Claim investigator work from home jobs

DETAILS Complex Claims Specialist - Property & Casualty Department: Property and Casualty Claims Reports To: Claims Supervisor FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Claims Supervisor ATHENS ADMINISTRATORS Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits-every single day! With offices throughout the United States, Athens Administrators offers Workers' Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Complex Claims Specialist to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA, and WV). This position does allow for work from home if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week. The Complex Claim Specialist is responsible for the review, investigation, analysis, and processing of complex claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure and often entail litigation and complex coverage. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Advanced knowledge in the following areas: 1) Complex Auto or General Liability claims handling concepts, practices and techniques, to include but not limited to complex coverage issues, and product line knowledge, 2) advanced, functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills. Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure Ensure appropriateness of all coverage memorandums and payments Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities Provide superior customer service to all layers of authorities within the county Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account. May assist management in hiring other account dedicated examiners Provide guidance and serve as a technical expert to less experienced examiners May conduct meetings or training sessions to help develop less experienced examiners Attend all required meetings and educational seminars for professional development Conduct on-sight or frequent claim reviews in Ventura County with the client representatives, as required. Maintain required licenses ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred Additional State Adjuster License(s), may be required within 180 days Maintain licenses and continuing education requirements in all states Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 8-10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims Experience with relevant insurance laws, codes, and procedures Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures Understanding Auto and General Liability exposure and unique coverage endorsements Understanding of medical, legal terminology and liability concepts Proficiency in investigation and resolution of severe to major level casualty claims Time Management and project management skills Strong negotiation and litigation management skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************** This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at *************************************************

Park Nicollet is looking to hire a Claims Specialist to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day. This position ensures that insurance and other 3rd party claims are submitted and/or paid in a timely manner and are compliant with applicable regulations and payer requirements. Specific assignments may include pre-adjudication and/or follow-up, facility and/or professional claims, commercial and/or government payers. Effective performance of these functions helps the organization achieve strong cash flow and maximize patient satisfaction. Required Qualifications: Knowledge, Skills, and Abilities: Requires strong attention to detail and demonstrated problem resolution skills. Must be able to effectively communicate verbally and via written documents. Moderate personal computer proficiency with word processing, spreadsheets and email is required (preference for Microsoft Suite). Working knowledge of typical office equipment is expected. Preferred Qualifications: Education, Experience or Equivalent Combination: Experience in a health care revenue cycle environment preferred. Knowledge, Skills, and Abilities: Ability to acquire and retain complex knowledge of department/company processes, government policy/regulation, and payer requirements. Prior medical terminology and procedural/diagnostic coding (CPT, ICD) knowledge will be helpful. Proficiency with Health Information Systems (e.g., Epic) preferred. Benefits: Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly into communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine, which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers, which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Sub-Investigator will be responsible for regional travel mixed with remote tele-medicine work to support our clinical research. Care Access is looking for Nurse Practitioners or Physicians Assistants to support clinical trial related activities in states throughout the USA. How You'll Make An Impact * Work closely with the Principal Investigator to oversee the execution of study protocols, delegating study related duties to site staff, as appropriate, and ensuring site compliance with study protocols, study-specific laboratory procedures, standards of Good Clinical Practice (GCP), Standard Operating Procedures (SOPs), quality (QA/QC) procedures, OSHA guidelines, and other state and local regulations as applicable * Attends and participates in meetings with the director, other managers, and staff as necessary * Complies with regulatory requirements, policies, procedures, and standards of practice * Read and understand the informed consent form, protocol, and investigator's brochure * Be available to see subjects virtually or in-person as dictated by project design, answer their questions, and resolve medical issues during the study visit * Sign and ensure that the study documentation for each study visit is completed * Perform all study responsibilities in compliance with the IRB approved protocol * Review screening documentation and approves subjects for admission to study * Review admission documentation and approves subject for randomization * Provide ongoing assessment of the study subject/patient to identify Adverse Events * Ensure that serious and unexpected adverse events are reported promptly to the Pl * Review and evaluates all study data and comments to the clinical significance of any out of range results * Perform physical examinations as part of screening evaluation and active study conduct * Provide medical management of adverse events as appropriate The Expertise Required * Excellent working knowledge of medical and research terminology * Excellent working knowledge of federal regulations, good clinical practices (GCP) * Ability to communicate and work effectively with a diverse team of professionals * Strong organizational skills: Able to prioritize, support, and follow through on assignments * Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients and vendors * Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring positive and supportive attitude to achieving these goals * Strong computer skills with demonstrated abilities using clinical trials database, IVR systems, electronic data capture, MS word and excel * Ability to balance tasks with competing priorities * Critical thinker and problem solver * Curiosity and passion to learn, innovate, able to take thoughtful risks and get things done * Friendly, outgoing personality; maintain a positive attitude under pressure * High level of self-motivation and energy * Ability to work independently in a fast-paced environment with minimal supervision * Must have a client service mentality Certifications/Licenses, Education, and Experience: * Nurse Practitioner or Physician Assistant with 5+ years of clinical experience * Currently licensed in good standing in one or more states listed above * A minimum of 1 year of relevant work experience as Sub-Investigator (preferred) in a Clinical Research setting How We Work Together * Location: This role is 100% on-site at our Memphis, TN clinic. * Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. * Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. Benefits & Perks * Paid Time Off (PTO) and Company Paid Holidays * 100% Employer paid medical, dental, and vision insurance plan options * Health Savings Account and Flexible Spending Accounts * Bi-weekly HSA employer contribution * Company paid Short-Term Disability and Long-Term Disability * 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

