Specialty Claims Examiner
Claim processor job in Austin, TX
Staffing Now is looking for a detail-oriented and customer-focused contract to hire
Specialty Claims Examiner
to join our clients team in the Austin area. In this role, you'll be responsible for accurately processing and adjudicating GAP and Anti-Theft claims while delivering an exceptional service experience.
What You'll Do
Review loan, insurance, and contract documents to confirm claim eligibility
Process claims submitted through phone, email, and chat
Document all claim interactions in our system with accuracy and clarity
Provide timely updates on open and pending claims
Manage your assigned queue to ensure efficient claim resolution
Interpret insurance and dealership documents, including payment histories
Maintain strong product knowledge and deliver high-quality customer service
Support administrative tasks and assist with special projects as needed
What You Bring
High school diploma or equivalent
2+ years of claims experience in a call center or insurance setting
Working knowledge of GAP and Anti-Theft claims
Strong communication skills, critical thinking, and the ability to read and interpret contracts
Ability to manage high contact volume (40+ calls/emails/chats daily)
Preferred Qualifications
Active Claims Adjuster License
Previous experience in the insurance industry
If you're driven, organized, and ready to make an impact, this could be the perfect next step in your career.
Claims Specialist
Claim processor job in Plano, TX
Duration:6 Months+
Roles & Responsibilities
Maximize customer satisfaction by providing prompt actions to customer's need and obtain quality photos/data to determine root cause of claim to defend or accommodate customer's claim
Provide efficient solutions to customer-facing agents by developing and operating guide and contents
Use various tools/dashboard/systems to quantify the agent's performance of customer care and develop appropriate actions to improve performance and quality
Spanish speaking agent recommended but not a requirement.
[Customer Experience Management] Analyze end-to-end processes that customers experience and participate in providing suitable resolutions accordingly and in controlled & monitored turnaround time for each action of customer claim process
[Quality Management] Monitor and review customer calls/tickets for customer care quality control, carry out activities to secure quality competitiveness of our company and customers
Maintains and improves operational quality by monitoring system performance; identifying and resolving problems; preparing and completing action plans.
Qualifications & Experience
College Graduate
3~5 Years in customer experience
Case management for MX/CE claims
CE Tender management
Pending Management (KPI, LTP)
Case Tracker Management for special issue
CPSC claim management (Customer care/tracker) (CE)
Monitoring FCCM report quality (ACQ/OS Reports)
Special Projects
Customer Care Resolution
EnR Submission/Management
Work to de-escalate customer situations while finding an appropriate solution; involve upper management as needed
Skills
Customer Care Experience (Call Center)
Claims Management Experience
Insurance Claims or Adjuster background beneficial
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details:
Name: P Praveen Chary
Email: ****************************
Internal Id: 25-54476
Medical Claims Processor
Claim processor job in San Antonio, TX
FCE Benefit Administrators, Inc. is seeking a detail-oriented and motivated Claims Processor to join our dynamic and growing team. The ideal candidate will be responsible for the accurate and timely processing of a wide range of claims while ensuring compliance with company standards and regulatory requirements. This role requires strong attention to detail, effective communication skills, and the ability to work efficiently in a fast-paced environment.
Key Responsibilities
Accurately process a variety of claim types, including Medical, Vision, Dental, HRA, Critical Illness, and Accident claims.
Manage the entire claim lifecycle, including adjustments, voids, and payment reissues.
Conduct audits on processed claims to ensure accuracy and compliance with policies.
Serve as a point of contact for claim-related inquiries from members, providers, and internal AE (Account Executive) and CS (Customer Service) teams.
Handle escalated client questions and issues via phone and email with professionalism and urgency.
Participate in special projects and organizational initiatives as assigned.
Assist with training and mentoring team members (for more experienced candidates).
Education
High school diploma or equivalent required.
Associate's degree or vocational training in a related field (e.g., Medical Billing & Coding, Business Administration) preferred.
Experience
1-3 years of experience in medical claims processing, data entry, customer service, or a general administrative role required.
Technical Skills
Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
Strong data entry capabilities and 10-key proficiency.
Familiarity with claims management platforms or Electronic Health Record (EHR) systems preferred.
Soft Skills
Exceptional attention to detail and strong organizational abilities.
Clear written and verbal communication skills.
Strong problem-solving and critical thinking abilities.
Ability to work independently while managing a high volume of tasks in a fast-paced environment.
Commitment to maintaining confidentiality and handling sensitive information with integrity.
Working Conditions
Standard office environment.
Prolonged periods of sitting and computer use may be required.
Ability to lift up to 20 lbs occasionally (e.g., handling physical records or mail).
