Claims Processor
Claim Processor Job 20 miles from Cudahy
As a Claims Processor, you will support the achievement of member outcomes and goals by delivering exceptional support services to employees, providers, members, and other stakeholders. Your role will involve identifying and participating in efforts to continuously improve the quality of support services, while understanding and contributing to our member-centered culture.
Responsibilities
* Accurately keys claims data into the claims processing system and resolves routine edits up to assigned complexity, according to established Claims Department policies and procedures.
* Performs assigned workload within established timeframes to assure Claims turnaround time goals are met.
* Resolves issues before claims payment to avoid re-adjudication.
* Refers complex claims or claims falling out of standard policies and procedure guidelines to Team Leader.
* Performs other duties as assigned.
* Protects privacy and maintains confidentiality of sensitive employee, participant, and agency information.
* Meets departmental performance goals, which are measured by meeting claims turnaround time, individual productivity, quality, and accuracy of work completed.
Essential Skills
* Experience with healthcare, insurance, Medicaid, and Medicare.
* Familiarity with electronic health records (EHR) and electronic medical records (EMR).
Additional Skills & Qualifications
* Strong understanding of healthcare systems and insurance processes.
* Ability to identify and implement improvements in operational processes.
* Excellent data entry skills and attention to detail.
Pay and Benefits
The pay range for this position is $19.00 - $24.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Waukesha,WI.
Application Deadline
This position is anticipated to close on Feb 4, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
* Hiring diverse talent
* Maintaining an inclusive environment through persistent self-reflection
* Building a culture of care, engagement, and recognition with clear outcomes
* Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Technical Claim Specialist - Casualty
Claim Processor Job 10 miles from Cudahy
Introduction Looking to join a vibrant organization that makes a difference? At Church Mutual, we Stand for Good: Our work is powerful, inspiring and meaningful because we serve those who serve others. We specialize in insuring purpose-driven organizations, leading the way in markets that include nonprofit and human services organizations, religious institutions of all denominations, schools, senior living communities, and camps and outdoor recreation facilities. We foster a workplace where all employees are treated with dignity and respect. Diversity, inclusion and belonging are woven into the fabric of our company through our customers, employees, leadership, business relationships and outreach programs.
What you'll be doing:
Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, umbrella claims, punitive damage claims, severe injury, long duration indemnity, permanent total disability, structural building damage, multiple location damage, including business income exposure and other extensive exposure claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense attorney. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives.
On any given day, you'll:
I. Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle all claims in accordance with state and federal laws.
II. Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner. Deny losses within authority level, providing detailed explanation, citing facts, and policy language.
III. Perform a thorough investigation based upon the type, complexity, and severity of the claim. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the potential high exposure and extensive damages, including potential full or partial liability and compensability denials. Formulate and document an action plan based on the covered damages and injuries.
IV. Determine and set reserves based on the most probable outcome of the claim, within authority level. Evaluate and negotiate directly with insured, claimant, or claimant's attorney on all cases within authority level. Review claim facts and exposure with claims management, as appropriate, to guide claim strategy. Make complete, accurate, and timely payments within authority for covered losses.
V. Maintain a professional, courteous, and helpful approach when communicating in-person, on the phone, or through email and other correspondence with internal and external customers, business partners, and brokers.
VI. Provide knowledge and guidance to other claim handlers regarding claim strategy, coverage interpretations, and in-depth jurisdictional and legal nuances. Field questions from team members related to coverage/compensability decisions.
VII. Investigate and refer identified claims to Loss Recovery Services, as applicable.
VIII. Direct work of defense attorney through collaboration on claim strategy and resolution. Ensure defense attorney is adhering to Litigation Management guidelines. Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim.
IX. Engage in direct investigation, control, and settlement negotiations when outside adjusting and legal services are not necessary or available.
X. Attend mediations, depositions, and trials. Present complex claim files during roundtables and claims committee meetings.
Here's what we expect
1. Prior Experience:
Eight or more years in technical insurance claim roles with increasing responsibilities is required.
2. Education:
* Bachelor's degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.• Evidence of continuing education in the insurance industry is required.• Additional legal education or law degree is highly desirable.• Completion of AIC and/or CPCU is preferred.
