Claims Processor
Claim processor job in Seattle, WA
Are you looking for a new career in a challenging industry? Does paid training for a job that provides a sense of accomplishment as you help others sounds like your perfect fit? If so, check out our role on our pension claims processing team! What you'll be doing...
As a pension claims processor, you will be assisting customers who are going through a significant change in their life-planning for retirement. You will have your own case load to manage that requires timely and accurately performed tasks according to benefit plan rules and federal time restrictions. You will:
* Meet with customers, by phone, to explain the pension claims process
* Verify benefit eligibility and follow up on eligibility issues
* Correspond with customers about documents necessary to complete their benefit claim
* Accurately enter data into claims processing system
Successful completion of the 12-week paid training program is required! Training begins in our Seattle, WA office on January 13, 2026.
Who you are...
* Organized. Able to juggle and prioritize workloads, have strong analytical skills
* Communicator. Strong verbally and in writing including interpersonal skills
* Service Minded. Passionate about customer service--delivering it like you expect to receive it
* Detailed. Attentive to detail with excellent problem-solving skills
* Technically Savvy. Proficient with technology, intermediate level with Excel and Word
Who we are...
Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. We administer one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of our team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package.
* Union scale wages, raises every 6 months, starting at $24.64/hr up to $34.30/hr.
* Medical, Dental, Vision & Rx benefits
* Employer provided/fully funded Defined Benefit Pension
* Up to 8.6 days of Paid Leave and 10 Holidays
* Strong team environment with good work-life balance
Auto-ApplyAnalyst, Claims Research
Claim processor job in Bellevue, WA
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: $21.16 - $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.
Property Casualty Claims Representative
Claim processor job in Bellevue, WA
Job Title: Property Casualty Claims Representative Type: Contract Compensation: $37/Hour Contractor Work Model: Hybrid Hours: Normal Daytime Shift // In office Tuesday, Wednesday and Thursday - office address is 3326 160th Ave SE Bellevue, WA 98008 - free parking
* This job is non-exempt in California, Colorado, New York, Washington
Qualification :
In essence, a Claims Representative is responsible for managing the entire claims process from start to finish, ensuring that claims are resolved fairly, promptly, and in a manner that aligns with the coverage provided by the policy, the policyholder's needs and the company's guidelines.
Job Requirements:
Education: Bachelor's Degree or equivalent experience.
Field of Study: Liberal Arts, Business or a related discipline.
Experience: Generally, 6 months to 3 years of related experience.
ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.
What you will be doing: A Claims Representative plays a crucial role in the insurance industry by managing and resolving insurance claims. The primary responsibility is to ensure that claims are handled efficiently, fairly, and in accordance with policy terms. Here's a breakdown of a Claim Representative's typical duties:
+ Investigates and Maintains Claims: You will gather information related to the claim, such as accident reports, statements from involved parties, photos, estimates, and any other necessary documentation.
+ Evaluating Claims: Assess the details of the claim, including policy coverage, the extent of damages, and liability.
+ Communicating with Stakeholders: You will serve as the main point of contact on each claim for policyholders, agents, legal representatives, and other involved parties. They provide updates on the status of the claim, answer questions, and explain the claims process via both verbal and formal written communication. This includes conveying simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties and maintaining a professional demeanor in all situations.
+ Negotiating Settlements: Claims Representatives often negotiate settlements with claimants or their representatives. You will aim to reach agreements that are fair and within the limits of the policy coverage.
+ Documenting and Reporting: You will maintain detailed and accurate records of all communications, investigations, and decisions related to the claim. This essential task ensures compliance with company policies and legal requirements.
+ Collaborating with Other Departments: You may work with other departments, such as legal, underwriting, or special investigation units, to resolve claims. In Specialty Equipment, a Claims Representative also collaborates with Divisional leaders on complex claims.
+ Ensuring Compliance: Ensure that all claims are handled in line with industry regulations and company guidelines. This includes staying updated on relevant laws and best practices. Complying with and adhering to each state's handling requirements is an essential job function.
+ Providing Customer Service: Throughout the claims process, you will focus on delivering excellent customer service by being responsive, empathetic, and professional. Exceptional customer service helps to maintain the company's reputation and customer satisfaction.
