Claim processor jobs in Austin, TX - 24 jobs

WHO WE ARE: Texas Workforce Commission connects people with careers across the state. While we are based in downtown Austin, TX just north of the Texas State Capitol, we have offices statewide. We're a Family Friendly Certified Workplace with great work-life balance, competitive salaries, extensive opportunities for training and development, and fantastic benefits. This position is based in our main office in downtown Austin, Texas at 101 E. 15th Street. TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. You must be a Texas resident to work for the Texas Workforce Commission or willing to relocate to Texas. WHO YOU ARE: A person with an eye for details, who is able to calmly explain facts and laws to customers. You are a problem solver and good listener, who communicates effectively and who understands the need to empathize with people who may be in difficult situations. Someone who is eager to assist people and provide them with essential information relating to their unemployment benefit debts. WHAT YOU WILL DO: The Interstate Unemployment Insurance (UI) Claims Examiner II - III performs complex to advanced (senior level) unemployment insurance overpayment collection work. Work involves reviewing unemployment insurance benefit overpayments for accuracy and completeness, verifying balance due and getting claimants to agree to a payment plan, or explaining collection action affecting their claim. This position will have a focus on receiving and referring interstate overpayments. Works under general to limited supervision, with moderate to considerable latitude for the use of initiative and independent judgment. YOU WILL BE TRUSTED TO: * Respond to external and internal communications via telephone, letter or e-mail and provide thorough, timely information. * Review the TWC Unemployment Benefits automated system to relay to parties how overpayments were established, encourage payment, and to provide payment options. * Provide claimants with information on collection actions taken on their benefit overpayments and the consequences of that action. * Receive overpayment data from Unemployment Agencies in other states and logging into TWC system in order to collect overpayments from current Texas claimants. * Keep reports and other production documentation up to date, based on time frames indicated by supervisor or other management. * Perform other duties as assigned. YOU QUALIFY WITH: * UI Claims Examiner II: Three years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues and programs. * UI Claims Examiner III: Four years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues or programs. * Both Levels: Relevant academic credits may be applied toward experience qualifications for this position. YOU ARE A GREAT FIT WITH: * Basic billing or collections experience * Basic experience with use of MS Excel, Word, Outlook, and SharePoint or their equivalents * Experience in taking calls from a shared phone queue line * Good conversational/listening skills and/or verbal "de-escalation" skills * Familiarity with the TWC Unemployment Benefits system, ICON and or IRORA is a plus YOU GAIN * A Family Friendly Certified Workplace. * Competitive starting salary: $3,100.00-$4,500.00/month * Defined Retirement Benefit Plan * Optional 401(k) and 457 accounts * Medical Insurance * Paid time off, including time for vacation, sick and family care leave * Additional benefits for active employees can be found at *********************************************************** VETERANS: Use your military skills to qualify for this position or other jobs! Go to ************************* to translate your military work experience and training courses into civilian job terms, qualifications, and skill sets. Also, you can compare this position to military occupations (MOS) at the Texas State Auditor's Office by pasting this link into your browser: *************************************************************************** HOW TO APPLY: To be considered, please complete a State of Texas Application for Employment and apply online at ******************* or on Taleo. TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. A position utilizing this classification will be designated as security sensitive according to the Texas Labor Code, Section 301.042.

