Claim processor jobs in Clarkstown, NY - 20 jobs

Claims Processor - Entry Level Duration : 6 Months Total Hours/week : 40.00 1st Shift Client: Medical Device Company Job Category: Customer Service Level Of Experience: Entry Level Employment Type: Contract on W2 (Need US Citizens or GC Holders Only) Remote role for now. Local candidates apply . So, anyone that is applying will be working from their home - they will need internet access. Job Description: Heavy telephone contact with end user consumer customers. Must be highly skilled communicator. Data entry required for all contacts in database requires proficiency in timely data entry. Some interaction with other business functions, as needed. Associates degree (diploma) is required for entry to position. Responsibilities: Excellent telephone and verbal communications skills highly preferred. Strong administrative and organizational skills, highly desired. Ability to work cooperatively with co-workers; must be a team player. Computer proficiency: ability to adapt quickly to new software programs Willingly accepts direction.

We have an immediate need for a Construction Claims Analyst based in Pearl River NY or Albany NY. Come join our team! We are looking to build services and capabilities through the growth of our key asset- our staff. Ranked among the nation's top A/E firms by Engineering News-Record, LiRo-Hill provides construction management, engineering, environmental, architectural, and program management solutions. You can become part of an organization that has a strong track record and is looking to strengthen relationships and capabilities to continue being a trusted resource for our clients in the public and private sector. We are proud to be known as an “Integrated Construction, Design and Technology Solutions” firm and we have delivered on that label time and again. Recently, Global Infrastructure Solutions Inc. (GISI), the parent company of The LiRo Group and Hill International, Inc. consolidated a portion of the highly experienced staff of both LiRo and Hill in the Northeast to create a larger, more efficient, and cost-effective team to serve clients. LiRo-Hill is a 1100-person firm with offices in NYC, Long Island, Buffalo, Rochester, Boston and Edison, NJ. The client for this project is the NYS Office of General Services (OGS). Responsibilities Construction Claims Analyst The Construction Claims Analyst will focus on the careful review and analysis of construction delay claims filed against the NY State. This role is well-suited for someone who values independent, detail-oriented work and thrives in an environment where critical thinking and written analysis are essential. Key Responsibilities: Evaluate contractors' delay claim notices for validity in accordance with contract requirements. Review and interpret detailed schedule analyses using Primavera P6. Conduct forensic delay analysis by examining project records, such as meeting minutes, schedules, and correspondence. Track, document, and manage assigned delay claims with accuracy and consistency. Facilitate fact-finding meetings with design and construction staff to gather information and ensure thorough review. Audit claim costs-including certified payrolls and invoices-and prepare clear, well-documented recommendations; negotiate settlements when appropriate. Prepare clear, concise reports on high-priority and problem projects for executive staff on a regular basis. Qualifications Education/Experience: Bachelor's degree in Construction Management or a related field, or Associate degree with 2+ years of experience in a similar role, or 4+ years of experience in a comparable position. Experienced in Primavera 6 construction schedules, schedule analysis, and time impact analysis. Experience in contracts, project management, and scheduling in a construction environment. Ability to work independently, manage workload efficiently, and produce clear, well-documented analysis. Strong attention to detail, critical thinking, and problem-solving skills. Effective written communication skills for reports and documentation; comfortable participating in structured, focused meetings. Construction project management or scheduling experience preferred. OSHA 10 certification required. At Liro-Hill we are committed to your success, and we invest in your growth and development to unlock your full potential. Our benefits include: Competitive Total Compensation Package Employee- Only Stock Purchase Plan Mentoring programs Continuing Education Program Employee referral bonus Compensation range for this role: Minimum: $100,000 to - $125,000 annually The range provided is the salary that the Firm in good faith believes at the time of this posting is willing to pay for the advertised position. Exact compensation will be determined on the individual candidates' qualifications and location #ID22 #ZR22 #LI-CM1 Minimum USD $100,000.00/Yr. Maximum USD $125,000.00/Yr.

