The Permanent Northeast Floater manages complex workers' compensation claims across New England, ensuring compliance and optimal outcomes. This role involves investigating claims, establishing reserves, coordinating return-to-work efforts, and managing litigation and subrogation.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Medical Case Manager facilitates recovery for injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person evaluations, developing treatment plans, and ensuring cost-effective, appropriate care.
The Lien Specialist negotiates and resolves medical treatment liens to facilitate the expedited closure of claim files. They also participate in WCAB litigation, prepare legal documents, and analyze defenses for claims adjusters.
The Indemnity Claims Specialist manages non-complex workers' compensation claims by determining validity, establishing reserves, and authorizing payments. They also communicate claim status to customers and clients while adhering to company and carrier guidelines.
The Senior Indemnity Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Service Coordinator provides administrative support and customer service to claimants and providers regarding ancillary healthcare services. Responsibilities include managing case files, verifying documentation, and maintaining regular communication with all case stakeholders.
The representative is responsible for addressing client and provider inquiries via various communication channels while adhering to state and contractual guidelines. They must also maintain accurate records, review provider history, and collaborate with internal departments to resolve issues.
The Customer Service Representative addresses client and provider inquiries via various communication channels while adhering to contractual and state guidelines. They are responsible for maintaining accurate records, consulting with supervisors, and managing provider history documentation.
The Intake Specialist provides administrative support by handling precertification calls, managing files, and completing forms. They are responsible for accurately entering patient and provider data into the CareMC system while maintaining professional communication with stakeholders.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person evaluations, developing treatment plans, and ensuring cost-effective, high-quality care delivery.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, evaluating treatment plans for medical necessity, and attending various medical and legal appointments.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment. They evaluate treatment plans for medical necessity, communicate with physicians, and provide recommendations to payers to ensure optimal patient outcomes.
The Provider Relations Specialist assists providers with bill review inquiries via phone and email while documenting errors to improve team performance. They ensure compliance with company standards and interpret complex Workers Compensation guidelines and client contracts.
The Claims Assistant supports claims staff by setting up new workers' compensation claims and managing case administration tasks. Responsibilities include processing mail, handling files, inputting system notes, and assisting examiners with provider and claimant communications.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. They assess treatment appropriateness, communicate with physicians, and support the objectives of the Case Management department.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, developing treatment plans, and ensuring the medical necessity and cost-effectiveness of care.
The Bill Review Analyst is responsible for auditing and data-entry of medical bills to ensure compliance with state fee schedules and customer guidelines. The role requires maintaining high accuracy standards and meeting specific keystroke performance metrics.
The Liability Claims Specialist manages non-complex medical and minor lost-time liability claims under senior supervision. They are responsible for determining claim validity, establishing reserves, and communicating status updates to clients and claimants.
The Senior Claims Specialist manages complex Workers' Compensation claims by determining compensability, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating with case managers to reduce costs. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, evaluating treatment plans for cost-effectiveness, and attending medical or legal appointments.
The Data Scientist will design, build, and deploy scalable machine learning models and data products to support enterprise initiatives. They will collaborate with engineering and product teams to integrate these solutions into production environments while ensuring performance and reliability.
The Claims Specialist manages non-complex workers' compensation claims, including determining compensability and authorizing payments. They also communicate claim status to customers and clients while adhering to company and carrier guidelines.
The supervisor manages a team of workers' compensation claims staff to ensure quality, productivity, and regulatory compliance. They also assist with recruitment, training, and providing technical guidance on complex claims and litigation.
The Senior Liability Claims Specialist manages mid to complex auto and general liability claims, including investigating validity and determining compensability. They are responsible for establishing reserves, authorizing payments, and maintaining clear communication with clients and claimants throughout the claims process.
The Clinical Auditor performs DRG validation reviews of medical records to ensure billing accuracy and regulatory compliance. They also assist the quality control team and medical director with appeals and rebuttals while identifying potential reimbursement savings.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care between patients, families, and medical providers. Responsibilities include conducting in-person evaluations, developing treatment plans, and ensuring cost-effective care through regular site visits.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, evaluating treatment plans for cost-effectiveness, and attending medical or legal appointments.
The Claims Specialist manages non-complex workers' compensation claims within delegated authority while adhering to company and client guidelines. They are responsible for determining claim validity, establishing reserves, and maintaining clear communication with customers and claimants.
The Case Manager gathers clinical information to certify medical necessity and determine appropriate lengths of stay for patient admissions. They also communicate with stakeholders, document all review activities, and ensure compliance with safety and regulatory standards.
