Adjudicator, Provider Claims-Ohio-On the Phone
Claim processor job in Lincoln, NE
The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.
Knowledge/Skills/Abilities
* Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
* This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.
* Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
* Assists in the reviews of state or federal complaints related to claims.
* Supports the other team members with several internal departments to determine appropriate resolution of issues.
* Researches tracers, adjustments, and re-submissions of claims.
* Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
* Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
* Handles special projects as assigned.
* Other duties as assigned.
Knowledgeable in systems utilized:
* QNXT
* Pega
* Verint
* Kronos
* Microsoft Teams
* Video Conferencing
* Others as required by line of business or state
Job Function
Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.
Job Qualifications
REQUIRED EDUCATION:
Associate's Degree or equivalent combination of education and experience;
REQUIRED EXPERIENCE:
2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.
1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
PREFERRED EDUCATION:
Bachelor's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
4 years
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $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.
Commercial Auto Claim Examiner
Claim processor job in Omaha, NE
We are currently seeking an experienced and detail-oriented Commercial Auto Claim Examiner to join our team and support our clients in managing their commercial auto claims efficiently and effectively. The Commercial Auto Claim Examiner will be responsible for investigating, evaluating, and resolving commercial auto claims. This role requires a strong understanding of commercial auto insurance policies, coverage, and claims handling processes. The successful candidate will ensure timely and accurate claims processing while maintaining high standards of customer service and compliance.
Salary/Benefits
$90k-$95k+/ Yearly (based on experience)
Handling litigated and non-litigated Commercial Auto claims
Will handle claims from all over the US
Average caseload: 135-160 MAX
Litigated files 50%
Requirements
5+ years of experience handling complex Commercial Auto Claims
Need to have Bodily Injury experience
Ideally TX or FL license
Litigation experience required
Bachelor's Degree required
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
#LI-CD5
#LI-BC1
INDTJG-CTT
Claims analyst
Claim processor job in Omaha, NE
Job Title: Claims analyst
Duration: 12 months
Job Description:
Family Summary/Mission
Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.
Position Summary/Mission
Reviews and adjudicates routine claims in accordance with claim processing guidelines.
Fundamental Components & Physical Requirements include but are not limited to
(* denotes essential functions)
• Analyzes and approves routine claims that cannot be auto adjudicated. (*)
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*)
• Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
• Routes and triages complex claims to Senior Claim Benefits Specialist. (*)
• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*)
• May facilitate training when considered topic subject matter expert. (*)
• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*)
• Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*)
Performance Measures
Background/Experience Desired
• Experience in a production environment.
• Claim processing experience.
Qualifications
Education and Certification Requirements
High School or GED equivalent.
Additional Information (situational competencies, skills, work location requirements, etc.)
• Ability to maintain accuracy and production standards.
• Analytical skills.
• Technical skills.
• Oral and written communication skills.
• Understanding of medical terminology.
• Attention to detail and accuracy.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Associate Claims Examiner - Equine
Claim processor job in Omaha, NE
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills.
Job Responsibilities
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
* Conducts, coordinates and directs investigation into loss facts and extent of damages.
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
* Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents.
* Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting.
Required Qualifications
* This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred.
* Must have or be eligible to receive claims adjuster license.
* Successful completion of basic insurance courses or achievement of industry designations.
* Ability to be trained in insurance adjusting up to two years of claims experience.
* 2-4 years of experience in general liability, construction defect, or related liability lines preferred.
* Bachelor's degree preferred
* Excellent written and oral communication skills.
* Strong organizational and time management skills.
#LI-Hybrid
US Work Authorization
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
* We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
* All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
* We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
Are you ready to play your part?
Choose 'Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
* All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
* All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Auto-ApplyProperty Claim Representative
Claim processor job in Council Bluffs, IA
Job Description
WHO WE ARE
IMT is proud of our heritage and will never forget where our roots are firmly planted. Locally run from its office in West Des Moines, Iowa, IMT has been a Midwest company since it was founded in Wadena, Iowa in 1884. That's over 140 years!
Today, IMT continues to offer a strong line of personal and commercial insurance products for which it has always been known, along with exceptional service for a competitive price. Our products are offered through Independent Agents throughout a six-state territory - Iowa, Illinois, Minnesota, Nebraska, South Dakota and Wisconsin.