Overview Multi-Line Claim Representative I or II - Remote (Commercial Trucking) Schedule: Monday-Friday, 8:00 AM-4:30 PM (local time) Salary Range: $60,000 to $75,000 annually, depending on experience Reports To: Claim Supervisor Caseload: Approximately 100 active files Client: Single, dedicated commercial trucking account Build Your Career With Purpose at CCMSI At CCMSI, we don't just process claims-we support people. As a leading Third Party Administrator and a certified Great Place to Work , we offer manageable caseloads, employee ownership, and a collaborative culture. Our employee-owners are empowered to grow, contribute, and make a meaningful impact every day. Job Summary We are seeking an experienced Multi-Line Claim Representative II to manage commercial trucking liability claims for a single, dedicated client. This remote position is ideal for a self-motivated professional who takes pride in thorough investigation, clear communication, and delivering high-quality service. You will handle claims from start to finish, ensuring fair and timely resolutions while adhering to CCMSI's corporate claim standards and client-specific service expectations. Responsibilities Investigate, evaluate, and adjust commercial trucking liability claims in accordance with established guidelines and jurisdictional regulations. Review claim documentation, legal correspondence, and invoices to determine coverage, liability, and damages. Authorize and process claim payments within settlement authority. Negotiate settlements with claimants, attorneys, and other parties as appropriate. Oversee litigation strategy and collaborate with defense counsel. Identify and pursue subrogation opportunities. Prepare detailed claim summaries, reserve updates, and client reports. Maintain accurate and timely documentation in the claim management system. Ensure compliance with service commitments, quality standards, and client-specific requirements. Qualifications Required: 5+ years of experience handling commercial trucking or multi-line liability claims. Active adjuster's license (in applicable jurisdictions). Strong written and verbal communication skills. Ability to work independently, prioritize effectively, and maintain confidentiality. Proficiency with Microsoft Office (Word, Excel, Outlook). Nice to Have: Experience managing claims for national commercial trucking clients. Knowledge of federal transportation regulations and industry best practices. Performance Metrics Performance is evaluated through annual reviews based on claim quality, timeliness, communication, and adherence to CCMSI's corporate and client standards. What We Offer • 4 weeks PTO + 10 paid holidays in your first year • Medical, Dental, Vision, Life, and Disability Insurance • 401(k) and Employee Stock Ownership Plan (ESOP) • Internal training and advancement opportunities • A supportive, team-based work environment Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: • Act with integrity • Deliver service with passion and accountability • Embrace collaboration and change • Seek better ways to serve • Build up others through respect, trust, and communication • Lead by example-no matter their title We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #ClaimsJobs #InsuranceCareers #TruckingIndustry #LiabilityClaims #ClaimsAdjuster #RemoteJobs #CareerGrowth #HiringNow #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Remote We can recommend jobs specifically for you! Click here to get started.

We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates Input and update patient account information and document calls into the Practice Management system Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: High School Diploma or GED required Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST Minimum of 1-2 years of previous healthcare administration or related experience required Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) Manage/ field 60+ inbound calls per day Bilingual a plus (Spanish & English) Proficient knowledge of business software applications such as Excel, Word, and PowerPoint Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone Ability and openness to learn new things Ability to work effectively within a team in order to create a positive environment Ability to remain calm in a demanding call center environment Professional demeanor required Ability to effectively manage time and competing priorities #LI-SM2 ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution, 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.

SOLV Energy is an engineering, procurement, construction (EPC) and solar services provider for utility solar, high voltage substation and energy storage markets across North America. The Property & Casualty Claim Specialist is responsible for managing and processing insurance claims related to property and casualty losses. This role involves investigating claims, assessing damages, claim reporting, and ensuring timely and accurate claim resolution. The ideal candidate will have a strong understanding of insurance policies, excellent analytical skills, and a commitment to providing outstanding service. : *This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned Position Responsibilities and Duties: Investigate and evaluate property and casualty claims to determine coverage, liability, and damages. Communicate with carriers, adjusters, claimants, and other stakeholders to gather necessary information and documentation. Analyze policy terms and conditions to determine claim eligibility. Coordinate with adjusters, contractors, and other professionals to assess and estimate damages. Work with carrier(s) in settlement negotiations with claimants and ensure fair and equitable claim resolution. Maintain accurate and detailed claim files and documentation. Provide regular internal updates on the status of claims. Ensure compliance with company policies, procedures, and regulatory requirements. Identify and report potential fraud or suspicious activities. Participate in training and development programs to stay current with industry trends and best practices. Minimum Skills or Experience Requirements: Bachelor's degree in a related field or equivalent work experience. Recommended heavy knowledge in Commercial Auto and Builders Risk coverages. Minimum of 5-10 years of experience in property and casualty claims handling - whether at a carrier, broker or with a construction client. Strong knowledge of insurance policies, coverage, and claim processes. Excellent analytical and problem-solving skills. Effective communication and negotiation abilities. Ability to work independently and as part of a team. Strong attention to detail and organizational skills. Customer-focused with a commitment to delivering high-quality service. SOLV Energy Is an Equal Opportunity Employer At SOLV Energy we celebrate the power of our differences. We are committed to building diverse, equitable, and inclusive workplaces that improve our communities. SOLV Energy prohibits discrimination and harassment of any kind against an employee or applicant based on race, color, age, religion, sex, sexual orientation, gender identity or expression, marital status, national origin, or ethnicity, mental or physical disability, veteran status, parental status, or any other characteristic protected by law. Benefits: Employees (and their families) are eligible for medical, dental, vision, basic life and disability insurance. Employees can enroll in our company's 401(k) plan and are provided vacation, sick and holiday pay. Compensation Range: $65,133.00 - $81,416.00 Pay Rate Type: Salary SOLV Energy does not accept unsolicited candidate introductions, referrals or resumes from third-party recruiters or staffing agencies. We require all third-party recruiters to communicate exclusively with our internal talent acquisition team. SOLV Energy will not pay a placement fee to any third-party recruiter or agency that has not coordinated their recruiting activity with the appropriate member of our internal talent acquisition team. In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. Any unsolicited candidate introductions, referrals or resumes sent by third-party recruiters to SOLV Energy or directly to any of our employees, or received through our website or career portal, will be considered property of SOLV Energy and will not be eligible for a placement fee. In the event a third-party recruiter submits a resume or refers a candidate without a previously signed vendor agreement, SOLV Energy explicitly reserves the right to pursue and hire the candidate(s) without financial liability to such third-party recruiter. Job Number: J11771 If you're interested in a meaningful career with a brighter future, join the SOLV Energy Team.