UI Claims Examiner (Austin) - (826035) Description WHO WE ARE:Texas Workforce Commission connects people with careers across the state. While we are based in downtown Austin, TX just north of the Texas State Capitol, we have offices statewide. We're a Family Friendly Certified Workplace with great work-life balance, competitive salaries, extensive opportunities for training and development, and fantastic benefits. This position is based in our main office in downtown Austin, Texas at 101 E. 15th Street. TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. You must be a Texas resident to work for the Texas Workforce Commission or willing to relocate to Texas. WHO YOU ARE:A person with an eye for details, who is able to calmly explain facts and laws to customers. You are a problem solver and good listener, who communicates effectively and who understands the need to empathize with people who may be in difficult situations. Someone who is eager to assist people and provide them with essential information relating to their unemployment benefit debts. WHAT YOU WILL DO:The Interstate Unemployment Insurance (UI) Claims Examiner II - III performs complex to advanced (senior level) unemployment insurance overpayment collection work. Work involves reviewing unemployment insurance benefit overpayments for accuracy and completeness, verifying balance due and getting claimants to agree to a payment plan, or explaining collection action affecting their claim. This position will have a focus on receiving and referring interstate overpayments. Works under general to limited supervision, with moderate to considerable latitude for the use of initiative and independent judgment. YOU WILL BE TRUSTED TO:-Respond to external and internal communications via telephone, letter or e-mail and provide thorough, timely information.-Review the TWC Unemployment Benefits automated system to relay to parties how overpayments were established, encourage payment, and to provide payment options.-Provide claimants with information on collection actions taken on their benefit overpayments and the consequences of that action.-Receive overpayment data from Unemployment Agencies in other states and logging into TWC system in order to collect overpayments from current Texas claimants. -Keep reports and other production documentation up to date, based on time frames indicated by supervisor or other management.-Perform other duties as assigned. YOU QUALIFY WITH: -UI Claims Examiner II: Three years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues and programs. -UI Claims Examiner III: Four years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues or programs. -Both Levels: Relevant academic credits may be applied toward experience qualifications for this position. YOU ARE A GREAT FIT WITH:-Basic billing or collections experience -Basic experience with use of MS Excel, Word, Outlook, and SharePoint or their equivalents-Experience in taking calls from a shared phone queue line-Good conversational/listening skills and/or verbal “de-escalation” skills-Familiarity with the TWC Unemployment Benefits system, ICON and or IRORA is a plus YOU GAIN-A Family Friendly Certified Workplace. -Competitive starting salary: $3,100.00-$4,500.00/month-Defined Retirement Benefit Plan-Optional 401(k) and 457 accounts-Medical Insurance-Paid time off, including time for vacation, sick and family care leave-Additional benefits for active employees can be found at *********************************************************** VETERANS:Use your military skills to qualify for this position or other jobs! Go to ************************* to translate your military work experience and training courses into civilian job terms, qualifications, and skill sets. Also, you can compare this position to military occupations (MOS) at the Texas State Auditor's Office by pasting this link into your browser: *************************************************************************** HOW TO APPLY: To be considered, please complete a State of Texas Application for Employment and apply online at ******************* or on Taleo. TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. A position utilizing this classification will be designated as security sensitive according to the Texas Labor Code, Section 301.042. Primary Location: United States-Texas-AustinWork Locations: Austin:101 E 15th St (320-4001) 101 E 15th St Austin 78778-0001Job: Tax Examiners and CollectorsOrganization: TWC Business UnitSchedule: Full-time Employee Status: RegularJob Type: StandardJob Level: Non-ManagementTravel: NoJob Posting: Jun 20, 2025, 5:00:00 AMWork From Home: No

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

Curative is reimagining health care and health insurance - with straightforward pricing and $0 out of pocket costs with a baseline visit. Join our growing team and help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. Curative is searching for a Claims Analyst to review claims for completeness and process per plan guidelines. Carries out all duties while maintaining compliance, confidentiality, and promoting the mission of the organization. This position requires meeting productivity and quality standards to be successful in this role and provides the opportunity to grow your skill set and learn health plan operations. No experience necessary, we will provide training. ESSENTIAL DUTIES AND RESPONSIBILITIES Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives. Documents clearly and concisely claims adjudication decisions in appropriate systems. Consults appropriate reference materials to verify proper coding. Ability to interpret and apply plan guidelines while processing to ensure correct plan setup. Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification. Proactively identify processes and system problems that can be improved, to reduce rework and provide accurate payment upon original processing. Maintains timely responses to appeals and reconsideration requests Attends and participates in departmental training, functions, and meetings. Ability to meet/ maintain the required accuracy and production standards after release from training. Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures Performs other duties, functions, and projects, as assigned, by team management. This position is located on-site in the Austin, TX office. EXPERIENCE No experience in claims processing is necessary, just a willingness to learn Working knowledge of Google Sheets and Excel required Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding is preferred. Experience on the HealthEdge Health Rule Payer System is plus Strong computer and keyboarding skills, including familiarity with Windows Strong interpersonal & problem-solving skills. Strong verbal and written communication skills to communicate clearly and effectively to all levels of staff, members, and providers. Ability to be focused and sit for extended periods of time at a computer workstation. Ability to work in a team environment and manage priorities Ability to calculate allowable amounts such as discounts, interest, and percentages EDUCATION, LICENSES and/or CERTIFICATIONS College graduates preferred Strong, demonstrated analytical skills preferred