PROPERTY CLAIM REPRESENTATIVE
IMT Insurance is now taking applications for the position of a Property Claim Representative in Council Bluffs, IA and surrounding area. This individual will conduct investigations and attempt settlement of claims submitted by policyholders for property losses. The ideal candidate will be an analytical, detailed worker, who can manage time and work on multiple projects while maintaining accuracy and service. IMT Property Claims Representatives investigate and evaluate claims involving personal and commercial property to determine proper policy coverages and apply best claims practices to ensure accurate settlements in accordance with company guidelines. If you're interested in joining our claims department, apply online today!
A DAY IN THE LIFE
Conduct interviews with insureds, claimants and other interested parties
Conduct thorough investigations and examine insurance policies to determine coverage
Inspect damages and prepare written estimates of repair or replacement
Correspond with insureds, claimants and other interested parties
Prepare and report findings and negotiate settlements
DESIRED QUALIFICATIONS
0 - 3 years Property claims experience preferred
Bachelor's Degree
Excellent verbal and written communication skills
Excellent problem-solving and negotiation skills
Good keyboard/PC skills
Excellent organizational and prioritization skills
Ability to climb ladder to assess roof damage
Ability to lift minimum 30 lbs
Must maintain valid driver's license
Able to travel/stay overnight for storm claim duty
BENEFITS & PERKS
IMT Insurance is committed to our employees and their families. When you work for IMT, you earn far more than just a paycheck. The IMT office was new in 2018 and offers a fitness room, game room and a variety of collaboration areas. This position includes learning and development opportunities and more! Below is a list of what IMT offers our employees:
Medical, dental, and vision insurance, Life & A D & D insurance, 401K retirement savings accounts, spending accounts, long and short-term disability, profit share, paid vacation & sick time, employee assistant program and additional voluntary benefits.
The salary range for this position is $53,000.00 - $99,000.00
Starting salary and level of position will depend on level of experience
This position is not eligible for tips or commission but may be eligible for additional bonuses
WHAT DEFINES US
Our vision is to provide peace of mind in the moments that matter.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant based on race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our agents and customers come from all walks of life and so do we. Our goal is to hire great people from a wide variety of backgrounds, because it makes our team stronger. If you share our values and our passion for creating a Worry Free life for others, we want to talk to you!
General Liability Property Damage Claims Manager
Claim processor job in Omaha, NE
Argo Group International Holdings, Inc. and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions.
Job Description
We are looking for a highly capable General Liability Property Damage Claims Manager to join our team and work from any of our US offices. This role will be managing a team of five adjusters of varying levels of experience adjudicating claims under technical direction within broad limits on assignments reflecting moderate to complex complexity, potentially with significant impact on departmental results.
The primary duties and responsibilities of the role are:
* Using your specialized knowledge in general liability property damage claims, provide technical resources, guidance and education for a team of claims adjusters with varying levels of experience to enable them to manage all claims to the appropriate outcome.
* Ensuring performance objectives and metrics are in place and being met to support and meet department goals.
* Providing advice and oversight into claim disposition strategies.
* Ensure Argo's best-in-class claim management operating characteristics, measurement criteria, and meaningful metrics benchmarking are communicated to the team and monitored to ensure there is accountability for proper and consistent claims performance, achieving the appropriate financial outcomes, and department goals.
* Working closely with adjusters and outside counsel to ensure cost-effective and appropriate litigation management strategies are in place that will lead to the best overall outcome.
* Support the selection process to hire and retain claims professionals that consistently demonstrate appropriate technical expertise, maturity and a professional commitment to excellence and customer service.
* Acting as a role model, and with sustained positive energy, demonstrating belief in, and commitment to, the values of Argo Group. Continuing to build and lead a value-based organization committed to long-term success.
* Having an appreciation and passion for strong claim management.
The successful candidate will be a motivated, solutions-oriented self-starter with high ethical standards. Additional qualifications and knowledge will include but are not limited to:
* Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' ability to be profitable).
* Requires advanced knowledge in leading people and managing the execution of processes, projects and tactics. This is typically achieved through:
* A minimum of ten years' prior relevant experience, including people management.
* Bachelor's degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating general liability property damage claims beyond the minimum experience required above may be substituted in lieu of a degree.
* Ability to ability to build consensus.
* A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders by:
* Finding a way to achieve success through adversity.
* Being solution (not problem) focused
* Thinking with a global mindset first.
* Strong focus on selection - determined to have the right people who do the best job.
* Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast paced environment that is evolving constantly.
* A team builder, someone who understands that success is dependent upon the performance of the team and not individual team members. Creates strong morale and spirit within the team: shares wins and celebrates success as a team
* Dedicated to developing talent. Understands and is committed to teaching technical skills and developing people so that they realize their full potential.
* Advanced technical expertise related to claims resolution and settlement principles, practices and procedures.
