Claim processor jobs in Boise, ID - 34 jobs

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Benefit and Claims Analyst
Highmark Health 4.5
Claim processor job in Boise, ID
This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827
$21.5-32.3 hourly 33d ago

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Technical Claims Specialist, Workers Compensation - West Region
Liberty Mutual 4.5
Claim processor job in Meridian, ID
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. Candidates should be based in California with California Self-Insured Certification or based in West Region with experience in handling Alaska Workers Compensation claims. The salary range posted reflects the range for the varying pay scale that encompasses each of the Liberty Mutual regions and the overall cost of living for that region. Responsibilities Investigates claims to determine whether coverage is provided, establish compensability and verify exposure. Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority. Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management. Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols. Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely. Identifies and appropriately handles claims with third party subrogation potential, SIF (Self-Insured Fund) and MSA (Medicare Set Aside) exposure. Establishes and maintains accurate reserves on all assigned files. Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority. Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds. Demonstrates the ability to understand new and unique exposures and coverages. Demonstrates the ability to understand key data elements and claims related data analysis. Confers directly with policyholders on coverage and resolution strategy issues. Coordinates and participates in training sessions for less experienced staff, including both Complex Non-Complex staff. Qualifications A bachelor's degree or equivalent business experience is required In addition, the candidate will generally possess 5-7 years of related claims experience with 1-2 years of experience in complex claims Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skills required About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.
$56k-84k yearly est. Auto-Apply 11d ago
Senior Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Boise, ID
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests 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: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-106.2k yearly 6d ago
Bodily Injury Claims Specialist
Auto-Owners Insurance 4.3
Claim processor job in Boise, ID
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. Follow claims handling procedures and participate in claim negotiations and settlements. Deliver a high level of customer service to our agents, insureds, and others. Devise alternative approaches to provide appropriate service, dependent upon the circumstances. Meet with people involved with claims, sometimes outside of our office environment. Handle investigations by telephone, email, mail, and on-site investigations. Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. Assist in the evaluation and selection of outside counsel. Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience A minimum of three years of insurance claims related experience. The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. The ability to effectively understand, interpret and communicate policy language. The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-CH1 #LI-DNP #LI-Onsite
$50k-67k yearly est. Auto-Apply 5d ago
PL CLAIM SPECIALIST
Sedgwick 4.4
Claim processor job in Boise, ID
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance PL CLAIM SPECIALIST **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$39k-50k yearly est. 8d ago
Senior Claim Benefit Specialist
CVS Health 4.6
Claim processor job in Homedale, ID
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. **Required Qualifications** - New York Independent Adjuster License - Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience - DG system knowledge **Education** **-** High School Diploma required - Preferred Associates degree or equivalent work experience. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 02/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
$18.5-42.4 hourly 5d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Claim processor job in Boise, ID
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755
$22.7-35.2 hourly 29d ago
Technical Claims Specialist, Workers Compensation - West Region
Liberty Mutual 4.5
Claim processor job in Meridian, ID
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. Candidates should be based in California with California Self-Insured Certification or based in West Region with experience in handling Alaska Workers Compensation claims. The salary range posted reflects the range for the varying pay scale that encompasses each of the Liberty Mutual regions and the overall cost of living for that region. Responsibilities * Investigates claims to determine whether coverage is provided, establish compensability and verify exposure. * Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority. * Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management. * Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols. * Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely. * Identifies and appropriately handles claims with third party subrogation potential, SIF (Self-Insured Fund) and MSA (Medicare Set Aside) exposure. * Establishes and maintains accurate reserves on all assigned files. * Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority. * Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds. * Demonstrates the ability to understand new and unique exposures and coverages. * Demonstrates the ability to understand key data elements and claims related data analysis. * Confers directly with policyholders on coverage and resolution strategy issues. * Coordinates and participates in training sessions for less experienced staff, including both Complex Non-Complex staff. Qualifications * A bachelor's degree or equivalent business experience is required * In addition, the candidate will generally possess 5-7 years of related claims experience with 1-2 years of experience in complex claims * Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skills required About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco
$56k-84k yearly est. Auto-Apply 11d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare 4.4
Claim processor job in Boise, ID
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 24d ago
Field Claims Representative
Auto-Owners Insurance 4.3
Claim processor job in Boise, ID
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI #IN-DNI
$42k-52k yearly est. Auto-Apply 44d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare Inc. 4.4
Claim processor job in Boise, ID
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 25d ago
Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Nampa, ID
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$22.8-46.4 hourly 6d ago
Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Caldwell, ID
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. - QNXT, Salesforce and basic SQL To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-46.4 hourly 3d ago
Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Meridian, ID
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$22.8-46.4 hourly 6d ago
Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Meridian, ID
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. - QNXT, Salesforce and basic SQL To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-46.4 hourly 3d ago
Analyst, Claims Research
Molina Healthcare Inc. 4.4
Claim processor job in Meridian, ID
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$22.8-46.4 hourly 7d ago
Analyst, Claims Research
Molina Healthcare Inc. 4.4
Claim processor job in Meridian, ID
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. * QNXT, Salesforce and basic SQL To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $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.
$21.7-46.4 hourly 4d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare 4.4
Claim processor job in Caldwell, ID
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 24d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare Inc. 4.4
Claim processor job in Caldwell, ID
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 25d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare 4.4
Claim processor job in Meridian, ID
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 24d ago

Learn more about claim processor jobs

How much does a claim processor earn in Boise, ID?

The average claim processor in Boise, ID earns between $22,000 and $50,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average claim processor salary in Boise, ID

$33,000

$22,00010%

$33,000Median

$50,00090%

What are the biggest employers of Claim Processors in Boise, ID?

The biggest employers of Claim Processors in Boise, ID are:

Sedgwick LLP
Welbehealth

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Claim processor jobs in Boise, ID - 34 jobs

Benefit and Claims Analyst

Technical Claims Specialist, Workers Compensation - West Region

Senior Analyst, Claims Research

Bodily Injury Claims Specialist

PL CLAIM SPECIALIST

Senior Claim Benefit Specialist

Senior Stop Loss Claims Analyst - HNAS

Technical Claims Specialist, Workers Compensation - West Region

Adjudicator, Provider Claims-On the phone

Field Claims Representative

Adjudicator, Provider Claims-On the phone

Analyst, Claims Research

Analyst, Claims Research

Analyst, Claims Research

Analyst, Claims Research

Analyst, Claims Research

Analyst, Claims Research

Adjudicator, Provider Claims-On the phone

Adjudicator, Provider Claims-On the phone

Adjudicator, Provider Claims-On the phone

Learn more about claim processor jobs

How much does a claim processor earn in Boise, ID?

What are the biggest employers of Claim Processors in Boise, ID?