Claim processor jobs in Charleston, WV

Adecco is hiring for a Scripts Processor in the Broadview Heights area. 1st shift Monday thru Friday. $18/hr This role ensures office visits and physical/occupational therapy appointments are scheduled and attended. Confirms physicians have all paperwork and insurance instructions and/or medical forms. Reviews medical forms indicating medical necessity for Durable Medical Equipment and makes necessary follow up calls to physicians' offices for appropriate documentation and completion of patient script. ESSENTIAL FUNCTIONS: Contacts patient with a future office visit and/or missed office or PT/OT office visit to explain the process and necessary information required by patient's insurance company Contacts physicians' office to verify patient information and follow up on required paperwork according to Medicare guidelines. Faxes and/or mails insurance forms necessary for physician to complete based on patient's Insurance. Follows up according to established procedures to confirm receipt of package and/or faxes and develops relationship with physicians' staff for return of requested forms. Analyzes responses received and determines re-evaluation needs. Accurately documenting and coding according to disease processes. Able to correctly document completed scripts and review for accuracy. Uses appropriate interpersonal skills to resolve difficult situations and maintain professional relationships. Sets a positive tone for the ongoing relationship with the physician's staff and client. Demonstrates high quality in calls and documentation of patient records. Attends and participates in team meetings and trainings. Assumes other special activities and responsibilities as requested. Daily call productivity should meet expectations as set my management. Works one (1) late shift per week and (1) Saturday per month. Works minimum 40-hour work week with required overtime as business needs dictate. JOB QUALIFICATIONS: Education/Experience/Technical Requirements High School Diploma or equivalent. Strong verbal and written communication skills. Ability to deal effectively with the public and fellow employees. Professional telephone skills. Excellent time management skills. Computer literacy in a Windows environment. Experience in the medical field a plus. PHYSICAL DEMANDS & WORK ENVIRONMENT: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Demands: While performing the duties of this job, the employee frequently sits, uses hand to finger motion, handles or feels objects, reaches with hands and arms, climbs stairs, stands, walks and talks. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Pay Details: $17.00 to $18.00 per hour Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled Military connected talent encouraged to apply To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: The California Fair Chance Act Los Angeles City Fair Chance Ordinance Los Angeles County Fair Chance Ordinance for Employers San Francisco Fair Chance Ordinance Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Established in 1991, Collabera has been a leader in IT staffing for over 22 years and is one of the largest diversity IT staffing firms in the industry. As a half a billion dollar IT company, with more than 9,000 professionals across 30+ offices, Collabera offers comprehensive, cost-effective IT staffing & IT Services. We provide services to Fortune 500 and mid-size companies to meet their talent needs with high quality IT resources through Staff Augmentation, Global Talent Management, Value Added Services through CLASS (Competency Leveraged Advanced Staffing & Solutions) Permanent Placement Services and Vendor Management Programs. Collabera recognizes true potential of human capital and provides people the right opportunities for growth and professional excellence. Collabera offers a full range of benefits to its employees including paid vacations, holidays, personal days, Medical, Dental and Vision insurance, 401K retirement savings plan, Life Insurance, Disability Insurance. Job Description Position Details : Industry: (Eye Wear Company) Location: Mason - OH Job Title: Claim Processor Duration: 3 Months (possible extension) Roles and Responsibilities: • Accurately and efficiently processes manual claims and other simple processes such as matrix and bypass. • Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication. Major duties and responsibilities: • Processing - Efficiently and accurately processes standard claims or adjustments • Consistently achieves key internals with respect to production, cycle time, and quality • May participate on non-complex special claims projects initiatives, including network efforts • Understands and quickly operationalizes processing changes resulting from new plans, benefit designs. • Drive client satisfaction - Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include EyeMed Account Managers, Operations, Information Systems, Client Representatives and EyeMed leadership team. • Drives Key Performance Indications - Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy. • Proactively works with supervisor to develop self-remediation plan when standards are not being met. Knowledge and skills: • Data entry and claims processing knowledge. Has a working knowledge of interface systems that include the EyeMed claims system, Metastorm Exclaim and EyeNet. Some basic working knowledge of software programs, specifically Excel and Access. • Understands third party benefits and administration. • Strong customer service focus. • Ability to work well under pressure and multi-task. Experience: • Claims processing/data entry experience. • Knowledge of PCs and spreadsheet applications. Education: • High school mandatory Qualifications Claims Processor Additional Information To know more about the position, please contact: Abhinav singh ************