* Ability to establish mentoring relationships with key employees and participates in the development of succession and training plans for all positions. Empowers others by driving decision-making, authority, and resources to trusted employees and providing stretch assignments.
* Ability to identify and resolve conflicts in a timely, objective manner, using sound judgment to reach a solution.
* Independent decision maker - takes full responsibility for making decisions keeping risk and compliance at the center of the process. Makes decisions with data driven tools and information.
* Demonstrates active listening and proactive communication by listening first, and then preparing carefully before engaging in conversation to communicate well thought out feedback.
* Shows care and concern by expressing curiosity authentically, being self-aware, constantly engaging input from others, and collaborating with ease.
* Ability to build rapport and foster collaborative, productive relationships with business partners and organizational peers with a focus on timely and meaningful exchanges of information and providing value-added solutions.
* Must demonstrate a desire for continued professional development and diverse experience opportunities for both self and others.
* The courage to offer and support others to express different opinions and ideas, regardless of popularity or immediate acceptable.
* Polished and professional written and verbal communication skills. The ability to read and write English fluently is required.
* Proficient in MS Office Suite and other business-related software.
The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary, all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package.
* Chicago and Los Angeles metro area Pay Range: $168,600 - $202,300
* Los Angeles and New York City Pay Range: $183,800 - $220,600
About Working in US Claims at Argo Group
* Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful.
* Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.
* We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses.
* Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.
* We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
PLEASE NOTE:
Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.
If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at ************.
Notice to Recruitment Agencies:
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.
We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
The collection of your personal information is subject to our HR Privacy Notice
Benefits and Compensation
We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.
Auto-ApplyLiability Claims Examiner - Auto & GL
Claim processor job in Omaha, NE
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
Liability Claims Examiner - Auto & GL
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?
* Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
* Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.
* Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
* Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.
* Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
* Enjoy flexibility and autonomy in your daily work, your location, and your career path.
* Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATIONS
Hybrid (2 Days In-Office)
PRIMARY PURPOSE: To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
* Analyzes and processes complex or technically difficult general liability and auto liability 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.
* Assesses liability and resolves claims within evaluation.
* Negotiates settlement of claims within designated authority.
* Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
* Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
* Prepares necessary state fillings within statutory limits.
* Manages the litigation process; ensures timely and cost effective claims resolution.
* Coordinates vendor referrals for additional investigation and/or litigation management.
* Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
* Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
* Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
* Communicates claim activity and processing with the claimant and 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.
QUALIFICATION
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Five (5) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
* Subject matter expert of appropriate 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 and Medicare 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
* Good interpersonal skills
* Excellent negotiation skills
* Ability to work in a team environment
* Ability to meet or exceed Service Expectations
TAKING CARE OF YOU
* Flexible work schedule.
* Referral incentive program.
* Career development and promotional growth opportunities.
* A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
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 $75,000 - $90,000. 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.
#Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
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.
Auto-ApplyLitigated Claims Examiner, Complex General Liability
Claim processor job in Omaha, NE
Applied Underwriters, Inc., a global risk services company, is seeking to hire an experienced Claims Examiner to join our large loss claims team. In this role, you will use your strong communication, investigation, and negotiation skills to successfully manage a diverse caseload of commercial general liability claims. This person must appreciate the sensitive nature of complex, litigated liability claims and have extensive knowledge on policy interpretation and negligence standards.
At Applied Underwriters, employees have been at the heart of our success story for more than 30 years. Headquartered in Omaha, NE, our company thrives on innovation and empowers our employees to shape the future of global risk services. Join a team where your ideas are valued and your talents are nurtured with formal, paid training and mentorship. Experience a workplace culture that celebrates initiative, recognizes results, and provides outstanding benefits that allow you to focus on achieving your full potential. Requirements:
Juris Doctorate
At least two years experience working in an insurance defense capacity or as a Commercial Claims Examiner. Personal injury attorneys encouraged to apply.
Proficient in the use of software programs, including Microsoft Word, Excel, and Outlook.
Our Benefits Include:
100% employer-paid medical, dental, and vision insurance for employees
401(k) plan with 100% immediate vesting and a 4% company match
Paid time off (PTO) and paid holidays
On-site pharmacy, Promesa, provides convenient prescription delivery directly to you
Life, disability, critical illness and accident insurance
Employee Assistance Program (EAP)
Pre-tax Flexible Spending Accounts for health, dependent care, and commuter-related expenses
Tuition reimbursement
Fitness reimbursement and various additional quality-of-life benefits
Applied Underwriters is a global risk services firm helping business and people manage uncertainty through its business services, insurance, and reinsurance solutions. As a company, we truly operate differently within our business sector. Applied Underwriters has one of the highest customer retention rates in the industry - a success directly attributed to our employees and their high level of commitment, hard work, and ambition.
