actuarial function. Oversees the analysis and evaluation of potential risks to determine the financial impacts of new or existing insurance plans. Develops policies, procedures, and formulas to guide statistical analysis and actuarial research and evaluate the likelihood and financial impact of various risks. Designs processes and guidelines to ensure re... View job details

Manages the analysis and evaluation of potential risks to determine and manage financial impacts. Implements policies and procedures to guide statistical analysis and actuarial research and evaluate the likelihood and financial impact of various risks. Monitors daily operations to ensure regulatory compliance of products and financial operations. Evaluates risk exposure data and calculates appropr... View job details

Manages the analysis and evaluation of potential risks to determine and manage financial impacts. Implements policies and procedures to guide statistical analysis and actuarial research and evaluate the likelihood and financial impact of various risks. Monitors daily operations to ensure regulatory compliance of products and financial operations. Evaluates risk exposure data and calculates appropr... View job details

Manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. ... View job details

Conducts the medical review activities needed to resolve and process clinical appeals and claims. Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases. Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. Documents ... View job details