System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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#DI-
Ref: #860-IT Cincinnati
System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
Claims Recovery Analyst I
Claim processor job in Seattle, WA
**This role is available remotely in Washington State Only.
Who we are
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:
Strive to apply an equity lens to all our work.
Reduce health disparities.
Become an anti-racist organization.
Create an equitable work environment.
About the Role
Responsible for conducting focused claim reviews and identifying and facilitating claim adjustments based on results found through Community Health Plan of Washington claim reviews or as identified by internal Community Health Plan of Washington departments. Responsible for sustaining processes and executing process improvement and quality monitoring. Responsible for contacting providers regarding negative balance collections.
Additionally, the role involves investigating and resolving escalated claims issues raised by internal Community Health Plan of Washington (CHPW) departments and committees. The incumbent monitors departmental compliance with state and CMS requirements, including managing the collection and submission of operational performance metrics and required data reporting. Finally, the position serves as a subject matter expert for Claims Recovery, contributing to companywide or specialized projects to improve processes and ensure accurate claims management.
To be successful in this role, you:
Have minimum two (2) years claims operations experience required, with proven broad knowledge and execution of quality improvement methods and tools or related experience. Experience in managed care preferred.
Have Medicaid Coordination of Benefits (COB) and Medicare Secondary Payor (MSP) experience preferred.
Have prior experience encouraging timely repayment from providers preferred.
Possess an understanding of the healthcare industry, specifically in the Operations area.
Have a GED or High School diploma or an equivalent combination of education and highly relevant experience in healthcare.
Essential functions and Roles and Responsibilities:
Identify and conduct focused and random claims audits.
Provide research for providers in a negative balance over 45 days.
Create demand letters and support collections effort.
Contacts providers to request refunds.
Regularly submit subrogation referrals.
Facilitate claim adjustments and system remediation as required.
Receive and research escalated claims issues identified by internal Community Health Plan of Washington departments and committees.
Regularly monitor departmental contractual compliance with state and CMS requirements including managing the collection and submission of required operational performance metrics and data reporting requirements.
Participate in companywide or specific projects as a subject matter expert for Claims Recovery.
Knowledge, Skills, and Abilities:
Analytical skills.
Project management skills and team facilitation skills.
Communication skills, both verbal and written.
Technical and process documentation skills.
Ability to work repetitive tasks.
Ability to work well with different people at all levels within the organization.
Ability to analyze, organize and prioritize work, while meeting multiple deadlines.
Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
As part of our hiring process, the following criteria must be met:
Complete and successfully pass a criminal background check.
Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Vaccination requirement (CHPW offers a process for medical or religious exemptions)
Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits:
The position is FLSA Non-Exempt and is eligible for overtime and has a 5% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year.
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty
Sensory/Physical/Mental Requirements:
Sensory*:
Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
Extended periods of sitting, computer use, talking and possibly standing.
Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
Frequent torso/back static position; occasional stooping, bending, and twisting.
Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.
Mental:
Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.
Work Environment:
Office environment. Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Workers Compensation Claims Supervisor
Claim processor job in Seattle, WA
The Jonus Group is an insurance-only, full-service recruiting firm that offers both direct hire and contract hire services and we are seeking a Washington Workers Compensation Claims professional to join one of our valued client's dynamic and growing team. As a key member of their Claims department, you will not only be responsible for managing their Workers Comp Claims but you will also be a key member of the team in building strong customer relationships, providing strong customer service, and ensuring timely and fair resolution for all parties involved.
What's in it for you:
$95,000 - $115,000/year based on experience
Annual bonus potential based on individual performance and company profit sharing
Competitive PTO package
10 Company identified holidays
Full benefits available
Growth Opportunities
Key Responsibilities:
Supervise claims staff in daily operations
Assist management with recruiting, interviewing, and training new team members
Ensure compliance with Workers' Compensation laws and regulatory reporting requirements
Promote team performance through ongoing training, coaching, and performance evaluations; recommend merit adjustments for management review
Provide technical guidance on complex claims, investigations, litigation, and client-specific requirements
Serve as a liaison to resolve claim-related or procedural issues for clients and employees
Maintain compliance with HIPAA regulations, policies, and procedures
Maintain regular and reliable attendance
Follow all safety rules and regulations as part of the Injury and Illness Prevention Program (IIPP)
Follow all organizational policies, procedures, and best practices
Perform other duties and special projects as assigned
Qualifications:
5+ years of experience as a Workers' Compensation Claims Adjuster or Supervisor background within Washington, Oregon, and Alaska Indemnity claims
WA Adjuster's license
Knowledge of Washington state workers' compensation laws, regulations, and industry practices
Proficient in claims management software and Microsoft Office Suite
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Outside Property Claim Representative Trainee - Seattle, WA
Claim processor job in Federal Way, WA
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$52,600.00 - $86,800.00
Target Openings
2
What Is the Opportunity?
