Medicare Claims Specialist - DSNP & Appeals
Solis Health Plans
Solis Health Plans in New York is seeking a detail-oriented Claims Examiner I to adjudicate medical claims within a DSNP/Medicare focused environment. You will apply benefit plans, coding rules, and regulatory guidelines to ensure accurate, timely processing and to support member and provider satisfaction. Responsibilities include reviewing and processing claims, reprocessing disputed items, handling appeals, and ensuring CMS compliance. #J-18808-Ljbffr Solis Health Plans
- A healthcare solutions provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal reviews. Candidates should have a Bachelor's degree in healthcare and valid RN license in Florida. Key responsibilities...SuggestedRemote job
- ...is Pondsy Anthony , and I am Recruiting Specialist with Mindlance Inc . I have reviewed your... ...that is within the past 6 months Appeal - submission, review, support, completion... ...purpose of this job: Verify member submitted claims forms, member’s eligibility and pharmacy...SuggestedContract workFor contractorsShift work
$16 per hour
...country. Feel free to check us out at Job Description Business Claim Specialist Location 255 Technology Park, Lake Mary FL 32746 Division... ...according to client guidelines making exceptions upon member appeal and client approval. Recognize and elevate appropriate system...SuggestedHourly payContract work$15 - $16 per hour
...Job Description Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location. In addition to working... ...timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds until accounts receivable...SuggestedHourly payPermanent employmentTemporary workImmediate startMonday to Friday- Position Summary The Claims Examiner I is responsible for the accurate and timely adjudication... ...on Dual Eligible Special Needs Plans (DSNP) and Medicare lines of business. This role involves... ...claims, overturned disputes, and appeals. The Claims Examiner plays a critical role...SuggestedWork at office
- ...meet the qualifications of Adjuster I and will be utilized at IRG’ discretion based on need. These Adjusters will handle less complex claims with direct oversight and must meet all of the following qualifications: Possess an active adjusting license in the State of...
$54k - $103k
...potential. This individual contributor role operates under moderate direction and within defined authority limits to manage commercial claims of moderate to high complexity and exposure within the General Liability line of business. The position is responsible for...Work experience placementWork at officeLocal areaFlexible hours- ...CNA Insurance in New York is seeking an experienced claims professional to manage commercial claims within the General Liability line. The role offers a flexible hybrid schedule, requiring 2 days in CNA offices per week, and frequent collaboration with customers and partners...Flexible hours
- ...internal and external contacts and escalates issues as necessary. Prepares written communication on adverse underwriting decisions, rate appeals, underwriting requirements, status and declinations. Verbally notifies agents of decisions where appropriate in order to ensure...Work at office
- A staffing agency is looking for a Claims Specialist to handle claims processing for their client in Lake Mary, FL. The ideal candidate should have a High School Diploma or GED and 1-3 years of Call Center and Reimbursement experience. Responsibilities include verifying...
- Zurich 56 Company Ltd is seeking a Claims Specialist II in Florida to join the Workers Compensation team. In this dynamic role, you will manage complex claims, documenting files accurately, determining liability, and negotiating settlements. The ideal candidate will possess...