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

We're excited you're considering joining a great place to work! Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law. About this PositionAt Texas Mutual, we're working to create a stronger, safer Texas. As the Supervisor of Claims for our Austin Regional Office, you will supervise and monitor the daily operations of claims processing in accordance with the Texas Workers' Compensation Act, rules of the Division of Workers' Compensation and internal procedures. You will manage the personnel, equipment, facilities and finances of assigned operations and ensure coordination and support of the overall goals and objectives of the division.Responsibilities & Qualifications In this role you will: Supervise and monitor the daily operations of claim processing in accordance with the Texas Workers' Compensation Act, rules of the DWC, and internal procedures. Provide guidance to staff regarding claim handling and desired outcomes. Recruit, retain, coach and mentor employees. Contribute to the development and implementation of division goals and objectives, policies, standards, procedures and budgets. It is required that you have: Bachelor's degree. Texas workers' compensation or all lines adjuster's license. Related experience in the range of four to six years (Texas preferred). Preferred Qualifications Industry-related designation. Texas Mutual Pay Transparency The base pay range is based on the market evaluation of the job and may include pay for multiple levels. Individual base pay within the range is determined by a variety of factors, including experience, performance, education, and demonstration of skills and competencies required for each role. Your recruiter can discuss the full value of our total compensation package with you, including our generous bonus plans and flex-hybrid work model. Base Pay Range: $99,985.50 - $123,511.50 Per YearFlex-Hybrid Work Environment: Texas Mutual's flex-hybrid schedule allows you to bring your best self to work by working remotely and collaborating in the office based on business needs. All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed. Our Benefits: Annual performance bonus and merit-based pay increase Lifestyle Savings Account ($1,000 per year) Automatic 4% employer contribution to retirement plan 401k plan with 100% employer match up to 6% Student loan repayment matching in 401k plan Three weeks' time off for vacation Nine paid holidays and two personal days each year Day one health, Rx, vision and dental insurance Life and disability insurance Flexible spending account Pet insurance and pet Rx discounts Free on-site gym, fitness classes, and health and wellness resources Free identity theft protection Free student loan repayment and refinancing consultation Professional development and tuition reimbursement Employee referral bonus Free onsite snacks

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced Claims Analyst/Examiner looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Daily Responsibilities: • Investigate rejected claims and analyze results • Review large data spreadsheets, analyze provider claims submissions and researching websites Hours for this Position: • Monday-Friday 9:00am- 6:00pm • Start Date: 10/26 Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience ($22-$24/hr.) • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment Qualifications • Bachelor's degree in related field or equivalent experience • Moderate Excel user • Analytical experience • System savvy • Must have Claims experience • Must have Healthcare experience preferred knowledge Medicaid, Medicare Requirements • Strongly prefer Managed Care experience • Preferred- experience with one or all of following software's - Viso, Amysis or Agile. (Systems that support management, delivery, and administration of healthcare services and healthcare benefits.) Additional Information Interested in being considered? If you are interested in applying to this position, please contact Sheena Lagaylay @ 407-965-2843 and click the Green I'm Interested Button to email your resume.

