1) to implement a governance model at a level under the VP of Governance, Risk and Opportunities, and serve as the second line of defense for the Business Unit. And 2) to drive the implementation of risk and opportunities processes and tools during project execution, as well as for the analysis of the risk and opportunities information to maintain visibility of top risks

Review and analyze medical claims to determine coverage and eligibility Investigate and gather information to support claim decisions Evaluate medical records, bills, and other documentation to ensure accuracy and compliance with coding standards Apply knowledge of medical terminology, coding systems (ICD 10, ICD 9), and billing procedures to process claims Communicate wi

Claims Specialist Auto Material/Property Damage Remote Job Locations US NJ MORRISTOWN Job ID 2024 3726 Category Claims Type Regular Division Surplus & Specialty Crum & Forster Company Overview Crum & Forster (C&F) with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance compan

Health & Group Benefits Consultants are an integral part of the overall client management and client relationship function in Milliman's Employee Benefits Consulting practice. The successful candidate will have at least ten years of Health & Welfare consulting experience, with a strong working knowledge of benefits design, delivery, vendor management, and strategy. This f

To examine, adjust, defend, claims and lawsuits against our insureds. Entails reviewing policies to determine coverage, resolving questions of coverage, investigating and making liability determinations, and evaluating damages such as property damage or medical records. Essential Duties and Responsibilities Review and verify coverage for each claim, includes policy review

Claim Representative III Commercial Liability Job Locations US ID 20243337 Category Claim Type Regular Full Time Introduction Looking to join a vibrant organization that makes a difference? At Church Mutual, our customers are at the heart of everything we do. For more than 125 years, we've made it our business to protect those who serve and inspire others through our spec

Will be primary claims department trainer. In this role you will use independent judgment and knowledge to determine training needs and perform all aspects of training for the Claim Department. Training will include policies, procedures, and QicLink system training for new hires as well as experienced staff. ESSENTIAL FUNCTIONS Work closely with the Audit Team and departm

The world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, challenge the status quo and shape the future for the greater good. You'll do all this in an en

Senior Manager/Principal, Vehicle Engineering (ADAS) ID 2023 1186 Location US AZ Phoenix Practice Vehicle Engineering Position Type Full time About Exponent Exponent is the only premium engineering and scientific consulting firm with the depth and breadth of expertise to solve our clients' most profoundly unique, unprecedented, and urgent challenges. We are committed to e

Promptly evaluates all assigned claims; establishes and executes a strategy to mitigate indemnity, medical and allocated loss adjustment expense exposure. Ensures timely disposition of all claims in accordance with regulatory and statutory requirements. Tracks status of assigned clams, individually and in the aggregate, using available management reports and tools such as

Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alerts Supervisor and Special Investigations Unit to potentially suspect claims Ensures timely denial or payment of benefits in accordance with jurisdi

Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alert Supervisor and Special Investigations Unit to potentially suspect claims Ensure timely denial or payment of benefits in accordance with jurisdictio

JOB DESCRIPTION Make your mark for patients. We're here because we want to build the future and transform patients' lives for the better. At UCB, our people are our experiences and achievements, our passion and drive. That's why we're looking for talented individuals with diverse backgrounds and experiences not just the best and brightest, but those who care about making

Develops fraud prevention policies used by fraud investigators. Explores new technologies that may be applied to combat emerging trends in fraud activity such as Internet fraud and identify theft, incorporating technology into processes and card products. Utilizes company system reports in identifying overall fraud loss trends across organizational units. Provides summari

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary This Position Is Responsible For Co