Worker's compensation insurance is a headache. We make it simple, smooth, and stress free. Join us in redefining workers' comp. Job Summary: The Workers' Compensation Claims Supervisor oversees a team of claims adjusters responsible for managing workers' compensation claims. This role ensures compliance with jurisdictional regulations, adherence to best practices, and attainment of performance targets. The Supervisor is responsible for technical guidance, training, quality assurance, and operational efficiency. Please note: This job description outlines general duties and expectations and is not intended to be exhaustive. Duties may change based on business needs. Essential Job Functions: Supervise daily activities of assigned workers' compensation claims adjusters. Triage new files to ensure assignments are appropriate. Review first diary within 7 days of assignment for coverage, compensability, damages, compliance, reserves, and plan of action. Monitor caseload distribution monthly and ensure appropriate workloads. Use appropriate metrics for Return to Work, New/Reopened claims, claim closures per month, penalties, and timely contact. Review claim files for quality assurance, reserve accuracy, and compliance. Conduct quality assurance audits (5-7 claims per adjuster monthly) and reserve accuracy audits per jurisdiction. Ensure all state forms are filed correctly and timely with zero penalties. Provide coaching, mentoring, and technical guidance to adjusters through monthly one-on-ones. Ensure timely and appropriate reserving and settlement authority adherence. Facilitate regular file audits and roundtables on complex or high-exposure claims. Coordinate training for new hires and continuing education for the team. Develop training modules and onboarding tasks for new adjusters. Serve as an escalation point for complex or litigated claims. Authority level: $50,000 for reserve and settlement; roundtable claims with managers for amounts ≥ $100,000; settlements ≥ $50,000. Communicate with insured and brokers on claims above $25,000 and work with the account manager to set up claim reviews. Collaborate with internal departments (Legal, Compliance, Risk Management). Generate reports for management including performance metrics and trends. Conduct monthly one-on-ones with the manager to review team metrics, audit scores, trends, and staffing. Identify process improvements to enhance claims efficiency and outcomes. Maintain knowledge of applicable jurisdictional regulations (e.g., NY, NJ, PA). Seek training opportunities with vendors and law firms to enhance knowledge and performance. Required Skills/Abilities: Excellent oral and written communication skills-able to convey complex information effectively. Detail-oriented with a high accuracy rate, ensuring precision in claim processing. Strong critical thinking and problem-solving skills to assess claims efficiently and make informed decisions. Flexible and tech-savvy, comfortable navigating various software tools and adapting to new processes. Highly adaptable, able to adjust to evolving laws and industry changes with ease. Thrives in a dynamic environment-willing to embrace change and contribute to continuous improvement. Self-motivated with excellent time management, capable of handling multiple priorities effectively. Education and Experience: Bachelor's degree preferred or equivalent work experience. Minimum 5 years of experience in workers' compensation claims handling. Prior leadership or supervisory experience 1-3 years preferred. Strong understanding of state-specific WC laws and regulations. Excellent communication, organization, and problem-solving skills. Proficient in claims management systems and Microsoft Office. Ability to use metrics as a tool to manage performance. Physical Requirements: Prolonged periods sitting at a desk and working on a computer. Prolonged periods of standing, walking, and/or sitting and reaching with hands and arms. Must be able to lift 10 pounds at a time. Additional Requirements: Due to the nature of our business, and urgency of our clients' needs, you may be required to participate in the company's on-call program and work on holidays/weekends according to the on-call schedule. Additional Details: This is a full-time in office position in Rockland County, NY. We offer a competitive salary ranging from $110-165k with generous PTO and Benefits. We are an Equal Opportunity Employer We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. We intend that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors. Powered by JazzHR ty IAeYh9zG

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.