":"* This is a full-time, remote position working from 9:45am to 6:15pm CST American Guardian Warranty Services, Inc. (AGWS), an affiliate of Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In this role you will work remotely and be responsible for investigating, evaluating and negotiating minor to complex vehicle repair costs to accurately determine coverage and liability. You will take inbound calls to determine coverage based on contracts in order to appropriately resolve customer issues. Responsibilities will include, but are not limited to: -\tAnswering inbound calls -\tProvide information about claim processing and explain the different levels of contract coverage and terms -\tAccurately establish, review and authorize claims -\tEntering claim and contract information into the AGWS' system A home office package will be provided for this position. This includes two computer monitors, a laptop, keyboard and mouse. ","job_category":"Customer Service","job_state":"NV","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-11-18","zip":"89101","position_type":"Full-Time","salary_max":"55,000. 00","salary_min":"50,000. 00","requirements":"2+ years of experience as an automotive mechanic within a service department, dealership, or independent shop~^~2+ years of experience adjusting automobile mechanical claims~^~ASE certification is a plus~^~Must have a quiet designated work space to work from home~^~Must have reliable internet with at least a download speed of 50mbps~^~Must be able to work effectively under pressure in a fast paced environment~^~Strong communication skills~^~Strong organizational and multi-tasking skills~^~High school diploma","training":"On the job","benefits":"We strive to offer an environment that provides our associates with the right balance between work and family. We offer a comprehensive benefits package including: - Medical, dental, vision, life insurance, and a health savings account - 401(k) with up to 6% matching - Professional development and training - Promotion from within - Paid vacation and sick days - Eight paid holidays - Referral bonuses Reynolds and Reynolds promotes a healthy lifestyle by providing a non-smoking environment. Reynolds and Reynolds is an equal opportunity employer. ","