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services Insureds/Agents in and around Seattle, Washington. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory.
What Will You Do?
* Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
* The on the job training includes practice and execution of the following core assignments:
* Handles 1st party property claims of moderate severity and complexity as assigned.
* Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
* Broad scale use of innovative technologies.
* Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
* Establishes timely and accurate claim and expense reserves.
* Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
* Negotiates and conveys claim settlements within authority limits.
* Writes denial letters, Reservation of Rights and other complex correspondence.
* Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
* Meets all quality standards and expectations in accordance with the Knowledge Guides.
* Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
* Manages file inventory to ensure timely resolution of cases.
* Handles files in compliance with state regulations, where applicable.
* Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
* Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
* Identifies and refers claims with Major Case Unit exposure to the manager.
* Performs administrative functions such as expense accounts, time off reporting, etc. as required.
* Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
* May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
* Must secure and maintain company credit card required.
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
* This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred.
* Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
* Verbal and written communication skills -Intermediate
* Attention to detail ensuring accuracy - Basic
* Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
* Analytical Thinking - Basic
* Judgment/ Decision Making - Basic
* Valid passport preferred.
What is a Must Have?
* High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
* Valid driver's license - required.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Submarine Certification Specialist - Washington, D.C.
Claim processor job in Navy Yard City, WA
Looking for an opportunity at a place you can have influence and make a difference every day? Then Serco has the right opportunity for you!
As the Program Analyst (Submarines), you will provide programmatic support to one of our NAVSEA customers in the Washington, DC area. Bring your expertise and collaborative skills to make an impact towards our military defense and safety of our sailors.
This position is contingent upon your ability to maintain/transfer your Secret clearance.
Serco is the prime on the SHAPM contract which deals with acquisition and construction of submarines. The Team Submarine concept unifies once diverse submarine-related activities into a single submarine-centric organization with the goal of eliminating traditional stovepipe structures and processes that created impediments and inefficiencies in the submarine research, development, acquisition, and maintenance communities. Team Submarine provides improved communication among the various offices that contribute to the overall success of the United States Submarine Force.
In this role, you will:
Provide Engineering and Technical support coordinating all matters relating to preparation, review and approval of Ship Certification correspondence for Fast Cruise and Sea Trials, Follow-On certifications and URO certifications.
Coordinate routing and processing of all ship certification documents for concurrence and approval signatures.
Prepare coordinated reports, presentations and briefings in support of program actions.
Analyzes requirements to develop program reporting including specifications, data gathering and analytical techniques, and evaluation methodology.
Support studies, surveys, reviews, and/or research projects to evaluate program accomplishments, effectiveness, and/or compliance with meeting specific goals, objectives, rules, and regulations.
Develop evaluation plans, metrics, procedures, and methodology as a result of studies performed.
Provide Subject Matter Expert (SME) support and assist the Government with technical analyses, inquiries, research, testing, data validation for any matters relating to US submarines.
Maintain applicable Plans of Actions and Milestones (POA&M) as directed/required.
Interface with stakeholders to identify, assign, and track action items, leveraging initiatives to benefit submarine sustainment support.
Collect information and provide recommendations to senior decision-makers through well-written documents.
Communicate with various Program Office representatives within NAVSEA and other Department of Navy organization in supporting PM concerns.
Coordinate with the technical community and develop white papers and presentations for the Government and the Navy on program status or issues impacting the program.
Organize and maintain Program tracking files/tools on program status, actions items and issues.
Support the team in performing additional duties and responsibilities as assigned.
Provide timely and efficient responses for all urgent tasking.
Ensure program correspondence and deliverables are in accordance with Serco's Quality Assurance Program.
Qualifications
To be successful in this role you will have:
An active or current DoD Secret clearance is required.
US Citizenship
Bachelor's Degree
An Associate's Degree and 2 years of additional experience will be considered in lieu of Bachelor's Degree or a High School Diploma/GED and 4 years of additional experience will be considered in lieu of Bachelor's Degree.