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

Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region! As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026. This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations. To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change. Responsibilities * Manages an inventory of claims to evaluate compensability/liability. * Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. * Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. * Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. * Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. * Performs other duties as assigned. Qualifications * Effective interpersonal, analytical and negotiation abilities required * Ability to provide information in a clear, concise manner with an appropriate level of detail * Demonstrated ability to build and maintain effective relationships * Demonstrated success in a professional environment; success in a customer service/retail environment preferred * Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent * Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory * Licensing may be required in some states About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures. Required: High school diploma or equivalent. Ability to follow written directions and work independently. Familiarity with medical terminology, CPT and ICD-10 coding is required. Computer and typing experience is required. Desired: Previous claims processing. Experience in billing or physician office experience is preferred. Responsibilities: Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines. Reports patterns of incorrect billing and utilization to manager or claims coordinator. Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines. Maintain a quality rating of 98%. Processes 15-20 claims per hour. Consistently displays a positive attitude and acceptable attendance. Participate in external and/or internal trainings as requested. Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. + Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. + Performs claim re-work calculations. + Follow through completion of claim overpayments, underpayments, and any other irregularities. + Process complex non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. + Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. + Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to lesser experience staff. + Utilize all resource materials to manage job responsibilities. **Required Qualifications** + 2+ years medical claim processing experience. + Experience in a production environment. + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. + Effective communications, organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Associate degree preferred. **Education** + High School Diploma or GED. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Job Description METIS | Location: Roanoke, VA | Full-Time Are you seeking a professional career in Roanoke? Do you like solving problems, analyzing details, and helping people? At Metis, we take a unique approach to commercial insurance through administering self-insurance Risk Pools. If you are looking for a change and a challenge, we're looking for a dedicated Property and Casualty Claims Specialist to join our growing team. What You'll Do: Manage and resolve property and casualty and/or general liability claims Assess and evaluate claims, conduct investigations, and ensure documentation is collected Build relationships with members and help claimants navigate the claims process What You Bring: Bachelor's Degree or higher - required 7+ years of experience in property and casualty claims handling Strong knowledge of policy analysis and associated legal issues A team player with excellent communication and a customer focused mindset *Please be sure to fully complete and upload the attached “Application for Employment” form along with your electronic application. Incomplete submissions may not be considered. What We Offer: Competitive compensation and performance bonuses Individual dental, life, short-term & long-term disability insurance at no cost Medical insurance with wellness incentives Health Savings Account with annual company contribution 401(k) with 200% company match up to 6% of salary Generous paid time off, including vacation, sick leave, and 11 paid holidays Support for continuing education and professional growth A beautiful campus with a collaborative, supportive, wellness-focused culture including onsite gym and café

The salary range for this job posting is $55,132.00 - $110,642.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. While we may prefer candidates who can work a hybrid schedule in our Charleston, WV office, we will consider candidates who live in any of our listed payroll approved states. Lost Time Workers' Compensation claims handling experience in Virginia, West Virginia, Kentucky, or Pennsylvania is preferred. The position reports to the Director, Workers' Compensation Claims on the Energy team. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team. Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. JOB OBJECTIVE: The Lost Time Claims Specialist, Workers' Compensation primarily manages indemnity claims. The Lost Time Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. The position's objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. ESSENTIAL FUNCTIONS: 1. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion. 2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. 3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. 4. Take recorded statements when necessary. 5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. 6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. 7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate. 9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker's safe and timely return to work. 11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim. 12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. 13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed. 15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure. 16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 18. Develops presentations for special projects such as internal/external meetings and conferences as needed. 19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor's Degree from an accredited college or university is preferred. • Three years of experience in the field of workers' compensation insurance required. • Ability to manage claims through the litigation process. • Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. • One valid workers' compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as required. • Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Experience in workers' compensation claims practices and laws, court procedures, precedents and state statutes. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitasks and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons. Ready to join our team? At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities. Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential. What you can expect from us Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations. Encova Insurance is an EOE/E-Verify employer. #LI-Hybrid#LI-MF1

