Medical Claims Review Manager jobs in Portland, ME

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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ME - 1099 Property Claims Adjuster
  • Copper Claims Services, Inc.
  • Portland, ME FULL_TIME
  • 1099 Property Claims Adjuster

    Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA.

    Copper Claims Services excels in providing custom claims solutions for Property and Casualty, Transportation and High Net Worth, with an emphasis on Specialized Programs.

    We are currently looking for licensed adjusters (or individuals who will obtain their license upon onboarding) to assist with daily claims handling for the Maine area. In this role, you will manage, investigate and resolve homeowner and commercial property losses of moderate to severe complexity with minimal supervision to include completing field investigations, evaluating and analyzing coverage, completing property damage estimates, reporting findings to various clients, and handling files to the conclusion of the claim.

    In this role, you will:

    • Handle claims during local catastrophes
    • Complete field investigations including inspections, interviews, preparing diagrams, taking photographs, and various other tasks
    • Analyze insurance coverage issues on specific claims and make appropriate recommendations to our clients
    • Prepare detailed estimates in Xactimate based on our client’s specifications and parameters
    • Prepare clear, concise, and timely narrative reports for our clients
    • Create ITV reports
    • Evaluate co-insurance calculations and penalties if applicable
    • Maintain continuous and professional communication with our clients to ensure their needs are being met.
    • Analyze and evaluate damages including reserves, property estimates, business personal property inventories, business interruption, and business income losses
    • Investigate, analyze, adjust and negotiate settlements with insured’s in compliance with our client’s direction
    • Coordinate and oversee vendors such as emergency service contractors, origin and cause investigators, general contractors, engineers, etc.

    Qualifications:

    • 5 years of field Property adjusting experience
    • Ability to climb ladders/Access roofs
    • Thorough knowledge and understanding of roofing, HVAC, and various other mechanical specialties
    • Knowledge of Commercial Lines insurance policies
    • Proficient in Xactimate including Sketch
    • Previous experience with Xactanalysis preferred
    • Proficient in Microsoft Office (Word, Excel, and Outlook)
    • Effective negotiation skills
    • Ability to effectively and independently manage workload
    • Proven ability to provide exceptional customer service
    • Strong written and verbal communication skills
    • Exceptional organization and time management skills

    Job Type: Full-time

    Pay: $30.00 - $35.00 per hour

    Schedule:

    • 8 hour shift
    • Monday to Friday

    Ability to Relocate:

    • Portland, ME: Relocate before starting work (Required)

    Work Location: On the road

  • 1 Month Ago

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Care Manager (RN) - Utilization Review
  • MaineHealth
  • Portland, ME FULL_TIME
  • Summary This is a bargaining unit position Date posted: 01/30/2024 For a limited time MaineHealth is offering up to $10,000 Sign on bonus for all eligible experienced Registered Nurses with 1-3 years ...
  • 26 Days Ago

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RN Care Manager, Care Coordination, Discharge Planning and Utilization Review
  • MaineHealth
  • Biddeford, ME FULL_TIME
  • Summary For a limited time MaineHealth is offering sign on bonuses for Registered Nurses: Registered Nurses with more than 3 years of experience: $20,000 (full time) Eligible candidates are hired into...
  • 12 Days Ago

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Breakfast Server
  • Residential Community Manager
  • Portland, ME PART_TIME
  • Calling all Restaurant Rockstars! The Hilton Garden Inn Portland Airport is now hiring for a Breakfast Server Part Time. Must be detail oriented, able to work on own and in a team, and must have good ...
  • 9 Days Ago

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RN Care Manager, Care Coordination, Discharge Planning and Utilization Review - Case Mgmt
  • MaineHealth
  • Biddeford, ME FULL_TIME
  • Summary For a limited time MaineHealth is offering sign on bonuses for Registered Nurses: Registered Nurses with more than 3 years of experience: $20,000 (full time) Eligible candidates are hired into...
  • Just Posted

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Registered Nurse – Authorization Review
  • Staffing Solutions Organization LLC (SSO)
  • Augusta, ME FULL_TIME
  • Registered Nurse - Health Services Consultant Authorization Review – Office of MaineCare Services in Augusta, METhis role will be Fulltime and will require 40 work hours per week. Position Duties: Man...
  • 15 Days Ago

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0 Medical Claims Review Manager jobs found in Portland, ME area

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Licensed Practical Nurse
  • Hiring Now!
  • South Portland, ME
  • About Milan Laser Hair Removal Milan Laser Hair Removal is one of the nation's premier laser hair removal providers. Tha...
  • 4/25/2024 12:00:00 AM

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Licensed Practical Nurse
  • Milan Laser Company
  • South Portland, ME
  • About Milan Laser Hair Removal Milan Laser Hair Removal is one of the nation's premier laser hair removal providers. Tha...
  • 4/24/2024 12:00:00 AM

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Child Psychiatrist
  • LifeStance Health
  • South Portland, ME
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

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Nurse Practitioner-Psychiatry
  • LifeStance Health
  • South Portland, ME
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

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Pharmacy Technician Supervisor - 1st Shift
  • Res-Care, Inc.
  • Portland, ME
  • Our Company PharMerica Overview PharMerica is seeking a highly capable and motivated individual to join our team. PharMe...
  • 4/22/2024 12:00:00 AM

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Psychiatrist Outpatient Only
  • LifeStance Health
  • Brunswick, ME
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

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Nurse Practitioner-Psychiatry
  • LifeStance Health
  • Brunswick, ME
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

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Nurse - (Case Management)
  • Sweetser
  • Saco, ME
  • $3,000 Sign-On Bonus! Provide nursing services to adults and consultation with Community Integration Workers in order to...
  • 4/21/2024 12:00:00 AM

Portland is a city in the U.S. state of Maine, with a population of 67,067 as of 2017. The Greater Portland metropolitan area is home to over half a million people, more than one-third of Maine's total population, making it the most populous metro in northern New England (an area comprising the states of Maine, New Hampshire, and Vermont). Portland is Maine's economic center, with an economy that relies on the service sector and tourism. The Old Port district is known for its 19th-century architecture and nightlife. Marine industry still plays an important role in the city's economy, with an a...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$96,499 to $123,037
Portland, Maine area prices
were up 1.6% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020