The Claims Technical Review Specialist provides advanced technical review of all types of claims in accordance with Company guidelines, client needs, and regulatory requirements.
Compensation
Compensation: $27.52/hr
Responsibilities
Performs technical review and analysis of all types of claims, including large dollar and technically complex claims, to ensure accuracy and adherence to prescribed procedures and plan guidelines.
Coordinates appeals through research and documentation; generates denial or approval letters.
Coordinates predetermination reviews and performs analysis to determine benefit allowance and benefit category on all types of claims.
Perform all functions of Third-Party Recovery (TPR); communicates with members, dependents, insurance companies, providers, and attorney offices throughout the process.
Processes refunds, voids, and overpayments, including related claim adjustments, file audits, monthly reports, and responses to general correspondence.
Requirements
High School Diploma
GED
Nice to have: third-party administrator experience
Senior maintenance technician responsible for skilled maintenance and repair of county facilities, buildings, equipment and fixtures, including carpentry, painting, plumbing, electrical, and HVAC, while leading and training lower-level staff.
Compensation
Starting Salary
$31,224
Responsibilities
Perform skilled maintenance tasks on county facilities
Performs work of considerable complexity and difficulty in supervising a staff of environmental health or other health related professionals engaged in a comprehensive environmental health program.
Compensation
$27.16 - $33.78 Hourly
Responsibilities
Supervises a staff of environmental health professionals
Manages environmental health program activities in an assigned area
Provides on-the-job training and performance evaluations
Maintains required credentials and participates in continuing education
Requirements
Bachelor's degree
Minor in environmental health, biological or physical science
Provides entry-level nursing functions and services to individuals and families under close supervision in a clinic or community setting, focusing on the prevention of illness, injury or disability, the promotion of health and maintenance of the health of populations.
Compensation
$24.68 - $30.69 Hourly
Responsibilities
Conducts nursing assessments and assists with community assessments and epidemiological investigations
Develops and implements a plan of care based upon identified health risks
Provides basic nursing care to the client consistent with the Core Clinical Service Guide
Documents services provided to the client according to standards of the CCSG and Administrative Reference
Maintains confidentiality and privacy according to guidelines
Requirements
RN license in Kentucky or compact state or provisional license in Kentucky