Title: Mechanical Claims Processing Specialist Reports to: Mechanical Claims Supervisor Department: Operations Direct Reports: No Exempt Status: Non-Exempt Position Type: Full-Time, Hybrid Schedule Claims Hours of Operation: Monday - Friday, 7 am - 7 pm, Saturday, 8 am - 3:30 pm Job Purpose The Mechanical Claims Processing Specialist role is responsible for providing essential clerical and administrative assistance to the Mechanical Claims Team. This position is not directly responsible for adjudicating claims, but plays a critical role in ensuring efficient and accurate claims processing. Essential Job Functions Review, upload, and organize mechanical claims-related documents into internal systems for review and processing Review service invoices and repair orders for accuracy and completeness prior to processing payment Process claims payments accurately and in a timely manner Coordinate with Claims Examiners on open or pending claims to resolve outstanding issues Perform accurate data entry and maintenance of claims records Monitor workflow to ensure claims and documents are processed within established timelines Communicate professionally with internal teams and external partners, as needed, regarding claim statuses and updates Other tasks as assigned by Management Minimum Qualifications Previous experience as Warranty Administrator, Automotive Service Advisor, or similar role preferred Familiarity with Vehicle Service Contracts and mechanical claims processes Experience handling financial transactions, invoice verification, and payment reconciliation Ability to read and understand contractual language as well as automotive repair terminology Ability to interpret automotive service invoices and repair orders Proficiency in data entry and Microsoft Office Suite (Excel, Outlook, Word) Excellent verbal and written communication skills High attention to detail and accuracy Maintain production level as assigned The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty-three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard-working Claims Processor who can join our growing team of professionals. Job Duties: Audits and ensure claim information is complete and accurate. claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management. Ensures accurate and timely billing of HCFA 1500 claims. Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.). Creates logs for providers of pending medical encounters and or encounters with errors. Work directly with other billing staff and management to meet end of month closing deadlines. Able to work with clearinghouse rejections, print, and mail secondaries. Address inquiries from insurance companies, patients, and providers. Understands CPT, ICD10, HCPCS coding and modifiers. Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc. Knowledge of ERAs, EOBs Knowledge of payer specific/LCD guidelines Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification Must be proficient with spreadsheets and word processing applications. Qualifications: Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting Experience with Medicare, Medicaid, Commercial insurance plans, Workers' comp, and Personal Injury cases. Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials. Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required. Excellent computer skills and familiarity with Microsoft Office Comfortable working in a growing, dynamic organization and able to navigate change. Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment. Bachelor's degree preferred. Experience using eClinicalWorks preferred. Experience with high level procedure billing and coding for Pain Management preferred The position is full time with competitive salary, PTO, health benefits and 401k match. The ideal candidate will be located in Georgia and able to be present at our administrative office, or near Austin, Texas where other members of the billing team are located.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance PL CLAIM SPECIALIST **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

About BCforward BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. BCforward's headquarters are in Indianapolis, Indiana and also operates delivery centers in 17 locations in North America as well as Hyderabad, India and Puerto Rico. We are currently the largest consulting firm and largest MBE certified firm headquartered in Indiana. With 14+ years of uninterrupted growth, the addition of two brands (Stafforward and PMforward) and a team of more than 1400 resources our teams deliver services for multiple industries from both public and private sectors. BCforward's team of dedicated staffing professionals has placed thousands of talented people over the past decade, with retention rates that are consistently higher than the industry average. Job Description: The Insurance Examiner collects group insurance information needed to review HIPP cases for program eligibility. The information is analyzed to ensure it meets State requirements. Responsibilities: Reviews and evaluates paystubs, group insurance plan information and other documentation to determine client eligibility in HIPP program Calculates group insurance premium Contacts employers and Medicaid clients to request group insurance plan information Performs research to locate group insurance information needed to complete case reviews. Communicates with insurance carriers to verify coverage Observes professional standards of conduct, including attendance, professional behavior and dress code Develop and maintain professional business relationships through verbal and written communication with team members, employers, Medicaid clients and insurance companies. Multi-tasking; ability to prioritize work and work under time constraints. Qualifications Need one who can speak Spanish. Additional Information Thanks & Regards, Namratha Gandavarapu |Sr. IT Recruiter Direct: ************.