Circet USA is the leading provider of Network Services in North America, and we're looking for talented professionals to join our team. We specialize in engineering and construction services delivering comprehensive solutions across Inside Plant, Outside Plant, and Wireless networks to meet the evolving infrastructure needs of our customers. With nearly 50 years of industry experience, we work with major telecom service providers, MSOs, cloud service providers, and utilities. At Circet USA, you'll have the opportunity to make an impact by helping to create customized solutions that address our clients' unique challenges. If you're passionate about innovation and thrive in a dynamic environment, we'd love to hear from you. Circet USA's benefits package includes the following: Medical, Dental, and Vision insurance Digital Health & Wellness Support Critical Illness, Accident, & Hospital Insurance Short-term & Long-term disability Group term & Voluntary life insurance Flexible Spending and Health Savings Accounts Paid Time Off & 401K Company Discount Website Job Summary and Responsibilities We are seeking a highly skilled and experienced Claims Specialist 3 to fulfill a staff augmentation role with Circet USA's customer. The primary objective of the Claims Specialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the Claims Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable. ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties may be assigned: Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators. Generate daily/weekly/monthly reports, with analysis and recommendations Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics Ensure that all projects have required documentation as they move through the project tollgates Communicate to Product Liability leadership on project status and escalation/decision points Works cross functionally with HQ teams in Korea (occasional evening conference call) and SEA operations to manage all possible risks. Pending Claim Management, KPI & TAT Management - Claim registration to closure Product Verification Liability Assessment by reviewing diagnosis results Reporting on high-profile claims to the leadership Qualifications Bachelor's Degree (or equivalent experience) 3-5 years of hands-on claims management & customer care experience Expertise in MS, Excel, and PPT Proven capability to analyze data and develop a course of action Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution Process, procedure, strategic planning and project development experience Experience working with and influencing cross-functional teams. Experience working within the insurance and/or home appliance industry a plus Experience with product development or testing a plus Experience working in a complex and wide organization and department Claims Adjuster License a plus Takes project ownership and possess leadership qualities with an entrepreneurial approach Circet USA is an Equal Opportunity Employer - Veteran/Disabled. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by law.

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: White Plains, 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 $66,000 - $91,200 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 $74,400 - $108,000 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.

HIGHLIGHTS On-Site Full-Time B2B Claims/Spiff Step into the innovative world of LG Electronics. As a global leader in technology, LG Electronics is dedicated to creating innovative solutions for a better life. Our brand promise, 'Life's Good', embodies our commitment to ensuring a happier life for all. We have a rich history spanning over six decades and a global presence in over 290 locations. Our diverse portfolio includes Home Appliance Solutions, Media Entertainment Solutions, Vehicle Solutions, and Eco Solutions. Our management philosophy, "Jeong-do Management," embodies our commitment to high ethical standards and transparent