System OneNewHealthcare Claims Adjuster I System OneHealthcare Claims Adjuster IBaltimore, MDRemote$24.89–$24.89 / hourSystem One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. In this role, you’ll investigate, evaluate, and resolve insurance claims while ensuring accuracy, compliance, and a positive experience for all stakeholders.
MedStar HealthNewPharmacy Technician MedStar HealthPharmacy TechnicianBaltimore, MD$19.55–$34.25Processes refills and performs data entry of new prescriptions including demographics insurance plans and prescription information under the supervision of a pharmacist and according to policy; brings to the attention of a pharmacist any claims requiring overrides or interventions; troubleshoots insurance claim rejects; and follows up on problem prescriptions. Processes cash check credit card and payroll deduction transactions; secures appropriate signatures; ensures compliance with HIPAA requirements; prepares delivery tickets; reconciles delivery transactions; performs end of day register procedures; runs daily cash report and completes deposits as assigned.
System OneNewClient Relationship Manager System OneClient Relationship ManagerBaltimore, MD$35–$35 / hourIn this role, you’ll manage escalated service issues and serve as a key point of contact for members and brokers—especially when situations are complex, urgent, or sensitive. System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America.
WGK Personal Injury LawyersBilingual Personal Injury Legal Assistant WGK Personal Injury LawyersBilingual Personal Injury Legal AssistantBaltimore, MD$25–$31.50 / hourThis includes fielding inbound lead calls, conducting intake interviews in Spanish to gather key facts, assessing case qualification, and guiding eligible clients through the sign-up process in their preferred language. Lost Wage and PIP/Med Pay Claims: You will be responsible for opening and managing first-party claims on behalf of clients, including PIP, MedPay, and lost wage claims.
Company ConfidentialRisk and Insurance Manager - Real Estate/Multi-Family Property Management Company ConfidentialRisk and Insurance Manager - Real Estate/Multi-Family Property ManagementGaithersburg, MD$100,000–$120,000 / yearFull timeWhile performing the duties of this job which coincide with visits to property sites, the employee may occasionally be exposed to wet and/or humid conditions; moving mechanical parts; high, precarious places; fumes or airborne particles; toxic or caustic chemicals; outside weather conditions; extreme cold; extreme heat; risk of electrical shock; and vibration. This role is exempt and has an anticipated annual pay range of $100k-$120k for a new employee depending on a number of relevant factors including individuals’ experience, qualifications, knowledge, skills, abilities, client/property or company budgetary limitations/guidelines, and other job-related company and market considerations.
Allsearch RecruitingClaims Service Manager - Independent Insurance Agency - Base Salary to 80k/year - York, PA Allsearch RecruitingClaims Service Manager - Independent Insurance Agency - Base Salary to 80k/year - York, PAYork, PA$65,000–$80,000 / yearThis role will serve as the primary liaison between insured clients, insurance carriers, and claims adjusters to help facilitate timely claim reporting, documentation, follow-up, and resolution. This is a client-facing insurance claims support position within an independent agency environment, ideal for someone with property and casualty claims experience who understands carrier communication, claims coordination, and insurance policy servicing.
TalteamNewClaims - Adjuster, Claims I TalteamClaims - Adjuster, Claims IBaltimore, MDVerifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
Lumen Solutions Group, Inc.NewClaims Adjuster Lumen Solutions Group, Inc.Claims AdjusterBaltimore, MDThis position is ideal for professionals who have hands-on experience reviewing, researching, adjusting, and resolving claims-related issues while ensuring accuracy and compliance with established guidelines. The ideal candidate will possess a strong background in healthcare claims processing and claims adjustments, with experience working on payer-side operations.
CorVel Enterprise Claims, Inc.Liability Claims Specialist CorVel Enterprise Claims, Inc.Liability Claims SpecialistRockville, MD$52,999–$85,473 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
CorVel Enterprise Claims, Inc.Senior Liability Claims Specialist CorVel Enterprise Claims, Inc.Senior Liability Claims SpecialistRockville, MD$61,053–$98,334 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Severna Park, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Severna Park, MarylandSeverna Park, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Joppa, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Joppa, MarylandJoppa, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Millersville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Millersville, MarylandMillersville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Bel Air, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Bel Air, MarylandBel Air, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Aberdeen, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Aberdeen, MarylandAberdeen, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Hanover, Pennsylvania MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Hanover, PennsylvaniaHanover, PAFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Baltimore, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Baltimore, MarylandBaltimore, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Nottingham, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Nottingham, MarylandNottingham, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Gaithersburg, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Gaithersburg, MarylandGaithersburg, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Ellicott City, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Ellicott City, MarylandEllicott City, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Lutherville Timonium, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Lutherville Timonium, MarylandLutherville Timonium, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Parkville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Parkville, MarylandParkville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Catonsville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Catonsville, MarylandCatonsville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Rockville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Rockville, MarylandRockville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Red Lion, Pennsylvania MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Red Lion, PennsylvaniaRed Lion, PAFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Essex, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Essex, MarylandEssex, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Cockeysville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Cockeysville, MarylandCockeysville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Elkridge, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Elkridge, MarylandElkridge, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Abingdon, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Abingdon, MarylandAbingdon, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Reisterstown, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Reisterstown, MarylandReisterstown, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Olney, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Olney, MarylandOlney, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Middle River, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Middle River, MarylandMiddle River, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Halethorpe, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Halethorpe, MarylandHalethorpe, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Laurel, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Laurel, MarylandLaurel, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Pikesville, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Pikesville, MarylandPikesville, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Edgewood, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Edgewood, MarylandEdgewood, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Glen Burnie, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Glen Burnie, MarylandGlen Burnie, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Columbia, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Columbia, MarylandColumbia, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Pasadena, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Pasadena, MarylandPasadena, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Severn, Maryland MileHigh Adjusters Houston IncIndependent Insurance Claims Adjuster in Severn, MarylandSevern, MDFull timeHow We Can Help You Succeed:At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Visit our website at www.milehighadjustershouston.com to explore our offerings and view our 375+ Five-Star Google Reviews.