Benefits Offered
We understand that top talent is attracted to organizations offering competitive compensation, comprehensive benefits, and opportunities for professional growth. FCE offers a robust benefits package including:
Medical, Dental, and Vision Coverage
Disability Insurance
401(k) with Company Match
Flexible Spending Accounts (FSA)
Health Savings Account (HSA) Contributions
Fitness Membership Discounts
Company-paid Life Insurance
Tuition/Professional Development Reimbursement
Employee Assistance Programs
Paid Time Off (PTO)
About FCE Benefit Administrators, Inc.
With nearly 30 years of experience, FCE Benefit Administrators, Inc. has helped hundreds of For-Profit and Not-For-Profit organizations achieve full compliance under the Service Contract Act (SCA), Davis-Bacon Act (DBA), Javits-Wagner-O'Day (JWOD), and related federal legislation. As trusted experts in government contracts, we specialize in the administration of bona-fide fringe benefit plans through an irrevocable funding arrangement, ensuring full compliance with SCA requirements.
Equal Opportunity Employer
FCE is an equal opportunity employer and is committed to creating an inclusive and diverse workplace.
Legal Claims Analyst
Claim processor job in Plano, TX
ERISA Recovery are experts in collecting complex and aged claims through the Federal ERISA appeals process. We are a fast-growing organization located in Plano, TX. If you would like to join a friendly, passionate team with limitless potential, we'd love to meet you. This extraordinary opportunity to advance your career and make a difference is now.
We are searching for a Legal Hospital Claims Analyst - someone who works well in a fast-paced setting. In this position, you'll provide support in analyzing comprehensive claims and identifying key metrics. You will be a subject matter expert in legal claims. You must be able to work both independently and as part of a team. Key attributes for the ideal candidate include working with intensity, focus, and being detail oriented.
Essential responsibilities and duties
Conducts legal research and investigation of claims
Drafting legal documents
Keeping track of changes in legal framework and providing timely updates on these changes
Utilizes ERISA law enforcement
Utilizes knowledge of health care standards appropriate to specific claim
Ability to understand and apply medical reimbursement policies, procedures, and standards
Ensures eligibility for claims is reasonable and correct by analyzing claims and providing supporting documentation
Utilize a variety of EHR systems
Thrives in a fast-paced environment
Collaborates effectively with other team members
Ability to adapt to changing needs
Consistently applies knowledge relevant to claims
Work intensely at a fast-paced rate
Ability to communicate effectively with third party administrators
Determine the status of medical claims through research
Meet the standards of the department and quality standards
Strong organizational skills
Desired skills and Qualifications
Bachelor's degree
3+ years working in the legal field
2+ years working with healthcare insurance claims (preferred)
Strong Communication skills
Working knowledge utilizing Microsoft software (Word, Excel, Outlook)
Ability to work in a fast-paced environment
Benefits:
401(k)
401(k) matching
Dental insurance
Health insurance
Paid time off
Vision insurance
Paid lunches
Bonus
ERISA Recovery is an Equal Opportunity Employer
Claims Supervisor (Bodily Injury)
Claim processor job in Dallas, TX
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage:
complex investigations
coverage determinations
liability assessments
bodily injury claim resolutions-through both settlement and litigation.
This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims.
If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors:
Ownership: You take responsibility for outcomes in all scenarios.
Adaptability: You navigate dynamic environments with creativity and resilience.
Leading People: You empower individuals and teams to achieve their best.
Collaboration: You build and strengthen partnerships across organizational lines.
Driving Value: You use data-driven insights to align actions with strategic goals.
What You'll Do:
Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust.
Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims.
Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority
Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations.
Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention.
Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service.
Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence.
Collaborate with leadership and cross-functional teams to identify and implement process improvements.
Serve as a resource for team members on insurance-related questions
providing mentorship and training to build their industry knowledge.
What We're Looking For:
Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases.
Active Adjuster license (required)
Expertise in Casualty claims, including knowledge of industry regulations and best practices
Strong ability to assess needs and guide associates in negotiating claim settlements as needed
Experienced in the use of various claims tools with ability to assist associates
Strong adherence to compliance and regulatory requirements
Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment
Strong results orientation, with a history of meeting or exceeding performance goals
Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations
Ability to analyze data and metrics to inform decision-making and improve customer outcomes
Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence
Why Join GEICO?
Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction.
Inclusive Culture: Join a company that values diversity, collaboration, and innovation.
Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit.
Professional Growth: Access GEICO's industry-leading training programs and development opportunities:
Licensing and continuing education at no cost to you.
Leadership development programs and hundreds of eLearning courses to enhance your skills.
Increased Earnings Potential:
Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually.
Incentives and Recognition:
Corporate wide bonus programs are in place to reward top performers.