3. Necessary Knowledge and Abilities:
* Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.• Advanced knowledge of recoveries such as subrogation, reinsurance, apportionment, and deductibles.• Advanced knowledge of reinsurance contracts, workers compensation pools, second injury funds, etc.• Advanced negotiation skills.• Strong listening, verbal, and written communication skills.• Advanced knowledge of policy terminology, legal principles involving insurance, and emerging industry trends.• Effective planning and organization skills.• Ability to travel to inspect loss sites, attend mediations, depositions, etc.
#li-remote
Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Exact compensation will vary based on consideration of a variety of factors including education, skills, experience, and location.
Minimum Compensation
USD $80,800.00/Yr.
Maximum Compensation
USD $121,100.00/Yr.
Analyst, Claims Research
Claim Processor Job 16 miles from Cudahy
Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely.
Job Duties
· Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects
· Assists with reducing re-work by identifying and remediating claims processing issues
· Locate and interpret regulatory and contractual requirements
· Tailors existing reports or available data to meet the needs of the claims project
· Evaluates claims using standard principles and applicable state specific policies and 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
· Helps to improve overall claims performance to ensure claims are processed accurately and timely
· Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance
· Works closely with external departments to define claims requirements
· Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing
· Fields claims questions from Molina Operations teams
· 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
· Provides excellent customer services to our internal operations teams concerning claims projects
· Appropriately convey information and tailor communication based on the targeted audience
· Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members
· Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance
· Manages work assignments and prioritization appropriately
· Other duties as assigned.
Job Qualifications
REQUIRED EDUCATION:
Associate's degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
· 2-5 years of experience in medical claims processing, research, or a related field
· Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas
· Knowledge and experience using Excel
PREFERRED EDUCATION:
Bachelor's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
· Project management
· Expert in Excel and PowerPoint
· Familiarity with Salesforce and iServe for managing claims inquiries and adjustment requests
**PHYSICAL DEMANDS:**
Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $21.16 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Claims Examiner - Auto
Claim Processor Job 10 miles from Cudahy
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Claims Examiner - Auto
**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
+ Responsible for litigation process on litigated claims.
+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
+ Reports large claims to excess carrier(s).
+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.
**Experience**
Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
**Skills & Knowledge**
+ In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
+ Knowledge of medical terminology for claim evaluation and Medicare compliance
+ Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
+ Strong oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Strong organizational skills
+ Strong interpersonal skills
+ Good negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Service Expectations
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical:** Computer keyboarding, travel as required
**Auditory/Visual:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Taking care of people is at the heart of everything we do. Caring counts**
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)
Claim Examiner
Claim Processor Job 20 miles from Cudahy
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 responsible for the resolution of claims of average complexity and low to mid exposure claims. The primary purpose of this job is to investigate, evaluate, negotiate and settle assigned claims by collecting and analyzing data according to policy application and/or contract provisions. The position will have responsibility for decision making within their authority and work under the general direction from their manager.
Job Summary
* This position will be responsible for the resolution of claims of average complexity and low to mid exposure claims. The primary purpose of this job is to investigate, evaluate, negotiate and settle assigned claims by collecting and analyzing data according to policy application and/or contract provisions. The position will have responsibility for decision making within their authority and work under the general direction from their manager.
Job Responsibilities
* Typically handles low to moderate low exposure claims.
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Analyzes coverage and communicates coverage positions.
* Ability to draft coverage position letters independently
* Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.
* Conducts, coordinates, and directs investigation into loss facts and extent of damages
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
* Sets reserves within authority or makes recommendations concerning reserve changes to manager
* Utilizes diary system to pro-actively resolve outstanding issues and to ensure timely processing and closure of the claim.
* Negotiates and settles claims directly with claimant
* Prepares reports by collecting and summarizing information
* Participates in special projects or assists other team members as requested
* Ability to travel to industry conferences or meetings, if required.
* Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.
* Identifies subrogation opportunities and fraud potential and makes appropriate referrals
* Strong emphasis on customer service to both internal and external customers
Education
* Bachelor's degree or equivalent work experience
* Advanced degree, or focused technical degree a plus
Certification
* Must have or be eligible to receive claims adjuster license
* Successful completion of basic insurance courses or achievement of industry designation (INS, IEA, AIC, ARM, SCLA, CPCU) preferred
Work Experience
* Minimum of 2 to 5 years of claims handling experience or equivalent combination of education and experience preferred
* Substantive experience in handling marine liability, hull/yacht physical damage claims
Skill Sets
* Excellent written and oral communication skills
* Strong analytical and problem solving skills
* Strong organization and time management skills
* Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
* Ability to work in a team environment
* Strong desire for continuous improvement
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 national average salary for the Claims Examiner is $54,814 - $76,230 with 12% 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.