Our roster has an opening with your name on it This role is responsible for leading and conducting comprehensive, complex investigations related to regulator concerns related to deposit fraud, play integrity, abuse, account takeovers, organized fraud, and other fraud specific investigations. This position will be a part of internal quality assurance testing as it relates to fraud processes along with preparing and presenting findings. This role is required to stay current on fraud trends and emerging threats and present case studies to the broader team on a recurring basis. As a Fraud Investigative Lead Supervisor, you will be contributing to state-specific reporting and regulatory-related fraud reviews. In addition to completing and leading investigations, this role will be responsible for overseeing direct reports, and managing tasks such as coordinating job rotations, providing regular and consistent feedback to direct reports, reporting significant findings and activity updates to the Fraud investigative Manager, goal coaching, and other supervisory tasks. This role may assist in designing, documenting, implementing, and monitoring of new procedures/services. Candidates for this role must pass the required licensing as mandated by various state gaming and racing regulatory bodies. Failure to be licensed or retain licensure will result in termination of employment. This position reports to the Fraud Investigative Manager. In addition to the specific responsibilities outlined above, employees may be required to perform other such duties as assigned by the Company. This ensures operational flexibility and allows the Company to meet evolving business needs. THE GAME PLAN Everyone on our team has a part to play Train and mentor Fraud Investigators and Fraud Prevention Analysts within our department Participate in quality assurance testing related to fraud prevention efforts Prepare investigation reports, summaries, and present findings Investigate and research allegations of fraud or abuse of system controls and communicate root cause findings Lead applicable state-specific regulatory fraud form reporting and regulator investigations Research, evaluate, and analyze information and intelligence to determine risk Aid in developing fraud mitigation strategies OSINT collection and analysis Collaborate with other departments within our organization, such as Security, Risk, Compliance, and other related teams Analyze past and current fraud trends and suspicious behavior tracking Continually learn and adapt to changing fraud trends and behavior Other tasks and projects as assigned by the leadership team THE STATS What we're looking for in our next teammate 3+ years of fraud experience in daily fantasy sports, online gaming or related industries 1+ years of leadership experience preferred Proficiency with SQL required Experience with digital payments and understanding of e-Commerce platforms Cybersecurity experience a plus Experience interacting with regulators and compliance a plus Prior experience using open-source intelligence Strong verbal and written communication skills Bachelor's degree in related field preferred Demonstrated aptitude for process execution, including identification of areas for improvement In-depth knowledge and understanding of common fraud trends and emerging threats Advanced knowledge of common fraud prevention strategies and systems Intermediate understanding of Check, ACH, Wire, Debit/Credit card, PayPal and other payment channel operating rules Effective communication, organizational, problem-solving, and analytical skills Passion for sports and/or gaming industry a plus Licensure: Must be able to pass required licensing as mandated by various state racing and gaming regulatory bodies ABOUT FANDUEL FanDuel Group is the premier mobile gaming company in the United States and Canada. FanDuel Group consists of a portfolio of leading brands across mobile wagering including: America's #1 Sportsbook, FanDuel Sportsbook; its leading iGaming platform, FanDuel Casino; the industry's unquestioned leader in horse racing and advance-deposit wagering, FanDuel Racing; and its daily fantasy sports product. In addition, FanDuel Group operates FanDuel TV, its broadly distributed linear cable television network and FanDuel TV+, its leading direct-to-consumer OTT platform. FanDuel Group has a presence across all 50 states, Canada, and Puerto Rico. The company is based in New York with US offices in Los Angeles, Atlanta, and Jersey City, as well as global offices in Canada and Scotland. The company's affiliates have offices worldwide, including in Ireland, Portugal, Romania, and Australia. FanDuel Group is a subsidiary of Flutter Entertainment, the world's largest sports betting and gaming operator with a portfolio of globally recognized brands and traded on the New York Stock Exchange (NYSE: FLUT). PLAYER BENEFITS We treat our team right We offer amazing benefits above and beyond the basics. We have an array of health plans to choose from (some as low as $0 per paycheck) that include programs for fertility and family planning, mental health support, and fitness benefits. We offer generous paid time off (PTO & sick leave), annual bonus and long-term incentive opportunities (based on performance), 401k with up to a 5% match, commuter benefits, pet insurance, and more - check out all our benefits here: FanDuel Total Rewards. *Benefits differ across location, role, and level. FanDuel is an equal opportunities employer and we believe, as one of our principles states, “We are One Team!”. As such, we are committed to equal employment opportunity regardless of race, color, ethnicity, ancestry, religion, creed, sex, national origin, sexual orientation, age, citizenship status, marital status, disability, gender identity, gender expression, veteran status, or any other characteristic protected by state, local or federal law. We believe FanDuel is strongest and best able to compete if all employees feel valued, respected, and included. FanDuel is committed to providing reasonable accommodations for qualified individuals with disabilities. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please email ********************. The applicable salary range for this position is $78,000 - $97,000 USD, which is dependent on a variety of factors including relevant experience, location, business needs and market demand. This role may offer the following benefits: medical, vision, and dental insurance; life insurance; disability insurance; a 401(k) matching program; among other employee benefits. This role may also be eligible for short-term or long-term incentive compensation, including, but not limited to, cash bonuses and stock program participation. This role includes paid personal time off and 14 paid company holidays. FanDuel offers paid sick time in accordance with all applicable state and federal laws. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. #LI-Hybrid

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Hill Physicians Care Solutions (HPCS) is a wholly owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage claims for the full risk line of business. Under the leadership of the HPCS Supervisor, the Full Risk Claims Analyst is responsible for ensuring Full Risk claims and disputes are processed accurately and timely pursuant to health plan coverage and Hill Physicians' reimbursement policies as well as within CMS and AB1455 regulations. The analyst will be Responsible for resolving/responding to complex issues for members, health plans and physicians by conducting detailed research and by interfacing with appropriate departments and management to ensure that the standards for claims resolution processes are met. Analyst must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Essential Responsibilities Adjudicating and/or adjusting claims, specifically for the full risk line of business, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Ensure these full risk claims are handled accurately, timely and appropriately. Claim contains pertinent and correct information for processing. Services have the required authorization. Accurate final claims adjudication/adjustment by using pricing system and provider contracts. Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims. Adjudicate claims on Epic Tapestry according to HPCS and HPMG guidelines. Navigate and decipher pricing rules using Optum Prospective Pricing System. Review, interpret and process MS DRG rules, Home Health and ASC groupings, DME and ambulance claims. Ensure all claim lines post to the appropriate fund. Maintain departmental productivity goal. Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate in Claims Services Determine benefits using automated-system controls, policy guidelines, and HMO Fact Sheets. Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Review and process out of network claims according to the guideline/out of network claims research protocol in order to contain out-of-network cost Conduct second-level review of all Medicare denials for Not Authorized and/or Not A Covered Benefit. Research, resolve, and respond to claim resubmission disputes and inquires Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Provide claims contact resolution to the call center. Complete special projects as assigned to meet department and company goals. Document follow-up information on the system and generate appropriate letters to member and providers. Skills and Experience Required Minimum years of experience required - 3 Minimum level of education required - High School/GED Licenses and certifications required - None. Must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Working knowledge of CPT, Revenue codes, PDGM Home Health, ICD-10 codes, Red Book, MS DRGs, HCPC codes and ASC groupings. Three years' experience in claims-payment adjudication at a Health Maintenance Organization (HMO) Health Plan or IPA. (Internal applicants are expected to have one year of experience in claims-payment adjudication). Ability to process all claim types on UB-04 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology. Ability to understand member benefits and patient cost-shares. Ability to calculate and convert standard drug measurements. Knowledge of CMS and the DMHC rules and regulations. Excellent problem solving, organizational, research and analytical skills. Strong written- and verbal-communication skills. Strong Microsoft application skills. Strong interpersonal skills and the ability to interact with employees and others in a professional manner. Strong judgment, decision-making and detailed oriented skills. Ability to work independently or as a team. Ability to work in a fast- paced environment. Additional Information Remote - Multiple Positions Available Salary: $28 - $32 hourly Hill Physicians is an Equal Opportunity Employer

