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Alternate job titles: Claims Review and Settlement Senior Manager | Claims Service and Operations Senior Manager

Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the v more...



Alternate job titles: Disability Claims Examiner, Sr.

The Disability Claims Senior Reviewer examines claims material to ensure insurance coverage and validity. Reviews, evaluates and processes disability insurance claims according to procedure and practice. Being a Disability Claims Senior Reviewer typically requires a bachelor's degree or its equivalent. Has contact with agents, claimants, and policy holders. In addition, Disability Claims Senior Reviewer typically reports to a supervisor/manager. Working as a Disability Claims Senior Reviewer typically requires 2 to 4 years of related experience. Gains exposure to some of the complex tasks with more...


Alternate job titles: Claims Quality Auditor III | Claims Quality and Compliance Auditor III

The Claims Quality Auditor - Senior selects claims through random processes and/or other criteria. Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Being a Claims Quality Auditor - Senior typically requires an associate's degree. Makes recommendations to improve quality, workflow processes, policies and procedures. In addition, Claims Quality Auditor - Senior typically reports to a supervisor or a manager. Claims Quality Auditor - Senior is a specialist on complex technical and business matters. Work is highly independent more...


Alternate job titles: Automotive Claims Adjuster III | Claims Investigator III | Insurance Claims Senior Adjuster | Property/Casualty Claims Adjuster III

The Insurance Claims Adjuster, Senior examines claim forms and other records to determine coverage. Denies, settles, or authorizes payments to more complex property/casualty claims based on coverage, appraisal, and verifiable damage. Being an Insurance Claims Adjuster, Senior conducts field investigations to inspect and document damage or loss. Responsible for corresponding with policyholders, claimants, witnesses, attorneys, etc. to gather important information to support contested. In addition, Insurance Claims Adjuster, Senior prepares report of findings of an investigation. May require a b more...



Alternate job titles: Automotive Claims Adjuster III | Claims Investigator III | Insurance Claims Adjuster, Senior | Property/Casualty Claims Adjuster III

The Insurance Claims Senior Adjuster examines claim forms and other records to determine coverage. Denies, settles, or authorizes payments to more complex property/casualty claims based on coverage, appraisal, and verifiable damage. Being an Insurance Claims Senior Adjuster conducts field investigations to inspect and document damage or loss. Responsible for corresponding with policyholders, claimants, witnesses, attorneys, etc. to gather important information to support contested. In addition, Insurance Claims Senior Adjuster prepares report of findings of an investigation. May require a bach more...


Alternate job titles: Disability Claims Senior Reviewer

Reviews, evaluates and processes disability insurance claims according to procedure and practice. Examines claims material to ensure insurance coverage and validity. Has contact with agents, claimants, and policy holders. Typically requires a bachelor's degree or its equivalent. Typically reports to a supervisor/manager. Typically requires 2 to 4 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. more...



Alternate job titles: Claims Manager, Senior | Claims Service and Operations Senior Manager

The Claims Review and Settlement Senior Manager oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Being a Claims Review and Settlement Senior Manager assures timely and proper disposition of claims based on policy provisions. Manages appraisal and examination staff and processes. In addition, Claims Review and Settlement Senior Manager recommends and implements best practices to ensu more...


Alternate job titles: Claims Manager, Senior | Claims Review and Settlement Senior Manager

The Claims Service and Operations Senior Manager oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Being a Claims Service and Operations Senior Manager assures timely and proper disposition of claims based on policy provisions. Manages appraisal and examination staff and processes. In addition, Claims Service and Operations Senior Manager recommends and implements best practices to e more...


Alternate job titles: Claims Payment Clerk I

Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Verifies coverage eligibility. Calculates settlement amounts according to guidelines. Processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. more...



Alternate job titles: Medical Policy Specialist

The Provider Claims Process and Controls Analyst recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Being a Provider Claims Process and Controls Analyst responds to questions from medical staff and communicates details about policy and guidelines. Establishes the proper codes to use for claims processing. In addition, Provider Claims Process and Controls Analyst r more...


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