Auto-ApplyBranch Claims Representative
Claim processor job in Omaha, NE
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to:
* Investigate, evaluate, and settle entry-level insurance claims
* Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products
* Learn and comply with Company claim handling procedures
* Develop entry-level claim negotiation and settlement skills
* Build skills to effectively serve the needs of agents, insureds, and others
* Meet and communicate with claimants, legal counsel, and third-parties
* Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment
* Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements
Desired Skills & Experience
* Bachelor's degree or direct equivalent experience with property/casualty claims handling
* Ability to organize data, multi-task and make decisions independently
* Above average communication skills (written and verbal)
* Ability to write reports and compose correspondence
* Ability to resolve complex issues
* Ability to maintain confidentially and data security
* Ability to effectively deal with a diverse group individuals
* Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
* Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage
* Continually develop product knowledge through participation in approved educational programs
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
* Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-KC1 #LI-Hybrid
Auto-ApplyClaims Investigator - Part Time
Claim processor job in Omaha, NE
Claims Investigator (Part-Time)
Omaha, NE area
Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continues its expansion into all areas of investigations, allowing continual growth for its employees.
Responsibilities/ Requirements
Responsibilities:
Duties and responsibilities include essential functions of positions assigned to this classification. Depending on assignment, the employee may perform a combination of some or all the following duties:
Ability to conduct multiple types of complex claims investigations
Daily submission of updates regarding work performed on each case
Ability to manage time
Maintain a sufficient level of client billable hours
Write and record detailed statements
Conduct scene investigations
Submit professional and client ready investigative reports
Conduct background/activity checks and courthouse research
Due to driving, constant state of alertness in a safe manner is an essential function of this position
Requirements:
Licensed or eligible to be licensed as a Private Investigator in Nebraska and in surrounding states
1 year or more of full time report writing experience on field investigations cases
Field investigations experience - face to face statements
Ability and willingness to travel within a multi-state coverage area (as necessary)
Experienced in investigation of product/auto/general liability claims, Workers Compensation, disability claims, life insurance and contestable death claims
Flexibility to work varied/irregular hours and days including nights, weekends
Reliable and fuel efficient vehicle with minimum of auto liability insurance
Possess or is willing to purchase: digital recording device and laptop computer with Windows Operating System with access to Microsoft Word and other necessary equipment for position
Educational/Experience Qualifications:
Associate or Bachelor's Degree in Criminal Justice or related field
Experience as a Private Investigator or detective
Military or Law Enforcement background
Comprehensive knowledge of insurance law and underwriting
Self-starter who holds themselves accountable for results and performance
Strong attention to detail with commitment to accuracy and quality
Ability to adapt and work under stressful and sensitive situations
Can type 50 words or more a minute
Benefits
CoventBridge offers the most premiere compensation package in the industry.
Flexibility to self-schedule
Ability to work from home-based office
Competitive pay
Monthly vehicle allowance
Company fuel card
Company cell phone
Company matching 401(k)
Travel and report writing compensation
Company paid investigator licensing fees
Paid ongoing career advancement training
Timely expense reimbursement with very minimal out-of-pocket expenses
About Us:
CoventBridge Group is the global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
CoventBridge (USA) Inc. Nebraska License # 1234
Auto-ApplyClaims Representative
Claim processor job in Omaha, NE
Experienced Claims Representative - Workers' Compensation
We are seeking a seasoned workers' compensation professional to work with clients to control costs and exposure and help injured workers get back to work. In this position, you will handle workers' compensation claims involving litigated, loss time and complicated medical claims. This position offers a hybrid/ home-based work opportunity .
The successful candidate must reside in the state of SD, KS, NE, MO, or IA to be considered.
A minimum of three years of progressive workers' compensation claims handling experience to include handling litigated claims and files with larger losses is required
Experience in the Midwest jurisdictions is preferred
Proven decision making and problem-solving skills
Excellent verbal and written communication skills
Must be proficient in Microsoft Word and Excel
In our 30+-year history, we've soared to great heights, reimagined ourselves, and gained a profound awareness of the value we bring as experienced workers' compensation insurance providers. Today our reputation has grown as the region's leading workers' compensation insurance writer . While our product is insurance, what we truly sell is safer workplaces, help for companies looking to protect their employees, and support for people at their most vulnerable.
