to evaluate the accuracy of charges and the medical necessity of care provided. This is a remote position. ESSENTIAL FUNCTIONS... & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner...
and understanding of managed care claims processing systems and medical claims coding preferred Licenses and Certifications: A license... to other appropriate internal teams as needed. Supports the provider escalation project team to resolve claims and payment issues...
Position Overview The Workers’ Compensation Claims Examiner is responsible for managing and resolving Texas workers...’ compensation claims while ensuring compliance with the Texas Department of Insurance–Division of Workers’ Compensation (TDI-DWC...