- Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations.
- Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines.
- Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement.
- Only for registered members Augusta, ME
We are seeking experienced Independent Insurance Claims Adjusters to join our team in Augusta, Maine. As an adjuster, you will play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. · ...
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Asset Manager I
6 days ago
Only for registered members Augusta, METhe Asset Manager I assists with the oversight of regulatory administration of some of the more standardized projects within MaineHousing's multi-family portfolio as well as properties under the PBCA contract held with Housing and Urban Development (HUD). · Review projects for co ...
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Office Associate II
2 weeks ago
Only for registered members Augusta, METhis position is part of the Board's Claims Management Unit and will have an assigned caseload of insurers, third party administrators and self-insureds. · ...
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Project Manager
2 days ago
Only for registered members AUGUSTA, MEWe are looking for an experienced Project Manager to lead projects from initiation to close. The right applicant will work well with a diverse team and be highly organized and detail-oriented. · ...
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Office Associate II
2 weeks ago
Only for registered members Augusta, METhis position is part of the Workers' Compensation Board's Claims Management Unit and will have an assigned caseload of insurers, third party administrators and self-insureds. · ...
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Safety Manager
4 days ago
Reeves Construction Company AugustaThe Safety Manager provides regional direction and leadership for all safety functions; directs, coordinates and is responsible for the implementation and maintenance of Reeves Safety programs and associated activities based out of Augusta GA. · ...
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Systems Analyst
1 week ago
Only for registered members Augusta, METhis is advanced technical services work involving the analysis design development and implementation of diverse enterprise-wide application systems. · The ideal candidate will understand all aspects of application system analysis formulating solutions to complex business problem ...
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Workers Comp Attorney Advocate
2 weeks ago
Only for registered members Augusta, METhis position provides advocacy and legal services to injured workers. It involves representing workers before administrative bodies and assisting in preparation of case presentations. · Represents injured workers in administrative hearings. · ...
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Office Associate II
2 weeks ago
Only for registered members Augusta Full time $17.30 - $24.91 (USD)This unit is responsible for managing the life cycle of approximately 85,000 filings for Workers' Compensation claims filed in Maine.The Claims Management Unit receives and processes approximately 60,000 paper payment forms annually. · ...
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Senior Software Test Engineer
1 month ago
Only for registered members AugustaSyms Strategic Group (SSG) is seeking a talented Senior Software Test Engineer. · ...
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Software Developer in Test
3 weeks ago
Only for registered members AugustaWe are seeking a talented Software Developer in Test (SDET) to join our team. · Strong programming skills, often in languages such as C#, Java, or Python · ...
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Software Developer in Test
2 weeks ago
Only for registered members AugustaSyms Strategic Group (SSG) is seeking a talented Software Developer in Test (SDET)-II to develop and execute test plans, test cases, and test procedures to ensure that all information systems meet organizational standards. · Develop and execute test plans, test cases, and test pr ...
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Safety & Compliance Manager
1 month ago
Only for registered members Augusta $75,000 - $85,000 (USD)We Deliver the Goods: Competitive pay and benefits, including Day 1 Health & Wellness Benefits, Employee Stock Purchase Plan, 401K Employer Matching, Education Assistance, Paid Time Off, · Growth opportunities performing essential work to support America's food distribution syste ...
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Hearings Examiner
3 weeks ago
Only for registered members Augusta, METhe Hearing Examiner is a key member of the Maine Paid Family and Medical Leave team. · ...
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Program Integrity Analyst I
1 month ago
Only for registered members Augusta, METhe State of Maine is seeking a Program Integrity Analyst I to join the Department of Health and Human Services. As a Comprehensive Health Planner I in the Program Integrity Unit, you will direct and conduct studies to identify areas of fraud, abuse, and waste in the MaineCare Pr ...
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Program Integrity Analyst I
2 weeks ago
Only for registered members Augusta, METhis job is for a Program Integrity Analyst I at the State of Maine Department of Health and Human Services in Augusta, ME. The analyst will direct and conduct studies to identify fraud, abuse, and waste in the MaineCare program using data analytics review systems. · ...
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Pharmacy Help Desk Associate
2 weeks ago
Only for registered members Augusta Full timeThe Pharmacy Help Desk Associate will respond to calls from MaineCare Members, pharmacists, and technicians representing various coverage plans. · Educate MaineCare Members regarding various Medicare Part D plans and how to choose a plan. · ...
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Office Associate II
2 weeks ago
Only for registered members Augusta Full time $17.30 - $24.91 (USD)This position works with forms filed by insurers third party administrators self-insureds verifying accuracy of information data calculations documenting payment of lost-time medical benefits contesting claims initiating litigation recording settlement of individual cases answeri ...
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Pharmacy Help Desk
1 month ago
Only for registered members Augusta Full time $18.76 - $27.03 (USD)+The Pharmacy Help Desk Specialist will respond to calls from MaineCare members regarding pharmacy claims and prior authorizations, educate members on Medicare Part D plans, assist with enrollment processes, review insurance coverage for pharmacies and other organizations. · ...
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Systems Analyst
1 week ago
Only for registered members Augusta+This is advanced technical services work involving the analysis, design, development, · and implementation of diverse enterprise-wide application systems. · Rearching and analyzing business needs · Formulating system scope and objectives · + ...
- Only for registered members Augusta Full time $71,843 - $139,110 (USD)
The Office of the Attorney General has an opening for an Assistant Attorney General within the Litigation Division in the Augusta Office. · ...
Medical Claims Reviewer - Augusta - Broadway Ventures
Description
Job Responsibilities
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Independent Insurance Claims Adjuster in Augusta, Maine
Only for registered members Augusta, ME
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Asset Manager I
Only for registered members Augusta, ME
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Office Associate II
Only for registered members Augusta, ME
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Project Manager
Only for registered members AUGUSTA, ME
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Office Associate II
Only for registered members Augusta, ME
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Safety Manager
Reeves Construction Company- Augusta
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Systems Analyst
Only for registered members Augusta, ME
-
Workers Comp Attorney Advocate
Only for registered members Augusta, ME
-
Office Associate II
Full time Only for registered members Augusta
-
Senior Software Test Engineer
Only for registered members Augusta
-
Software Developer in Test
Only for registered members Augusta
-
Software Developer in Test
Only for registered members Augusta
-
Safety & Compliance Manager
Only for registered members Augusta
-
Hearings Examiner
Only for registered members Augusta, ME
-
Program Integrity Analyst I
Only for registered members Augusta, ME
-
Program Integrity Analyst I
Only for registered members Augusta, ME
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Pharmacy Help Desk Associate
Full time Only for registered members Augusta
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Office Associate II
Full time Only for registered members Augusta
-
Pharmacy Help Desk
Full time Only for registered members Augusta
-
Systems Analyst
Only for registered members Augusta
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Assistant Attorney General- Litigation Division
Full time Only for registered members Augusta