WHAT IS THE OPPORTUNITY? Responsible for performing and documenting through root cause analysis on clients' transactions identified through fraud operations and strategy to identify rings, scams, fraudulent activities that impact CNB's clients, and corporate losses. Additionally, the Fraud Investigator will quarterback internal events and investigation activities to strengthen operational processes to reduce fraud risk. WHAT WILL YOU DO? * Perform analysis on clients' transactions identified through the monitoring system that involves various transaction types including but not limited to credit, cash, wire transfers, remote deposit capture and loans. * Conduct and document, timely investigations with well-reasoned and supported decision-making. * Utilize a variety of internal bank systems and external research tools to investigate, research, and prepare documentation related to fraud investigations consistent with the resolution of the investigation and perform root cause analysis to identify solutions to reduce future fraud risk. * Conducts follow-up with line colleagues and clients for any missing or necessary information. * Demonstrate personal excellence including punctuality, integrity, and accountability. * Think critically and exercise independent judgement. * Apply subject matter expertise in the financial services industry to drive improved fraud detection and prevention. * Champion activities across the fraud organization for identified risk events. * Provide escalation support for fraud operations. * Communicate emerging fraud trends across client operations. WHAT DO YOU NEED TO SUCCEED? *Required Qualifications** * Bachelor's Degree or equivalent * Minimum 5 years experience in risk management or fraud related functions * Minimum 5 years experience in fraud investigations *Additional Qualifications* * Must work well in a team environment, as well as independently. * Advanced computer experience required (e.g., MS Word, Outlook and Excel) * Analytical skills, use of good judgment, attention to detail, internet savvy. * Solid understanding of deposit, credit, and money movement transactions and potential fraud attack vectors. * Must have a strong and positive work ethic and follow CNB core values. * Must be flexible and adapt quickly to change. * Must be able to multi-task, adapt well to changing priorities, and meet specific performance goals. * Advanced Knowledge of PC functions in a Windows based environment. * Proficient in Excel and Word. * Effective written and oral communication skills to interact effectively with all levels of bank personnel and clients. * Demonstrated experience in root cause analysis and event management coordination. * CFE and/or CFCI certification desired * Familiarity/proficiency in programming tools such as Snowflake, Python, SAS for data queries desired *WHAT'S IN IT FOR YOU?* *Compensation*Starting base salary: $65,296 - $104,304 per year. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions. *Benefits and Perks* At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including: * Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date * Generous 401(k) company matching contribution * Career Development through Tuition Reimbursement and other internal upskilling and training resources * Valued Time Away benefits including vacation, sick and volunteer time * Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs * Career Mobility support from a dedicated recruitment team * Colleague Resource Groups to support networking and community engagement Get a more detailed look at our ********************************* ABOUT US Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at ********************************** *INCLUSION AND EQUAL OPPORTUNITY EMPLOYMENT* City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. *Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled. Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.

Job Description Nymbus (******************** is a high growth fintech company that enables financial institutions to transform their capabilities and drive value in today's digital finance world. At Nymbus, we believe when you set off on the path to innovation you should feel excitement and confidence, not fear and dread. With Nymbus we are bringing delight back into the banking process. We want our partners to be thrilled about the possibilities we are creating together and the lasting impact our collaboration will bring to the industry and consumers. The journey to growth begins with doing something different. And that journey starts with the great people that make Nymbus. Thank you for considering and entrusting Nymbus to be the catalyst that helps take your career through your next chapter. WORK ENVIRONMENT: We are a remote first company. This role, as most of our positions, is remote. You may be required at times to visit client sites or attend meetings at designated locations. POSITION SUMMARY: The Fraud Investigator plays a critical role in protecting the financial assets, operational integrity, and reputation of Nymbus clients by leading advanced investigations into complex and high-impact fraud cases across multiple payment channels and products. This role involves the proactive identification of suspicious patterns and anomalies through the review of transactional data, case alerts, and non-alert-based referrals from both internal and external sources. The Investigator will perform in-depth case analysis, connect cross-channel and cross-client fraud activity, and determine the root cause of fraudulent behavior. They will work directly with clients to present investigative findings, provide recommendations for risk mitigation, and ensure timely resolution of escalated cases. This includes preparing comprehensive reports, tracking key trends, and recommending targeted process enhancements. Collaboration is essential, as the Fraud Investigator partners closely with internal operations teams, external client contacts, and third-party fraud detection platforms to resolve cases efficiently and in compliance with regulatory standards. The role also involves drafting and maintaining investigative procedures, mentoring Fraud Analysts, and contributing to the development of enterprise-wide fraud prevention strategies. The ideal candidate will have proven expertise in fraud investigation, strong pattern-recognition skills, deep knowledge of financial regulations, and the ability to work effectively under pressure in a high-volume, deadline-driven environment. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES: Include, but are not limited to: Lead end-to-end investigations into complex and high-impact fraud cases, ensuring timely and thorough resolution. Analyze transactional data across multiple sources to identify patterns, trends, and emerging fraud typologies. Develop and maintain detailed fraud reports for clients, highlighting findings, trends, and recommended actions. Collaborate with internal operational and support teams to ensure accurate documentation, escalation, and resolution of fraud incidents. Work with clients to provide investigative updates, final case reports, and recommended preventive measures. Conduct in-depth reviews of customer claims involving Debit card, Credit card, ACH, P2P, Bill Payments, and other payment channels, with a focus on complex and recurring cases. Identify gaps and recommend procedural enhancements to strengthen fraud prevention measures. Draft, update, and maintain fraud investigation procedures and best practices documentation. Serve as a subject matter expert for escalated fraud inquiries from Fraud Analysts and other team members. Track and report investigation metrics for client review. Stay current on industry fraud trends, regulatory changes, and compliance requirements to ensure investigative processes remain effective. Provide training and mentorship to Fraud Analysts on investigative techniques and case handling. QUALIFICATIONS: Associates degree in Business, Criminal Justice, Finance, or a related field preferred. Minimum 5 years of experience in fraud investigation or advanced fraud analysis, preferably in a financial institution or fintech environment. Proven track record managing complex investigations from initiation to resolution. Strong understanding of fraud detection tools and platforms (e.g., Verafin, DataVisor) and the ability to leverage multiple systems for analysis. Fraud certification (CFE, CFCI, or equivalent) strongly preferred. Expertise in identifying patterns, connecting data points, and recognizing emerging fraud trends. Strong understanding of banking operations, payment systems, and relevant regulations. Exceptional written and verbal communication skills, including the ability to prepare and deliver investigation reports to diverse audiences. Proven analytical, research, and problem-solving skills, with a detail-oriented mindset. Ability to work independently on complex assignments while collaborating effectively with cross-functional teams. Proficient in Microsoft Office and Google applications, with strong Excel and data analysis skills. Comfortable navigating multiple systems and applications in a fast-paced, deadline-driven environment. HOURS: Monday - Friday, 8:00 AM - 5:00 PM EST Rotating weekend coverage as scheduled Occasional flexibility may be required for urgent investigations or client needs. SALARY & BENEFITS: $65,000 - $75,000 Annual Salary Annual Cash Bonus and Equity Options commensurate with the role level and experience 100% Fully Remote Robust 401(k) plan with company match Insurance - Health, Dental and Vision (Nymbus covers 100% of the Healthcare and Basic Dental premiums) Flexible Paid Time Off Ready to join? We invite you to watch this video and learn who we are and how we build and innovates together! Let's Go!

