Claim processor jobs in Buffalo, NY

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

FLSA Status: Non-Exempt Starting Rate: $19.50 per hour The Claims Specialist is responsible for maintaining, entering, and following up on all client medical insurance and financial information. The position prepares claim data for transmission to Medicaid, Medicare, and Managed Care plans. A Claims Specialist will organize billing and rebilling materials as well as create and analyze reports from the billing system to provide feedback to program sites. The Claims Specialist is responsible for maintaining positive and professional client and external insurance agency relations. POSITION RESPONSIBILITIES * Enters, updates, and verifies client data from service documents. * Using Medicaid EMEVS or E-PACES verifies client Medicaid information. * Tracks client referrals and authorizations in system. * Prepares claim batches for transmission to Medicaid, Medicare, and 3rd party payers. * Maintains claims batch reports. * Posts client payments to the service level. * Posting and mailing of client statements. * Produces and analyzes routine reports in a timely manner. * Reviews and processes payer denials. * Performs all other duties as assigned. QUALIFICATIONS * High school diploma or equivalency plus a minimum of two years paid experience in medical insurance billing. -OR- Associates degree in Business Administration plus a minimum of 1 year paid experience in medical insurance billing. * Completion of medical billing certification preferred. * Experience working with clients to assist with their medical insurance co-payments/deductibles and other related medical billing inquiries required. * Experience following up with medical insurance companies regarding clients claims and submitting medical insurance claims. * Experience balancing a cash drawer/cash reconciliation. * Knowledge of OMH, DOH, Medicaid, Medicare, and TPA regulations. * Strong ability to utilize common office technology/software including the use of the Microsoft Office Suite (Excel and Outlook mainly) * Ability to organize and maintain billing materials. * High attention to detail. * Ability to take initiative, make appropriate decisions, and solve problems with autonomy * Ability to perform routine arithmetic computations. * Excellent communication skills with all levels of staff Some things you can look forward to: * Welcoming, team environment, that inspires you to thrive and be your BestSelf! * Rewarding work experience! * Generous paid time off * Flexible schedule * Multiple and diverse health insurance options * Many other unique lifestyle & personal insurance options * Tuition reimbursement * CASAC certification tuition support * Career growth and advancement opportunities * We look forward to telling you more!

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $67,000.00 - $110,600.00 Target Openings 3 What Is the Opportunity? This role is eligible for a sign-on bonus. Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner. In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. What Will You Do? Provide quality claim handling of auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations. Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates. Determine claim eligibility, coverage, liability, and settlement amounts. Ensure accurate and complete documentation of claim files and transactions. Identify and escalate potential fraud or complex claims for further investigation. Coordinate with internal teams such as investigators, legal, and customer service, as needed. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's Degree. Three years of experience in insurance claims, preferably auto claims. Experience with claims management and software systems. Strong understanding of insurance principles, terminology with the ability to understand and articulate policies. Strong analytical and problem-solving skills. Proven ability to handle complex claims and negotiate settlements. Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. What is a Must Have? High School Degree or GED with a minimum of one year bodily injury liability claim handling experience or successful completion of Travelers Claim Representative training program is required.

Job Type: Permanent Build a brilliant future with Hiscox Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required. Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations: Manhattan, NY West Hartford, CT Atlanta, GA Chicago, IL Boston, MA The Role: The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also: Adjusts and resolves complex to severe claims that includes all phases of litigation With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters Reviews and analyses claim documentation and legal filings Drives litigation best practices to lead defense strategy on litigated files Mentors Claim Examiners Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions Identifies emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with special investigations unit Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities Develops content and conducts training for claims team and underwriters as requested The Team: The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling. Requirements: 8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.) Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Experience in mentoring and training other claims examiners Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University preferred Additional Factors Considered Ability to act a subject matter expert within team Demonstrated ability to work with minimal oversight Experience attending and leading mediations, arbitrations and trials Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars. What Hiscox USA offers 401(k) with competitive company matching Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) Company paid group term life, short- term disability and long-term disability coverage 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days Paid parental leave 4-week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing 2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox USA Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. Diversity and flexible working at Hiscox At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range $125,000 - $155,000 (Boston, Manhattan, West Hartford) Salary range $120,000-$130,000 (Chicago, Atlanta) 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. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-AJ1 Work with amazing people and be part of a unique culture