Metro Public Adjustment459763 Public Adjuster Metro Public Adjustment459763 Public Adjusterbaltimore, MDFull timeConduct a virtual walk-through inspection of the property, take some pictures, and fill out about 5 minutes worth of paper work. We are seeking motivated, self-starters in your area, who want to succeed.
GallagherSenior Workers Compensation Claims Adjuster - VA, DC, MD GallagherSenior Workers Compensation Claims Adjuster - VA, DC, MDBaltimore, MarylandRemoteThe actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives.
GallagherSenior Lost Time Workers Compensation Claims Adjuster - MD, VA, DC GallagherSenior Lost Time Workers Compensation Claims Adjuster - MD, VA, DCHunt Valley, MarylandRemoteThe actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives.
Lumen Solutions Group IncNewClaims Adjuster Lumen Solutions Group IncClaims AdjusterBaltimore, MDFull timeRequired Qualifications Minimum 4+ years of healthcare claims experience, including: 3+ years of claims processing experience (MUST HAVE) 1+ year of claims adjusting experience (MUST HAVE) Strong knowledge of healthcare claims processing and adjudication. This position is ideal for professionals who have hands-on experience reviewing, researching, adjusting, and resolving claims-related issues while ensuring accuracy and compliance with established guidelines.
CorVel Enterprise Claims, Inc.Workers' Compensation Medical Only Claims Specialist CorVel Enterprise Claims, Inc.Workers' Compensation Medical Only Claims SpecialistNottingham, MD$16.74–$26.92 / hourPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
Ultimate Staffing ServicesClaims Administrator Ultimate Staffing ServicesClaims AdministratorSparks, Maryland$55,000–$65,000This entry-level position is ideal for individuals interested in launching a career in insurance and gaining hands-on experience in claims handling. * Proficiency in Microsoft Word, Excel, and Outlook, with the ability to learn new systems quickly.
CorVel Enterprise Claims, Inc.Claims Specialist CorVel Enterprise Claims, Inc.Claims SpecialistNottingham, MD$51,807–$83,551 / yearPart timeThe Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Sun Life FinancialSenior Manager, Insurance and Claims Advocacy Sun Life FinancialSenior Manager, Insurance and Claims AdvocacyBaltimore, MD$76,200–$114,300 / yearThrough employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
HealthCare Resolution ServicesClaims Quality Auditor HealthCare Resolution ServicesClaims Quality AuditorColumbia, MDThe claimant was eligible for benefits on the date(s) of service based on data in the administrator's eligibility files, The provider's network participation was correctly determined based on the date of service, Claims requiring utilization review approval were reviewed and processed in accordance with utilization review decisions, Deductibles, coinsurance and other appropriate cost-sharing features of the benefit plan were considered and correctly applied, The claim data was entered into the claim system correctly, and whether a paper claim was keyed or scanned, Appropriate checks were made to ensure that there was no other coverage available to the claimant or, if there was other coverage, payments were coordinated correctly, The "reasonable and customary" or provider discount features of the plan were correctly applied, including unbundling for physician services, Appropriate edits were made to ensure that the claim was not paid twice, The procedure(s) billed and paid were, in fact, covered by the plan and do not appear to be fraudulent billings by the provider, The mathematics and computations were correct, Any pre-authorization limits were appropriately applied, The paper claim form was completed appropriately and signed by the appropriate parties, The administrator adhered to its own internal policies and procedures when processing the claim, Appropriate approvals were applied to high dollar claims (pre- and post-payment), and. Audit a portion, as mutually agreed between the parties, of the combined financially stratified/attribute claim sample of medical and dental claims processed by medical care administrators.
Ruppert CompaniesClaims Manager Ruppert CompaniesClaims ManagerLaytonsville, MDFull timeRuppert Landscape is a leading provider of commercial landscape maintenance and installation services with more than 3,500 employees serving customers from 55+ branchesacross the Northeast, Mid-Atlantic, and Southeastern US. This role is all aboutmanaging incident documentation and reporting, supporting operation teams’ adherence to a safety-first mindset, and managing relationships with outside vendors and representatives.