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Hill Physicians Care Solutions (HPCS) is a wholly owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage claims for the full risk line of business. Under the leadership of the HPCS Supervisor, the Full Risk Claims Analyst is responsible for ensuring Full Risk claims and disputes are processed accurately and timely pursuant to health plan coverage and Hill Physicians' reimbursement policies as well as within CMS and AB1455 regulations. The analyst will be Responsible for resolving/responding to complex issues for members, health plans and physicians by conducting detailed research and by interfacing with appropriate departments and management to ensure that the standards for claims resolution processes are met. Analyst must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Essential Responsibilities Adjudicating and/or adjusting claims, specifically for the full risk line of business, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Ensure these full risk claims are handled accurately, timely and appropriately. Claim contains pertinent and correct information for processing. Services have the required authorization. Accurate final claims adjudication/adjustment by using pricing system and provider contracts. Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims. Adjudicate claims on Epic Tapestry according to HPCS and HPMG guidelines. Navigate and decipher pricing rules using Optum Prospective Pricing System. Review, interpret and process MS DRG rules, Home Health and ASC groupings, DME and ambulance claims. Ensure all claim lines post to the appropriate fund. Maintain departmental productivity goal. Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate in Claims Services Determine benefits using automated-system controls, policy guidelines, and HMO Fact Sheets. Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Review and process out of network claims according to the guideline/out of network claims research protocol in order to contain out-of-network cost Conduct second-level review of all Medicare denials for Not Authorized and/or Not A Covered Benefit. Research, resolve, and respond to claim resubmission disputes and inquires Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Provide claims contact resolution to the call center. Complete special projects as assigned to meet department and company goals. Document follow-up information on the system and generate appropriate letters to member and providers. Skills and Experience Required Minimum years of experience required - 3 Minimum level of education required - High School/GED Licenses and certifications required - None. Must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Working knowledge of CPT, Revenue codes, PDGM Home Health, ICD-10 codes, Red Book, MS DRGs, HCPC codes and ASC groupings. Three years' experience in claims-payment adjudication at a Health Maintenance Organization (HMO) Health Plan or IPA. (Internal applicants are expected to have one year of experience in claims-payment adjudication). Ability to process all claim types on UB-04 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology. Ability to understand member benefits and patient cost-shares. Ability to calculate and convert standard drug measurements. Knowledge of CMS and the DMHC rules and regulations. Excellent problem solving, organizational, research and analytical skills. Strong written- and verbal-communication skills. Strong Microsoft application skills. Strong interpersonal skills and the ability to interact with employees and others in a professional manner. Strong judgment, decision-making and detailed oriented skills. Ability to work independently or as a team. Ability to work in a fast- paced environment. Additional Information Remote - Multiple Positions Available Salary: $28 - $32 hourly Hill Physicians is an Equal Opportunity Employer

Responsibilities Identify and conduct investigations into known or suspected FWA with high autonomy Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity) Participate in the development and presentation of FWA-related education for assigned Customers Perform coding reviews for flagged claims, to support Coding team (if applicable). Requirements Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field. Bachelor's degree in Criminal Justice or a related field, or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies. Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity Experience handling confidential information and following policies, rules, and regulations Experience with commercial, Medicare, or Medicaid claims Strong analytical and problem-solving skills, with attention to detail and accuracy Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP), or similar is preferred Certified Professional Coder (CPC) or similar is preferred