Beware of scams! As a recruiter, I will only contact you through ************ email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ...@geico.com.
keywords: litigation, auto liability, liability claims#geico300#LI-AL2
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Litigation Claims Supervisor
Claim processor job in Dallas, TX
Litigation Claims Supervisor - Commercial Auto & Bodily Injury
Join a dynamic and growing organization as a Litigation Claims Supervisor, where you will provide daily leadership and direction to a dedicated team of 6-9 Litigation and Bodily Injury claims adjusters. This highly visible, on-site role is based in Westlake, Texas.
In this role, you will be crucial in ensuring the consistent delivery of high-quality claim handling and customer service within the Commercial Auto division. You will utilize strong critical thinking and judgment to guide your team in the proper resolution of claims, fostering an environment of accountability, teamwork, and professional development. As a leader, you will coach and guide your team through organizational and industry changes, promoting an entrepreneurial spirit and driving outstanding achievement of unit and company goals.
Key Responsibilities
Team Leadership & Performance Management
Lead and manage a team of 6-9 commercial lines claims adjusters to meet or exceed key performance indicators (KPIs), metrics, and best practices on a monthly and quarterly basis.
Provide clear daily goals and solutions to address challenges in work completion and customer service.
Offer direction, leadership, and training on coverage, investigations, and claim evaluations, ensuring adherence to company policy and regulations.
Conduct management oversight and quality assurance reviews on all open claim inventory (both non-litigated and litigated files).
Authorize reserve and settlement decisions according to established company guidelines.
Champion a diverse, inclusive, and trusting work environment, encouraging staff to professionally challenge the status quo and identify improvements.
Technical & Compliance Oversight
Ensure 100% compliance with all claim adjuster licensing requirements.
Act as a professional representative of the organization to both internal and external customers.
Communicate information to Senior Management and the claims or legal management team regarding claim files with unusual circumstances or excess exposure potential.
Maintain strict confidentiality concerning sensitive information and employee matters.
Required Qualifications
Experience: A minimum of 7+ years of Auto Bodily Injury and litigated claims experience is required.
Supervisory Background: Prior experience of 3-5 years in a claims supervisory role is mandatory.
Technical Skills: Must possess a strong technical and administrative background in auto claims handling.
Licensing: A Texas Adjuster license is required.
Education: A High School Diploma or equivalent is required; a Bachelor's degree is preferred.
Workplace & Environment
This is an On-Site position based in Westlake, Texas. The ideal candidate must be able to work independently on technical and administrative matters in accordance with company policy and procedures.
Specimen Processor
Claim processor job in Lewisville, TX
Pride Health is urgently seeking candidates for a Specimen Processor/Technician in Lewisville TX 75067.This is a Contractual role with possibility for extension or conversion to full time.
Schedule: Tues-sat from 5pm-130 am (40hrs/week) or Overnight 10PM-6:30AM
Pay Range: $17-$17.88/hr/hour
*Pay offered will be based on experience, expertise and education.
Job Duties:
Responsibilities/Duties for Specimen Technician:
Responsibilities: Includes data entry, A-station duties, presorting, handling specimen pickup and delivery, imaging, centrifugation, and aliquoting.
Skills Needed: Requires strong organizational skills, accuracy, and the ability to learn about different specimen types and test requirements.
Regulatory Knowledge: Must understand compliance regulations related to test ordering, which can change frequently.
Performs accurate data entry of the samples.
Qualifications:
High School Diploma or GED is required.
Experience in healthcare.
Data entry experience a must.
Interested? Apply Now!
“Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors.
About Pride Health
Pride Health is Pride Global' s healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.
As a minority-owned business that delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds, Pride Health's expert team provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment of trust and loyalty.
Equal Employment Opportunity Statement
As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.
Claims Examiner
Claim processor job in Marshall, TX
Kelly Services in partnership with Nissan is currently seeking high skilled individuals to fill Production Technician openings at the Nissan manufacturing plant located in Canton, MS. Job Description JOB REQUIREMENTS: 1) High School diploma or GED
2) At least one year office environment experience
3) Data entry and/or typing experience
4) Clear and concise written and verbal communication skills
Additional Information
All your information is kept confidential as per EEO standards.
Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!
Technical Claims Specialist
Claim processor job in Texas
Company Details
Berkley Oil & Gas, (a W.R. Berkley Company) is an insurance underwriting manager providing unique property and casualty products and risk services to customers engaged in the energy sector. Our customers recognize the importance of the expertise we provide and appreciate the opportunity to work with professionals who understand their business. We are in turn committed to delivering innovative products and exceptional service to them, our valued agents and brokers, Berkley Oil & Gas is dedicated in its efforts to be well-informed of the changing dynamics of the industry; support industry efforts to minimize and mitigate risks and hazards in the ‘oil patch', and to constantly seek ways to improve our products and services to meet customer needs.
