The Medical Case Manager will provide 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 necessity, attending various provider and facility visits, and conducting home evaluations.
Remote Jobs & Work From Home Positions in United States (121,349)
Remote in = United States
The Bill Review Analyst is tasked with reviewing, auditing, and data-entering medical bills across multiple states and lines of business to ensure compliance with fee schedules, guidelines, and discounts. Essential functions include auditing bills for appropriateness and meeting high accuracy and keystroke targets.
Key Account Managers are responsible for building and improving relationships with clients, suppliers, and partners while driving client engagement through various KPIs like subscription upgrades and pipeline generation. They also focus on ensuring maximum client satisfaction by educating clients on products and promptly resolving any complaints or issues.
The Knowledge Center Representative assists claimants, providers, and other interested parties by receiving and answering telephonic inquiries. This role focuses on delivering high-quality inbound and outbound customer service with an emphasis on accuracy and first call resolution.
CA Senior Liability Claims Specialist
CorVel Corporation
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Full Time
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13 Weeks Ago
CorVel Corporation
The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, focusing on achieving optimal outcomes for the company and clients. Responsibilities include receiving claims, confirming coverage, investigating, determining compensability, establishing reserves, and authorizing payments within limits.
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The Appeals Representative is tasked with reviewing, analyzing, and responding to provider inquiries and appeals received through various communication channels, ensuring adherence to regulatory guidelines and client policies. This role requires accurately setting up and efficiently initiating the appeals process in a timely manner to support overall operations.
The Itemization Review Nurse analyzes charges on a UBIB submitted by a medical facility by collecting supporting data to determine the accuracy of billed charges. This role requires appropriate documentation of work and final conclusions in the designated computer program.
Manufacturing Engineer
Industrial Technologies Group, an affiliate of The Heico Companies
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Full Time
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13 Weeks Ago
Industrial Technologies Group, an affiliate of The Heico Companies
The Manufacturing Engineer develops and implements optimal, cost-effective manufacturing processes aligned with product specifications and quality standards, often working directly on the shop floor to analyze layout, workflow, and utilization to reduce waste. This role involves leading continuous improvement efforts using Lean Manufacturing tools and collaborating with design staff to ensure efficient production methods.
The supervisor is responsible for managing the daily production flow of a designated department, which may involve human resources and customer service functions, while promoting a positive influence over Setup Analysts. Key duties include implementing new business development, directing daily employee operations, setting department goals, and ensuring adherence to company policies and HIPAA compliance.
The position is responsible for prospecting, qualifying, and generating new sales leads to support Account Executives by identifying prospects from various sources like inbound leads, lists, and research. Responsibilities include developing new business via phone, email, and social media, cultivating prospect relationships, and managing data in the CRM.
The Claims Training Specialist develops curricula to ensure adherence to best practices, improves quality metrics, and equips the claims workforce to meet client requirements. Responsibilities include conducting classroom, virtual, and field training, developing materials, and monitoring new hires.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, focusing on confirming coverage, determining compensability, establishing reserves, and authorizing payments. They are responsible for communicating claim status to customers, claimants, and clients while adhering to guidelines and assisting with more complex claims when necessary.
The Medical Case Manager facilitates recovery for injured workers by providing in-person and telephonic case management, collaborating closely with patients, providers, and employers. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and implementing necessary care like negotiating equipment delivery.
The Professional Review Nurse analyzes medical services to determine the appropriateness of charges on medical bills and reviews medical reports to assess the quality of medical care provided. Key duties involve identifying review necessity, collecting and analyzing data, and using clinical expertise to detect inappropriate billing practices and errors.
The Closing Team Lead monitors and tracks all closing processes, running queries, maintaining reports, and overseeing training for new Closing Analysts. This role also involves assisting analysts with escalations, serving as final Quality Control, tracking errors, and leading meetings.
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 for Public Sector clients. Key duties involve generating revenue using industry expertise, developing account plans, building trusted advisor relationships, and managing sales activities within the CRM system.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. Responsibilities include providing medical case management, assessing treatment plan appropriateness, and communicating recommendations to physicians and payers.
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The Appeals Representative is tasked with reviewing, analyzing, and responding to provider inquiries and appeals received through various communication channels, ensuring adherence to regulatory guidelines and client policies. This role requires accurately setting up and efficiently initiating the appeals process in a timely manner to support overall operations.
The Medical Only Claims Specialist manages non-complex, medical-only workers’ compensation claims under close supervision, supporting departmental goals. Essential functions include receiving claims, confirming coverage, determining compensability, establishing reserves, and communicating claim status to relevant parties.
The Telehealth Billing agent is responsible for processing medical bills for various ancillary healthcare services by reviewing notes, claim forms, and authorizations to ensure alignment with diagnosis and provider recommendations. This involves applying strong data-entry skills to guarantee accurate and timely submission for provider payments and client invoicing.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. This involves assessing treatment plan appropriateness using clinical expertise and communicating directly with treating physicians to evaluate and recommend alternative care options.
The Intake Specialist provides administrative customer service by receiving and entering new ancillary healthcare referrals via telephonic and written communication. They must maintain a high focus on accuracy and urgency to quickly process service orders aligned with customer needs.
The Intake Specialist provides administrative customer service by receiving and entering new ancillary healthcare referrals via telephonic and written communication. They must maintain a high focus on accuracy and urgency to quickly process service orders aligned with customer needs.
The Account Executive will manage the entire sales cycle for smaller accounts, from initial prospecting through closing, onboarding, and driving renewals for SaaS and mobile solutions. This role involves building strong customer relationships and ensuring clients gain maximum value before transitioning larger accounts to an Area Sales Manager.
This position supports the sales team through strategic pre-sales, functional assessment, and technical scoping activities to meet department sales targets. The role involves understanding client business challenges and technology to guide the provision of optimal solutions to both business and technical stakeholders.
WC Disability Claims Specialist II - NY Pension/ PPD
CorVel Corporation
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Full Time
·
13 Weeks Ago
CorVel Corporation
The Claims Specialist manages workers’ compensation disability claims toward the best possible outcome, focusing on closure and identifying settlement opportunities through regular reviews. Essential functions include receiving claims, confirming coverage, reviewing validity, authorizing payments within limits, and ensuring timely benefit payments.
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SENIOR PROPERTY AND LIABILITY CLAIMS ADJUSTER
Arizona Department of Administration
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Full Time
·
13 Weeks Ago
Arizona Department of Administration
This senior role involves managing high-exposure claims and complex civil lawsuits against the State of Arizona, requiring independent investigation, accurate reserve establishment, and comprehensive settlement authority requests. The adjuster will act as a primary negotiator, represent the State in mediations, and liaise with the Attorney General’s Office to protect state interests.
The Market Physician Executive leads the in-home multi-specialty care model, overseeing clinical strategies, policies, and daily operations, including direct patient care and supervision of clinical and operations teams. A primary focus is delivering exceptional outcomes through disease detection, evidence-based clinical pathways, and managing total cost of care and quality improvement metrics.
The Billing Specialist is responsible for completing invoicing processes for all Ancillary Healthcare services, which includes administrative review of vendor and provider bills, determining appointment types, and generating vendor payments and customer invoices with a high focus on accuracy and urgency. This role also involves providing quality and friendly inbound and outbound telephonic customer service to assist customers and vendors with billing questions.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, ensuring adherence to company best practices and supporting departmental goals. Key duties include confirming coverage, determining compensability, establishing reserves, authorizing payments, and communicating claim status to all relevant parties.
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