operations. Grounded in the principles of 'Customer-Value Creation' and 'People-Oriented Management', these values shape our corporate culture, fostering creativity, diversity, and integrity. At LG, we believe in the power of collective wisdom through an inclusive work environment. Join us and become a part of a company that is shaping the future of technology. At LG, we strive to make Life Good for Everyone. Responsibilities * Responsible to apply account credits and payment on customer claims following claim review and validation of documents * Review results of account reconciliation, on a monthly, quarterly and yearly basis to analyze trends related to safety and monitor non-safety claims * Identify discrepancies with transactions, escalate for review to respective departments and notify customers to respond or resubmit claim * Research claim history to validate claim amount by matching the backup documentation provided * Full responsibility on customer claims for payment * Analyze monthly, quarterly and yearly trends related to safety and non-safety claims * Able to reconcile/analyzing/monitoring claims and resolve related issues/problems * Good written/communication/reporting skill * Responsible for customer's credit memo eligibility upon credit request- check duplication claim, over claim and invalid claim * Responsible to check and process daily claim submitted by Customer, Sales, Collection and other related department to follow up timely matter * Able to understand & interpret documentation and research system skill (GERP, Sales Portal, EDW) * Able to communicate internal/external to resolve any issues and problem Qualifications * Bachelors Degree * Bilingual in English and Korean * Good written/communication/reporting skill * Knowledge of Microsoft office (Excel/power point/word- Intermediate level) * Able to reconcile/analyzing/monitoring claims and resolve related issues/problems * Able to work in team environment * Require over time if needed Recruiting Range $60,000-$70,000 USD Benefits Offered Full-Time Employees: * No-cost employee premiums for you and your eligible dependents for competitive medical, dental, vision and prescription benefits. * Auto enrollment with immediate vesting of competitive company matching contributions in a 401(k) Retirement Savings Plan with several investment options. * Generous Paid Time Off program that includes company holidays and a combined bank of paid sick and vacation time. * Performance based Short-Term Incentives (varies by role). * Access to confidential mental health resources to help you and your loved ones improve your quality of life. Personal fitness goal incentives. * Family orientated benefits such as paid parental leave and support for families raising children with learning, social, behavioral challenges, or developmental disabilities. * Group Rate Life and Disability Insurance. Benefits Offered Temporary/Contractors: * Eligible for the relevant benefit programs offered through our partner agencies. Privacy Notice to California Applicants At LG, we aspire to empower people and celebrate differences because we believe diversity will create the unexpected. We provide equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Consistent with our commitment to providing equal opportunity and embracing diversity, LG has implemented affirmative action to ensure applicants are employed and employees are treated without regard to these characteristics. In addition to the above, LG believes that pay transparency is a key part of diversity, equity, and inclusion. Our salary ranges take into account many factors in making compensation decisions including but not limited to skillset, experience, licensure, certifications, internal equity, and other business needs. While we consider geographic pay differentials in final offers, because we operate in many geographies where applicable, the salary range listed may not reflect all geographic differentials applied.