8 years of experience (Experience with Navy acquisition and/or In-Service Programs highly preferred)
Strong customer, interpersonal and organizational level communication skills (written and verbal).
Proficiency with Microsoft Office Suite programs, to include Excel and PowerPoint.
Written communication skills (e.g., drafting program impact statements and Congressional Appeals)
Experience leading a project and interfacing with an end item customer.
Ability to travel at least 10% of the time.
Additional desired experience and skills:
Active-Duty experience in submarine service (preferably SSN) is a plus.
Recent experience in Team Submarine would be ideal.
If you are interested in supporting and working with our military and sailors and a passionate Serco team- then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
Meet Your Recruiter!
In compliance with the District of Columbia's Equal Pay for Equal Work Act, the salary range for this role is $101,342.27 to $164,679.85 however, Serco considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate's work experience, education/training, and key skills.
Company Overview
Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: ************************************************************ If you require an accommodation with the application process please email: ******************** or call the HR Service Desk at ************, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email *********************.
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Auto-ApplyClaims Examiner - General Liability | Hawaii License Required
Claim processor job in Seattle, WA
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 Examiner - General Liability | Hawaii License Required
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 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 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 $80,000 - $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-ApplyClaims Analyst Credits Corrections - Auburn Univ Medical Cen
Claim processor job in Auburn, WA
EAMC MISSION
At East Alabama Medical Center, our mission is high quality, compassionate health care, and that statement guides everything we do. We set high standards for customer service, quality, and keeping costs under control.
POSITION SUMMARY
Performs billing functions for the department. The analyst must be familiar with medical terminology, sensitivity to confidential matters and exhibit the ability to problem-solve.
POSITION QUALIFICATIONS
Minimum Education
High school diploma or equivalent.
Familiarity with Medical terminology
Minimum Experience
6 months to 1 year of eligibility and benefits experience in a providers office or hospital department
Required Registration/License/Certification
n/a
Preferred Education
Billing and Insurance certification
Preferred Experience
4 years Billing, collection, customer service, aging patient and insurance accounts
Preferred Registration/License/Certification
N/A
Other Requirements
N/A
Outside Property Claim Representative Trainee - Seattle, WA
Claim processor job in Federal Way, WA
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$52,600.00 - $86,800.00Target Openings2What Is the Opportunity?This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services Insureds/Agents in and around Seattle, Washington. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory.What Will You Do?
Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Handles 1st party property claims of moderate severity and complexity as assigned.
Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves.
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
Negotiates and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with the Knowledge Guides.
Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations, where applicable.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
Identifies and refers claims with Major Case Unit exposure to the manager.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Must secure and maintain company credit card required.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred.
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
Verbal and written communication skills -Intermediate
Attention to detail ensuring accuracy - Basic
Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
Analytical Thinking - Basic
Judgment/ Decision Making - Basic
Valid passport preferred.
What is a Must Have?
High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
Valid driver's license - required.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Auto-ApplyCERTIFICATION SPECIALIST II
Claim processor job in Everett, WA
Starting Salary Range: $60,907 - $79,179 annually ($31.24 - $40.61 per hour), plus benefits
This position will remain open until filled with priority given to applications received by 5:00PM, Tuesday, October 28th, 2025.
Our Agency: Everett Housing Authority (EHA) is a diverse, innovative public agency located in Everett, WA, only minutes from the waterfront. At EHA, we are committed to more than just providing a roof over people's heads. We believe that our work extends to creating and fostering vibrant communities where the households that we serve can thrive. Those interested can expect:
A competitive salary
Accrue up to12 days of paid vacation in your first year of employment
13 days of sick leave each year
13 paid holidays each year
A strong benefit package including robust health, dental, and life insurance as well as a pension plan (PERS).
Vision and long term disability Insurance
Tuition reimbursement
Employee Assistance Program
Wellness Program
Work that makes a difference!
POSITION SUMMARY:
Under the direction of the Housing Choice Voucher (HCV) Manager, this position performs a variety of tasks including technical, administrative, compliance, scheduling, customer service, and processing functions in support of clients participating in EHA's HCV program. Work is complex and fast paced, and requires attention to detail, excellent time management skills, and ability to learn quickly and work independently.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Determines eligibility for housing assistance for new and existing clients in accordance with program policy, procedures, and regulations. Participates in waiting list openings, provides customer service to applicants, and assists with waiting list activities. Processes denials for applicants that are not eligible for the program.