The Claims Training Specialist develops and delivers training curricula to ensure adherence to best practices and improve claims outcomes. They are responsible for identifying training needs, monitoring new hire progress, and maintaining an eLearning library to support operations.
The Medical Case Manager provides in-person and telephonic case management to facilitate the recovery of injured workers. Responsibilities include evaluating treatment plans for medical necessity, coordinating with healthcare providers, and conducting home visits.
The Medical Case Manager facilitates the recovery of injured workers by coordinating with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, developing treatment plans, and ensuring cost-effective care delivery.
The Medical Only Claims Specialist manages non-complex workers' compensation claims by determining compensability and establishing reserves. They also communicate claim status to customers and clients while adhering to established guidelines.
The Case Management Supervisor directs daily department operations, including staff supervision, human resources matters, and quality of service. They may also oversee clinical case management activities, manage reports, and participate in limited marketing and sales functions.
The Medical Case Manager facilitates the recovery of injured workers by coordinating with patients, families, and medical providers. They are responsible for assessing treatment plans, ensuring medical necessity, and conducting in-person or telephonic evaluations.
The Permanent Northeast Floater manages complex workers' compensation claims across New York and New England, including determining compensability and managing action plans. The role involves coordinating with case managers and attorneys, overseeing subrogation, and ensuring compliance with state regulations.
The Administrative Assistant performs diverse administrative tasks including answering phones, managing calendars, and coordinating travel arrangements. They are also responsible for preparing reports, presentations, and assisting with basic accounting functions.
The Medical Case Manager provides in-person and telephonic case management to facilitate the recovery of injured workers. Responsibilities include assessing patient progress, coordinating with medical providers, and ensuring treatment plans are appropriate and cost-effective.
The supervisor manages a team of claims staff to ensure quality, productivity, and compliance with Workers' Compensation laws. They also assist with recruitment, training, and resolving complex claim issues for clients.
The Senior Liability Claims Specialist manages mid to complex auto and general liability claims, including handling litigated files and determining compensability. They are responsible for establishing reserves, authorizing payments, and maintaining clear communication with customers and clients.
The Network Relations role supports network development by overseeing provider data integrity and managing provider contracts. Responsibilities include resolving provider disputes, conducting site surveys, and maintaining accurate provider databases.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also negotiate settlements, manage subrogation and litigation, and maintain professional relationships with customers and claimants.
The Bill Review Analyst is responsible for auditing, reviewing, and performing data entry for medical bills across various states and business lines. They must ensure all bills adhere to state fee schedules, customer guidelines, and PPO discounts while maintaining high accuracy standards.
The EDI Specialist is responsible for the timely and accurate submission of First and Subsequent Reports of Injury in compliance with state workers' compensation requirements. They will analyze claim documentation, resolve transaction errors, and communicate with internal stakeholders to ensure data accuracy and regulatory adherence.
The Itemization Review Nurse analyzes medical facility charges on UBIB forms to ensure billing accuracy. They are responsible for documenting conclusions and maintaining compliance with HIPAA regulations.
The Bill Review Analyst is responsible for auditing, reviewing, and performing data entry for medical bills to ensure compliance with state fee schedules and customer guidelines. The role requires maintaining high accuracy standards and meeting specific keystroke productivity targets.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care with patients, families, and medical providers. They are responsible for assessing treatment plans for medical necessity and cost-effectiveness while conducting in-person and telephonic case management.
The Senior Claims Specialist manages complex Workers' Compensation claims, including investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Medical Only Claims Specialist manages non-complex workers' compensation claims, including determining compensability and authorizing payments. They also communicate claim status to customers and clients while adhering to established guidelines.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating return-to-work efforts. They also handle subrogation, litigation, and maintain professional relationships with customers and claimants.
The Data Science Manager will develop advanced quantitative modules and predictive assessments to support business decision-making. They are responsible for managing a team of data scientists and communicating complex analytical results to stakeholders.
The RN Field Case Manager provides in-person and telephonic medical case management to facilitate the recovery of injured workers. Responsibilities include assessing patient progress, coordinating with medical providers, and ensuring cost-effective treatment plans.
The Senior Claims Specialist manages complex Workers' Compensation claims by investigating validity, establishing reserves, and coordinating with case managers and attorneys. They are responsible for negotiating settlements, managing subrogation, and ensuring compliance with state regulations and company standards.
The Email Marketing Specialist will develop, execute, and optimize email campaigns while managing audience segmentation and lead lifecycle initiatives. They will also collaborate with cross-functional teams to ensure content alignment and monitor performance metrics to provide actionable insights.
The Salesforce Administrator will manage day-to-day configuration, support campaign operations, and maintain system integrity across Salesforce and Marketing Cloud. They will collaborate with cross-functional teams to translate business requirements into scalable, well-governed system solutions.