We offer a competitive wage and benefits package including medical, dental and vision coverage, paid holidays, paid parental leave PTO, 401K, and much more!
At RAS, we believe in an inclusive work environment, where employees are welcomed, valued, respected, and heard to ensure that individuals bring their best selves to work. RAS provides equal opportunities to all qualified candidates without regard to race, color, religion, sexual orientation, gender identity or expression, age, disability status, veteran status, national origin, or any other status protected under federal, state or local law.
Auto-ApplyMedical Claims Investigator
Claim processor job in Lincoln, NE
The work we do matters! Hiring Agency: Health & Human Services - Agency 25 Hiring Rate: $21.041 Job Posting: JR2025-00021531 Medical Claims Investigator (Open) Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):
12-29-2025
Job Description:
We're seeking candidates who bring a strong attention to detail and a commitment to accuracy, along with the ability to work effectively in a structured, fast-paced environment.
Join Our Team! Are you looking for a workplace where your attention to detail, passion for helping others, and love for teamwork are valued and make a difference every day? Join our dedicated team at the Department of Health and Human Services as a Medical Claims Investigator in our Medicaid and Long-Term Care Claims Division. We are committed to service, collaboration, and making an impact on the lives of Nebraskans - and we like to have a little fun along the way!
As a Medical Claims Investigator for the Recovery and Cost Avoidance team you'll play a vital role in ensuring Medicaid appropriately remains the payor of last resort for health and casualty claims. This detail-oriented role involves investigating the circumstances surrounding health claims when there is indication that payment for the claim may be obtained from sources other than Title XIX Medicaid funds.
As a Medical Claims Investigator, you will:
* Answer and direct calls placed or referred to the Coordination of Benefits /Casualty call line.
* Analyze claims for payor accuracy, investigate and resolve liability issues, and ensure compliance with Medicaid policies and procedures.
* Communicate with team members to address claim inquiries and support both internal teams and external partners.
* Initiate research and bring resolution to processed claims which may have been processed and paid and now need to be recouped and billed to a liable third-party resource.
* Research extent and sources of third-party liability for medical claims payment and ensure these payments are fully utilized.
* Perform Third Party verifications and accurately enter the findings into a database.
* Collaborate with appropriate program staff to report and follow-up if fraud, waste or abuse activities are identified.
* Perform related work as assigned.
Hiring Rate: $21.041 per hour. Non-Exempt
Location: Lincoln NE - NSOB 5th floor- In office only
Requirements / Qualifications:
Minimum Qualifications: Graduation from a standard four year high school, or its equivalency, four years full-time professional experience, plus one year of full-time paid employment in a responsible position performing duties related to investigative research, such as, police investigation, insurance investigation, or account collections. College work with emphasis in business administration, management, public administration, accounting, behavioral sciences, or closely related fields, may be substituted for the above general experience on a year for year basis with a maximum substitution of four years. There shall be no substitution for the one year of investigative research experience.
Preferred Qualifications:
* Experience with health insurance terminology/processes, Microsoft Office (Excel, Word, Outlook, etc.) databases, Medicaid Claims Processing, and Medicaid eligibility. Experience with C1/MMIS, N-FOCUS, and OnBase would be beneficial.
* Strong analytical and problem-solving skills, including the ability to interpret and apply regulations, identify discrepancies, and recommend appropriate actions.
* A professional, customer-focused approach when communicating with providers, clients, business partners and internal team members.
* Comfort using multiple computer systems and databases to research, update, verify and manage insurance related information efficiently.
If you're detail-oriented, dependable, and ready to support our mission
of helping Nebraskans - we'd love to hear from you!
Knowledge, Skills, and Abilities
* Customer Service Skills - Ability to communicate clearly, listen actively, and handle questions or complaints with professionalism.
* Attention to Detail - Able to review forms and data accurately to catch errors or missing information.
* Computer Proficiency - Comfortable using Microsoft Office (Word, Excel, Outlook) and navigating multiple computer systems.
* Time Management - Capable of handling a high volume of work, staying organized, and meeting deadlines.
* Problem-Solving - Able to identify issues, think critically, and find practical solutions for customers or internal processes.
* Communication Skills - Strong written and verbal communication to explain processes, respond to inquiries, and document work.
* Teamwork - Willing to work cooperatively with others and assist team members when needed.
* Adaptability - Able to learn new systems, take on different tasks, and adjust to changes in a fast-paced environment.
* Confidentiality Awareness - Understands and follows privacy regulations like HIPAA when handling sensitive information.
What we offer:
* State-matched retirement contribution of 156%!