2. Conducts client interviews and briefings to collect information from clients and educate them on program requirements and benefits. Communicates with clients on a regular basis in person, on the phone, and in writing. Responds appropriately and in a timely manner to resolve concerns and answer questions.
3. Administers, interprets, and applies rules, regulations, policies, procedures, and other requirements needed for eligibility and continuing assistance. Educates and assists tenants and landlords with program requirements.
4. Completes detailed data entry for client files quickly and efficiently. Prepares and maintains client files to ensure all files meet state government audit standards. Prepares statistical, status, and productivity reports.
5. Processes a mid level volume of new admissions, annual, interim, and special reviews by verifying household, income, expenses, and deductions; accurately calculate Housing Assistance Payments (HAP). Processes changes in HAP in a timely manner to ensure adequate notice to tenants and landlords. Sends notifications to landlords, tenants, and other agencies. Reviews and approves household composition changes.
6. Documents changes in HAP that result from reviews; certifies payments and balance changes for monthly and semi-monthly check runs.
7. Determines voucher size based on family composition and program policies. Issues rental assistance vouchers to clients for new admissions to the program and when clients move to new units.
8. Reviews and processes Request for Tenancy Approval packets. Determines if housing units meet affordability restrictions and other program eligibility requirements. Performs rent reasonableness determinations. Negotiates rent with landlords. Ensures accuracy of unit and vendor information.
9. Generates HAP contracts and tenancy addendums; reviews completed inspections; reviews and completes data entry related to lease dates, rent amount, utilities, and concessions; calculates owner payments; ensures accurate and timely execution of HAP contracts; provides accurate and timely payments to landlords and places payments on hold.
10. Investigates program violations, compiles supporting documentation, conducts meetings with tenants and landlords to discuss violations and remedies.
11. Coordinates information with supervisor for applicant denials, non-compliance, and termination of program participation. Alerts the HCV Manager of potential management problems including client disputes and program fraud and abuse.
12. Compiles and presents documentation and evidence in informal reviews and hearings to support EHA programmatic decisions in compliance with regulations and policies.
13. Coordinates with language interpreters to serve clients with Limited English Proficiency.
14. Supports continuous improvement of operations, including decreasing turnaround times, streamlining work processes, and working collaboratively with colleagues to provide seamless customer service to clients, landlords, and other agency departments.
15. Participates in the development and implementation of goals, work plans, performance measures, and continuous improvement of service delivery to assist in attaining the department initiatives and goals, agency core strategies, and mission through a spirit of service, teamwork, and respect.
Requirements
KNOWLEDGE AND SKILL REQUIREMENTS:
Excellent verbal and written communication with a wide variety of audiences.
Skill in reading, understanding, interpreting, and explaining complicated rules and regulations.
Ability to remain calm under pressure.
Ability to work respectfully and courteously with other EHA employees, residents, landlords, and the public.
Knowledge of effective conflict resolution strategies and ability to effectively resolve disputes.
Skill in managing, organizing, and completing an entry level volume of tasks timely and efficiently with limited supervision.
Attention to detail and effective time management skills.
Ability to exercise independent judgment within organizational guidelines.
Ability to speak, read, write, and understand English and follow oral and written directions.
Proficiently use computer programs (Outlook, Word, Excel, and specialized software programs)
Ability to perform basic math skills including addition, subtraction, multiplication, division, fractions, and percentages.
Knowledge of Federal and local housing, community service and supportive service programs
Ability to drive a vehicle and defensive driving skills.
Ability to develop letters, memoranda, reports, leases, forms, and legal papers using grammatically correct and professional English.
Skill in public speaking for program briefings.
Additional Desirable Qualifications
Compassion and a passion for serving less-enfranchised people within the community.
Fluency in Russian, Ukrainian, Vietnamese, Arabic or Spanish language.
Experience working with a public housing authority.
Knowledge and/or experience in property management and the Section 8 program.
Experience using Yardi software.
EDUCATION AND EXPERIENCE:
Education
: A high school diploma.