Sign On Bonus: $1,000 **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law This position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. + Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. + Translates medical policies into reimbursement rules. + Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. + Coordinates research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre-adjudication claims reviews to ensure proper coding was used. + Prepares correspondence to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when new/modified reimbursement contracts are needed. **Minimum Requirements:** Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. **Preferred Skills, Capabilities and Experience:** + CEMC, RHIT, CCS, CCS-P certifications preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Come to work with us at Community Health Services! We offer full-time benefits, 10 paid holidays, no weekend hours and so much more! We are looking for a full-time Claims Specialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrific team. The Claims Specialist will be responsible for performing general finance functions, entering encounters, processing and recording claims and all other duties as assigned. Hours for this position are: Mondays 7am-7pm, Tuesdays through Thursdays 8am-5pm, Fridays 8am-1pm Qualified candidates must have the following to be considered for employment: * Associate's degree from an accredited college or university * Experience in accounting/bookkeeping * Demonstrates ability to organize and implement general accounting and bookkeeping procedures for a healthcare organization * Ability to work with clinic personnel and patients in a courteous, cooperative manner * Ability to function as part of a team * Must have excellent customer service skills * Must have excellent multi-tasking, problem solving, and decision-making skills * Ability to follow instructions with attention to detail * Demonstrates professional relationship skills, and a strong work ethic * Prioritizes responsibilities, takes initiative, and possesses excellent organizational skills * Demonstrates effective communication skills * Ability to work with a culturally diverse group of people At CHS, we value our team and the critical role they play in patient care. If you're dependable, detail-oriented, and passionate about making a difference in your community, we'd love to hear from you. CHS is a drug-free/nicotine free organization. Candidates must pass a drug and nicotine screening upon employment offer.

Job Description An Account Resolution Specialist I is responsible for researching and identifying unpaid, partially paid, incorrectly paid or denied claims. They must follow-up with insurance carriers verbally or via on-line tools and properly discuss the problem with the knowledge of how to negotiate payment/additional payments on all claims. In the event the needs arise, they will also resubmit a corrected claim and/or follow-up with patients regarding the issue(s) as needed. Minimum Education Must have a high-school diploma or a GED. Minimum Work Experience No prior work experience in this related field is required at this level. Required Skills Customer service Must have general Microsoft Office (Word, Excel, PPT, and Outlook) experience. Ability to manage their time in order to meet job requirements. Ability to review an account and come to a decision as to what the proper solution would be to resolve the account. Must be a team player. Screening Requirements: Drug Screen Tuberculosis Test Background Check Physical Exam Respirator Fit Eligible Benefits: Medical, Dental and Vision *Excellent Low Premiums!*- No copays or Deductibles when utilizing MCCH services! Life Insurance *ZERO premium* Retirement Plan Paid Time Off Bereavement Bridge Coverage *ZERO premium for self-coverage when enrolled in medical coverage Tuition Reimbursement Our Mission: To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals. Our Vision: To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors. Our Values: Competence, Excellence, Compassion, Respect and Integrity.

Claim Specialist needed to combat rising healthcare costs and empower health plans! The Phia Group is a service-oriented consultant that assists health plans nationwide. We provide our clients with innovative cost-cutting solutions and innovative service offerings. We continue to enjoy growth thanks to our most valuable resource - our talented and committed team. Until recently, surprise medical bills were a leading cause of financial distress and bankruptcy for American families. “Surprise” billing occurs when a patient presents to an out-of-network medical provider through no fault of their own - like in the case of an emergency - and the patient becomes responsible for amounts beyond what their insurance pays. Thankfully, beginning in 2022 with the implementation of the “No Surprises Act”, the legislature effectively banned surprise billing, instead prescribing a system of negotiation and arbitration that health plans and providers must follow to resolve billing disputes. The Claims Specialist will be responsible for supporting the team on all aspects of the No Surprises Act, including reviewing medical claims, keeping track of strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution, among many other tasks. The candidate will also be expected to support the team on balance billing and overpayment matters as needed. This position requires someone that is proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. The Phia Group is growing quickly and so the candidate must be comfortable in a dynamic fast-paced environment. Essential Duties and Responsibilities include the following. Other duties may be assigned. Manage a daily running inventory of unpaid claims or claim disputes. Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards. Contact facilities and providers to discuss charge adjustments and rationale. Contact facilities and explain benefits to resolve payment disputes. Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities. Capture detailed notes on calls for future reference. As needed, handle member inquires in accordance to their medical plan. Work with The Phia Group's legal department to ensure escalation of claims. Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process. Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Experience and Qualifications Preferred: Baccalaureate degree (BA/BS) from an accredited college or university. Preferred: Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting. Computer literate, including Microsoft Office products. Working Conditions / Physical Demands Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines. This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary. External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis. Salary: $50,000 - $65,000 / year