Subrogation Claim Representative Trainee
Claim Processor Job 10 miles from Cudahy
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$44,200.00 - $72,800.00Target Openings5What Is the Opportunity?This is an entry level position that requires satisfactory completion of required training to advance to the Claim Representative, Recovery position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.What Will You Do?
Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Investigates each claim to obtain relevant facts necessary to evaluate recovery potential, identify the cause of loss, identify responsible party targets and their carriers, and develops theories of liability, through prompt and strategically-appropriate contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts); obtains necessary statements as strategically appropriate; adhering to Claim Best Practices and Special Account Communication instructions.
Delivers consistent service quality and effective diary management to ensure all claims are handled timely throughout the claim life cycle to achieve optimal outcome.
Directs the preservation of evidence; hires experts and identifies resources for specific activities to properly investigate, such as Risk Control, nurse consultants, fire or fraud investigators, and other experts. Verifies the nature and extent of the loss.
Evaluates liability and damages to assess Subrogation potential including consideration of jurisdictional statutes, case law and bodily injury value, where applicable. Updates as new information is presented.
Develops and employs creative resolution strategies.
Negotiates subrogation recoveries with responsible party, their carriers and other legal representatives/attorneys.
Recognizes and implements alternate means of resolution including arbitration, while controlling expenses.
Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy. Tracks and controls legal expenses to assure cost-effective resolution.
Manages both allocated and unallocated loss adjustment expenses.
Updates appropriate party as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in optimal resolution.
Recognizes cases, based on severity/ complexity protocols that should be transferred to another level of subrogation professional and refers on a timely basis.
Represents the company as a technical resource, may at times attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws.
Shares accountability with all business partners to achieve and sustain quality results.
Determines settlement value by assessing extent of liability of the responsible party, determining legally recoverable damages.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred.
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
Verbal and written communication skills -Intermediate
Attention to detail ensuring accuracy - Basic
Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
Analytical Thinking - Basic
Judgment/ Decision Making - Basic
What is a Must Have?
High School Diploma or GED.
A minimum of one year work experience required.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Claims Specialist, Motor Truck Cargo/Ocean Marine
Claim Processor Job 10 miles from Cudahy
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
This individual contributor position works under moderate direction, and within defined authority limits, to manage primarily motor truck cargo claims with moderate to high complexity and exposure. There may also be opportunity to handle ocean marine claims. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:
* Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
* Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
* Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols.
* Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
* Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
* Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
* Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
* Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
* Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
* Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
* May serve as a mentor/coach to less experienced claim professionals
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
* Solid working knowledge of motor truck cargo claims handling, liability analysis, policy coverage and claim practices.
* Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
* Demonstrated ability to develop collaborative business relationships with internal and external work partners.
* Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
* Demonstrated investigative experience with an analytical mindset and critical thinking skills.
* Strong work ethic, with demonstrated time management and organizational skills.
* Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
* Developing ability to negotiate low to moderately complex settlements.
* Adaptable to a changing environment.
* Knowledge of Microsoft Office Suite and ability to learn business-related software.
* Demonstrated ability to value diverse opinions and ideas
Education & Experience:
* Bachelor's Degree or equivalent experience.
* Typically a minimum four years of relevant experience, preferably in claim handling.
* Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
* Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
* Professional designations are a plus (e.g. CPCU)
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Maryland, New York and Washington, the national base pay range for this job level is $49,000 to $98,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
Subrogation Claim Representative Trainee
Claim Processor Job 15 miles from Cudahy
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$44,200.00 - $72,800.00
Target Openings
5
What Is the Opportunity?
This is an entry level position that requires satisfactory completion of required training to advance to the Claim Representative, Recovery position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
What Will You Do?
* Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
* The on the job training includes practice and execution of the following core assignments:
* Investigates each claim to obtain relevant facts necessary to evaluate recovery potential, identify the cause of loss, identify responsible party targets and their carriers, and develops theories of liability, through prompt and strategically-appropriate contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts); obtains necessary statements as strategically appropriate; adhering to Claim Best Practices and Special Account Communication instructions.
* Delivers consistent service quality and effective diary management to ensure all claims are handled timely throughout the claim life cycle to achieve optimal outcome.
* Directs the preservation of evidence; hires experts and identifies resources for specific activities to properly investigate, such as Risk Control, nurse consultants, fire or fraud investigators, and other experts. Verifies the nature and extent of the loss.
