Claim approver jobs near me

OMS National Insurance Co. is a nationwide company in search of nationwide talent. We have one simple mission at OMSNIC - We are dedicated to serving and protecting oral and maxillofacial surgeons and dental professionals nationwide. If you are an experienced medical malpractice claims professional based in the U.S, and would like to join us in our mission, we invite you to apply for this remote opportunity. Our claims analysts have direct contact with our policyholders and are regarded as trusted partners, managing an assigned caseload of claims. This includes the investigation, evaluation, and resolution of both pre-litigation and litigated matters. ESSENTIAL DUTIES AND RESPONSIBILITIES: Evaluate coverage Assign, collaborate with, and oversee outside defense counsel Review and analyze medical records Investigate and evaluate issues of liability, causation, and damages, proactively moving the files toward resolution Participate in the formulation of case strategy Negotiate claims in a settlement posture Evaluate indemnity and expense reserves Prepare comprehensive claims reports Present claims to management and for internal review Regularly communicate with policyholders, keeping them informed of status and strategies Timely and accurately document claim files Help maintain claim file data for accurate reporting Review and approve invoices General: Contribute to departmental and company goals, initiatives and projects May attend or participate in training and development programs Planning and participation in Risk Management and Defense Counsel Seminars May participate in the training and development of new hires May participate in planning, development, and testing of technology solutions Competencies: Strong organizational and time management skills, ability to meet deadlines Effective written and oral communication skills to provide information in a clear and concise manner and to communicate with a variety of stakeholders Effective analytical and critical thinking skills to analyze facts and draw conclusions to make recommendations and resolve issues Ability to prepare robust reporting yet provide a broad scope overview and summary, when appropriate Superior customer service skills and ability to actively listen Strong interpersonal skills with ability to interact with policyholders, legal professionals, management, co-workers, agents, committee and board members, and external vendors Strong mediation and negotiation skills Microsoft Office Suite proficiency with emphasis on Word, Excel, and PowerPoint Education and Experience: Bachelor's Degree required JD preferred but not required Minimum 5 years' experience in medical professional liability claims management field Work Environment: Fully remote Travel required as needed Salary : $100,000-$140,000 The salary range represents the entirety of the pay grade for this role. Specific salaries will be determined using a variety of factors, including specific skills, years of experience, location, and comparison to team members already in this role Benefits: Medical, Dental, and Vision Insurance 401(k) Short and Long-term disability Life Insurance Employee Assistance Program Long-term incentive plan Educational Assistance and rewards program Paid Time Off Paid Holidays Paid parental leave Home office stipend #LI-Remote

About Us We're not like other insurance companies. From our specialty products to our business model, our culture to our results - we're different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn't just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us. RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar - a testament to our culture and validation of our reputation as an excellent underwriting company. Position Purpose Under occasional supervision, responsible for maintaining, processing, and resolving 1st and 3rd party Commercial Material Damage claims within defined authority. Assists in verifying policy limits, deductibles, locations, exclusions, and endorsements. Obtains information regarding each claim through various means and evaluates liability. Monitors claim status for potential exposure opportunities. Reviews coverage matters, analysis, and determinations. Principal Duties & Responsibilities * Responsible for the direct handling of RLI Transportation claims. * Investigate, analyze, and handle new and reassigned 1st and 3rd party Commercial Transportation and Trucking Physical Damage claims for coverage, liability, damages, and reserves. * Handles subrogation, arbitration, and salvage * Manage appraisers, investigators, adjusters and experts as needed. * Maintain claim files and ensure claims have full coverage, are properly documented, adjusted, and resolved. * May work on special projects. Education & Experience * Bachelor's degree in business administration, insurance, or a related field. * 4+ years of claim handling experience is preferred within the commercial/transportation field. * Experience in handling commercial trucking, bus and/or commercial auto claims is required. Moving and storage cargo experience is a plus. * AIC or CPCU designation preferred. Knowledge, Skills, & Competencies * Proactive in initial investigation, claim handling and resolution. * Superior communication skills to work effectively with insureds, underwriters and claimants. * Proficient in coverage analysis/verification involving commercial transportation policies with