Claims Coordinator Pay Rate: $21/hr - $23/hr Shift: Monday - Friday 8AM to 5PM Description: MAJOR RESPONSIBILITIES/TASKS Office Administration and Support 1. Set up new claim files, including completing data screens, setting initial reserves, and mailing acknowledgment letters. Update internal claim logs and reports, prepare claim files, and scan documents for vendor services as needed. Handle urgent claim setup requests as required. 2. Manage all incoming and outgoing correspondence. Act as a backup for reception, handling receipt, opening, and date-stamping of claims mail. Index each mail item with the appropriate claim number and ensure daily electronic transmission of medical bills to IMO. 3. Provide administrative assistance to the Claims Department, including coordinating meetings, preparing reports, making travel arrangements, and preparing expense reports for management. Assist in preparing for Hot Topics and other events. 4. Manage the worker s comp inbox, routing and processing incoming electronic mail throughout the day. 5. Handle incoming calls to the claims department, directing them to the appropriate team member as necessary. 6. Report information to respective entities as required by the Texas Department of Insurance. 7. Maintain and replenish printer supplies in the claims area and ensure office supplies are stocked for the department. 8. Provide backup support for the receptionist at the front desk and offer administrative assistance to other departments as needed. Invoice and Payment Processing 9. Process reviewed invoices, provide bill and check status updates to vendors/providers, and handle mileage reimbursements and check requests. 10. Manage weekly indemnity and expense payments. Process audited medical bills, attach necessary documentation, ensure timely mailing of checks, and file copies in the appropriate claim files. POSITION REQUIREMENTS, KNOWLEDGE, SKILLS & ABILITIES: Credentials, Knowledge, and Experience: - High school diploma - Minimum of two years experience in an administrative role - Availability to work in the office five days per week Skills and Abilities: - Strong organizational skills with attention to detail - Effective time management with the ability to prioritize multiple tasks - Proficiency in Microsoft Office Suite and quick adaptability to technology databases - Excellent verbal and written communication, including proof-reading - Initiative in troubleshooting and problem-solving - Team-oriented with strong collaboration skills - Professional demeanor and ability to work with diverse personalities