The Claims Specialist manages non-complex workers' compensation claims within delegated authority while adhering to company and client guidelines. They are responsible for determining claim validity, establishing reserves, and maintaining clear communication with all involved parties.
The Utilization Review Intake Specialist provides administrative support by handling precertification requests, managing files, and completing forms. They are responsible for accurately entering patient and provider data into the CareMC system while maintaining professional communication with stakeholders.
The Medical Case Manager facilitates the recovery of injured workers by coordinating with patients, families, and medical providers. Responsibilities include conducting in-person and telephonic assessments, evaluating treatment plans for medical necessity, and managing care strategies.
The Account Manager is responsible for managing client relationships, driving revenue growth, and ensuring high levels of customer satisfaction through consultative service. They must oversee stewardship reporting, handle collections, and coordinate internal implementations to meet client expectations.
The Claims Quality Assurance lead evaluates claim handling quality, accuracy, and compliance with industry standards while developing quality improvement strategies. This role also involves creating and presenting training sessions and reporting on operational performance to senior leadership.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. They evaluate treatment plans for medical necessity and communicate directly with physicians to recommend appropriate care options.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. They evaluate treatment plans for medical necessity and communicate directly with physicians to recommend appropriate care options.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care between patients, families, and medical providers. They are responsible for assessing treatment plans for medical necessity and cost-effectiveness while conducting in-person and telephonic case management.
The specialist handles precertification requests and ensures patient and provider information is accurately entered into the CareMC system. They provide administrative support to the Utilization Review and Case Management department through report typing and stakeholder communication.
Supervise a team of Workers' Compensation claims staff to ensure quality, productivity, and compliance with regulatory requirements. Provide technical guidance on complex claims and act as a liaison for clients and employees regarding claim resolutions.
Manage lower-level, non-complex workers' compensation claims by determining validity and establishing reserves. Communicate claim status to customers, claimants, and clients while adhering to carrier guidelines.
The Senior Claims Specialist manages complex Workers' Compensation claims, focusing on investigation, reserving, and settlement negotiations. The role involves coordinating with case managers and attorneys to reduce claim costs and ensure optimal outcomes for customers.
The Care Advocate Nurse assesses the severity of injured workers' injuries and evaluates prescribed treatments to support claims management. They act as a nurse consultant, coordinating between injured workers, employers, and medical providers to secure documentation and monitor return-to-work status.
Manages mid to complex Auto and General Liability claims, including bodily injury and property damage. Responsibilities include investigating claims, establishing reserves, and handling litigated files to achieve optimal outcomes.
Manage and resolve complex injury claims in litigation, specifically focusing on large loss transportation and trucking liability. This includes investigating coverage, determining settlement values, and partnering with defense counsel to achieve optimal outcomes.
Supports network development by overseeing provider data integrity and providing customer service to medical providers. Responsibilities include verifying contracts, managing credentialing protocols, and resolving provider payment disputes.
Manage complex and high-profile Workers' Compensation claims, including investigating validity, establishing reserves, and negotiating settlements. Coordinate with case managers and attorneys to develop action plans that reduce claim costs and ensure early return-to-work efforts.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Communicates with physicians, patients, and adjusters to evaluate treatment appropriateness and recommend alternative care options.
Lead the end-to-end product life cycle for Pharmacy Benefit Management (PBM) and Ancillary Benefit Management (ABM) offerings. Drive the development, execution, and growth of specialty network services while ensuring alignment with business objectives and regulatory compliance.
The specialist manages lower-level, non-complex workers' compensation claims to ensure the best possible outcomes. Key duties include confirming policy coverage, establishing reserves, and communicating claim status to customers and clients.
The specialist analyzes and monitors claims audit data to ensure accurate reimbursement for healthcare providers. Key duties include identifying payment variances, repricing claims according to contracts, and producing statistical reports on revenue cycle data.
The analyst is responsible for verifying provider information and requesting documentation such as medical records and itemized bills to audit claims. They must ensure the accuracy of patient and client data while maintaining strict confidentiality of PHI and PII.
Provide telephonic first aid and treatment recommendations to injured workers using national triage protocols. Document clinical assessments and communicate care plans to customers and supervisors.
The Account Executive is responsible for selling new services, managing executive-level client relationships, and increasing market share. Key duties include conducting sales calls, managing opportunities in Salesforce, and responding to RFPs.
Leads the Policy and Payment Integrity team by reviewing pre and post-pay claim audits for accuracy based on client and CMS guidelines. Oversees team productivity, conducts quality assurance reviews, and implements best practices for payment policies.