* Evaluates liability and damages to assess Subrogation potential including consideration of jurisdictional statutes, case law and bodily injury value, where applicable. Updates as new information is presented.
* Develops and employs creative resolution strategies.
* Negotiates subrogation recoveries with responsible party, their carriers and other legal representatives/attorneys.
* Recognizes and implements alternate means of resolution including arbitration, while controlling expenses.
* Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
* Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy. Tracks and controls legal expenses to assure cost-effective resolution.
* Manages both allocated and unallocated loss adjustment expenses.
* Updates appropriate party as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
* Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in optimal resolution.
* Recognizes cases, based on severity/ complexity protocols that should be transferred to another level of subrogation professional and refers on a timely basis.
* Represents the company as a technical resource, may at times attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws.
* Shares accountability with all business partners to achieve and sustain quality results.
* Determines settlement value by assessing extent of liability of the responsible party, determining legally recoverable damages.
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred.
* Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
* Verbal and written communication skills -Intermediate
* Attention to detail ensuring accuracy - Basic
* Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
* Analytical Thinking - Basic
* Judgment/ Decision Making - Basic
What is a Must Have?
* High School Diploma or GED.
* A minimum of one year work experience required.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Liability Claims Analyst (On-Site)
Claim Processor Job 19 miles from Cudahy
About the Role As Liability Analyst, you will compile facts and investigate customer injury claims to evaluate and negotiate resolution of complex non-litigated liability claims (moderate to highly severe injuries) to protect the interests of the company.
What You'll Do
+ Correspond with claimants, witnesses, internal partners to document event statements
+ Investigate and verify customer injury statements and facts, compiles evidence, video and claim data to document according to written procedures
+ Conduct recorded statements from claimant and as needed, witnesses
+ Evaluate liability based on verifiable and disputed evidence to create action plan
+ Evaluate liability to set financial reserves
+ Follow written procedures to reports claims that meet specific criteria to excess insurers and/or escalate claims internally
+ Communicate with excess insurance carrier on escalated claim status and current action plans
+ Assist panel counsel defense attorneys with claim positioning and evaluation, as appropriate
+ Deny, settle or authorize payment directly with claimants and/or claimant attorneys to resolve complex non-litigated moderate to highly severe injuries
+ Additional task may be assigned as necessary
What Skills You Have
Required
+ Minimum 2-4 Years related claims experience and experience adjusting general liability claims
+ Working knowledge of general liability insurance
+ Proficient experience in investigations, resolution of injury complaints including negotiation and settlement
+ Must have good presentation, written and oral communication skills
+ Must be able to multitask, be well organized and detail oriented
+ Proficient working with database and processing software, Excel, Word and similar systems
+ Must have strong analytical, problem solving, critical thinking and negotiating skills
Preferred
+ Bachelor's degree or equivalent experience
+ 3+ years of multi-state or national experience for an Insurance carrier and/or self-insured company
+ Knowledge of medical terminology and procedures
+ Professional designation in claims and/or insurance
+ Experience using RisKonnect or other RMIS
+ Retail experience
Special Requirements
+ Ability to travel infrequently
Coin Processor- Milwaukee
Claim Processor Job 10 miles from Cudahy
With a network of nearly 200 branches, Loomis armored transportation, cash management centers, and cash inventory vaults keep cash flowing throughout financial institutions and retail businesses across the US. Loomis prides itself on providing employees with opportunities for career advancement and job satisfaction. In fact, many of our company's managers, vice presidents, and corporate executives started out in the branches as driver/guards and tellers. Our work can be challenging, but the thousands who have stayed with our company for decades will tell you that if you have the desire to learn and the drive to succeed, Loomis is the place to be. Come join our team!