Looking for a career with purpose and reward? At LoanCare we help customers every day with what is for many their largest and most personal financial transaction: the purchase of their home. With the mission to simplify the complex with empathy and insight, we are constantly innovating and are a top provider in the mortgage services industry as a result. We are actively seeking to fill the role of Claims Specialist II. Our ideal candidate enjoys working with clients, both internal and external, eager to learn and maximize results, is detail oriented and driven to meet tight deadlines in a fast-paced environment. Background in the mortgage or real estate industry is a plus. If this sounds like you, and you are ready for a career and not just your next job, apply today! Responsibilities • Prepare mortgage insurance claims for two or more agencies- or investor-acquired properties. • Complete reconciliation of all advances to be included in the claim. • Assist in conducting internal department quality control audits of post claim activity. • Validate all the necessary supporting documents needed for the claim. • Maintain clear records and reports for management regarding daily production. • Assist with updating appropriate workstations for claim payments. • Follow up and track payment of filed claims. • Conduct miscellaneous research to complete daily tasks. • Conduct research for post-claim activities such as “missing documents and/or agency inquiries”. • Complete tasks queue and notate internal system accordingly. • All other duties as assigned. Qualifications 2-4 years of experience in default mortgage servicing and/or mortgage insurance claim and/or the legal field. Knowledge of accepted business practices in the mortgage industry and understanding of claims process. Proficient knowledge of foreclosure process and appropriate guidelines (FHD). LPS-MSP (Mortgage Servicing Platform) experience. Ability to manage time and priorities wisely. Ability to make sound decisions and resolve issues. Ability to work independently and effectively meet deadlines. Ability to communicate effectively in writing, in person, and by telephone. Ability to use Microsoft Office applications, specifically, Excel and Word. Ability to maintain strict confidentiality. Total Rewards LoanCare's Total Rewards Package offers a comprehensive blend of health and welfare, financial, lifestyle and learning benefits to support employee well-being and engagement. Highlights include: Health & Welfare Coverage: Optional medical, dental, vision, life, and disability insurance Time Off: Paid holidays, vacation, and sick leave Retirement & Investment: Matching 401(k) plan and employee stock purchase plan Wellness Programs: Access to mental health resources, including free Calm memberships, and initiatives that promote physical and emotional well-being Employee Recognition: Programs that celebrate achievements and milestones Lifestyle & Learning Perks: Enjoy discounts on gym memberships, pet insurance, and employee purchasing programs, plus access to a tuition reimbursement program that supports your continued education and professional growth. Compensation Range: $17.88 - $26.73 hourly. Actual compensation may vary within the range provided, depending on a number of factors, including qualifications, skills and experience. Build Your Future with LoanCare At LoanCare, we don't just service mortgage loans-we serve people. As a leading full-service mortgage loan subservicer, we deliver excellence to banks, credit unions, independent mortgage companies, investors, and the homeowners they support. Backed by the strength and stability of Fidelity National Financial (NYSE: FNF), a Fortune 500 company, we offer a career foundation built on integrity, innovation, and collaboration. Here, you'll find: A culture that helps you thrive, with resources and support to fuel your growth Flexibility to work remotely, while staying connected through virtual engagement Opportunities to make a real impact in an industry that touches millions of lives If you're ready to grow your career in a place that values your contributions and empowers your success, we invite you to join our team. About Remote Employment We provide the necessary equipment; all you need is a quiet, private place in your home and a high-speed internet connection with a minimum network download speed of 25 megabits per second (MBPS) and a minimum network upload speed of 10 MBPS. Work Conditions Able to attend work and be productive during normal business hours and to work early, late or weekend hours as needed for successful job performance. Overtime required as necessary. Physical Demands Sitting up to 90% of the time Walking and standing up to 10% of the time Occasional lifting, stooping, kneeling, crouching, and reaching Equal Employment Opportunity LoanCare, its affiliates and subsidiaries, is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, protected veteran status, national origin, sexual orientation, gender identity or expression (including transgender status), genetic information or any other characteristic protected by applicable law.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. (AHIMA CCS, COC or AAPC CPC certification required) Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. QUALIFICATIONS · 5+ years of directly related experience · Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I) · Medical Terminology and anatomy knowledge is required · Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. · Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines. · Strong Microsoft Excel, PowerPoint, Word and OneNote skills · Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS) · Strong analytical capability, independent thinker and good decision-making skills · Excellent written and verbal communication and presentation skills · Strong computer and technology knowledge and skills · Highly professional demeanor, great client satisfaction skills ESSENTIAL DUTIES AND RESPONSIBILITIES · Become proficient in the use of the PARA Data Editor, our proprietary software; · Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. · Audit all aspects of claim including (but not limited to): o Omitted or incorrect charges, o Review OPPS and CAH charges and apply guidelines. o CMS/Payer specific guidelines o Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) o Departmental review for inaccuracies, omitted data/documentation and charges o NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, o Units of services o E/M Profee/Facility o Units of services o Documentation improvement. · Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries. · Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing. · Participate in presentations to clients and prospective clients, typically over web meetings. · Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant. · Maintain current certifications and accreditations (as applicable). · Research new guidelines, data elements, payer specifications, etc. · Other duties may be assigned as necessary. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