Experience
: Two (2) years of relevant paid work experience such as in property management, assisted housing, social services, or similar activity, including:
· At least one (1) year of related work experience including experience as a Program Specialist I at Everett Housing Authority, or equivalent experience at another Public Housing Agency. Must have demonstrated proficiency in all Program Specialist I duties, timely completion of all assigned work, positive tenant file audit results, ability to handle an entry level volume of program administration processing, as evidenced in meeting or exceeding expectations in employee evaluations and other documented performance.
COMPETENCIES:
Adaptability and Flexibility: demonstrates a willingness to adapt to organizational change, new challenges, and demanding situations. Accepts construction criticism and uses it to improve performance and teamwork.
Communication: Communicates clearly and listens effectively. Responds appropriately to challenging questions or comments. Adapts communication to diverse audiences. Remains professional.
Customer Service: Understands and strives to meet internal and external customer needs and expectations. Responds in a timely manner. Proactively works to resolve conflicts and misunderstandings. Is available, approachable, and respectful to all regardless of their background.
Integrity and Accountability: Demonstrates high ethical standards and accountability. Follows policies and procedures. Asks for clarifications on assignments and help when needed. Practices EHA's values. Implements EHA's strategic plan.
Productivity: Completes work on time and meets applicable EHA safety requirements, deadlines, and quality standards. Effectively prioritizes and plans workload. Masters new tasks and methods, learns and retains knowledge.
Teamwork: Asks questions and readily shares their knowledge with others. Supports colleagues, team, department, and agency projects. Interacts professionally with team members and builds authentic relationships with colleagues of all backgrounds. Resolves conflicts constructively. Appreciates and recognizes contributions of others.
Required Workplace Standards
1. Works regular and reliable hours on site as required;
2. Attendance must be punctual and consistent;
3. Works an agreed-upon schedule and works additional hours as necessary to complete work;
4. Works effectively, cooperatively and respectfully with co-workers, clients, and other contacts;
5. Follows all EHA Safety Policies and Procedures;
6. Follows all EHA Personnel Policies and Procedures;
7. Performs other duties as assigned.
LICENSES AND OTHER REQUIREMENTS:
Certification of the following (or equivalent):
Fair Housing Certificate
HCV Specialist (Eligibility, Occupancy, Rent Calculation)
Salary Description $60,907-$79,179
Member Service/Provider Service Healthcare Rep
Claim processor job in Tacoma, WA
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
Job Title Member Service/Provider Service Healthcare Rep
City, State: Tacoma, Washington
Position Summary:
Receive and respond to member/provider inquires.
Hours for this Position:
M-F 8:00-5:00 pm
Advantages of this Opportunity:
•Competitive salary 14-19hr
•Fun and positive work environment
•Long term position (Benefits Offered)
•Advancement Opportunities
More Insight of Daily Responsibilities:
•Receive and respond to all telephone or written correspondence inquiries from members within established timeframes and policies.
•Assist members with plan benefits via telephone, in writing, in person or make referral to outreach representative as appropriate.
•Document in the computer system all members' issues and resolution.
•Utilize current reference materials to assist and resolve any member inquiries.
•May coordinate member transportation.
Qualifications
What We Look For:
• MUST have HS Diploma or GED (Verifiable! pass on candidates w/ degrees from other countries we can't verify) - Please list on resume
• MUST have Healthcare experience
• Must have Claims Experience any type (Commercial, Medicare, and Medicaid)
• Call Center experience strongly preferred but no required. With that being said we need to make sure 100% that they are comfortable working in this type of environment.
• Will consider candidates w/ Healthcare expr & have provided ‘customer service' to people, but don't have to be in a call center setting
• For EXP: Front Desk in a busy doctor's office where they are answering phones, greeting patients, scheduling appts, etc.
Additional Information
Are you an experienced Member Service/Provider Service/Enrollement Rep looking for a new opportunity with a prestigious healthcare company? Do you have experience with Medicare/Medicaid Claims? 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!
If interested in learning more please contact Ryan Chojnacki by replying to this job post and including your resume
Analyst, Claims Research
Claim processor job in Bellevue, WA
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: $21.16 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Outside Property Claim Representative Trainee - Seattle, WA
Claim processor job in Federal Way, WA
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$52,600.00 - $86,800.00
**Target Openings**
2
**What Is the Opportunity?**
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services Insureds/Agents in and around Seattle, Washington. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory.
**What Will You Do?**
+ Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
+ The on the job training includes practice and execution of the following core assignments:
+ Handles 1st party property claims of moderate severity and complexity as assigned.
+ Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
+ Broad scale use of innovative technologies.
+ Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
+ Establishes timely and accurate claim and expense reserves.
+ Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
+ Negotiates and conveys claim settlements within authority limits.
+ Writes denial letters, Reservation of Rights and other complex correspondence.
+ Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
+ Meets all quality standards and expectations in accordance with the Knowledge Guides.
+ Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
+ Manages file inventory to ensure timely resolution of cases.
+ Handles files in compliance with state regulations, where applicable.
+ Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
+ Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
+ Identifies and refers claims with Major Case Unit exposure to the manager.
+ Performs administrative functions such as expense accounts, time off reporting, etc. as required.
+ Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
+ May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
+ Must secure and maintain company credit card required.
+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
+ In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
+ This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred.
+ Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
+ Verbal and written communication skills -Intermediate
+ Attention to detail ensuring accuracy - Basic
+ Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
+ Analytical Thinking - Basic
+ Judgment/ Decision Making - Basic
+ Valid passport preferred.
**What is a Must Have?**
+ High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
+ Valid driver's license - required.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
Medical Claims Processor
Claim processor job in Seattle, WA
Are you an experienced medical claims processor? This could be the opportunity for you!
What you'll be doing...
At NWA, we process claims per specific plan requirements. These plans are highly customized and can vary greatly. A successful claim processor at NWA understands the nuances involved with medical claims and the importance of claims being processed timely and accurately. If hired you will:
Process medical claims accurately, thoroughly and according to plan requirements
Follow up on claims needing additional information
Refer problem claims to a supervisor and/or auditor for review
Monitor “inbox” to ensure that claims and referrals are handled timely
Special projects as assigned
Located in Mountlake Terrace, WA, Federal Way, WA or Seattle, WA.
Who you are...
Organized. Able to juggle and prioritize workloads, have strong analytical skills
Experienced. Knowledgeable about medical claims processing, minimum 1 year
Communicator. Strong verbally and in writing including interpersonal skills
Service Minded. Passionate about customer service--delivering it like you expect to receive it
Detailed. Attentive to detail with excellent problem-solving skills
Technically Savvy. Proficient with technology, intermediate level Excel and Word
Who we are...
Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. We administer one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of our team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package. See what our associates are saying about us at Northwest Administrators Inc. | Careers (nwadmin.com)
If hired, you can expect...
Union scale wages, raises every 6 months, starting at $24.64/hr. up to $34.30/hr.
Medical, Dental, Vision & Rx benefits
Employer provided/fully funded Defined Benefit Pension
Up to 8.6 days of Paid Leave and 10 Holidays
Strong team environment with good work-life balance
Equal Employment Opportunity
NWA is proud to be an Equal Employment Opportunity employer. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, physical or mental disability, marital status, amnesty, veteran status, citizenship, family medical history or genetic information or any other characteristic protected by local, state, or federal laws. NWA prohibits any discrimination or harassment based on any of these characteristics.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact Human Resources at ************** to request accommodation.
Northwest Administrators Inc. | Privacy Policy (nwadmin.com)
Auto-ApplySubmarine Certification Specialist - Washington, D.C.
Claim processor job in Navy Yard City, WA
Looking for an opportunity at a place you can have influence and make a difference every day? Then Serco has the right opportunity for you!
As the Program Analyst (Submarines), you will provide programmatic support to one of our NAVSEA customers in the Washington, DC area. Bring your expertise and collaborative skills to make an impact towards our military defense and safety of our sailors.
Serco is the prime on the SHAPM contract which deals with acquisition and construction of submarines. The Team Submarine concept unifies once diverse submarine-related activities into a single submarine-centric organization with the goal of eliminating traditional stovepipe structures and processes that created impediments and inefficiencies in the submarine research, development, acquisition, and maintenance communities. Team Submarine provides improved communication among the various offices that contribute to the overall success of the United States Submarine Force.
In this role, you will:
Provide Engineering and Technical support coordinating all matters relating to preparation, review and approval of Ship Certification correspondence for Fast Cruise and Sea Trials, Follow-On certifications and URO certifications.
Coordinate routing and processing of all ship certification documents for concurrence and approval signatures.
Prepare coordinated reports, presentations and briefings in support of program actions.
Analyzes requirements to develop program reporting including specifications, data gathering and analytical techniques, and evaluation methodology.