WHO WE ARE: Texas Workforce Commission connects people with careers across the state. While we are based in Austin on the north lawn of the Texas State Capitol, we have offices statewide. We're a Family Friendly Certified Workplace with great work-life balance, competitive salaries, extensive opportunities for training and development, and fantastic benefits. This position is located at 101 E 15th St, Austin, Texas in the Division of Fraud Deterrence and Compliance Monitoring (FDCM). TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. You must be a Texas resident to work for the Texas Workforce Commission or willing to relocate to Texas. WHO YOU ARE: A Wage and Hour Claims Examiner I is someone who gathers and verifies information and evidence through interviews, reviewing, and analyzing records and logs. Uses proper methods to search for, collect, and maintain various types of data to support and generate conclusions. WHAT YOU WILL DO: The Wage and Hour Claims Examiner I (UI Claims Examiner I) performs routine (journey-level) wage and hour claims work. Work involves reviewing wage and hour claims for accuracy and completeness, determining claimant eligibility, and determining unemployment liability. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. YOU WILL BE TRUSTED TO: * Conduct research to determine if wages were properly made. * Evaluate and summarize findings. * Examine, review, and audit wage records. * Review and research wage claim issues as needed. * Use personal computer to data enter decisions, record decisions, and document case information to the Payday System. * Respond to oral and written inquiries from claimants, employers, and agency staff to provide customer support in a busy work environment. * Review investigative techniques and recommends improvements as appropriate. * Work quickly, performs multiple tasks, pays attention to detail, and adheres to work schedules and strict deadlines. * Work in a highly stressful environment. * Perform heavy telephone contact with public utilizing strong interviewing and communication skills. * Treat customers with courtesy and respect as well as handles hostile customers in a professional manner. * May participate in projects. * Perform other duties as assigned. YOU QUALIFY WITH: * Two years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues and programs. * Relevant academic credits may be applied toward experience qualifications for this position. YOU ARE A GREAT FIT WITH: * Recent Wage and Hour experience and knowledge of wage regulations * Examiner experience * Ability to gather data/information * Bilingual; Spanish/English YOU GAIN: * A Family Friendly Certified Workplace. * Competitive salary: $3,320.33/month * Defined Retirement Benefit Plan * Optional 401(k) and 457 accounts * Medical Insurance * Paid time off, including time for vacation, sick and family care leave * Additional benefits for active employees can be found at *********************************************************** VETERANS: Use your military skills to qualify for this position or other jobs! Go to ************************* to translate your military work experience and training courses into civilian job terms, qualifications, and skill sets. Also, you can compare this position to military occupations (MOS) at the Texas State Auditor's Office by pasting this link into your browser: *************************************************************************** HOW TO APPLY: To be considered, please complete a State of Texas Application for Employment and apply online at ******************* or on Taleo (Job Search). TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. A position utilizing this classification will be designated as security sensitive according to the Texas Labor Code, Section 301.042.

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

Wage and Hour Claims Examiner (Austin) - (826629) Description WHO WE ARE:Texas Workforce Commission connects people with careers across the state. While we are based in Austin on the north lawn of the Texas State Capitol, we have offices statewide. We're a Family Friendly Certified Workplace with great work-life balance, competitive salaries, extensive opportunities for training and development, and fantastic benefits. This position is located at 101 E 15th St, Austin, Texas in the Division of Fraud Deterrence and Compliance Monitoring (FDCM). TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. You must be a Texas resident to work for the Texas Workforce Commission or willing to relocate to Texas. WHO YOU ARE:A Wage and Hour Claims Examiner I is someone who gathers and verifies information and evidence through interviews, reviewing, and analyzing records and logs. Uses proper methods to search for, collect, and maintain various types of data to support and generate conclusions. WHAT YOU WILL DO: The Wage and Hour Claims Examiner I (UI Claims Examiner I) performs routine (journey-level) wage and hour claims work. Work involves reviewing wage and hour claims for accuracy and completeness, determining claimant eligibility, and determining unemployment liability. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. YOU WILL BE TRUSTED TO:- Conduct research to determine if wages were properly made. - Evaluate and summarize findings. - Examine, review, and audit wage records. - Review and research wage claim issues as needed. - Use personal computer to data enter decisions, record decisions, and document case information to the Payday System. - Respond to oral and written inquiries from claimants, employers, and agency staff to provide customer support in a busy work environment. - Review investigative techniques and recommends improvements as appropriate. - Work quickly, performs multiple tasks, pays attention to detail, and adheres to work schedules and strict deadlines. - Work in a highly stressful environment. - Perform heavy telephone contact with public utilizing strong interviewing and communication skills. - Treat customers with courtesy and respect as well as handles hostile customers in a professional manner. - May participate in projects. - Perform other duties as assigned. YOU QUALIFY WITH: - Two years of full-time experience in the gathering of information, interviewing, counseling, or in the instruction, demonstration, and interpretation of policies in a public or private enterprise; in unemployment insurance work; or in workforce development issues and programs. -Relevant academic credits may be applied toward experience qualifications for this position. YOU ARE A GREAT FIT WITH:-Recent Wage and Hour experience and knowledge of wage regulations -Examiner experience-Ability to gather data/information-Bilingual; Spanish/English YOU GAIN: - A Family Friendly Certified Workplace. - Competitive salary: $3,320. 33/month - Defined Retirement Benefit Plan - Optional 401(k) and 457 accounts - Medical Insurance - Paid time off, including time for vacation, sick and family care leave - Additional benefits for active employees can be found at ************ ers. texas. gov/Active-Employees/Health-Benefits. VETERANS:Use your military skills to qualify for this position or other jobs! Go to www. texasskillstowork. com to translate your military work experience and training courses into civilian job terms, qualifications, and skill sets. Also, you can compare this position to military occupations (MOS) at the Texas State Auditor's Office by pasting this link into your browser: *********** sao. texas. gov/Compensation/MilitaryCrosswalk/MOSC_Employment. pdf HOW TO APPLY: To be considered, please complete a State of Texas Application for Employment and apply online at www. workintexas. com or on Taleo (Job Search). TWC is not considering applications from individuals who require sponsorship for an employment visa, including those currently on student or postgraduate visas. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. A position utilizing this classification will be designated as security sensitive according to the Texas Labor Code, Section 301. 042. Primary Location: United States-Texas-AustinWork Locations: Austin:101 E 15th St (320-4001) 101 E 15th St Austin 78778-0001Job: Insurance Claims ClerksOrganization: TWC Business UnitSchedule: Full-time Employee Status: RegularJob Type: StandardJob Level: Non-ManagementTravel: NoJob Posting: Jan 15, 2026, 6:00:00 AMWork From Home: No