The Claims Specialist works on highly complex claim assignments requiring specialized knowledge. The role handles activities including, but not limited to, coverage analysis, liability and damage investigation, litigation, and expense management. The role also evaluates claims for reserve and settlement, executes settlement strategy, negotiates settlements proactively, attends arbitrations and ensures appropriate file documentation. Westfield Casualty Claims resolves third party liability claims involving injury, property damage, construction defect, personal & advertising injury, and environmental cleanup - both pre-suit and in litigation. Job Responsibilities * Determines whether proper coverage exists for the type of claim assigned, investigates thoroughly to obtain relevant facts concerning coverage, liability, legal climate, potential exposure, and damages, and makes decisions on claim resolution. * Determines the value of damage through physical inspections, uses appropriate tools, reviews policy coverages, inspects damages, determines cause and origin, investigates questionable circumstances, and considers subrogation and salvage possibilities. * Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. * Completes appropriate reports so that the current status of the claim is clearly documented at all times. * Assists claims professionals in the handling of large or complicated property losses. * Participates in the coaching, development, training and education of claims professionals. * Collaborates with property leadership team in the identification of property training needs. * Assists in the design, development, and delivery of training to claims professionals. * Provides outstanding customer service, works well with the insured and broker in the adjustment of mainstream risks, and claims. * Collaborates in the defense and resolution of claims, reviews and analyzes contracts for risk transfer potential. * Documents relevant events timely as case facts are developed, evaluates liability, damages, and exposure, negotiates timely settlements and refers claims exceeding authority to appropriate leader or complex claims specialist with recommendations. * Provides general administrative, clerical and customer service assistance on the routine tasks to the Claims Adjustment team. * Collaborates with internal and external business partners, large account customers, peers and other departments to make decisions that are in the best interest of the company. * Remains current on industry topics, trends, processes, technology, best practices through research, industry events, networking, etc. * Shares knowledge gained with others, drives new and updated policies, processes, and procedures. * Supports and reports on the claims process improvement program, including the coordination and participation in best practice creation, monthly metric analysis etc. * Supports catastrophe management efforts, organizes, deploys personnel, trains independent contractors, utilizes loss adjusting software and supports business partners by maintaining and enhancing relationships with customers and brokers. * Travels as often as needed to cover assigned territory. * This may involve traveling on short notice or other daily driving duties as assigned. Job Qualifications * 6+ years of Claims Handling experience. * Bachelor's Degree in Business or a related field and/or commensurate work experience. * For field roles only: Valid driver's license and a driving record that conforms to company standards. Location Remote Licenses and Certifications * Certified Professional Claims Management (CPCM) (preferred) * Certified Claims Adjuster (CCA) (preferred) * Chartered Property Casualty Underwriter (CPCU) (preferred) Behavioral Competencies * Collaborates * Communicates Effectively * Customer Focus * Decision Quality * Nimble Learning Technical Skills * Account Management * Claims Investigations * Claims Adjustment * Claims Resolution * Claims Settlement * Financial Controls * Auditing * Claims Case Management * Customer Relationship Management * Business Process Improvement * Auditing * Data Analysis and Reporting This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