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR rXzZkqANop

At Jacobs, our PMCM team works seamlessly with clients by delivering projects and programs that achieve our clients' goals. What we do is more than construction; we play a part in moving a vision from concept to reality. If you're interested in a rewarding career working on ENR's #1 Program Management and Construction Management-for-Fee firm, then Jacobs is where you belong. This candidate will work in the claims department, analyzing delay claims brought against the State within a geographic region. The successful candidate will be responsible for managing the workload within the geographic region assigned to them independently and think critically to make contractual decisions. Responsibilities: * Perform review, interpret and perform complex schedule analysis using P6 * Review Contractor's notice of claim in accordance with the Contract, determine validity * Day-to-day tracking, review, and management of delay claims assigned to the successful candidate * Audit contractor's claim costs, including certified payrolls and invoices and negotiate settlements with Contractors * Host fact finding meetings for claims with design and construction staff to facilitate the review of claims * Review project history to assist in forensic delay analysis, including meeting minutes, schedules, and correspondence * Report on high priority projects and problem projects to the executive staff monthly, or as frequencies needed * Bachelor's degree in construction management or related field, or associates degree * 2-4 years of contract, project management and scheduling experience * Familiar with navigating construction schedules, schedule analysis, and time impact analysis * Possess an OSHA 10 Certification * Experience performing complex schedule analysis using P6 * Willing and able to work at the client's site with the program team Monday-Friday in West Seneca, NY. Ideally, you'll have: * Cost estimating experience #EastPMCM #NorthPMCM #LI-SD2 Jacobs is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, religion, creed, color, national origin, ancestry, sex (including pregnancy, childbirth, breastfeeding, or medical conditions related to pregnancy, childbirth, or breastfeeding), age, medical condition, marital or domestic partner status, sexual orientation, gender, gender identity, gender expression and transgender status, mental disability or physical disability, genetic information, military or veteran status, citizenship, low-income status or any other status or characteristic protected by applicable law. Learn more about your rights under Federal EEO laws and supplemental language.

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$65,300.00 - $107,600.00Target Openings2What Is the Opportunity?Potential for a $2,500 sign-on bonus! This position is responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment process. This may include interpreting and applying laws and statutes for multiple state jurisdictions. Claim types include moderate complexity Bodily Injury claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.What Will You Do? Customer Contacts/Experience: Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions. Coverage Analysis : Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for moderate complexity Bodily Injury liability claims in assigned jurisdictions. Verifies the benefits available, the injured party's eligibility and the applicable limits. Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security, Workers Compensation or others relevant to the jurisdiction. Consults with Unit Manager on use of Claim Coverage Counsel. Investigation/Evaluation: Investigates each claim to obtain relevant facts necessary to determine coverage, the extent of liability, damages, and contribution potential with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. Takes recorded statements as necessary. Utilizes evaluation documentation tools in accordance with department guidelines. Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings. Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit. Reserving: Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities in accordance with established procedures to resolve claim in a timely manner. Negotiation/Resolution: Determines settlement amounts, negotiates and conveys claim settlements within authority limits to claimants or their representatives. Recognizes and implements alternate means of resolution. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to claimants. Handles both unrepresented and attorney represented claims. May manage litigated claims on appropriately assigned cases. Develops litigation plan with staff or panel counsel, track and control legal expenses. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Insurance License: In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred. 2 years bodily injury liability claim handling experience preferred. General knowledge and skill in claims handling and litigation. Basic working level knowledge and skill in various business line products. Demonstrated ownership attitude and customer centric response to all assigned tasks Demonstrated good organizational skills with the ability to prioritize and work independently Attention to detail ensuring accuracy Keyboard skills and Windows proficiency, including Excel and Word - Intermediate Verbal and written communication skills - Intermediate Analytical Thinking- Intermediate Judgment/Decision Making- Intermediate Negotiation- Intermediate Insurance Contract Knowledge- Intermediate Principles of Investigation- Intermediate Value Determination- Intermediate Settlement Techniques- Intermediate Medical Knowledge- Intermediate What is a Must Have? High School Degree or GED with a minimum of one year bodily injury liability claim handling experience or successful completion of Travelers Claim Representative training program is required. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere! Key Objective: Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines. Duties may include but are not limited to: Receive new assignments. Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business. Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. Arrange for surveys and experts where appropriate. Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Sets reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. Timely and appropriate management of litigation files. Assists Team Leader in developing methods and improvements for handling claims. Settles claims promptly and equitably. Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses. Informs claimants, insured's/customers/ agents or attorney of denial of claim when applicable. May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial. Refers claims to subrogation as appropriate. May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current exposure and future risks Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts Depending on line of business, other duties may include: Maintaining system logs Investigating compensability and benefit entitlement Reviewing and approving medical bill payments or forwarding for outside review as necessary. Managing vocational rehabilitation Scope: The position reports directly to a Claims Team Leader or other member of claims management. Qualifications 3-5 years experience handling higher level Workers' Compensation claims. Basic knowledge of claims handling and familiarity with claims terminologies. Effective negotiation skills. Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses. Ability to self motivate and work independently. Knowledge of Chubb products, services, coverages and policy limits, along with awareness of claims best practices Knowledge of applicable state and local laws State adjusters licensing a plus or will require future licensing. Familiar in computer systems 40 words per minute typing skills An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam. The pay range for the role is $62,200 to $105,800. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled. ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $21.00 an hour and up Sign-On Bonus: $5,000 for employees starting before January 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion

Full-time Description We're looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you'll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise. Key Responsibilities Accurately process claims within established timelines Review and complete claim adjustment requests Research claim reversal requests to determine approval or denial Manage debit card dispute workflows, including fraudulent or disputed transactions Provide clear and professional responses to routine phone and written inquiries related to claim processing Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules Adjudicate transactions that fail auto-review and determine whether additional documentation is needed Requirements High School Diploma or equivalent Knowledge of ERISA guidelines preferred Strong written and verbal communication skills with excellent attention to detail Ability to manage multiple priorities using strong organizational and time-management skills Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally Self-starter who can work independently in a fast-paced environment with critical deadlines An Equal Opportunity Employer. Salary Description 16.00 - 18.00

Summary: Works to resolve claims/issues that impact the customer as it relates to errors in Order Processing, Accounts Receivable, Shipping, and defective products. There is a strong troubleshooting/problem solving component to this position Essential Responsibilities: Customer Care - Help resolve customer complaints/issues when an order was not entered, shipped, or received correctly. Investigation of customer complaints and ensuring resolution to these issues. Create CFB, document and report policy and procedure errors, and see CFBs through to resolution. Carrier Claims - Investigate and gather documentation with evidence. Prepare paperwork and submit claims for pursuance of payment/reimbursement. Act as the liaison with carriers involved with shipping errors. UPS - Coordinate the filing of UPS clams DOT - Ensure Liberty Pumps is in compliance with all DOT requirements/regulations; stay abreast of new DOT requirements; provide training/education to drivers; maintain driver completed log books Risk Management - Assist & work closely with Senior Claims Analyst and Chief Financial Officer in the administration of product liability claims Accounts Receivable - work with A/R in the resolution of disputes such as billing errors & shipping errors to ensure timely payments. Safety - Members are held responsible and accountable to follow safety guidelines, maintain a clean and organized work area, and use good safety judgment. Able to work well in a team environment and diverse group settings You will be expected to operate according to ISO 9001 requirements. Held responsible and accountable to follow safety guidelines, maintain a clean and organized work area, and use good safety judgment. Expected to report all unsafe activities and conditions to the Supervisor and/or Safety Representative. This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the member for this job. Duties, responsibilities, and activities may change at any time with or without notice. Minimum Qualifications: Organizational skills and being able to remain flexible at all times is necessary. Computer literate in common word processing, spreadsheet, and other Windows-based PC programs. Education/Training: High school diploma or GED Experience/Skills/Abilities: Ability to read, write, edit, analyze, and comprehend instructions, short correspondence, and general business documents. Ability to speak effectively before groups of customers or employees of organization. Ability to define problems, collect data, establish facts, and draw valid conclusions. Proficient personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, graphics, etc. Handle multiple projects simultaneously. Willing to work in a team environment. Self-motivated, capable of taking direction as well as working with minimal supervision. Ability to remain calm under pressure such as working through an employment situation. Work Schedule/Hours: Monday - Friday with typical business hours. Occasional overtime may be necessary when working on special projects. Minimal overnight travel (up to 10%) by land and/or air. Working Conditions: Well-lighted, heated, and/or air-conditioned indoor office/shop environment with adequate ventilation. Light physical activity performing non-strenuous daily activities of an administrative nature. Moderate noise (examples: business office with computers and printers, light traffic).