knowledge of trucking policies as a plus. * Excellent negotiation skills. * Detail-oriented with good organizational skills. * Self-motivated and task-oriented. Compensation Overview The base salary range for the position is listed below. Please note that the base salary is only one component of our robust total rewards package at RLI. The salary offered will take into account a number of factors including, but not limited to, geographic location, experience, scope & responsibilities of the role, qualifications/credentials, talent availability & specialization, as well as business needs. The below range may be modified in the future. Base Pay Range $67,212.00 - $96,113.00 Total Rewards At RLI, we're all owners. We hire the best and the brightest employees and allow them to share in the company's success through our Total Rewards. With the Employee Stock Ownership plan at its core, the Total Rewards program includes all compensation, benefits and perks that come with being an RLI employee. Financial Incentives * Annual bonus plans * Employee stock ownership plan (ESOP) * 401(k) - automatic 3% company contribution * Annual 401k and ESOP profit-sharing contributions (Up to 15% of eligible earnings) Work & Life * Paid time off (PTO) and holidays * Paid volunteer time off (VTO) to support our communities * Parental and family care leave * Flexible & hybrid work arrangements * Fitness center discounts and free virtual fitness platform * Employee assistance program Health & Wellness * Comprehensive medical, dental and vision benefits * Flexible spending and health savings accounts * 2x base salary for group life and AD&D insurance * Voluntary life, critical illness, & accident insurance for purchase * Short-term and long-term disability benefits Personal & Professional Growth RLI encourages its employees to pursue professional development work in insurance and job-related areas. We make a commitment to employees to provide educational opportunities that help them enhance their skills and further their career advancement. RLI fosters a true learning culture and encourages professional growth through insurance courses, in-house training and other educational programs. RLI covers the cost for most programs and employees typically earn a bonus upon successful completion of approved courses and certifications. Our personal and professional growth benefits include: * Training & certification opportunities * Tuition reimbursement * Education bonuses Diversity & Inclusion Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers. We actively support, and participate in, initiatives led by the American Property Casualty Insurance Association that aim to increase diversity in the insurance industry. Cultivating an exceptional and diverse workforce to deliver excellent customer service reinforces our culture and is a key to achieving superior business results. RLI is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.

The Senior Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements. Your Impact Perform in-depth claims file reviews for accuracy and compliance. Document findings and provide recommendations for corrective action. Identify trends and collaborate with departments to improve claim practices. Support audit reporting and analytics. Successful Candidate Will Have Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus. 4 - 6 years of claims or audit experience (specific stop loss or first dollar medical). Strong understanding of claims handling and insurance regulations. Analytical, organized, and skilled in Excel/audit systems. At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $51,800 -$75,000 annually. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and over 5,000 employees across the US and Canada. Our industry recognition includes being named a Best Places to Work in Insurance for five years (2018-2022) and on the Inc. 5000 list as one of America's Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: 51,800 - 75000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is seeking an influential and dynamic Claims Examiner to join our Group Life Claims organization. Claims Examiner is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. Key Job Responsibilities Claims Management: Responsible for active case management of Life claims. Ensures claims are processed accurately within regulatory and company guidelines. Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved. Review and interpret medical records, utilizing resources as appropriate. Complete financial calculations specific to claims when applicable. Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication. Apply contract/policy provisions to ensure accurate eligibility and liability decisions. Demonstrate and apply analytical and critical thinking skills. Client and Customer Relationships: Foster strong relationships with customers to understand their needs and ensure high levels of satisfaction. Addresses and resolves any customer challenges or concerns promptly. Communication via telephone, email, and text with employees, employers, attorneys, and others. Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards. Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities. Work independently as well as within a team structure. The base salary range for this position is $53,000 - $62,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program Required Qualifications · 2+ years prior experience managing Life claim products. · Excellent client relationship management skills. · Strong verbal, written communication, and presentation skills. · Comfortable dealing with complexity and ambiguity and able to explore multiple solutions. Preferred Qualifications · Previous experience with FINEOS Claims software platform highly desired. · Exceptional customer service skills; Proven skills in positive and effective interaction with challenging customers. · Strong knowledge of regulatory requirements for Life claims. · Ability to handle sensitive information with confidentiality and professionalism. · Strong written and oral communication skills demonstrated in previous work experience. · Excellent organizational and time management skills with ability to multitask and prioritize deadlines. · Ability to manage multiple and changing priorities. · Detail oriented; able to analyze and research contract information. · Demonstrated ability to operate with a sense of urgency. · Experience in effectively meeting/exceeding individual professional expectations and team goals. · Demonstrated analytical and math skills. · Ability to exercise critical thinking skills, risk management skills and sound judgment. · Ability to adapt, problem solve quickly and communicate effective solutions. · High level of flexibility to adapt to the changing needs of the organization. · Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment. · Continuous improvement mindset · A commitment to support a work environment that fosters diversity and inclusion. · Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word. · Reliability and dependability throughout our extensive training program is crucial. Skills Analytical Thinking\: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations\: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems\: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities\: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving\: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. #LI-Remote ABOUT EQUITABLE At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. ********** Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE\: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.

Claims Processor needs office support, administrative assisting experience Claims Processor requires: Hybrid 2x in office a week. Hours: M-F/Full-Time; 8-4:30 (30-Minute lunch) Data Entry Test Scores required Ability to learn and adopt new processes quickly and with ease Ability to work remotely and autonomously Accustomed to working in a high-paced, high-volume environment Strong attention to detail Medium-Advance level of expertise with Microsoft Excel Proficient with Outlook Familiar with Cloud-based applications (i.e. OneDrive) Ability to multi-task and perform duties using multiple sources or systems; Data Entry experience preferred Ability to clearly articulate findings, issues or concerns requiring resolution Claims Processor duties: Ø Monitor team shared Outlook mailbox for incoming membership documents sent from clients, brokers or Third Party Administrators Review incoming membership documents (Microsoft Excel and Word) to confirm accuracy in formatting and validity of data; includes communicating when updates are needed for successful membership enrollment and/or submission for processing.

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job purpose The Claims Examiner III is responsible for the processing and/or adjusting and the releasing of hospital or medical claims according to established policies and procedures. Must identify procedural and system inefficiencies and work with the appropriate entities to resolve issues. Examiners also perform research, analysis, reporting and special projects as assigned. Examiners must be able to meet production requirements and quality standards. Must be able to successfully perform all the duties of the Claims Examiner II. Duties and responsibilities Participate in claims workflow projects. Create and run Crystal /SQL reports for distribution to claims examiners, other department as needed to maintain claims turnaround time compliance. Processing claims for all lines of business including complex claims. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit preparation/activities. Responsible for the processing of claims that are either the financial responsibility of the assigned IPA or capitated Hospital. Must meet quantitative production standard of 100 - 150 claims per day. Must maintain an error accuracy of under 5%. Responsible for validating the diagnosis and procedure codes against the authorized services on Inpatient claims. Responsible for the resolution of Provider Disputes (PDR's) and their documentation (code driven) for required Acknowledgement and Resolution Letters to send to providers. Responsible for requesting additional information required to adjudicate claims, by correctly coding claims notes to generate Development Letters and or Notifications to providers. Responsible for accurately coding claims notes to generate Denial Letters for claims denied as member liability. Ability to resolve claims issues on identified processing errors and make recommendations for improvements to avoid error. Identify any overpayment/underpayment in a review and or history search. Follow department protocol for reporting and following up. Adjusts voids and reopens claims within guidelines to ensure proper adjudication. Resolve any grievances