CBsalary.com Home » Salary Calculator » Salary Search Results for Claims Representative Associate - Las Vegas, NV

Search Results

Oversees and directs the management of the claims function to include review and approval of claims. Directs the implementation and ongoing maintenance of claims handling systems, policies, and procedures. Typically requires a college degree and five or more years of claims management experience.: Monitors departmental operations to ensure compliance with regulatory agencies as well as contractual obligations. Performs regular data analysis of claims payment reports to identify variances so that areas of focus may be identified and resources may be appropriately deployed. Provides support on complex claims issues. Prepares and manages the departmental budget and manages expenses. Hires, develops, and motivates a qualified claims processing staff.

Medical Claims Review Manager

Manages the medical claims review staff to ensure process improvement and quality in claims review. This position typically requires a Bachelor’s degree with five years of medical review experience. This position may require a nursing degree.: Manages the medical claims review staff to ensure process improvement and quality in claims review. Translates benefit plan language (Summary Plan Descriptions) into standard review program procedures. Interfaces with clients to conduct/manage random sample reviews to determine medical claims processing accuracy and timeliness. Works with clients to coordinate operational reviews to assess administrative processes and controls. Reviews company claims, eligibility, provider, and medical management systems to identify issues affecting quality and productivity. Documents findings and write follow-up reports. Provides planning, organizing and budgeting for the department. Develops, administers and reports service quality indicators for each team under supervision. Recommends and implements innovative strategies to retain members, contain medical costs and improve efficiency. Hires, trains, coaches, counsels and evaluates performance of direct reports. This position typically requires a Bachelor’s degree with five years of medical review experience. This position may require a nursing degree.

Claims Quality Audit Manager

Supervises and facilitates the coordination and scheduling of all external claims audits conducted by customers, audit firms, external vendors, and regulators. Assists in the preparation of audits and management of the audit process. : Notifies appropriate parties of the audit and schedules entrance and exit conferences. Develops tools to assist staff in effectively coordinating audits and holds staff meetings as needed. Reviews customer contracts for audit rights, and prepares necessary audit confidentiality agreements and Par Plan addendum agreements. Supervises the obtaining and reviewing of claim samples and documentation. Ensure all HIPAA requirements applicable to the job are met. Directs and oversees analysis of requested data in order to minimize organization's risks. Ensures data integrity. Assures that auditors have a positive experience. Reviews findings and responses for adequacy and appropriateness. Reviews draft and final audit reports from auditors. Prepares responses to report findings. May travel to other claims audit locations as needed.

Claims Quality Audit Director

Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically requires a college degree in a related field and an in-depth understanding of claims auditing.: Provides oversight of departmental training and auditing activities. Monitors departmental operations to ensure compliance with regulatory agencies and contractual obligations. Develops strategic initiatives and transforms initiatives into action plans. Hires, trains, and motivates a qualified management staff. Oversees the development of training programs that are targeted toward error reduction and decision quality in claims processing. Analyzes audit and training reports to determine department effectiveness.

Claims Quality Audit Supervisor

Supervises employees engaged in claims auditing and training. Implements claim auditing department policies, practices, and procedures to ensure identification of claims processing errors. Typically requires prior experience as a Claims Processor or Adjudicator and an in-depth understanding of claims auditing.: Supervises auditing activities by monitoring weekly backlogs, distributing audit assignments based on work loads, and reviewing and responding to audit inquiries. Responds to error rebuttals from Claims Processors or Adjudicators. Assists in hiring, training, coaching, and evaluating performance of assigned staff. Contributes to the development of training programs that are targeted toward error reduction and decision quality in claims processing. Monitors training programs to evaluate effectiveness.

Claims Supervisor

Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years of claims examining/auditing experience may be required to fulfill the requirements of this position.: Ensures evaluation of all claims through determination of types and amounts of benefit payable. Ensures/oversees documenting of provider claims/billing forms to support payment/decisions. Ensures claims processing is consistent with applicable policies, procedures, and department guidelines. Supervises maintenance of claims records. Reviews appeals and complaints that Examiners are unable to resolve. Analyzes and approves insurance claims. Conducts personal interviews with claimants to explain procedure for filing claims. Submits statement of claim liabilities to actuarial department for review. Informs departmental supervisors on claims status. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports, and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. May participate in the specialized training and handling of complex claim situations and projects requiring advanced claim knowledge and experience, as delegated by Claims Manager and/or Director. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.

Supervisor Claims

Claims Auditor

Conducts claims audits to ensure accuracy of claims determinations. Manages and coordinates the reporting, review, and maintenance of data for use in supporting audit functions. : Performs claims audits based on audit program and specified target audits as assigned. Documents audit findings accurately. Assures quality of claim determinations and ensures compliance with regulations and plan requirements. Researches, analyzes, and understands claims processing and payment regulations. Understands and applies standard pricing methodologies for claims. Identifies underpayments/overpayments and generates reports to quantify amounts detected through audit process. Communicates errors to Production Manager or Supervisor and trends errors for corrective actions. Identifies and develops potential areas for claim audits. Evaluates audit initiatives and identifies enhancements to the audit processes and procedures as needed. Determines whether to accept, reject, or request additional information based on policies and procedures.

Disability Work Compensation Claims Specialist

Reviews, analyzes, investigates, makes liability decisions and approves the release of benefit payments up to authorized levels on initial, continued and reopened claims.: Independently reviews simple to complex claims for adjudication purposes. Evaluates new and ongoing claims to determine liability according to contract provisions, medical evidence, and vocational evidence and duration contract guidelines. Performs periodic follow-up to determine continuing existence of a disabling condition. Analyzes documentation and summarizes data gathered from a variety of sources. Responds to telephone and written inquiries from claimants, attorneys, physicians and policy holders. Updates and maintains accurate records. This position typically requires knowledge of case law and state worker’s compensation laws. A minimum of three years of claims adjudication experience is typically required.

Claims Adjudicator (Entry)

Adjudicates or processes health and dental benefit claims for payment.: Under direct supervision, reviews and adjudicates claims. Determines whether to return, suspend, deny or pay claims within established policies and procedures. Compares claim application and/or provider statement with plan file and other records to evaluate completeness and validity of claim. Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and or reason for denial. Requests information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information. Compares data on claim application, death certificate, or physician's statement with policy file and other company records to ascertain validity and to adjudicate the claim. Routes claims requiring additional information or high-level decision-making. Researches claims as needed. Communicates with agents and claimants to correct errors or omissions on claim forms. This is an entry level position and typically does not require previous claims processing experience.

Search Again

1 2 3 Next

Search Jobs by Salary Range

Job Openings

Based on your search criteria, you may be interested in the following jobs

- Claims Representative Associate - Las Vegas, NV
...vital and complex system. Claims Representative Associate - Las Vegas, NV Primary Responsibilities: Provide expertise or general claims support to...

- Claims Representative II
Claims Representative II MEADOWBROOK...approximately 950 associates in 24 offices throughout...for a full time Claims Representative II, to join our...

- Claims Representative II
Claims Representative II MEADOWBROOK INSURANCE...approximately 950 associates in 24 offices throughout...for a full time Claims Representative II, to...

Negotiating Salary? Would a Degree Help?

Employment Spot

Navigation