internet/social networking for investigative purposes. Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA... of complex, large loss, and multi-injury claims that may contain elements of fraud or claims otherwise deemed suspicious...
evaluating information, propositions, and claims General Physical Ability: Using strength, endurance, flexibility, balance...'s license will be accepted during the application process. Education: An Associate Degree from an accredited institution...
in Financial Services & Insurance OSS Coordinator PRIMARY PURPOSE: To support and maintain the claims management system.... ESSENTIAL FUNCTIONS and RESPONSIBILITIES Completes examiner update reports, claim adjustments, provider requests...
& RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner... and timelines (must maintain a score of 98% or higher on performance audits) EDUCATION & EXPERIENCE: Associate’s degree...
to other appropriate internal teams as needed. Supports the provider escalation project team to resolve claims and payment issues... within established service level agreements, WellCare best practice and quality standards. Applies a comprehensive knowledge of claims...