$59.9k - $98.2k
Claims Specialist II, Workers Compensation Zurich North America is seeking a skilled and experienced Claims Specialist II to join our dynamic Workers Compensation team. This is an exciting opportunity to make a meaningful impact by delivering exceptional claims service...Full timeTemporary workApprenticeshipWork at officeLocal areaRemote workVisa sponsorship$14.9 - $29.06 per hour
Molina Healthcare in California seeks a Senior Claims Examiner to provide support for claims examination, focusing on evaluating claims for coding errors and fraud. You will manage a caseload and ensure compliance with state and federal regulations while maintaining meticulous...Hourly payWork at office- Florida Casualty Claim Specialist - The Auto Club Group Reports to: Claim Manager II Job Overview The Auto Club Group is seeking a highly experienced Claims Specialist who can work independently, manage complex casualty claims, and apply advanced investigative, coverage...Work experience placementWork at officeLocal areaRemote work
- Westcor Land Title Insurance Company® is seeking a Claims Administrator located in Town of Florida, New York. The ideal candidate will handle title insurance claims, provide administrative support, and possess strong communication skills. Responsibilities include investigating...Full time
$48k - $55k
Tata Consultancy Services Limited is looking for a professional to handle Absence case management and claim adjudications based on related medical documentation. Ideal candidates will possess 1+ years of experience in Disability/FMLA/PFL claims, excellent communication...$68.5k - $85k
Position Overview Position Title: Multi-Line Claim Specialist (Product) Location: Maitland, FL (hybrid reporting) Schedule: 8:00 am-4:30 pm ET Salary Range: $68,500-$85,000 The Multi-Line Claim Specialist is responsible for the investigation and adjustment of general...Local area$16 per hour
A national recruiting company is seeking a Business Claim Specialist to verify and process claims in a fast-paced environment. Candidates should have a high school diploma or equivalent, strong data entry skills, and be detail-oriented. The position operates from Monday...Contract workMonday to Friday- Tata Consultancy Services is hiring for a role managing Absence case management and claim adjudications in the Town of Florida, New York. The position involves analyzing claims and medical documentation, determining benefits, and making timely payments. The ideal candidate...
$80k - $88k
Vanliner Insurance Company is seeking a Claims Adjuster in the Town of Florida, NY, to manage claims and negotiate settlements. The role requires a Bachelor's Degree and at least 5 years of experience in property and casualty claims handling. Responsibilities include investigating...- Prepare monthly reimbursement claims, validate data across multiple systems (e.g., MIPS, FANS, FLIPANY is a 501c (3) non-profit, community-based agency that serves to advance health equity through healthy meals, nutrition education, mentored physical activities, and...Contract workSeasonal workWork at office
- National General, part of The Allstate Corporation, is hiring for auto claims adjuster roles across levels. The position involves handling advanced auto claims with discretion, reviewing injuries, and identifying subrogation or fraud potential. Responsibilities include...Remote job
- ...an experienced all-lines adjuster in the Town of Florida, New York. The ideal candidate will have a strong background in insurance claims processing and at least one year of PIP handling experience for Florida PIP claims. Responsibilities include evaluating claims, conducting...
- A recruitment agency is seeking candidates for a reimbursement verification role in New York. The position will involve verifying claims, processing documentation, and ensuring compliance with guidelines. Ideal candidates should possess strong data entry skills and some...Contract workFlexible hours
$53.8k
Florida Farm Bureau Insurance in Maitland, Florida, is seeking a Claims Representative to resolve damage and injury claims for insureds. The starting salary is $53,800, and a company car is provided. Benefits include health, dental, vision, PTO, extended illness leave,...Work at office$59.9k - $98.2k
A leading insurance company is seeking a Litigated Claims Specialist to manage complex commercial general liability claims. The role emphasizes a hybrid work model, ensuring flexibility while fostering collaboration within a high-performing team. Candidates should have...- Florida Farm Bureau General Insurance Company is looking for a Claims Representative in Gainesville, FL. This position involves handling claims and negotiating settlements within an assigned territory. The ideal candidate will have a Bachelor's degree and must obtain an...Work at office
$75.8k - $124.1k
Sr. Claims Specialist, Workers Compensation Zurich North America is looking for an exceptional Senior Workers' Compensation Claims Specialist to join our dynamic and dedicated claims team. This is an exciting opportunity to manage complex, multi-party commercial Workers...Full timeTemporary workApprenticeshipWork at officeLocal areaRemote workVisa sponsorship$95k - $105k
...Hawaii is seeking an experienced professional to investigate and settle complex first and third-party commercial insurance property claims. The role requires evaluating claims, making coverage decisions, and thoroughly understanding insurance products and policy terms....Remote jobWork at office- Farmers Group Inc. is offering a structured training program for individuals to become Special Claims Representatives. Trainees will learn to handle a range of claims under supervision, progressing toward more complex cases with guidance from experienced trainers. Eligibility...Traineeship
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