Company URL: ***************************
The company is an equal opportunity employer.
Responsibilities
The Technical Claims Specialist position will be responsible for handling, negotiating and resolving first and third party commercial general liability, property, Inland Marine and automobile bodily injury and property damage claims to conclusion. This position may also handle worker's compensation claims. This would include coverage verification, policy interpretation, contract interpretation, liability investigation and evaluation and negotiation of claims consistent with company policies and state regulations.
Conduct and manage the investigative process, while demonstrating ongoing communication with the customer and relevant internal and external parties.
Documenting files to include all key activities, contacts made, statements taken, including a full outline covering all aspect of the claim requirements for resolution.
Demonstrate understanding of medical terms, medical treatment and injury descriptions.
Recognition and evaluation of potential damages related to injuries.
Manage the claim authorization process.
Conduct complete investigation of losses through appropriate techniques including interviews, recorded statements, documentation/data gathering and securing/preserving evidence.
Evaluate compensability and exposure; identify subrogation opportunities or suspicious claims. Prepare timely, concise reports and state filings as required by the jurisdiction.
Promptly establish and maintain accurate reserves. Adhere to state regulatory compliance requirements.
Verify, analyze, and correctly apply coverage.
Develop strategy and negotiate claims to a timely conclusion, properly applying state compliance and company policies and procedures.
Develop a resolution plan (e.g. pay, deny, dispute) based upon analysis of the facts, defenses, compensability, and statutory/case law.
Keep policyholders, underwriting and agents advised of file status and other matters as required.
Participation in presentations, meetings, or visits to agents, policyholders, prospective accounts and other groups related to claims resolution, service or technical issues.
Successfully complete relevant continuing education as required.
Qualifications
Minimum of 7 years of multi-line experience
Must possess a current Texas claims adjuster licenses; additional licenses a plus.
Multi-jurisdictional experience preferred.
Familiarity with Contractual Risk Transfer concepts and anti-indemnity laws
Ability to follow detailed procedures and ensure accuracy in documentation and data.
Excellent written and verbal communications; with ability to listen well.
Recognizes differences in opinions and misunderstandings and encourages open discussion while working towards resolution.
Accepts individual responsibility for all actions taken. Holds self and others accountable to the organization and stakeholders.
Excellent organizational skills; ability to prioritize workload
Ability to think critically and solve problems, including the ability to interpret related documentation
Strong negotiation skills leading to best claim outcomes
Demonstrate proficiency in computer programs, such as Microsoft Word, Outlook and Excel
Education Requirement
Bachelor's Degree required or equivalent work experience.
Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:
• Base Salary Range: $90,000 - $140,000
• Eligible to participate in annual discretionary bonus.
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
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.
The application window for this role is estimated to be open through January 30, 2026, but may be extended, if necessary, please submit your application as soon as possible prior to January 30, 2026. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
Auto-ApplyLoss Claims Specialists/ Project Manager
Claim processor job in Shreveport, LA
About the Role PuroClean of Shreveport is seeking a high-character individual to join our team as a Loss Claims Specialist. This is more than a job-it's a leadership role designed for someone who can take full ownership of a project from start to finish and align with our mission of providing empathetic, efficient, and professional restoration services to our community.
As a Loss Claims Specialist, you will serve in a project manager capacity, overseeing the execution of all services related to water damage, mold, biohazard, contents handling, and reconstruction. This role demands strong organizational skills, technical knowledge, and a commitment to both customer care and team collaboration.
Why Join Us
* Profit Sharing Position - your success is our success
* Annual Draw of $50,000 + laptop + software subscriptions
* Be part of a purpose-driven company that values integrity, excellence, and service
* Opportunities for growth and advancement in a fast-paced industry
What You'll Need
* A personal vehicle and reliable transportation
* A working phone
* A desire to learn and align with our SOPs and company goals
* Willingness to take ownership and be accountable for job outcomes
* Ability to manage multiple claims and ensure timely completion of each project
What You'll Do
* Manage restoration projects from intake through completion
* Coordinate and execute all mitigation and reconstruction services:
* Water Damage
* Mold Remediation
* Biohazard Cleanup
* Contents Pack-Out and Cleaning
* Reconstruction/Build-Back
* Estimate, invoice, and track jobs using software including:
* Xactimate
* Estimate
* Time and Materials platforms
* Learn and apply our internal SOPs with consistency and accuracy
* Meet or exceed quarterly performance goals
Preferred (but not required):
* Prior construction or restoration experience
* Familiarity with insurance claims processes or property loss mitigation
Who We're Looking For
We're looking for someone with more than just technical skills. We value character, accountability, and alignment with our company vision. If you take pride in your work, can lead by example, and are looking to grow in an environment that rewards dedication and results-you may be exactly who we're looking for.