* 13 paid holidays
* Generous leave accruals that begin immediately
* Tuition reimbursement program
* 79% employer-paid health insurance plans
* Dental and vision insurance plans
* Employer-paid $20,000 life insurance policy
* Career advancement opportunities as the largest and most diverse employer in the state
* Training and development based on your career goals
* Employee Assistance Program
If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: **************************
Benefits
We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.
Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: **************************************************
Equal Opportunity Statement
The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.
Auto-ApplyAthletic Aid Certification Specialist
Claim processor job in Omaha, NE
Responsible for determining that the financial aid a student-athlete is being offered is within the maximum limits and award criteria allowed, and when required will process reductions of athletic GIA (Grant-In-Aid) as needed to stay within allowable limits. Assist the Assistant Registrar with the required Reduction and Non- Renewal notifications from the Office of Financial Support & Scholarships, including creating and proofing the letters and appeal information being sent. Responsible for processing the approved Athletic GIA scholarships, including the actual award entry into the PeopleSoft system, and reviewing the automatic adjustments of federal and institutional aid to keep within federal and institutional guidelines. This position will assist with reconciling awards and scholarships entered and awards and scholarships disbursed to Student Accounts. Work cooperatively with members of the UNO Compliance Department in Athletics and the Faculty Athletic Representative to assure a consistent shared database of information and to assist in any NCAA or Summit League inquiry. Review and prepare data needed for any NCAA or conference audit. This position will also complete various projects as assigned.
Required Qualifications:
* Bachelor's degree
* 2 years administrative experience
* Equivalent combination of education and experience will be considered
Preferred Qualifications:
* Experience evaluating information to determine compliance with written standards, rules, regulations and procedures
* Experience communicating successfully and diplomatically with others in work-related situations
* Knowledge of NCAA rules or other comparable complex rules
* University experience working in admissions, registration and records, scholarships and financial aid, or other comparable work area
* Knowledge of computerized student/personnel information system.
Compliance Requirements:
* Background check
* Credit check
About Us:
The University of Nebraska at Omaha is an Equal Opportunity Employer, committed to preventing and eliminating discrimination against employees and prospective employees based on race, color, ethnicity, national origin, sex, pregnancy, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, marital status, and/or political affiliation. The University of Nebraska at Omaha does not condone or tolerate discrimination. In support of this policy, the University has implemented employment programs to recruit, employ, and promote qualified individuals based solely on their knowledge, skills, abilities and talents. These factors, along with our commitment to recruit, assess and select all candidates/employees using job-related criteria, ensure fairness, equal evaluation, and treatment in our selection decisions and processes.
Information at a Glance
Apply now
Req Id: 914
Campus Name: University of Nebraska Omaha (UNO)
Org Unit: Ofc of Financial Support/Scholarship UNO
Job Location: Omaha, NE 68182
Application Review Date: 9/18/25
Open Until Filled: Yes
Advertised Salary: $40,000 - $44,000
Job Type: Full-Time
Worksite Eligibility: On-site
Benefits Eligible: Yes
Apply now
For questions or accommodations related to this position contact: Jean Phillips
Special Instructions to Applicant: None
The University of Nebraska does not discriminate based on race, color, ethnicity, national origin, sex, pregnancy, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, marital status, and/or political affiliation in its programs, activities, or employment.
Posting Start Date: 10/17/25
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Adjudicator, Provider Claims
Claim processor job in Lincoln, NE
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: $21.16 - $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.
Claims analyst
Claim processor job in Omaha, NE
Family Summary/Mission Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. /Mission
Reviews and adjudicates routine claims in accordance with claim processing guidelines.
Fundamental Components & Physical Requirements include but are not limited to
(* denotes essential functions)
• Analyzes and approves routine claims that cannot be auto adjudicated. (*)
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*)
• Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
• Routes and triages complex claims to Senior Claim Benefits Specialist. (*)
• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*)
• May facilitate training when considered topic subject matter expert. (*)
• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*)
• Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*)
Performance Measures
Background/Experience Desired
• Experience in a production environment.
• Claim processing experience.
Qualifications
Education and Certification Requirements
High School or GED equivalent.
Additional Information (situational competencies, skills, work location requirements, etc.)
• Ability to maintain accuracy and production standards.
• Analytical skills.
• Technical skills.
• Oral and written communication skills.
• Understanding of medical terminology.
• Attention to detail and accuracy.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Liability Claims Examiner - Auto & GL
Claim processor job in Omaha, NE
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
Liability Claims Examiner - Auto & GL
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?
+ Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
+ Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.
