The specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided. Key duties include identifying review necessity, collecting and analyzing data to make decisions, and documenting final conclusions in designated software.
Remote Jobs & Work From Home Opportunities (201,835)
The Senior Claims Specialist manages complex Workers' Compensation claims by confirming coverage, determining compensability through investigation, and establishing reserves while authorizing payments within authority limits. This role involves developing action plans with case managers to reduce claim costs, coordinating return-to-work efforts, and managing subrogation and potential claim recoveries.
The specialist manages non-complex, medical-only workers’ compensation claims, confirming coverage, determining validity, and establishing reserves under close supervision. Responsibilities also include communicating claim status to all relevant parties and adhering to client and carrier guidelines.
Part-Time Online Facilitator
Eastern Kentucky University
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Full Time
·
12 Weeks Ago
Eastern Kentucky University
The primary function is to serve as a part-time online facilitator for various nursing programs, including RN-BSN, MSN (FNP or PMHNP), or Doctorate in Nursing programs. This role requires facilitating learning within the School of Nursing at Eastern Kentucky University.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, aiming for the best possible outcome under senior supervision. Responsibilities include receiving claims, confirming coverage, determining validity, establishing reserves, authorizing payments, and communicating claim status to all relevant parties.
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The Itemization Review Nurse analyzes charges on a UBIB submitted by a medical facility to determine the accuracy of billed charges by collecting and reviewing supporting data. This role requires documenting work and final conclusions in a designated computer program while maintaining an understanding of surgical implants.
This position is responsible for prospecting, qualifying, and generating new sales leads to support Account Executives by identifying prospects from various sources including inbound leads and research. The role involves developing new business via phone, email, and social media, cultivating prospect relationships, and managing data in the CRM.
This position is responsible for all sales activities, including identifying, qualifying, developing, and closing revenue from both new customer acquisition and expansion of existing solutions focused on software and payment processing. Essential duties involve generating revenue through expertise in ECM solutions, building senior-level relationships, developing proposals, managing sales activities in CRM, and leveraging partner networks.
The position is responsible for all sales activities, including identifying, qualifying, developing, and closing revenue from both new customer acquisition and expansion of existing solutions focused on software and payment processing for the Public Sector.
This strategic individual contributor role involves owning complex system design and architectural decisions, driving them to conclusion with limited oversight while setting technical direction for the department. Responsibilities include defining scalable architectures, leading modernization efforts, and mentoring senior engineers to elevate technical judgment across the team.
This strategic individual contributor role involves acting as the technical partner to the Sr. Engineering Director, taking ownership of complex system design and architecture to accelerate departmental progress without compromising quality. The individual will define and evolve scalable, secure, and high-performing architectures, setting technical direction and mentoring senior engineers through expertise and influence.
The Claims Supervisor manages a team of direct reports, ensuring adherence to quality, productivity, and customer service standards while following company policies. This role involves supervising daily operations, assisting with staff recruitment and onboarding, and providing technical guidance on complex claims issues.
The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage, aiming for optimal outcomes for the company and clients. Responsibilities include receiving claims, confirming coverage, determining validity, investigating, establishing reserves, authorizing payments, and communicating claim status.
The Lead Software Engineer will design and implement features for the enterprise customer self-service platform, leading development and maintenance of web applications using Java, Spring, and Angular. This role involves designing RESTful APIs, ensuring code quality through reviews, and mentoring junior developers.
The Principal Software Engineer acts as a technical leader, driving architecture decisions and best practices for the enterprise customer self-service platform using deep expertise in Java/Spring and Angular. This involves designing scalable systems, mentoring developers, leading complex technical initiatives, and collaborating with product owners on the roadmap.
Market Physician Executive - South New Jersey
Monogram Health
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Full Time
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12 Weeks Ago
Monogram Health
The Market Physician Executive leads the in-home multi-specialty polychronic care model, overseeing daily clinical and business operations, and is responsible for developing and executing clinical strategies, policies, and protocols to drive improved patient health outcomes within the market. This role involves direct patient care, reviewing and approving care plans for advanced practice providers, and collaborating with community partners on patient care decisions.