Top 100 Agency for 2025 Best Agencies to Work for in 2024 by the Insurance Journal Big “I” Best Practices Agency in 2023 Annual bonus eligibility No weekends required - great work/life balance 3+ weeks of Paid Time Off 8 Paid Company Holidays We are looking for someone who will Manage the claims reporting process for agency clients. Report claims to the appropriate carrier and maintain records in the agency management system by documenting claim actions in accordance with established procedures. Follow up on claim to obtain the specific adjuster and claim number relevant to the reported loss. Notify appropriate parties when a claim is processed with carrier, providing accurate and timely claim information. Continuously monitor claims until claims are closed by the insurance carrier. Report any potential issues with a claim to the client's Account Manager and Producer, escalating to management as needed. Prepare reports by collecting and summarizing information as requested by management. Why Join AAA Club Alliance and the Energy Insurance team? A base rate of $20.00 to $25.00/hour, depending on experience and geographic location. Annual bonus potential Do you have what it takes? Minimum of 2 years experience handling claims for Commercial Insurance - general liability, workers compensation, commercial auto, etc. Strong communication skills (both verbal and written) and attention to detail Strong time management skills Ability to obtain property and casualty license within 60 days of hire Full time Associates are offered a comprehensive benefits package that includes: Medical, Dental, and Vision plan options Up to 2 weeks Paid parental leave 401k plan with company match up to 7% 2+ weeks of PTO within your first year Paid company holidays Company provided volunteer opportunities + 1 volunteer day per year Free AAA Membership Continual learning reimbursement up to $5,250 per year And MORE! Check out our Benefits Page for more information ACA is an equal opportunity employer and complies with all applicable federal, state, and local employment practices laws. At ACA, we are committed to cultivating a welcoming and inclusive workplace of team members with diverse backgrounds and experiences to enable us to meet our goals and support our values while serving our Members and customers. We strive to attract and retain candidates with a passion for their work and we encourage all qualified individuals to apply. It is ACA's policy to employ the best qualified individuals available for all positions. Hiring decisions are based upon ACA's operating needs, and applicant qualifications including, but not limited to, experience, skills, ability, availability, cooperation, and job performance. Job Category: Insurance

* Top 100 Agency for 2025 * Best Agencies to Work for in 2024 by the Insurance Journal * Big "I" Best Practices Agency in 2023 * Annual bonus eligibility * No weekends required - great work/life balance * 3+ weeks of Paid Time Off * 8 Paid Company Holidays We are looking for someone who will * Manage the claims reporting process for agency clients. * Report claims to the appropriate carrier and maintain records in the agency management system by documenting claim actions in accordance with established procedures. * Follow up on claim to obtain the specific adjuster and claim number relevant to the reported loss. Notify appropriate parties when a claim is processed with carrier, providing accurate and timely claim information. * Continuously monitor claims until claims are closed by the insurance carrier. Report any potential issues with a claim to the client's Account Manager and Producer, escalating to management as needed. * Prepare reports by collecting and summarizing information as requested by management. Why Join AAA Club Alliance and the Energy Insurance team? * A base rate of $20.00 to $25.00/hour, depending on experience and geographic location. * Annual bonus potential Do you have what it takes? * Minimum of 2 years experience handling claims for Commercial Insurance - general liability, workers compensation, commercial auto, etc. * Strong communication skills (both verbal and written) and attention to detail * Strong time management skills * Ability to obtain property and casualty license within 60 days of hire Full time Associates are offered a comprehensive benefits package that includes: * Medical, Dental, and Vision plan options * Up to 2 weeks Paid parental leave * 401k plan with company match up to 7% * 2+ weeks of PTO within your first year * Paid company holidays * Company provided volunteer opportunities + 1 volunteer day per year * Free AAA Membership * Continual learning reimbursement up to $5,250 per year * And MORE! Check out our Benefits Page for more information ACA is an equal opportunity employer and complies with all applicable federal, state, and local employment practices laws. At ACA, we are committed to cultivating a welcoming and inclusive workplace of team members with diverse backgrounds and experiences to enable us to meet our goals and support our values while serving our Members and customers. We strive to attract and retain candidates with a passion for their work and we encourage all qualified individuals to apply. It is ACA's policy to employ the best qualified individuals available for all positions. Hiring decisions are based upon ACA's operating needs, and applicant qualifications including, but not limited to, experience, skills, ability, availability, cooperation, and job performance. Job Category: Insurance