Job Description Circet USA is the leading provider of Network Services in North America, and we're looking for talented professionals to join our team. We specialize in engineering and construction services delivering comprehensive solutions across Inside Plant, Outside Plant, and Wireless networks to meet the evolving infrastructure needs of our customers. With nearly 50 years of industry experience, we work with major telecom service providers, MSOs, cloud service providers, and utilities. At Circet USA, you'll have the opportunity to make an impact by helping to create customized solutions that address our clients' unique challenges. If you're passionate about innovation and thrive in a dynamic environment, we'd love to hear from you. Circet USA's benefits package includes the following: Medical, Dental, and Vision insurance Digital Health & Wellness Support Critical Illness, Accident, & Hospital Insurance Short-term & Long-term disability Group term & Voluntary life insurance Flexible Spending and Health Savings Accounts Paid Time Off & 401K Company Discount Website Responsibilities We are seeking a highly skilled and experienced Claims Specialist 3 to fulfill a staff augmentation role with Circet USA's customer. The primary objective of the Claims Specialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the Claims Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable. ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties may be assigned: Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators. Generate daily/weekly/monthly reports, with analysis and recommendations Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics Ensure that all projects have required documentation as they move through the project tollgates Communicate to Product Liability leadership on project status and escalation/decision points Works cross functionally with HQ teams in Korea (occasional evening conference call) and SEA operations to manage all possible risks. Pending Claim Management, KPI & TAT Management - Claim registration to closure Product Verification Liability Assessment by reviewing diagnosis results Reporting on high-profile claims to the leadership Qualifications Bachelor's Degree (or equivalent experience) 3-5 years of hands-on claims management & customer care experience Expertise in MS, Excel, and PPT Proven capability to analyze data and develop a course of action Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution Process, procedure, strategic planning and project development experience Experience working with and influencing cross-functional teams. Experience working within the insurance and/or home appliance industry a plus Experience with product development or testing a plus Experience working in a complex and wide organization and department Claims Adjuster License a plus Takes project ownership and possess leadership qualities with an entrepreneurial approach Circet USA is an Equal Opportunity Employer - Veteran/Disabled. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by law.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is Seeking a Commercial Lines Claims Specialist to join our growing team in Somers, NY. Part-Time Claims position. Accept and oversee all types of Commercial Auto Claims for accounts assigned. Assist in servicing consulting contracts. Provide prompt, accurate and courteous claim service to the Agency's customers, both internal and external. How You Will Contribute Acceptance of claims, making assignments to companies and/or independent services. Research coverage, leases and contracts and participate in discussions with Account Mangers and producers regarding same. Reading, analyzing, and processing of litigation paperwork. Reserve monitoring and communication with Companies regarding evaluation of same. Ongoing assistance in claims management of company claims. Maintain diary system relating to first party losses, claims in subrogation, and Select Top 100 losses. Completion of reports and suit activities as department policy dictates. Assist underwriting staff with claim information relating to policies qualifying for experience rating and/or workers' compensation dividend plans. Complete monthly report to clients which includes loss run and tracking of the physical damage claims. Complete monthly billing to clients for services. Preparation of claims management reports and experience modification reports as required by account size. Skills & Experience to Be Successful Minimum of two years college required. Two to four years claims adjusting experience, preferably commercial lines involving both first- and third-party claims. Arbitration forums participation Valid Driver's license. This position requires routine or periodic travel which may require the teammate to drive their own vehicle or a rental vehicle. Acceptable results of a Motor Vehicle Record report at the time of hire and periodically thereafter, and maintenance of minimum acceptable insurance coverages are a requirement of this position. College degree.(preferred) #LI-DA1 Pay Range $30.00 - $39.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is Seeking a Commercial Lines Claims Specialist to join our growing team in Somers, NY. Part-Time Claims position. Accept and oversee all types of Commercial Auto Claims for accounts assigned. Assist in servicing consulting contracts. Provide prompt, accurate and courteous claim service to the Agency's customers, both internal and external. How You Will Contribute * Acceptance of claims, making assignments to companies and/or independent services. * Research coverage, leases and contracts and participate in discussions with Account Mangers and producers regarding same. * Reading, analyzing, and processing of litigation paperwork. * Reserve monitoring and communication with Companies regarding evaluation of same. * Ongoing assistance in claims management of company claims. * Maintain diary system relating to first party losses, claims in subrogation, and Select Top 100 losses. * Completion of reports and suit activities as department policy dictates. * Assist underwriting staff with claim information relating to policies qualifying for experience rating and/or workers' compensation dividend plans. * Complete monthly report to clients which includes loss run and tracking of the physical damage claims. * Complete monthly billing to clients for services. * Preparation of claims management reports and experience modification reports as required by account size. Skills & Experience to Be Successful * Minimum of two years college required. * Two to four years claims adjusting experience, preferably commercial lines involving both first- and third-party claims. * Arbitration forums participation * Valid Driver's license. * This position requires routine or periodic travel which may require the teammate to drive their own vehicle or a rental vehicle. Acceptable results of a Motor Vehicle Record report at the time of hire and periodically thereafter, and maintenance of minimum acceptable insurance coverages are a requirement of this position. * College degree.(preferred) #LI-DA1 Pay Range $30.00 - $39.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: * Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance * Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement * Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services * Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, "The Power to Be Yourself".