and complaints received through Customer Services, responds when needed to portal/email inquiries and initiates steps to assist regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims. Support the Claims Department as business needs require. May have customer/client contact. May assist with training of team members. Works without significant guidance. Identify claims payment errors and/or system configuration flaws during day-to-day operation, report to department manager to correct/resolve them. Able to assist with check run preparation as needed. All other duties as assigned. Qualifications Must have experience with EZ-Cap 10+ years or more experience in processing HMO claims in a managed care environment. Familiar with all regulatory requirements including CMS, DMHC and DHS. Proficient with all Federal and state requirements in claim processing. Knowledge of medical terminology and coding. Proficient in rate application for outpatient PPS & Inpatient DRG facility, ASC, APC, Interim Rate Payment methods to applicable lines of business. (Medicare, Commercial, Medi-Cal). Recognize the difference between Shared Risk and Full Risk claims. Proficient in and knows how to use and apply Health Plan Benefit Matrix and Division of Financial Responsibility. Proficient understanding of AB1324. Proficient understanding of AB1455 Claims Settlement Practice & Dispute and Resolution regulations. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills

About Us Health Admins is a leading third-party administrator in the healthcare space. Our Vision is to radically improve the way individuals interact with the healthcare system. We are committed to providing innovative and efficient health care solutions to our clients, ensuring they receive the best possible care and service. Our team is currently seeking a highly skilled and experienced Claims Processor to join our dynamic team. What We Are Looking For Our ideal candidate will play a crucial role in managing our Medical Claims environment, optimizing its performance, and driving continuous improvements to support our business goals and enhance our service delivery. Every Team Member is Driven by a Commitment to Live out These Values: Be Authentic: Be true and honest Be Helpful: Pitch in and help Be Innovative: Seek & embrace innovation Be Accountable: Do what you say you are going to Employees are expected to embrace our core values by being “A Hero in Action.” These values lay the foundation for the way we engage with each other and with our clients. They form the guardrails for our decision making and approach to problem solving. Summary/Objective: We seek a meticulous and customer-focused individual to join our team as a Claims Processor. This role requires a combination of research acumen, attention to detail, and exceptional customer service skills. As a key member of our organization, you will be responsible for processing medical claims accurately, conducting thorough audits to ensure compliance with regulations and policies, and providing excellent service to our clients and healthcare providers. Key Responsibilities: Review and process medical claims submitted by members or providers promptly and accurately. Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. Ensure compliance with insurance policies and industry standards. Investigate and resolve any discrepancies or issues related to claim submissions. Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. Research complex medical billing and coding issues to support claims processing and audit activities. Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. Serve as members' primary point of contact regarding claims inquiries and resolution. Respond promptly to customer inquiries and concerns with professionalism and empathy. Collaborate with cross-functional teams to address customer issues and ensure timely resolution. Skills Required: Strong knowledge of medical terminology, medical coding, and insurance billing practices. Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines. Exceptional attention to detail and accuracy in data entry and documentation. Effective verbal and written communication skills with a customer-centric approach. Ability to work independently and collaboratively in a fast-paced, deadline-driven environment. Excellent verbal, written and interpersonal communication skills; Must be a self-motivator and self-starter; Exceptional listening and analytical skills; Solid time management skills; Ability to multitask and successfully operate in a fast paced, team environment; Must adapt well to change and successfully set and adjust priorities as needed; Education/Experience: High School Diploma or equivalent Proven experience in medical claims processing and healthcare reimbursement Technical Knowledge: SalesForce Experience Google Suite Experience Claims Management Software experience What We Offer Competitive salary and benefits package Dynamic and innovative work environment Opportunities for professional growth and development Remote work flexibility Equal Opportunity Statement We are deeply committed to building a workplace and global community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neuro diversity, disability, age or veteran status, or any other non-merit based or legally protected grounds. We are committed to providing reasonable accommodation to qualified individuals with disabilities in the employment application process.