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Representative, Auto **PRIMARY PURPOSE** : To analyze and process low to mid-level auto and transportation claims. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. + Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. + Maintains professional client relations. + Performs coverage, liability, and damage analysis on all claims assignments. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Three (3) years of personal line or commercial line property claims management experience or equivalent combination of education and experience required to include knowledge of construction basics. Property estimating software experience a plus. **Skills & Knowledge** + Familiarity with personal and commercial lines policies and endorsements + Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims. + Knowledge of total loss processing, State salvage forms and title requirements. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking **NOTE** : Credit security clearance, confirmed via a background credit check, is required for this position. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $50,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

We're excited you're considering joining a great place to work! Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law. About this PositionConducts claim investigations and administers benefits to injured workers and/or their beneficiaries in accordance with the Texas Workers' Compensation Act, rules of the Division of Workers' Compensation (DWC), and internal policies and procedures. Has reserving authority commensurate with experience. Works under general supervision.Responsibilities & QualificationsIn this role, you will: Administer workers' compensation benefits to injured workers, delivering excellent customer service. Conduct investigations and make recommendations. Maintain caseload and case files. Ensure regulatory compliance and proper claim handling. The successful candidate must have: Bachelor's degree or equivalent education, training and experience. At least two years of experience adjusting workers' compensation claims is required or equivalent education, training and experience. Current Texas workers' compensation or all lines adjuster license. Texas Mutual Pay Transparency The base pay range is based on the market evaluation of the job and may include pay for multiple levels. Individual base pay within the range is determined by a variety of factors, including experience, performance, education, and demonstration of skills and competencies required for each role. Your recruiter can discuss the full value of our total compensation package with you, including our generous bonus plans and flex-hybrid work model. Base Pay Range: $68,291.55 - $102,076.80 Per YearFlex-Hybrid Work Environment: Texas Mutual's flex-hybrid schedule allows you to bring your best self to work by working remotely and collaborating in the office based on business needs. All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed. Our Benefits: Annual performance bonus and merit-based pay increase Lifestyle Savings Account ($1,000 per year) Automatic 4% employer contribution to retirement plan 401k plan with 100% employer match up to 6% Student loan repayment matching in 401k plan Three weeks' time off for vacation Nine paid holidays and two personal days each year Day one health, Rx, vision and dental insurance Life and disability insurance Flexible spending account Pet insurance and pet Rx discounts Free on-site gym, fitness classes, and health and wellness resources Free identity theft protection Free student loan repayment and refinancing consultation Professional development and tuition reimbursement Employee referral bonus Free onsite snacks

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.