+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
+ Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.
+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.
+ Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
**OFFICE LOCATIONS**
Hybrid (2 Days In-Office)
**PRIMARY PURPOSE** : To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Analyzes and processes complex or technically difficult general liability and auto liability 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.
+ Assesses liability and resolves claims within evaluation.
+ Negotiates settlement of claims within designated authority.
+ Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
+ Prepares necessary state fillings within statutory limits.
+ Manages the litigation process; ensures timely and cost effective claims resolution.
+ Coordinates vendor referrals for additional investigation and/or litigation management.
+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
+ Communicates claim activity and processing with the claimant and 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.
**QUALIFICATION**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
**Experience**
Five (5) years of claims management experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ Subject matter expert of appropriate 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 and Medicare 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
+ Good interpersonal skills
+ Excellent negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Service Expectations
**TAKING CARE OF YOU**
+ Flexible work schedule.
+ Referral incentive program.
+ Career development and promotional growth opportunities.
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
_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 $75,000 - $90,000. 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._
\#Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
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**
Litigated Claims Examiner - Complex General Liability
Claim processor job in Omaha, NE
Applied Underwriters, Inc., a global risk services company, is seeking to hire an experienced Claims Examiner to join our large loss claims team. In this role, you will use your strong communication, investigation, and negotiation skills to successfully manage a diverse caseload of commercial general liability claims. This person must appreciate the sensitive nature of complex, litigated liability claims and have extensive knowledge on policy interpretation and negligence standards.
At Applied Underwriters, employees have been at the heart of our success story for more than 30 years. Headquartered in Omaha, NE, our company thrives on innovation and empowers our employees to shape the future of global risk services. Join a team where your ideas are valued and your talents are nurtured with formal, paid training and mentorship. Experience a workplace culture that celebrates initiative, recognizes results, and provides outstanding benefits that allow you to focus on achieving your full potential. Requirements:
JD degree
At least two years experience working in an insurance defense capacity or as a Commercial Claims Examiner. Personal injury attorneys encouraged to apply.
Exceptional verbal and written communication skills
Proficient in the use of software programs, including Microsoft Word, Excel, and Outlook
Our Benefits Include:
100% employer-paid medical, dental, and vision insurance for employees
401(k) plan with 100% immediate vesting and a 4% company match
Paid time off (PTO) and paid holidays
On-site pharmacy, Promesa, provides convenient prescription delivery directly to you
Life, disability, critical illness and accident insurance
Employee Assistance Program (EAP)
Pre-tax Flexible Spending Accounts for health, dependent care, and commuter-related expenses
Tuition reimbursement
Fitness reimbursement and various additional quality-of-life benefits
Applied Underwriters is a global risk services firm helping business and people manage uncertainty through its business services, insurance, and reinsurance solutions. As a company, we truly operate differently within our business sector. Applied Underwriters has one of the highest customer retention rates in the industry - a success directly attributed to our employees and their high level of commitment, hard work, and ambition.We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
Auto-ApplyProperty Claim Representative
Claim processor job in Omaha, NE
WHO WE ARE
IMT is proud of our heritage and will never forget where our roots are firmly planted. Locally run from its office in West Des Moines, Iowa, IMT has been a Midwest company since it was founded in Wadena, Iowa in 1884. That s over 140 years!
Today, IMT continues to offer a strong line of personal and commercial insurance products for which it has always been known, along with exceptional service for a competitive price. Our products are offered through Independent Agents throughout a six-state territory Iowa, Illinois, Minnesota, Nebraska, South Dakota and Wisconsin.
PROPERTY CLAIM REPRESENTATIVE
IMT Insurance is now taking applications for the position of a Property Claim Field Representative in Nebraska*. This individual will conduct investigations and attempt settlement of claims submitted by policyholders for property losses. The ideal candidate will be an analytical, detailed worker, who can manage time and work on multiple projects while maintaining accuracy and service. IMT Property Claim Field Representatives investigate and evaluate claims involving personal and commercial property to determine proper policy coverages and apply best claims practices to ensure accurate settlements in accordance with company guidelines. If you're interested in joining a growing company who values loyal, optimistic workers, apply online today!
A DAY IN THE LIFE
Conduct interviews with insureds, claimants and other interested parties
Conduct thorough investigations and examine insurance policies to determine coverage
Inspect damages and prepare written estimates of repair or replacement
Correspond with insureds, claimants and other interested parties
Prepare and report findings and negotiate settlements
DESIRED QUALIFICATIONS
3+ years Property claims experience preferred
Bachelor's Degree
Excellent verbal and written communication skills
Excellent problem-solving and negotiation skills
Good keyboard/PC skills
Excellent organizational and prioritization skills
Ability to climb ladder to assess roof damage
Ability to lift minimum 30 lbs
Must maintain valid driver s license
Able to travel/stay overnight for storm claim duty
Adjusters with advanced experience will be considered at the Sr. Level.