Job Title: Claims Processor Department: Operations Supervisor: Manager, Claims Operations Summary: Position is responsible for the timely and accurate claims adjudication and regulatory reporting functions including associated processes and reporting of key performance indicators. Position is also responsible for responding to incoming inquiries and coordination with other internal and external stakeholders to resolve the issue, determine the underlying cause and make recommendations regarding system changes that may be relevant. Essential Duties and Responsibilities include the following. Other duties may be assigned. Utilizing consistent standards, practices, and processes focused on timely and accurate adjudication of claims to review, evaluate and/or quality control review and final adjudication of paper/electronic claims for inpatient, outpatient and professional medical claims Resolve claim edits, review history records and determine benefit applicability for service including the review of pricing at final payment determination Works closely with stakeholders including clinical, operations and finance teams during the development of key workflows to ensure alignment of overall objectives and key requirements Shall perform user acceptance testing for any impacted changes to claims processing as directed Meets or exceeds production and quality standards including maintaining accurate recording and calculations as required Takes corrective action steps in collaboration with other business units including enrollment and benefits configuration Monitors claim inventory levels Consistently researches procedural questions using supporting documentation while identifying incomplete adjudications instructions found within the supporting documentation, allowing for participatory suggestions for updating and correcting procedures, identifies training issues and appropriately checking with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization Monitors system and reporting for volume shifts Candidate Qualifications Education Education: High School Diploma or equivalent required Licenses/Certification: None required; CPC preferred Ability to work from home with appropriate internet access and a quiet and private workspace. Skills Minimum two (2) years of claims and health care administration and/or managed care experience Strong knowledge of health insurance industry with all product lines (Medicare, Medicaid, Commercial, ASO, DSNP, etc…) Extensive knowledge of claims policies and procedures including regulatory requirements and industry standards from AMA, CMS and CCI edits. Strong computer skills, specifically with Microsoft Office and Windows. A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact Must have a strong work ethic and a sense of responsibility to other team members and external stakeholders to meet all needs represented by a robust sense of accountability Adaptable and a quick learner, willing to change to meet shifting customer and business needs. Excellent verbal and written communication skills Extremely organized and detail-oriented. Ability to work independently on a variety of projects in a high volume, fast paced, and sometimes nebulous environment required

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Claims Examiner is considered an expert in managing insurance claims for our policyholders. The Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. PRIMARY RESPONSIBILITIES: • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company's reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster's license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 2-3 years' experience in claims Must have Property & Casualty Insurance License #LI-BM1 #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

At DUAL North America, our core values dictate how we live and work. We are a group with independence and people at its heart and we are a home for talent with a unique culture: the biggest small company in the world. The focus on being a People First business has always been at the very heart of the Group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the Group has been and will continue to be key. DUAL North America, Inc. is seeking a Claims Examiner - Construction Defect Classification: Exempt/Full-time • Reports to: Claims Manager • Travel: 0-10% • Salary/hourly: $100,000.00-$120,000.00 Role overview DUAL North America is seeking a Casualty Examiner for the Construction Defect Claims team. At DUAL, Casualty Examiners play a critical role in managing and resolving insurance claims with accuracy and efficiency, while complying with state regulatory requirements. In this role, you will investigate claims, analyze policy coverages, and collaborate with internal and external stakeholders to ensure claim resolution. Supporting the Construction Defect Claims team, you will independently manage low to moderate exposure claims involving alleged defects in residential and commercial construction. Role responsibilities • Initiate timely contact with all relevant parties upon claim assignment • Handle low to moderate exposure construction defect claims involving residential and commercial projects. • Analyze insurance policies to determine applicable coverage • Draft and issues coverage position letters • Negotiate settlements • Ensure all claim activities comply with DOI regulations and internal policies • Retain and coordinate with defense counsel and experts while managing litigation plans and budgets to ensure effective case resolution • Maintain timely, accurate, and complete documentation of all claim activities and decisions • Collaborate with underwriting, and internal teams to share insights and coordinate claim strategies • Provide feedback to business partners to support continuous improvement in claims handling Key requirements • Bachelor's degree preferred • Professional designations (CPCU, SCLA, AIC, JD) are a plus • 2-7 