Insurance Claims Specialist
Claim processor job in Dallas, TX
The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager.
Specific Duties include:
Claims & Incident Management:
Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to:
Input and/or review all incidents reported in DPR's RMIS system.
Maintain incident records in Insurance Team's document management system.
Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements.
Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities.
Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable.
Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate.
Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date.
Provide in-network aluminum certified repair shop information to drivers following an incident.
Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement.
When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form.
Work with Insurance Controller on auto program claim reports
Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed.
Fleet Vehicle Safety & Operations Policy Management:
Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs
Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training
Ensure authorized driver list is kept current
Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions
Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy
Key Skills:
Strategic thinking
Ability to mentor and inspire others
Integrity
Team player
Strong writing and communication skills
Self-Starter
Highly organized and responsive - ability to meet deadlines
Detail Oriented
Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs.
Risk and dispute management - insured claims
Qualifications:
A minimum of five years relevant insurance industry experience
Previous experience in auto claims management highly desired
DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world.
Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek.
Explore our open opportunities at ********************
Auto-ApplyRisk Claims Specialist
Claim processor job in Dallas, TX
Job Description
Key Responsibilities: Customer Claims: • Manage Customer Injury and Liability Claims: Oversee the investigation, documentation, and resolution of customer claims related to personal injury, property damage, or any other incidents occurring on organization premises.
• Coordinate with Insurance Providers: Liaise with insurance companies to ensure proper claims filing and coordinate the resolution of claims involving external parties.
• Customer Support: Handle escalated customer claims and provide appropriate resolutions while ensuring the store's best interests are maintained.
• Documentation & Compliance: Ensure that all claims are properly documented in compliance with company policies and legal requirements. Keep detailed records of each customer-related claim.
• Risk Prevention: Identify trends or recurring incidents that may contribute to customer claims and work with store management to implement safety measures or preventive actions.
Employee Claims:
• Workers' Compensation Claims: Oversee and manage all workers' compensation claims, ensuring compliance with state and federal regulations, and ensuring employees receive appropriate benefits.
• Workplace Injury Claims: Manage the investigation of employee injury claims, including gathering evidence, interviewing witnesses, and ensuring all necessary forms are completed and submitted on time.
• Fleet Claims Management: Manage the investigation of employee fleet claims, support employee's injuries if any, gather witness statements
• Support and Guidance: Provide support to injured employees, ensuring they are informed throughout the claims process and are aware of their rights and available benefits.
• Collaboration with HR and Legal: Work with HR and legal teams to ensure employee-related claims are handled correctly and in compliance with labor laws, insurance regulations, and company policies.
• Collaboration with Safety Team: Work with the Safety Team to consistently do store visits, conduct safety audits, checklists and investigations as needed.
Development:
• Process Improvement: Identify opportunities to improve the claims process, whether through more efficient systems, better documentation, or enhanced communication strategies.
Risk Management and Reporting:
• Claims Analysis and Reporting: Review and analyze the data on claims to identify trends, recurring issues, or areas for improvement. Prepare detailed reports for management regarding claim frequency, costs, and risk mitigation efforts.
• Collaboration with Risk and Safety Teams: Work closely with the Risk Management and Safety teams to address underlying causes of incidents that may lead to claims and develop preventive strategies.
• Compliance: Ensure that all claims are processed in line with company policies, industry standards, and legal requirements, including managing documentation for audits or regulatory reviews.
• Invoices: Reconcile and verify all invoices generated from claims.
• Safety Monitor Report: Complete Safety Monitor report and communicate all parties involved to resolve an issue related to an investigation.
Qualifications:
• Bachelor's degree in Business, Risk Management, Insurance, or a related field (or equivalent experience).
• 3-5 years of experience in claims management, risk management, or a specialist role, preferably
in a retail or supermarket environment.
• Strong understanding of risk management principles, insurance claims processes, and workers' compensation regulations.
• Strong problem-solving and analytical abilities to investigate and resolve complex claims efficiently.
• Excellent communication skills, both written and verbal, with the ability to manage sensitive issues with customers and employees.
• Attention to detail and ability to maintain accurate records and reports.
• Proficient in Microsoft Office and experience with claims management software or risk management tools.
Physical Requirements:
• Ability to stand for extended periods
• Ability to lift up to 50 lbs as needed
Work Environment:
• Fast-paced, high-volume environment
• Occasional evening, weekend, or holiday work may be required
• Occasional travel to different company locations
Physical Demands:
Some lifting, carrying, pushing, and/or pulling; some stooping, kneeling, crouching, and/or crawling; and significant fine finger dexterity. Generally, the job requires 70% sitting, 20% walking, and 10% standing.