Support studies, surveys, reviews, and/or research projects to evaluate program accomplishments, effectiveness, and/or compliance with meeting specific goals, objectives, rules, and regulations.
Develop evaluation plans, metrics, procedures, and methodology as a result of studies performed.
Provide Subject Matter Expert (SME) support and assist the Government with technical analyses, inquiries, research, testing, data validation for any matters relating to US submarines.
Maintain applicable Plans of Actions and Milestones (POA&M) as directed/required.
Interface with stakeholders to identify, assign, and track action items, leveraging initiatives to benefit submarine sustainment support.
Collect information and provide recommendations to senior decision-makers through well-written documents.
Communicate with various Program Office representatives within NAVSEA and other Department of Navy organization in supporting PM concerns.
Coordinate with the technical community and develop white papers and presentations for the Government and the Navy on program status or issues impacting the program.
Organize and maintain Program tracking files/tools on program status, actions items and issues.
Support the team in performing additional duties and responsibilities as assigned.
Provide timely and efficient responses for all urgent tasking.
Ensure program correspondence and deliverables are in accordance with Serco's Quality Assurance Program.
Meet Your Recruiter!
Qualifications
To be successful in this role you will have:
Ability to obtain and maintain an active DoD Secret clearance.
US Citizenship
Bachelor's Degree
An Associate's Degree and 2 years of additional experience will be considered in lieu of Bachelor's Degree or a High School Diploma/GED and 4 years of additional experience will be considered in lieu of Bachelor's Degree.
8 years of experience (Experience with Navy acquisition and/or In-Service Programs highly preferred)
Strong customer, interpersonal and organizational level communication skills (written and verbal).
Proficiency with Microsoft Office Suite programs, to include Excel and PowerPoint.
Written communication skills (e.g., drafting program impact statements and Congressional Appeals)
Experience leading a project and interfacing with an end item customer.
Ability to travel at least 10% of the time.
Additional desired experience and skills:
Active-Duty experience in submarine service (preferably SSN) is a plus.
Recent experience in Team Submarine would be ideal.
If you are interested in supporting and working with our military and sailors and a passionate Serco team- then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
Company Overview
Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: ************************************************************ If you require an accommodation with the application process please email: ******************** or call the HR Service Desk at ************, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email *********************.
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Pay Transparency
Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance-so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.
Salary range: The range for this position can be found at the top of the posting. This range is provided as a general guideline and represents a good faith estimate across all experience levels. Actual base salary will be determined by a variety of factors, including but not limited to, the scope of the role, relevant experience, job-related knowledge, education and training, key skills, and geographic market considerations. For roles available in multiple states, the range may vary to reflect differences in local labor markets. In addition to base salary, eligible positions may include other forms of compensation such as annual bonuses or long-term incentive opportunities.
Benefits HIGHLIGHTS - Comprehensible Benefits for Full-time Employees (Part-time members receive a customized package tailored to their role).
Medical, dental, and vision insurance
Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract
401(k) plan that includes employer matching funds
Tuition reimbursement program
Life insurance and disability coverage
Optional coverages you can buy, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection
Birth, adoption, parental leave benefits
Employee Assistance Plan that includes counseling conditions
Specific benefits are dependent upon the specific contract as well as whether the position is covered by a collective bargaining agreement or the Service Contract Act.
To review all Serco benefits please visit: ******************************************
Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco's external (or internal) career site. This is a U.S.-based role. If an applicant has any concerns with job posting compliance, please send an email to: ********************.
Auto-ApplyProvider Service Representative
Claim processor job in Tacoma, WA
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 Provider Service Rep 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:
• Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner.
• Provide assistance to provider regarding website registration, navigation and customer related inquires
• Educate provider on health plan initiatives during interactions with providers via telephone
Hours for this Position: Monday-Friday 8am-5pm
Start Date: 01/11/2016
Advantages of this Opportunity:
• Competitive salary based on experience, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment
Qualifications
• High school diploma or GED Required.
• Healthcare and/or call center experience
• Knowledge of Medicare/Medicaid
• Looking for experience with claims/billing
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.
Adjudicator, Provider Claims
Claim processor job in Tacoma, WA
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.
Adjudicator, Provider Claims
Claim processor job in Everett, WA
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.
Analyst, Claims Research
Claim processor job in Tacoma, WA
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: $21.16 - $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.