Leads the Policy and Payment Integrity team by reviewing pre and post-pay claim audits based on CMS and industry guidelines. Oversees team quality, provides training, and performs internal audits and appeals to ensure claim accuracy.
Develop and implement a comprehensive content marketing strategy to drive brand awareness and customer engagement. Manage the company's LinkedIn presence and create high-quality materials such as blog posts, white papers, and case studies.
The Telehealth Coordinator Lead manages client and provider inquiries while providing daily guidance and leadership to an assigned team. Key duties include reviewing medical notes, managing work queues, and recommending process improvements for workflow efficiency.
Manage lower-level, non-complex workers' compensation claims by determining validity, establishing reserves, and authorizing payments. Communicate claim status to customers, claimants, and clients while adhering to carrier guidelines.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Communicates with physicians, patients, and adjusters to evaluate treatment appropriateness and recommend alternative care options.
The representative handles client and provider inquiries via email, phone, and written correspondence while adhering to contractual and state guidelines. Key tasks include reviewing provider history in internal systems and maintaining reports and spreadsheets.
The role involves researching and recommending secure technical solutions and partnering with engineering teams to threat model designs. It also focuses on maturing vulnerability management processes and conducting various risk assessments to protect corporate digital assets.
The analyst is responsible for auditing and data-entry of medical bills to ensure adherence to state fee schedules and customer guidelines. The role involves reviewing bills for multiple states and lines of business while maintaining high accuracy and keystroke speed.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Communicates with physicians, patients, and adjusters to evaluate treatment appropriateness and recommend alternative care options.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Collaborates with physicians, patients, and payers to evaluate treatment appropriateness and implement medical recommendations.
Identify subrogation potential for workers' compensation and property/auto claims and negotiate settlements with insurance carriers and attorneys. Manage a queue of 250-300 claims while maintaining professional relationships with stakeholders and adhering to client guidelines.
Supervise a team of Workers' Compensation claims staff to ensure quality, productivity, and compliance with regulatory requirements. Provide technical guidance on complex claims and act as a liaison for clients and employees regarding claim resolutions.
The analyst is responsible for conducting pre- and post-pay claim audits based on client policies and CMS guidelines. This includes reviewing itemized bills and DRG validations while providing professional written communication for audits and appeals.
Manages mid to complex Auto and General Liability claims, including bodily injury and property damage. Responsibilities include investigating claims, establishing reserves, and handling litigated files to achieve optimal outcomes.
The Senior Corporate Paralegal prepares, reviews, and negotiates a high volume of customer-facing and corporate agreements. They partner with internal stakeholders to manage the contract lifecycle and drive process efficiency through standardized templates and workflows.
Directs the day-to-day operations of a designated department, overseeing human resources, customer service, and clinical case management activities. Responsible for ensuring quality of service and managing reports, invoices, and limited sales activities.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Communicates with physicians, patients, and adjusters to evaluate treatment appropriateness and recommend alternative care options.
Manage inbound and outbound calls to support the Workers' Compensation department and assist claim adjusters. Document interactions and provide accurate claim information to claimants and internal teams.
Coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and return to work. Communicates with physicians, patients, and adjusters to evaluate treatment appropriateness and recommend alternative care options.
The Utilization Review Nurse evaluates clinical information for inpatient and outpatient admissions to certify medical necessity and determine appropriate lengths of stay. They also communicate with stakeholders, document all review activities, and ensure compliance with safety and regulatory standards.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care between patients, families, and medical providers. They are responsible for assessing treatment plans for medical necessity and cost-effectiveness while conducting regular in-person visits.
The Medical Case Manager facilitates the recovery of injured workers by coordinating care between patients, physicians, and employers. Responsibilities include conducting in-person and telephonic assessments, evaluating treatment plans for medical necessity, and managing local travel to provider and home visits.
The Field Case Manager provides in-person and telephonic medical case management to injured workers to facilitate their recovery and ensure appropriate care. They collaborate with patients, families, and medical providers to develop effective treatment plans while managing cost-effectiveness and local travel requirements.
The Claims Supervisor manages a team of workers' compensation staff to ensure quality, productivity, and regulatory compliance. They also assist with recruitment, training, and providing technical guidance on complex claims and litigation.
The ServiceNow Developer is responsible for developing, configuring, troubleshooting, and implementing baseline and custom applications to augment the ServiceNow platform. This role also involves leading development projects, maintaining platform stability, and collaborating with stakeholders to devise innovative solutions.
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, planning, implementing, and evaluating patient progress while ensuring treatment plans are appropriate, medically necessary, and cost-effective.