This job is performed in a generally clean and healthy office environment.
Claims Specialist - Auto
Claim processor job in Plano, TX
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a Claims Specialist - Auto to join our team.
JOB SUMMARY
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
Communicates with all relevant parties and documents communication as well as results of investigation.
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
Travel is required to attend customer service calls, mediations, and other legal proceedings.
JOB REQUIREMENTS
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
• National Range : $82,800.00 - $97,300.00
• Ultimate salary offered will be based on factors such as applicant experience and geographic location.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
Auto-ApplyLogistics Claims Representative
Claim processor job in Shreveport, LA
Purpose/Job Function:
The claims associate will support the filing, tracking, and management of claims for all modes supporting a MTS customer. This role will include working closely with the customer at both corporate offices as well as in the field. There will also be frequent communications with carriers to collect documentation as well as status updates. The data collection and analysis produced in this role will be critical in driving continuous improvements to the customer's service performance.
Essential Functions:
File and manage LTL and Parcel freight claims including freight, shortages, overages, and damages.
Deliver reliable service throughout the entire life cycle of each claim, including but not limited to: prompt contact and timely communication throughout the process until the claim is closed, explaining the process, setting expectations, follow-ups and meeting commitments to achieve optimal outcome on every file.
Assist with client and vendor damage claims.
Develop and grow effective relationships with clients, vendors, and internal business partners.
Update and maintain records
Recognize and request appropriate inspection type based on the details of the loss and coordinate the appraisal process.
Maintain oversight of the repair process and ensure appropriate expense handling, manage approvals per guidelines.
Manage and report weekly review of LTL carrier complaints.
Provide reports to support visibility to claims trends and opportunities to reduce issues.
Run reports and data analysis as needed.
Qualifications/Requirements:
Excellent verbal and written communication in order to respond effectively to sensitive inquiries and complaints
Strong data entry and record keeping skills (may include maintaining records in database/s)
Ability to apply principles of logical thinking to a wide range of practical problems
Strong organizational skills with accurate attention to detail
Aptitude to spot trends in shipment data and detail
Proficient in use of Microsoft Office Suite (use of Excel, Word, Outlook)
Education/Experience:
Highschool diploma or GED
Prior data entry experience preferred
Working Conditions/Physical Demands:
The Claims Associate will sit in front of a computer for long hours at a time responding to emails, communicating with clients, teammates and carriers, and entering financial data. Staring at the computer may cause eye irritation or even muscle strain.
The increased repetitive motions and awkward postures attributed to the use of computer keyboards may also result in cumulative trauma disorders (CTDs).
The job as Claims Associate does not require any strenuous or physical activity.
Customary Work Hours: 8:00 A.M. to 5:00 P.M., Monday through Friday
Auto-ApplyParalegal/Claims Specialist
Claim processor job in Irving, TX
As a 100% employee-owned contractor, when you work at Sundt, you're not just hiring on at a company, you're joining a culture. Because everyone at Sundt is part owner, you'll join a team of people who are deeply invested in their work. From apprentices to managers, we're passionate about the details and deliberate in everything we do.
At Sundt we focus on building long-term prosperity for our clients, communities, and employee-owners. We offer competitive pay, industry-leading benefits including a 401k and employee stock ownership plan, incentive programs for craft and administrative employees as well as training that focuses on your personal and professional growth. We're driven by skill, grit and purpose. Join us as we strive to be the most skilled builder in America.
Job Summary
The Paralegal / Claims Specialist supports the company's Legal and Risk Management functions by assisting attorneys and insurance professionals in the investigation, evaluation, and resolution of claims and lawsuits. The role involves direct collaboration with outside counsel, insurance adjusters, and internal Safety and Operations teams. The Paralegal/Claims Specialist will independently manage the day-to-day handling of routine litigation and claims matters, including discovery, documentation, and coordination with defense counsel.
Key Responsibilities
1. Assists attorneys with trial preparation, exhibits, witness coordination, and logistics.
2. Assists company attorneys with responding to non-party subpoenas and regulatory inquiries.
3. Attends mediations, depositions, and hearings as appropriate to support counsel, our internal personnel and maintain awareness of case progress.
4. Communicates directly with claimants, witnesses, experts, and internal personnel to obtain and analyze relevant information, including managing internal electronic data preservation in coordination with IT team, and oversee transfer of preserved data for discovery.
5. Coordinates with Safety personnel regarding incident intake, documentation, and potential claims escalation.
6. Drafts and edits legal documents including correspondence, discovery requests and responses, routine pleadings, affidavits, and case summaries.