HAAWK is looking for a Claiming Specialist to join our team. In this role you will be responsible for accuracy and integrity of music assets within YouTube's Content Management System (CMS), and play a critical part in ensuring proper monetization, rights enforcement, and conflict resolution across digital content platforms. The ideal candidate is highly detail-oriented, technically proficient, and possesses a strong understanding of YouTube's platforms and policies. What You Will Be Doing: * Monitoring and troubleshooting issues related to claims, monetization, and policy enforcement within YouTube CMS. * Investigating and resolving disputed claims, reference overlaps, and ownership conflicts to ensure proper asset management. * Maintaining accurate metadata, confirming correct ownership, and applying appropriate policies across music assets. * Serving as a point of contact for clients and partners, providing timely assistance with content-related issues and conflict resolution. * Stay up-to-date and informed on YouTube platform developments, Content ID tools, and industry best practices. What Makes You Qualified: * Proficiency in organizing and analyzing data using tools such as Microsoft Excel or Google Sheets. * Strong attention to detail, with excellent organizational and analytical problem-solving abilities. * Comfortable working with and learning new technologies. * Proven ability to work collaboratively in a team environment with a positive, solutions-oriented attitude and a willingness to support others to achieve shared goals. * Hands-on experience with YouTube CMS or similar content management systems. * Background in music, digital rights management, or copyright is a plus. * Solid understanding of popular music and awareness of current and emerging trends in the music industry. * Exceptional communication skills with the ability to interact professionally in client-facing situations.

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year medical billing/medical office experience CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to professional billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. Communicates problems hindering workflow to management in a timely manner. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 UHA Patient Financial Services

Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings motivated, highly skilled, and creative people together to solve the government's most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Responsibilities will Include:- Review, sort, and analyze data using computer software programs such as Microsoft Excel.- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).- Develop HCF case referrals including, but not limited to:- Ensure that HCF referrals meet agency and USAO standards for litigation.- Analyze data for evidence of fraud, waste and abuse.- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc. - Assist conducting witness interviews and preparing written summaries. Qualifications:- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.- Experience and expertise in performing the requisite services in Section 3.- Must be a US Citizen.- Must be able to obtain a favorably adjudicated Public Trust Clearance.Preferred qualifications:- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.- Relevant experience working with a federal or state legal or law enforcement entity. #CJ

The Claims Coverage Specialist is a technical resource on the Hagerty Claims Legal team who conducts legal research and assists the Hagerty Claims team with providing accurate and consistent application of policy coverages among all jurisdictions. As a Claims Coverage Specialist, you will play a critical role in providing advice to assist the Claims team with the resolution of insurance claims by analyzing coverage, identifying risks, and supporting the Claims team in making informed decisions. This role requires strong analytical skills, attention to detail, and the ability to collaborate effectively across teams. Ready to get in the driver's seat? Join us! What you'll do Coverage Analysis: Review and interpret insurance policies to provide advice to the Claims team regarding coverage and liability issues. Provide clear, well-reasoned coverage recommendations to claim adjusters and leadership. Support the Claims team by preparing written communications that explain coverage issues. Provide claim adjusters with assistance drafting clear, professional correspondence to communicate coverage positions and decisions to policyholders and other stakeholders. Contribute to the review and updating of policy language to ensure accuracy, compliance, and clarity. Stay current on emerging coverage issues, regulatory changes, and industry trends. Share knowledge and resources with the team. Provide guidance and training to claims staff on coverage matters and best practices. Risk Awareness: Identify potential risks and recommend strategies to mitigate exposure. Support cross-functional initiatives, respond to legal or regulatory inquiries, and assist with projects requiring coverage expertise. This might describe you Education: Juris Doctor and admission to at least one state bar Experience: Minimum of 3+ years in insurance claims, coverage analysis, or related legal/industry work. Auto or casualty insurance experience is a plus. Skills: Strong analytical and problem-solving abilities. Excellent written and verbal communication skills. Comfortable working on multiple priorities in a collaborative environment. Knowledge: Familiarity with insurance coverage principles, claims processes, and regulatory requirements. Litigation or dispute resolution experience is a plus. Excellent written, verbal and interpersonal communication skills Able to prioritize multiple tasks with good time management skills Able to work accurately and effectively in a highly confidential, detail- and results-oriented environment. Able to work independently with minimal direction while functioning well in a team environment Excellent judgment (common sense) and business instincts. Ability to collaborate with employees at all levels across the enterprise and in team settings. Self-managed, self-motivated, and ability to work both independently and as part of a team on assigned tasks. Highest levels of personal and professional integrity. Ability to effectively prioritize and execute tasks in a fast-paced environment. Proven experience in interfacing with executive teams, business management and external law firms. Other things to note This position may require occasional travel to attend industry conferences or training sessions This position is open to U.S. remote work. Say hello to Hagerty Hagerty is an automotive enthusiast brand and the world's largest membership organization. Along with being a best-in-class provider of specialty insurance for enthusiasts, Hagerty is also home to the Hagerty Drivers Foundation, Garage + Social, Hagerty Drivers Club, Marketplace and so much more. Committed to saving driving for future generations, each and every thing Hagerty does is dedicated to the love of the automobile. Hagerty is a rapidly growing company that values a winning culture. We provide meaningful work for and invest in every single team member. At Hagerty, we share the road. We are an inclusive automotive community where all are welcomed, valued and belong regardless of race, gender, age, or car preference. We are united by our shared passion for driving, our commitment to preserve car culture for future generations and our desire to make a positive impact in the world. If you reside in the following jurisdictions: Illinois, Colorado, California, District of Columbia, Hawaii, Maryland, Minnesota, Nevada, New York, or Jersey City, New Jersey, Cincinnati or Toledo, Ohio, Rhode Island, Vermont, Washington, British Columbia, Canada please email ********************** for compensation, comprehensive benefits and the perks that set us apart. #LI-Remote EEO/AA US Benefits Overview Canada Benefits Overview UK Benefits Overview If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!