Responsibilities include but are not limited to: Investigate customer claims related to unauthorized or erroneous electronic transactions (e.g., debit card, ACH, ATM) in accordance with Regulation E, EFTA, and NACHA guidelines. Ensure all claims are processed within regulatory timeframes, including provisional credit issuance and final resolution. Communicate clearly and professionally with customers regarding claim status, required documentation, and resolution outcomes. Collaborate with internal departments such as Fraud, Risk, Compliance, Customer Service, and Retail to gather supporting evidence and ensure accurate claim adjudication. Document all investigative steps, findings, and communications in the bank's case management system. Monitor claim trends and escalate suspicious activity or potential fraud to the appropriate teams. Stay current on changes to Reg E, NACHA rules, and other relevant banking regulations. Participate in audits and compliance reviews related to claims handling and Reg E adherence.

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

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is Seeking a Commercial Lines Claims Specialist to join our growing team in Somers, NY. Part-Time Claims position. Accept and oversee all types of Commercial Auto Claims for accounts assigned. Assist in servicing consulting contracts. Provide prompt, accurate and courteous claim service to the Agency's customers, both internal and external. How You Will Contribute Acceptance of claims, making assignments to companies and/or independent services. Research coverage, leases and contracts and participate in discussions with Account Mangers and producers regarding same. Reading, analyzing, and processing of litigation paperwork. Reserve monitoring and communication with Companies regarding evaluation of same. Ongoing assistance in claims management of company claims. Maintain diary system relating to first party losses, claims in subrogation, and Select Top 100 losses. Completion of reports and suit activities as department policy dictates. Assist underwriting staff with claim information relating to policies qualifying for experience rating and/or workers' compensation dividend plans. Complete monthly report to clients which includes loss run and tracking of the physical damage claims. Complete monthly billing to clients for services. Preparation of claims management reports and experience modification reports as required by account size. Skills & Experience to Be Successful Minimum of two years college required. Two to four years claims adjusting experience, preferably commercial lines involving both first- and third-party claims. Arbitration forums participation Valid Driver's license. This position requires routine or periodic travel which may require the teammate to drive their own vehicle or a rental vehicle. Acceptable results of a Motor Vehicle Record report at the time of hire and periodically thereafter, and maintenance of minimum acceptable insurance coverages are a requirement of this position. College degree.(preferred) #LI-DA1 Pay Range $30.00 - $39.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Responsibilities include but are not limited to: * Investigate customer claims related to unauthorized or erroneous electronic transactions (e.g., debit card, ACH, ATM) in accordance with Regulation E, EFTA, and NACHA guidelines. * Ensure all claims are processed within regulatory timeframes, including provisional credit issuance and final resolution. * Communicate clearly and professionally with customers regarding claim status, required documentation, and resolution outcomes. * Collaborate with internal departments such as Fraud, Risk, Compliance, Customer Service, and Retail to gather supporting evidence and ensure accurate claim adjudication. * Document all investigative steps, findings, and communications in the bank's case management system. * Monitor claim trends and escalate suspicious activity or potential fraud to the appropriate teams. * Stay current on changes to Reg E, NACHA rules, and other relevant banking regulations. * Participate in audits and compliance reviews related to claims handling and Reg E adherence. Required Skills: * Strong understanding of banking operations, fraud detection, and consumer protection laws. In-depth understanding of Regulation E, EFTA, and electronic payment systems. Familiarity with banking platforms, dispute resolution systems, and fraud detection tools. Strong analytical, problem-solving, and decision-making skills. Excellent written and verbal communication skills. Ability to manage multiple cases and meet strict deadlines. Required Experience: * High School diploma or GED and minimum of 2 years of experience in banking operations, fraud investigations, or claims processing. Preferred Experience: * Bachelor's degree in a related field and direct experience handling Reg E claims.

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.

Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors. * Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors. * Prepares, tracks and provides claims audit findings reports according to established timelines. * Presents claims audit findings and makes recommendations to leadership for improvements based on audit results. * Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements. * Maintains minimum claims audit accuracy rate per contractual guidelines. * Supports claims department initiatives to improve overall claims function efficiency. * Meets claims audit department quality and production standards. * Completes basic claims projects as assigned. * Experience in reviewing high $ claims, claims payment method. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience. * Audit, research, and data entry 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. Preferred Qualifications * Health care claims auditing/billing 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: $18.35 - $42.2 / 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 claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors. + Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors. + Prepares, tracks and provides claims audit findings reports according to established timelines. + Presents claims audit findings and makes recommendations to leadership for improvements based on audit results. + Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements. + Maintains minimum claims audit accuracy rate per contractual guidelines. + Supports claims department initiatives to improve overall claims function efficiency. + Meets claims audit department quality and production standards. + Completes basic claims projects as assigned. + Experience in reviewing high $ claims, claims payment method. **Required Qualifications** + At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience. + Audit, research, and data entry 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. **Preferred Qualifications** + Health care claims auditing/billing 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: $18.35 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

is February. Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. KNOWLEDGE/SKILLS/ABILITIES This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Services Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. Preferred Education Bachelor's Degree. Preferred Experience * 5 years' experience in managed healthcare administration and/or Provider Services. * 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

is February.** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. **KNOWLEDGE/SKILLS/ABILITIES** This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. + Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. + Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. + Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. + Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. + Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. + Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). + Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). + Trains other Provider Services Representatives as appropriate. + Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. **Required Experience** + 2 - 3 years customer service, provider service, or claims experience in a managed care setting. + Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. **Preferred Education** Bachelor's Degree. **Preferred Experience** + 5 years' experience in managed healthcare administration and/or Provider Services. + 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.