7. In conjunction with attorneys, manages litigation, including coordinating discovery and e-discovery, tracking deadlines, managing document production, approving and processing legal invoices and maintaining organized case files.
8. Maintains accurate and up-to-date records in Risk Information Management Systems {RIMS) or other claims databases.
9. Reviews and analyzes claims in coordination with legal and risk management professionals determine liability, damages, and insurance coverage.
10. Works closely with company attorneys, outside counsel, and insurance adjusters to investigate, evaluate, and resolve claims and lawsuits.
Minimum Job Requirements
1. 5-10 Years of Experience
2. Bachelor's degree
3. Knowledge working for a law firm or an insurance company representing clients in responding to claims and lawsuit preferred.
4. Paralegal certification
Note: is subject to change at any time and may include other duties as assigned.
Physical Requirements
1. May stoop, kneel, or bend, on an occasional basis
2. Must be able to comply with all safety standards and procedures
3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis
4. Will interact with people and technology frequently during a shift/work day
5. Will lift, push or pull objects up to 50Ibs on an occasional basis.
6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day.
7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors
Note: Job Description is subject to change at any time and may include other duties as assigned.
Physical Requirements
1. May stoop, kneel, or bend, on an occasional basis
2. Must be able to comply with all safety standards and procedures
3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis
4. Will interact with people and technology frequently during a shift/work day
5. Will lift, push or pull objects up to 501bs on an occasional basis.
6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day.
7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors
Equal Opportunity Employer Statement: Sundt is committed to the equal treatment of all employees, and/or applicants for employment, and prohibits discrimination based on race, religion, sex (including pregnancy), sexual orientation, gender identity, color, age, disability, national origin, covered veteran status, genetic information; or any other classification protected by applicable Federal, state, or local laws.
Benefit list:
Market Competitive Salary (paid weekly)
Bonus Eligibility based on company, group, and individual performance
Employee Stock Ownership Plan & 401K
Industry Leading Health Coverage Starting Your First Day
Flexible Time Off (FTO)
Medical, Health Savings, and Wellness credits
Flexible Spending Accounts
Employee Assistance Program
Workplace Wellness Programs
Mental Health Program
Life and Disability Insurance
Employee-Owner Perks
Educational Assistance
Sundt Foundation - Charitable Employee-Owner's program
#LI-KA1
Auto-ApplyMedical Coding Appeals Analyst
Claim processor job in Grand Prairie, TX
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Coding Appeals Analyst
Claim processor job in Grand Prairie, TX
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed/Certified - Other
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Claims Process Specialist
Claim processor job in San Antonio, TX
SafeRide Health is looking for a hands-on Claims Specialist to scale SafeRide. We are looking for a leader with deep experience managing Medicare and Medicaid programs as we scale past $100M in annual revenue. The Billing Specialist is responsible for elevating SafeRide's billing function and continuously enhancing the effectiveness of the organization. Strong business and financial orientation as well as a passion for growth and development are critical for this role.
Responsibilities:
Facilitates data processing and processes claims for NEMT and GMR rides.
Performs reconciliation of billing data to encounter data. Works closely with the operations team to resolve issues.
Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations.
Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines.
Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner.
Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules.
Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team.
Served as the Billing team's subject matter expert and primary contact for claims related projects and critical activities.
Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues.
Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas).
Champion and reinforce SafeRide's culture.
Required Education/Experience:
Minimum 1 years of experience in billing/claims management
Must be bilingual Spanish Speaking
Preferred
NEMT/transportation background preferred
Knowledge of CMS/HHSC regulations preferred
Skills
Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc.
Self-starter, ability to work independently and in a team environment.
Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions
Ability to adapt to unforeseen circumstances quickly
Keen attention to detail
Ability to work with a variety of stakeholders
What we offer you
An inclusive, encouraging and collaborative company culture
Strong support for career growth, including access to our investor communities
Competitive compensation with upside for growth (including stock options and performance grants)
Competitive benefits including health/vision/dental insurance, 401k match and 18 day's PTO
About SafeRide Health: SafeRide's mission is to restore access and dignity to care. SafeRide is transforming access to care for the nations sick, poor and underserved. We are a high growth, tech enabled services firm that's growing past 400 employees. SafeRide is backed by premier investors like NEA and clients like Fresenius. We operate nationally and now deliver over 5M rides per year. Learn more at ***********************
Insurance Claims Specialist
Claim processor job in Monroe, LA
Salary: $16.00 - $20.00
Insurance Claims Specialist
Peach Tree Dental - Monroe, West Monroe, Ruston, Jonesboro
Job Details:
Salary: Starting from $16.00-$20.00/hourly
Pay is based on experience, qualifications, and desired location.
**incentives after training vary and are based on performance
Job Type:Full-time
Qualifications For Insurance Claims Specialists:
High school or equivalent (Required)
Takes initiative.