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency. Responsibilities Include: * Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans * Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations. * Manages the inventory of claims against standard service level agreements (SLA's) * Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement. * Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics * Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance * Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems * Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance * Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades * Performs other duties as deemed essential and necessary Qualifications: Required Skills and Abilities: * Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims. * Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team. * Analytical Skills: Ability to analyze claims data and make informed decisions based on findings. * Experience: Previous experience in claims processing or a related field, including supervisory experience. * Understands health insurance benefit administration in a Self-Funded environment * Ability to read and understand various forms, documentation, files, and information with the department. Education and Experience: * Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment * Candidate must have at least 3 years of experience supervising a claims team * Candidates must have prior experience with a highly automated and integrated claim adjudication system * Experience working with HealthRules Payer * Understanding of health insurance benefits administration in a self-funded environment Preferred Qualifications: * Past Training Experience * Experience working at TPA * Experience with self-funded plans Work Location: * An ideal candidate would be assigned to the Buffalo Office with ability to work from home. * If not in the Buffalo area, the opportunity can be remote. Leadership Skills & Behaviors: ● Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward. ● Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function. ● Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically. ● Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps. ● Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know. ● Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding. ● Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development. ● Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network. ● Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere! KEY OBJECTIVE: Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines. MAJOR DUTIES & RESPONSIBILITIES: Duties may include but are not limited to: • Receive new assignments. • Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business. • Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. • Arrange for surveys and experts where appropriate. • Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract. • Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. • Sets reserves within authority limits and recommends reserve changes to Team Leader. • Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. • Timely and appropriate management of litigation files. • Assists Team Leader in developing methods and improvements for handling claims. • Settles claims promptly and equitably. • Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses. • Informs claimants, insured's/customers/ agents or attorney of denial of claim when applicable. • May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial. • Refers claims to subrogation as appropriate. • May participate in claim file reviews and audits with customer/insured and broker. • Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current exposure and future risks • Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts Depending on line of business, other duties may include: • Maintaining system logs • Investigating compensability and benefit entitlement • Reviewing and approving medical bill payments or forwarding for outside review as necessary. • Managing vocational rehabilitation SCOPE INFORMATION: The position reports directly to a Claims Team Leader or other member of claims management. Qualifications DESIRED QUALIFICATIONS: • 3-5 years experience handling higher level Workers' Compensation claims. • Basic knowledge of claims handling and familiarity with claims terminologies. • Effective negotiation skills. • Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses. • Ability to self motivate and work independently. • Knowledge of Chubb products, services, coverages and policy limits, along with awareness of claims best practices • Knowledge of applicable state and local laws • State adjusters licensing a plus or will require future licensing. • Familiar in computer systems • 40 words per minute typing skills An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam. The pay range for the role is $62,200 to $105,800. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled. ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

Full-time Description Are you a motivated leader with a knack for guiding teams to success? Join our Reimbursement Account Services Department as a Claims Supervisor and take charge of a dynamic claims team! In this role, you'll ensure smooth workflow, provide expert guidance on claims adjudication, and uphold the IRS regulations that govern our services, all while helping your team thrive. Requirements What You'll Do: Lead, motivate, and organize the claims team to meet productivity and quality goals. Oversee workflow, ensuring adherence to procedures and IRS regulations. Streamline processes to boost efficiency without compromising customer service. Coach, develop, and hold your team accountable; praise achievements and provide guidance when needed. Support staffing, onboarding, training, and employee development. Stay up to date on federal, state, and local regulations for accurate claim processing. Assist with claims processing and resolving participant inquiries as needed. What We're Looking For: Associate's degree required 3-5 years of reimbursement account experience Claims processing experience preferred Proven supervisor experience is a must Salary Description $55,000-$65,000