Job DescriptionService Wire Company, a premier supplier of industrial and utility wire and cable, is currently seeking a Customer Quality and Claims Specialist in Culloden, WV. If you are looking to join a great organization and a chance to become a part of our growing team, this may be the opportunity for you! Position Summary:The Customer Quality and Claims Specialist supports internal and external customers by managing product claims, returns, and quality related inquiries. The role investigates issues, coordinates resolutions across departments, and ensures timely, accurate, and professional communication while recommending process improvements to prevent future claims.Tasks/Duties/Responsibilities: Monitor and manage customer cases, proactively addressing delays Investigate and resolve product claims, pricing adjustments, and deductions in coordination with Sales, Shipping and Quality Control Analyze customer complaints to determine root cause, corrective actions, and preventive measures Communicate findings, resolutions, and recommendations to customers and internal stakeholders Manage freight claim by providing raw material scrap values and re-claimed materials while tracking the funds received Check records, such as bills, computer printouts, and related documents and correspondence, and converse or correspond with customer and other company personnel, such as sales, shipping, engineering, and credit, to obtain facts regarding customer complaint Notify customer and designated personnel of findings, adjustments, and recommendations, such as exchange of merchandise Recommend improvements in product, packaging, shipping methods, service, or billing processes to minimize future claims. Perform additional duties as assigned Knowledge/Skills/Requirements: High school diploma or equivalent; 2-year degree preferred Strong research, documentation, and analytical skills Proficient with Microsoft Office Solid basic math skills Ability to multi-task, prioritize, and manage time effectively Strong written and oral communication skills Ability to effectively interact with internal and external customers Ability to travel from time to time (less than 10%) Familiarity with office equipment including printers, copiers, scanners etc. Reports To: Quality Assurance Manager

Claims Healthcare Specialist needs 1 year claims system experience, in the Healthcare industry . Claims Healthcare Specialist requires: 1 year claims system experience, preferably in the Healthcare industry Basic analytical and problem solving skills Good communication and interpersonal skills Ability to work independently and with others Ability to manage more than one assigned tasks at the same time. Claims Healthcare Specialist duties: Resolve client structure setup questions/issues sent to the team with minimal supervisor guidance Maintain relationships with Implementation Managers and Account Managers to facilitate fulfillment of implementation questions and requests in a timely manner Self-manage completion of work inventory in the Plan Setup production queues within established quality and turnaround time guidelines Recommend process and system enhancements for the Plan Setup team to drive improvements to performance Support the management team with misc. projects and resolving assigned Plan setup issues

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be the acknowledged technical expert and be responsible for the resolution of high complexity and high exposure claims. The position will have significant responsibility for decision making and work autonomously within their authority. Responsibilities: * High complexity coverage interpretation, liability investigation, multiple vehicles, potential extra-contractual, litigation or significant injuries. * Direct involvement in litigation claims management to reach desired outcomes and minimize expenses * Investigate, negotiate and settle complex liability cases. Maintain and make sure alignment to Markel's guidelines and procedures. * Ensure proper adherence to internal large loss reporting requirements. * Promptly communicate with Claims Manager on case developments and provide information on issues affecting the lines of business * Chip in and assist in the implementation of a range of initiatives, discussion and action plans brought forth by the Claims Manager * Connect with underwriting as needed to handle claims and to alert of any significant developments * Participate in agent related functions and meetings as required Requirements: * 7-10+ years of Liability claims handling experience with a commercial insurance company * Successful Liability claim handling experience is critical * College degree and/or professional designation preferred * Sound comprehension of personal and commercial liability coverages. * Excellent written and oral communication skills. * Experience in resolving contractual obligations, coverage analyses, and investigations. * Ability to run sophisticated large liability exposures, set loss and expense reserves and evaluate settlement values. * Ability to proactively self-manage an active caseload. * Ability to analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form. * Travel required as necessary (less than 15%). * Adjuster license in multiple states or across the US strongly preferred. US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Pay information: The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $97,520 - $134,000 with a 25% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. 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 $20.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 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