*Territory includes Omaha, NE and surrounding areas.
BENEFITS & PERKS
IMT Insurance is committed to our employees and their families. When you work for IMT, you earn far more than just a paycheck. The IMT office was new in 2018 and offers a fitness room, game room and a variety of collaboration areas. This position includes a hybrid work arrangement, learning and development opportunities and more! Below is a list of what IMT offers our employees:
Medical, dental, and vision insurance, Life & A D & D insurance, 401K retirement savings accounts, spending accounts, long and short-term disability, profit share, paid vacation & sick time, employee assistant program and additional voluntary benefits.
The salary range for this position is $47,000.00 - $99,000.00
Starting salary and level of position will depend on level of experience
This position is not eligible for tips or commission but may be eligible for additional bonuses
WHAT DEFINES US
Our vision is to provide peace of mind in the moments that matter.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant based on race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our agents and customers come from all walks of life and so do we. Our goal is to hire great people from a wide variety of backgrounds, because it makes our team stronger. If you share our values and our passion for creating a Worry Free life for others, we want to talk to you!
Complex Claims Specialist - WC (WEST)
Claim processor job in Omaha, NE
Complex Claims Specialist - Workers' Compensation (Remote)
Seeking an experienced Complex Claims Specialist with a strong background in handling complex Workers' Compensation claims. This role involves managing a caseload of high-severity claims, including catastrophic injuries, across multiple jurisdictions. The ideal candidate will possess extensive knowledge of Workers' Compensation regulations, laws, and best practices. This is a 100% remote position with occasional travel required for mediations, training, and departmental meetings.
Compensation Package
Salary Range: $100,000 - $125,000 (depending on experience)
Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.
Responsibilities
As a Complex Claims Specialist, your key responsibilities will include:
Investigating coverage, determining compensability, and managing high-exposure Workers' Compensation claims involving catastrophic injuries and complex cases.
Establishing and updating reserves throughout the claim lifecycle to reflect exposure, with documented rationale.
Resolving claims within authority limits and making case value recommendations to senior leadership for cases exceeding authority.
Collaborating with outside defense counsel to manage litigated files in accordance with established guidelines.
Partnering with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills.
Ensuring compliance with state and federal Workers' Compensation regulations.
Providing exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors.
Developing creative resolution strategies for complex cases, utilizing internal and external resources effectively.
Documenting claim files in accordance with company and regulatory guidelines.
Identifying subrogation potential and red flags requiring Special Investigations Unit (SIU) involvement.
Training new team members and acting as a technical resource for less experienced claims representatives.
Maintaining continuing education requirements.
Qualifications/Requirements Knowledge and Experience:
Active adjuster license required.
Minimum of 10 years of experience handling complex Workers' Compensation claims.
Multi-state experience in jurisdictions such as California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions is required).
Proficiency in structured settlements and Medicare Set-Asides.
Strong negotiation, analytical, organizational, and time management skills.
Ability to work independently in a fast-paced, virtual office environment.
Advanced verbal and written communication skills for interacting with internal and external stakeholders.
Proficiency in MS Word, Excel, and internet applications.
Highly detail-oriented with the ability to prioritize tasks effectively under pressure.
Education:
Bachelor's degree required.
Industry designations such as AIC, SCLA, or CPCU are a plus.
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
#LI-BC1
Adjudicator, Provider Claims-Ohio-On the Phone
Claim processor job in Bellevue, NE
The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.
Knowledge/Skills/Abilities
* Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.
* This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.
* Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.
* Assists in the reviews of state or federal complaints related to claims.
* Supports the other team members with several internal departments to determine appropriate resolution of issues.
* Researches tracers, adjustments, and re-submissions of claims.
* Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.
* Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.
* Handles special projects as assigned.
* Other duties as assigned.
Knowledgeable in systems utilized:
* QNXT
* Pega
* Verint
* Kronos
* Microsoft Teams
* Video Conferencing
* Others as required by line of business or state
Job Function
Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.
Job Qualifications
REQUIRED EDUCATION:
Associate's Degree or equivalent combination of education and experience;
REQUIRED EXPERIENCE:
2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.
1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry
PREFERRED EDUCATION:
Bachelor's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
4 years
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $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.