The role involves developing and maintaining complex software systems, requiring the acquisition of extensive business and system knowledge to diagnose and resolve intricate problems. Responsibilities also include performing requirements analysis, design, peer reviews, documentation, and providing reliable effort estimates and risk identification.
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Senior Structural Engineer (PE) – Construction Product Evaluation- Remote
IAPMO
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Full Time
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12 Weeks Ago
IAPMO
The engineer will produce evaluation reports and listings for construction products by assessing technical data and quality documentation to confirm building code compliance for materials and assemblies. This involves writing reports based on reviewing new technologies, test results, drawings, and calculations to ensure adherence to product standards.
The Medical Case Manager provides in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and developing long-term care strategies.
The Medical Case Manager provides in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and conducting home evaluations.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority to achieve the best possible outcome under direct supervision. Responsibilities include receiving claims, confirming coverage, determining validity, establishing reserves, authorizing payments, and communicating claim status to relevant parties.
Commercial General Liability Claims Specialist
CorVel Corporation
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Full Time
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12 Weeks Ago
CorVel Corporation
The specialist will manage mid to complex Commercial General Liability claims, including bodily injury and property damage, aiming for optimal outcomes and potentially handling litigated files. Essential functions include receiving claims, confirming coverage, determining validity, investigating, establishing reserves, authorizing payments, and communicating claim status to all relevant parties.
Auto and General Liability Claims Supervisor
CorVel Corporation
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Full Time
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12 Weeks Ago
CorVel Corporation
The supervisor is responsible for overseeing a team of direct reports, ensuring adherence to quality, productivity, and customer service standards while supporting departmental and company goals. This role involves supervising daily operations, assisting with staffing, ensuring legal compliance, and providing technical guidance on complex claims issues.
The Medical Case Manager provides in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and implementing care strategies like negotiating equipment delivery.
Sr. Technical WFM Consultant (Remote)
Mosaic Consulting Group
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Full Time
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12 Weeks Ago
Mosaic Consulting Group
The consultant will primarily focus on UKG Boomi Integration Development while also configuring integrations within the UKG Pro WFM system, providing consultative support to clients to achieve exceptional results. Responsibilities also include mentoring junior consultants, troubleshooting integration issues, and building strong client and internal relationships.
Houston Astros Staff Identification Program
Houston Astros
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Full Time
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12 Weeks Ago
Houston Astros
Participants will be immersed in the inner workings of the Astros Player Development department, learning from current staff and coordinators through virtual exposure and professional development classes. Objectives include introducing foundational elements of player development, developing competency in instruction, and learning to leverage data and communication for effective coaching.
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Junior Performance Marketing Manager - Fokus Meta | VZ/TZ/Werkstudent:in
Inspyr GmbH (drink&paint)
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Full Time
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12 Weeks Ago
Inspyr GmbH (drink&paint)
The role involves the operational implementation and continuous optimization of paid channels, primarily Meta Ads, working closely with founders and the growth marketing team. Responsibilities include setting up performance campaigns across Meta, Google, and Pinterest, managing launch, testing, iteration, and developing scalable campaign structures.
Online Course Facilitator - Biological Sciences
Eastern Kentucky University
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Full Time
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12 Weeks Ago
Eastern Kentucky University
The Online Course Facilitator supports the delivery of high-enrolled online courses by fostering regular and substantive interaction with assigned students under the direction of the Instructor of Record (IOR). This role involves providing timely, comprehensive, and meaningful assessment of course assignments as directed by the IOR, alongside consistent communication and collaboration with the IOR.
The Medical Case Manager provides in-person and telephonic case management to injured workers, involving coordination with patients, physicians, providers, and employers. Responsibilities include assessing, planning, implementing, and evaluating the patient's progress while ensuring treatment plans are appropriate, medically necessary, and cost-effective.
The Claims Supervisor oversees a team of direct reports, ensuring adherence to quality, productivity, and customer service standards while complying with company policies. This role involves supervising daily operations, assisting with staff onboarding, providing technical guidance on complex claims, and acting as a liaison for final claim resolutions.
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