Claim processor jobs in Buffalo, NY - 27 jobs

Casualty Analyst - Specialty Claims Seeking a highly skilled and motivated Casualty Analyst - Specialty Claims to join a dedicated team. This role focuses on providing high-level technical expertise in the handling of complex commercial umbrella, excess liability, and multi-party catastrophic injury claims. The ideal candidate will have a strong background in managing high-exposure liability claims and a commitment to achieving optimal outcomes for both the company and its policyholders. Compensation Package Salary Range: $85,000 - $115,000 annually + annual bonus opportunities based on company and individual performance Competitive benefits package, paid time off, professional development opportunities, etc. Responsibilities Build and maintain strong relationships with internal staff, policyholders, attorneys, agents, and service providers to achieve optimal claim outcomes. Provide high-level technical expertise in managing complex and high-exposure liability and extra-contractual claims. Handle a portfolio of complex claims, including commercial umbrella, excess liability, and multi-party catastrophic injury claims. Stay updated on case law developments, statutory, and regulatory changes impacting liability claims or coverage interpretation. Serve as a training and information resource for casualty and litigation claim representatives and claim management. Oversee all claim-handling activities, including investigation, litigation management, evaluation, settlement negotiations, and risk transfer guidance. Prepare and present claims to the Large Loss Committee and ensure proper reinsurance reporting and communication. Qualifications/Requirements Minimum of 5+ years of experience handling complex claims. Bachelor's degree or equivalent work experience. Strong technical expertise in liability claims and coverage interpretation. Excellent communication and relationship-building skills. Ability to work effectively in a hybrid work environment, with 8 in-office days per month. #LI-BR1

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.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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 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-RM1 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

Market Cities & Places At Jacobs, we're challenging today to reinvent tomorrow by solving the world's most critical problems for thriving cities, resilient environments, mission-critical outcomes, operational advancement, scientific discovery and cutting-edge manufacturing, turning abstract ideas into realities that transform the world for good. Your impact 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 Here's what you'll need * 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 Posted Salary Range: Minimum 120,000.00 Posted Salary Range: Upper 135,000.00 Our health and welfare benefits are designed to invest in you, and in the things you care about. Your health. Your well-being. Your security. Your future. Employees have access to medical, dental, vision, and basic life insurance, a 401(k) plan, and the ability to purchase company stock at a discount. Eligible employees may also enroll in a deferred compensation plan or the Executive Deferral Plan. Jacobs has an unlimited U.S. Personalized Paid Time Off (PPTO) policy for full-time salaried/exempt employees, seven paid holidays, one floating holiday, and caregiver leave. And certain roles may be eligible for additional rewards, including merit increases, performance discretionary bonus, and stock. The base salary range for this position is $120,000.00 to $135,000.00. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Job posted on October 10, 2025. This position will be open for at least 3 days. Onsite employees are expected to attend a Jacobs Workplace on a full-time basis, as required by the nature of their role. Your application experience is important to us, and we're keen to adapt to make every interaction even better. If you require further support or reasonable adjustments with regards to the recruitment process (for example, you require the application form in a different format), please contact the team via Careers Support. Locations CityStateCountryBuffaloNew YorkUnited States

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Buffalo, New York. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $55,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $62,000 - $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

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 $23.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 28, 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

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

Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a medical claims representative trainee, you'll be instrumental in keeping the medical claims process efficient and supportive for our customers. Focusing on personal injury protection (PIP) medical coverage, you'll analyze accident details, medical records and terminology. You'll also adjust claims while maintaining solid relationships with customers. Bring your passion for helping others and we'll teach you the insurance stuff - allowing you to be confident when speaking with customers. This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like. Duties & responsibilities after training * Research policy contract, regulation and cause of injury to make coverage decisions * Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions * Identify and research wage loss expenses and documentation for payment consideration * Review and interpret policy language when subrogation demands are received Must-have qualifications * Three years of work experience OR * Bachelor's degree OR * Two years work experience and an associate degree Schedule * Monday - Friday 8:00 AM - 4:30 PM during Onboarding Compensation * Once you complete training (which means passing any necessary training requirements) your salary will be $60,500 - $63,000. However, during training, you will be paid an hourly rate based on your salary. * Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Benefits * 401(k) with dollar-for-dollar company match up to 6% * Medical, dental & vision, including free preventative care * Wellness & mental health programs * Health care flexible spending accounts, health savings accounts, & life insurance * Paid time off, including volunteer time off * Paid & unpaid sick leave where applicable, as well as short & long-term disability * Parental & family leave; military leave & pay * Diverse, inclusive & welcoming culture with Employee Resource Groups * Career development & tuition assistance Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership. Equal Opportunity Employer Applicants must be authorized to work for any employer in the U.S. without the need or potential need, of current or future sponsorship for employment. Progressive does not hire candidates with (e.g., F-1 CPT, OPT, or STEM OPT, H-1B, O-1, E-3, TN) statuses for this role. For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************** Share: Email X Facebook LinkedIn Apply Now

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists. - Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- New York Independent Adjuster License- Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- 18+ months of medical claim processing experience- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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.

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.

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.

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 - $77K

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment. * Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * 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. * 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 re-adjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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 Auditor who will be responsible for conducting pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including complex, high-dollar claims. This role plays a key part in maintaining the integrity of our claims operations by supporting all aspects of the Claims Quality Review program, establishing processing standards, responding to quality findings, assisting with performance improvement plans, and providing data to support service level agreements (SLAs). The Claims Auditor will also help ensure that audit reports are completed accurately and distributed in a timely manner. Responsibilities Include: Perform auditing of claims, ensuring processing, payment, and financial accuracy by verifying all aspects of the claim have been handled correctly and according to both standard process and the client's summary plan description. Completes reporting of audits finalized with decision methodology for procedural and monetary errors, which are used for quality reporting and trending analysis utilizing QA tools. Responsible to communicate corrections and adjustments to Examiners as identified on pre-payment audits, including high dollar claims, and to verify corrections and adjustments are complete and accurate. Identify and escalate trends based on the quality reviews. Confer with Claims QA Lead, Claims Supervisors, Claim Managers, and/or Training Lead on any problematic issues warranting immediate corrective action. May investigate and research issues as required to create or improve standard processing guidelines and may participate in projects as a subject matter expert as needed. Perform any other additional tasks as necessary, including processing of claims, creating policies, training, and/or mentoring examiners through quality improvement plans. Qualifications: Required Skills and Abilities: Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred. Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines. Strong analytical, organizational, and interpersonal skills, with the ability to communicate effectively with others. Attention to details, organized, quality and productivity driven. Education and Experience: High School diploma or GED required. Associate or bachelor's degree preferred. Minimum of three (3) years of experience as a claim examiner and/or auditor with self-funded health care plans and processing in a TPA environment, meeting production and quality goals/ standards. Proficient experience in MS Word, Excel, Outlook, and PowerPoint required. Preferred Qualifications: Ability to acquire and perform progressively more complex skills and tasks in a production environment. Ability to work under limited supervision and provide guidance and coaching to others. Excellent coaching skills and ability to mentor others towards quality improvement. Work Location: Candidates located within commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. All other applicants will be considered for remote positions. 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.