years of construction defect claims experience is preferred with consistent high level of performance and achievement • Must be licensed or have the ability to become licensed in all required states • Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) • Knowledge of industry trends and legal developments affecting claims handling • Ability to manage multiple claims and competing priorities • Ability to adapt to evolving regulatory and legal environments • Complete assigned tasks correctly, on time and able to learn quickly • Self-motivated and demonstrating attention to detail • Be able to work independently for extended periods • Excellent written and verbal communication skills as well as general business understanding • Must be able to remain in a stationary position 50% of the time, with occasional movement in the office to access cabinets and equipment • If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team. What we offer: A career that you define. Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more. We provide an environment where new ideas are encouraged and celebrated, where people who want to have a real hand in our success thrive. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community. EEO Statement: We consider our people our chief competitive advantage and as such we treat colleagues, candidates, clients, and business partners with equality, fairness, and respect. DUAL North America provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. DUAL will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role We are seeking a skilled BI-LIT Claims Examiner to manage litigated files and attend trials, conferences, mediations, and arbitrations. The successful candidate will: Investigate and gather all necessary information and documentation related to claims Evaluate liability and damages Negotiate and settle claims Manage litigation cases related to auto claims disputes The BI-LIT Claims Examiner will also be responsible for maintaining electronic files, analyzing defense counsel's performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Managing legal aspects of litigated cases, including evaluation of legal process and expenses Analyzing and reviewing auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders Collaborating with defense counsel, claims counsel, and litigation claims management for strategic planning, including developing and maintaining positive working relationships with approved defense firms and other vendors in the industry Reviewing legal documents and ensuring compliance with initial suit-handling plan of action Serving as corporate representative for discovery review and depositions, and appearing as Corporate Representative at depositions and trials when needed Analyzing policy language and reaching appropriate coverage decisions, drafting frequent and complex coverage correspondence, and proactively managing primarily litigated claim files from inception to closure Directing and controlling the activities and costs of numerous outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Transportation litigation (rideshare, auto, trucking, etc) is preferred but those with personal lines experience should still apply if they meet all other requirements. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department's performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting staff as required for continually improved file handling. · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel. · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures. · Complete research pertaining to complex coverage issues, industry trends, and related topics. · May assist with targeted audits of a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management re-audits to verify calibration and accuracy of the first level reviews completed. · Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling Job Qualifications Formal Education & Certification Bachelor's degree or equivalent work experience Knowledge & Experience · A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty claims with high complexity. · Prior claims management experience and/or auditing preferred. Skills & Competencies · Communication and analytical ability at a level to interact with associates, managers, agents and vendors. · Demonstrated team building and coordination skills. · Must possess strong interpersonal skills and the ability to present critical information to Senior Management. · Ability to manage multiple priorities and work independently. · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts. · Must be able to work in a fast-paced automated production environment and possess solid planning and organizational skills including time management, prioritization, and attention to detail. · Must meet company guidelines for attendance and punctuality and professional appearance/decorum. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUMMARY DESCRIPTION: The Residential Claims Examiner is responsible for approving and settling residential property claims from the field where an estimate of damage has been prepared, or for preparing and settling estimates, or documenting claims decisions and settling those claims with the policyholder and claimants. The role's primary duties include phone scoping, reviewing coverage, determining settlement amounts, communicating with the policyholder or their representative, and documenting the claim file as outlined by the client or RENFROE. They are also responsible for documenting all activity, submitting required claims documentation, issuing settlement payments, settling and closing the claim using fair claims settlement practices, and ensuring compliance with legal and contractual obligations. REPORTS TO: Assigned RENFROE Manager ESSENTIAL JOB FUNCTIONS: · Follows RENFROE and clients' policies and procedures to handle all assigned property claims · Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills · Assigns task work for property inspections and interacts with field adjusters and estimators to determine the scope of loss · Oversees claims files for assigned claims and updates claims as new information becomes available using the client's proprietary software · Manages the progression of claims/tasks and claim inventories assigned to them · Contacts and interacts with the policyholder or their representative to obtain documents such as purchase receipts, bills, photographs, or other documents to establish the existence, ownership, and value of the items claimed damaged · Determines coverage and amounts for additional living expenses such as rental housing, travel, meals, etc. · Sets claim reserves following the client's guidelines · Calculates settlement amounts and, within their settlement authority or after receiving requested authority from the client's designee, issues settlement checks with supporting claim documentation · Writes closing reports, including recommendations for the pursuit of subrogation or the disposal of salvage · Reviews the claim file to support and draft coverage decision letters · Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE · Does not handle claims for which they do not have client authorization or for which they are not licensed · Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes · Makes suggestions on ways to improve process efficiency · Participates in special projects and completes other duties as assigned Non-Authorized Activities: Claims Examiners should not: · Communicate training requirements to client staff adjusters and non-affiliated firms · Communicate training requirements to any claim handler who is not deployed with RENFROE · Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE · Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind EXPERIENCE/QUALIFICATIONS: · Minimum of 1 year of property claims experience is preferred · Participation in technical insurance coursework is preferred, such as CPCU · Experience using various claims processing systems is preferred · Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes · Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others · Strong analytical skills and consistent attention to detail · Knowledge of ISO forms, and client policy coverage, procedures, and systems · Communicates clearly and effectively, both verbally and in writing · Strong customer service orientation and good rapport with the insured · Well-organized and hard-working, with the ability to thrive in a fast-paced work environment · Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact · Computer skills, including but not limited to practical knowledge of Word and Excel PHYSICAL DEMANDS: · Sitting in a chair for extended periods of time · Ability to operate a telephone, computer, mouse, keyboard, and other similar equipment for extended periods of time · Extended and varying work schedules, which may include work from home or work from a centralized office · Regular attendance required, working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays · Ability to work in a fast-paced, changing, and multi-tasking environment

Job Title: Healthcare Claims Processor Type: Contract Compensation: $21/HR Contractor Work Model: 100% Remote ALTA IT Services is staffing a contract to hire opportunity for a Healthcare Claims Processor to support a leading health insurance customer. The individual will review and adjudicate paper/electronic claims, also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies, and procedures allowing timely considerations to be generated using multiple systems. Must have: FACETS v. G6 ESSENTIAL FUNCTIONS + Performs claims adjudication for complex medical claims. + Performs regular auditing. + Schedules regular meetings with key provider groups to provide reporting and work through claim resolution issues. + Handles provider phone calls and emails regarding claims. + Generates weekly Claims Resolution reports for management in accordance with schedule set by supervisor. Requirements: + Required: High school education plus at least 2 years of experience in claims or related field. + Abilities/Skills: Must be detail-oriented, have good time management and organizational skills, analytical skills, written and oral communication skills, PC skills + Knowledge of Microsoft excel, Adobe PDF, ICD-10 and Medicaid. + Having a Laptop/PC + The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan. System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law. #M-2 #LI-AJ1 Ref: #850-Rockville (ALTA IT) System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan. System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for this position. Job Overview: In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies. Job Type: Full-time - This is a fully remote position Pay: up to $20.00 per hour- DOE Responsibilities: Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. Participate in ongoing training and professional development activities. Maintain accurate and detailed records of claims processing activities. Review claim forms and supporting documents Determine eligibility, verify data accuracy Request additional information when needed Process claims end-to-end Identify and escalate complex or unusual claims for further review or investigation. Participate in ongoing training and professional development activities. Handle more complex claims with multiple services, providers Experience: At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment. Understanding of health claims processing/adjudication Ability to perform basic to intermediate mathematical computation routines Medical terminology strongly preferred Understanding of ICD-9 & ICD-10 Basic MS office computer skills Ability to work independently or within a team Time management skills Written and verbal communication skills Attention to detail Must be able to demonstrate sound decision-making skills What We Offer: Remote work offered Equipment provided Paid training to set you up for success Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) Paid Time Off (PTO) 7 paid holidays A supportive team and a company that values internal growth Ready to Grow Your Career? We'd love to meet you! Click “Apply Now” and tell us why you'd be a great addition to the Imagenet team. About Imagenet, LLC Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Hi, we're Oscar. We're hiring a Claims Processor to join our Claims Production team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role You will process incoming work associated with Claims operations following standard operating procedures. You will report to the Claims Production Team Lead. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year Responsibilities Develop an excellent grasp of the Administrative Operations system and overall workflows. Develop a comprehensive understanding of the current review processes that exist and additional processes needed to improve consistency and quality of review. Contribute to the reduction of the daily inventory. Form relationships with all partners. Take ownership of monitoring, tracking, and providing a status on the health of all work-in-progress issues. Manage the escalation and resolution process with external vendors to ensure appropriate turnaround times (where applicable). Contribute to team-wide goals that support the success of Claims Productions daily operations. Compliance with all applicable laws and regulations Other responsibilities as assigned Qualifications 1+ years previous work experience in claims processing 1+ years quantitative analysis skills demonstrated through the use of Excel or Google Sheets Bonus Points A bachelor's degree in Business, Accounting, Finance, Economics, Healthcare, Public Policy, Technology or Math In-depth knowledge of general Insurance or Health Insurance operations processing protocols and payment schemes. Experience manipulating and entering accurate data in a production environment. Experience handling Personal Health Information (PHI). Ability to balance competing priorities and continue to accomplish projects. This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Through our dedicated associates, Arsenault delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Remote Data Entry Associate Equipment Provided Temp with chance to convert to full time Salary: $15-$20 HR. Hours: 8:00 am to 4:30 pm EST, M-F Would you enjoy being part of a team that makes a difference in people's lives Do you love helping people solve complex problems and delivering solutions? About The Role As a member of the team, you will be processing FSA and HSA claims. You will review and research the claim and process them on a web-based application. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.We have 3 different classes with the 1st one starting in early October. A successful candidate will be computer literate, maintain good attendance, and have the right attitude and discipline to work from home. You will take pride in being a contributing member of a busy team. Meet your quality and volume requirements consistently. This starts as temporary position. You will receive fully paid training of 4-6 weeks. Based on performance and attendance you may be converted to a permanent employee with benefits. What You Will Be Doing Review and research claims Determine if the claim is valid to approve Process claims on a web-based application Completes assignments using multiple source documents to verify data or use additional information to do the work. Follows up on pending documents involving analysis. Requirements Be computer literate able to set up equipment and operate with ease Have own highspeed internet connection: 25 download and 5 upload Must be at least 18 years of age or older. Must have a high school diploma or general education degree (GED). Must be eligible to work in the Los Angeles, CA. Must be able to clear a criminal background check and drug test. Arsenault is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following: + Adjudicate claims by following departmental policies, operating memos, and corporate guidelines. + Resolve claims and related issues in compliance with policy provisions. + Compare claims applications and provider statements with policy files and other records to ensure completeness and validity. + Process payments for claims that are approved. Additional Skills & Qualifications + High school diploma or equivalent preferred. + 2-4 years claims processing experience required + Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. + Past experience using QNXT Claims Workflow a plus + Prior experience with ACA, Medicaid, or similar health plans preferred. + Coding experience preferred. Job Type & Location This is a Contract to Hire position based out of Brookfield, WI. Pay and Benefits The pay range for this position is $19.25 - $19.25/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 19, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * Telecommute schedule * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Life, short-term, and long-term disability options * Career advancement opportunities and professional development * Wellness programs that promote a healthy work-life balance * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting * Processing of Medicare, Medi-Cal, or Commercial claims required * Proficient in rate applications for Medi-Cal and/or Medicare pricers * High school diploma or GED required Key Qualifications * ICD-9 and CPT coding and general practices of claims processing * Prefer knowledge of capitated managed care environment * Microcomputer skills, proficiency in Windows applications preferred * Excellent communication and interpersonal skills, strong organizational skills * Professional demeanor * Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $23.98 USD Hourly - $30.57 USD Hourly