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Summary of the Role: The Senior Claims Data Analyst will play a pivotal role in enhancing the efficiency and scalability of our claims operation. This individual will drive insights through advanced analytics and develop high-impact reporting and dashboards. Partnering closely with the claims operations team, the analyst will identify opportunities for process improvement and own the analytics that empower our operations and leadership teams to succeed. This individual will go beyond surface-level reporting to identify patterns, uncover root causes, and drive strategic improvements that enhance operational efficiency, service delivery, and customer satisfaction. Responsibilities Include: Collaborate with claims and stop loss operations teams to understand analytics and reporting needs that drive efficiency and scalability. Scope, gather, and structure requirements into actionable opportunities and solutions. Extract, manipulate, and analyze large datasets from claims databases using SQL or similar querying languages. Translate data into actionable insights and strategic recommendations that inform process improvements, resourcing decisions, and operational priorities Develop models and algorithms to identify trends, anomalies, root causes of inefficiencies and areas for operational improvement. Design and maintain scalable dashboards and reports using tools like Tableau, Power BI, or similar platforms. Create and monitor productivity and performance metrics to assess and enhance departmental efficiency. Present findings to operations leadership with clear narratives that tie analytics to business outcomes. Serve as a technical liaison between claims operations and the core data team to ensure accuracy and quality in analytics. Develop and maintain SLA reporting to ensure claims operations meet and exceed client expectations. Proactively identify and recommend areas for automation, workflow enhancements, and optimization across the claims lifecycle. Ensure data integrity and accuracy across all analyses. Required Skills and Abilities: Proficiency in SQL with the ability to write complex queries and manipulate large datasets. Strong skills in Python or R for data analysis and insight generation. Strong skills in building interactive dashboards using Tableau, Power BI, or equivalent tools. Familiarity with data warehousing and cloud platforms (e.g., AWS, Snowflake). Exceptional attention to detail and commitment to data accuracy. Critical thinking and structured problem-solving abilities. Strong interpersonal skills for effective collaboration across operations, IT, and business teams. Excellent verbal and written communication skills, with the ability to translate technical findings into business-friendly language. Education and Experience: Bachelor's degree in Data Science, Statistics, Healthcare Administration, or a related field. 5 years of experience in data analytics, preferably within healthcare or insurance claims operations. 5 years of experience in healthcare, claims processing, stop loss reporting and data needs and relevant regulations (e.g., ACA, HIPAA). Work Location: This position is remote Access to Buffalo or NYC office if local Centivo Values: Resilient - This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don't give up. Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon. Positive - We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Description We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Supervisor in Management Ancillary Services (CMAS). The Supervisor will be responsible for the oversight and management of the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery. The CMAS Supervisor will have direct management of a team that supports, researches, and resolves the accurate processing of healthcare claims for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. They will collaborate with internal and external partners to resolve issues and standardize processes, ensuring standard processes are established, policies are enforced, and issues are mitigated through collaborative decision-making. Responsibilities Include: Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans Ensures that claims, appeals, and adjustments are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations Manages the inventory of claims against standard service level agreements (SLA's) Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement. Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance Liaison for the CMAS Team on various projects and/or initiatives including claims and testing needs to support system implementations and/or upgrades Performs other duties as deemed essential and necessary Qualifications: Required Skills and Abilities: Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims. Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team. Analytical Skills: Ability to analyze claims data and make informed decisions based on findings. Experience: Previous experience in claims processing or a related field, including supervisory experience. Understands health insurance benefit administration in a Self-Funded environment Ability to read and understand various forms, documentation, files, and information with the department. Education and Experience: High School diploma or GED required. Bachelor's degree or equivalent work experience. 5 years or more experience with healthcare claims administration, self-funded preferred. Experience leading and delegating tasks to multiple direct reports. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment. Proficient experience in MS Word, Excel, Outlook, and PowerPoint required. Candidates must have prior experience with a highly automated and integrated claim adjudication system; El Dorado-Javelina and/or Health Rules Payer experience preferred but not required. Preferred Qualifications: Experience with member appeals, recovery processes, including NSA, subrogation and overpayment process, member, and/or client escalations. Ability to understand how, and to do thorough research, comfortable interviewing internal expertise and applying the 5 W's and/or other tools to complete root cause analysis. Ability to assimilate quickly to the organization or department's culture and speak in the voice of the brand; able to see the perspective of others and how to translate towards effective solutions. Ability to take complex issues and break them down so that it can be understood by others; ability to communicate with non-expert audiences. Strong knowledge of benefit plans, policies, and procedures, understanding of medical terminology. Strong technical and analytical skills. Work Location: An ideal candidate would be assigned to the Buffalo Office with ability to work from home. If not in the Buffalo area, the opportunity can be remote. Leadership Skills & Behaviors: Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward. Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function. Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically. Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps. Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know. Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding. Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development. Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network. Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them. Centivo Values: Resilient - This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don't give up. Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon. Positive - We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co. Compensation Range: $70K - $80K