Has excellent verbal and written skills.
Ability to manage all public dealings in a professional manner.
Ability to recognize problems and problem solve.
Ability to accept feedback and willingness to improve.
Ability to set goals, create plans, and convert plans into action.
Is a Brand ambassador, both in and outside of the facility.
Benefits Offered For Full-Time Insurance Claims Specialists:
Medical, Dental, Vision Benefits
Dependent Care & Healthcare Flexible Spending Account
Simple IRA With Employer Match
Basic Life, AD&D & Supplemental Life Insurance
Short-term & Long-term Disability
Perks & Rewards For Full-Time Insurance Claims Specialists:
Competitive pay + bonus
Paid Time Off & Sick time
6 paid Holidays a year
Full Job Description:
With our hearts, minds, and hands, we build better smiles, better relationships, and better lives. Living this purpose over the last 25 years has allowed us to create a world-class dental organization that continues to grow. At every turn, you will see our continued investment in leadership, the community, and advanced technologies. Do you want to be a part of developing one of the leading models of dental care in Louisiana? Do you thrive in a fast-paced, progressive environment? The role of the Insurance Claims Specialist could be for you!
Please go to WWW.PEACHTREEDENTAL.COMto complete your online application and assessments or use the following URL:**********************************************
Provider Claims Infusion Specialist
Claim processor job in Dallas, TX
Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com.
About You:
You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small & big wins.
INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas.
You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren't just the individuals using your product. They are the driving factor in your motivation to make a change.
Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear.
You thrive in a Team Environment. Collaboration is key in innovation and creating change.
These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life.
If this sounds like you, we would love to connect to speak further about career opportunities at Lantern.
Please apply to our role & someone from our Talent Acquisition Team will reach out to help you navigate our interview process.
Job Overview
Our Reimbursement Specialists are a central points of contact for our provider network. The primary responsibility of the role is to deliver effective, accurate payment and communication to our providers. The day-to-day responsibilities of our Reimbursement Specialists include payment processing, researching, accurate billing/payment disbursement, and ensuring payment data accuracy and integrity. The desired candidate is articulate, empathetic, pragmatic, self-starting and ambitious. In addition, our Reimbursement Specialists are horizontal thinkers, analytical, organized and detail oriented.
Key Responsibilities:
Processes provider payments in accordance with company policies and procedures.
Serves as primary contact to Finance Department regarding payment, determinations and payment processing activities.
Assist in the final determination on claim disposition and payment determination.
Serves as liaison to internal departments regarding provider related inquiries on claims related content.
Processes adjustments or provider disputes providing timely follow-up.
Coordinates research and responds to system inquiries from providers regarding payment, reimbursement determination, provider contact information and claims billing procedures.
Communicates with supervisor on a daily and/or weekly basis regarding any outstanding claims issues related to system, authorizations, reimbursement/payment errors or internal approvals.
Works with provider contracting staff when new/modified reimbursement contracts are needed
Performs pre-adjudication claims reviews to ensure proper terms and schedules were used.
Initiate necessary actions regarding pending claims or payment documentation.
Follow up on open items reports to timely and accurate resolution.
Respond proactively to provider issues and concerns and give feedback to management.
Provide feedback to the manager regarding proper claims billing procedures in accordance with company policy and procedures.
Assist in training new Payment Specialists.
Initiate change requests to resolve system issues impacting claims/payment processing or issue resolution
Runs and analyzes daily activity reports.
Analyze, develop and deliver claims resolutions quickly and accurately according to company policies and procedures.
Requirements:
Minimum Bachelor's degree in healthcare, business, marketing or related field; or HS Diploma (or GED) and 4 years' applicable experience
Minimum 2 years of experience in previous claims, health insurance or healthcare practice
Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) preferred
Knowledge of commonly used medical data resources preferred
Knowledge of payor contracts and interpretation
Knowledge of general office operations and/or experience with standard medical insurance claim forms preferred
Strong communication (verbal, written and listening), teamwork, negotiation and organizational skills
Ability to commit to providing a level of customer service within established standards
Ability to provide attention to detail to ensure accuracy including mathematical calculations
Ability to organize workload to meet deadlines and participate in department/team meetings
Ability to analyze data and arrive at a logical conclusion
Ability to identify issues and determine appropriate course of action for resolution
Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone
Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software
Ability to work with accuracy in a fast-paced environment
Ability to work independently and handle PHI and confidential information
Ability to process detailed verbal and written instructions
Benefits
Medical Insurance
Dental Insurance
Vision Insurance
Short & Long Term Disability
Life Insurance
401k with company match
Paid Time Off
Paid Parental Leave
Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.
Auto-Apply