Job Description
As a Coin Processor, you work with your team to maintain inventory in our cash vaults for our Loomis customers
Responsibilities
Count, sort, and handle coin bags weighing 50 pounds
Manage the proper storage of pallets of boxed coin
Requirements
Repetitiously lift, without assistance, at least 50 pounds from floor level to 3-4-foot level
Ability to move bulk coin with hand carts or manual pallet jacks
Working Conditions
Work in a large area within a vault with little or no exposure to outside light
Full-time schedule can potentially consist of an average of 40 to 50 hours/week, with a minimum of 5 days during a 6-day period
Essential Functions/Job Qualifications
As part of the qualification process for the Coin Processor position, a Human Performance Evaluation (HPE) is required. This evaluation requires successful completion of testing in the following areas:
Lift:
- 25lbs vertical lift from 10 inches to 66 inches from the floor (1X)
Lift-Carry:
- 18lbs vertical lift from 1 inch to 44 inches from the floor, and horizontally transfer 15ft (4X)
- 18lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 300ft (1X)
- 50lbs vertical lift from 10 inches to 36 inches from the floor and horizontally transfer 2ft (2X)
Push-Pull:
- Horizontally transfer 47lbs of force on a sled (single, non-dominant arm), a distance of 1ft (2X)
Repetitive Coupling:
- Squeeze Jamar Hand Dynamometer requiring forces up to 30lbs / both right & left hands (4X each)
Benefits
Loomis offers one of the most comprehensive employees benefit packages in the industry, which includes:
Vacation and Sick Time (PTO) as well as Paid Holidays
Health & Dental Insurance
Vision Insurance
401(k) Plan
Basic Life Insurance Plan
Voluntary Life Insurance Plan
Flexible Spending and Health Savings Account
Dependent Care Account
Industry leading Training and Development
Loomis is an Equal Opportunity Employer and Drug Free Workplace. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability. Other details
Job Family Hourly
Job Function Coin Processor
Pay Type Hourly
Hiring Rate $17.00
Team Uniform Processor - Full & Part Time
Claim Processor Job 15 miles from Cudahy
Join a FAST-paced, high-ENERGY team BUILD & ASSESS amazing, high-quality team uniforms Assure QUALITY of each uniform we build construction PREPARE uniforms for delivery Have FUN while making money
Stefans Soccer is looking for a enthusiastic Team Uniform Processor to join our fast-paced and high-energy team. In this position you will be responsible for building and assessing amazing, high-quality team uniforms. You may be responsible for printing uniforms, assuring the quality of each uniform, and/or preparing uniforms for delivery. We are looking for someone who takes pride in their work and wants to have fun while making money.
No experience necessary, paid training. We will figure out what best suits you! Extraordinary Attention to detail - must have the patience, acumen and determination to work with many details at the same time
Requirements
Able to work under pressure in a fast-paced environment
Team player - works well in a group environment
Able to lift boxes up to 30 pounds
Able to stand for long periods of time
Responsibilities
Accountability - Ability to accept responsibility and account for his/her actions
Communication, Oral-Ability to communicate effectively with others using the spoken word
Honesty/Integrity - Ability to be truthful, maintain high level of confidentiality and be seen as credible in the workplace
Time Management - Ability to utilize the available time to organize and complete work within given deadlines
Compensation & Benefits
Wage ranges:
Full-time:
Part-time:
Full-time employees will receive:
Company-contributed health insurance, dental and vision
401K program with generous company match
Paid Personal Time Off and Holidays
All employees will receive
Great work environment with a high energy team in a family business and exciting industry
No experience necessary, paid training
Quick opportunities for raises as experience, reliability and job performance dictates
Employee discount at our retail stores
Property Claims Representative (CAT team)
Claim Processor Job 36 miles from Cudahy
Recognized as a
Milwaukee Journal Sentinel
Top Workplace for 12 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities.
Job Summary
West Bend Mutual Insurance is the preeminent mutual insurance carrier in the upper Midwest and has experienced continuous growth for nearly 130 years strong! As we continue to grow, we are looking for an experienced CAT Adjuster to join the team. This is a wonderful opportunity for an individual who has established themselves as a self-starter, driven, and focused on providing superior service to our insureds and claimants. You will be provided with the tools, training, and support to succeed in your role and there are numerous opportunities given to you to advance in your field.
West Bend is proud to be recognized as an employer of choice and this is a testament to the hard work and dedication of our associates. Join a culture built on a commitment to excellence, integrity and responsibility and see why West Bend is consistently recognized as a top workplace.
Responsibilities & Qualifications
Summary of Responsibilities
Handle moderate to complex claims with minimal supervision and guidance from the manager. Research and determine coverage, conduct thorough investigations, evaluate damages and liability. Negotiate settlements with insureds, claimants and attorneys. Responsibilities also include active file management, ensuring proper reserving and participation in training activities. Consistently exhibit a high level of customer service and adherence to department audit guidelines. Participate in projects and initiatives as needed.
Preferred Experience and Skills:
Proficiency with computers and current technology
Interpersonal skills
Oral and written communication skills
Negotiation skills and problem solving skills
Prior claims handling experience
Preferred Education and Training:
Bachelor's degree in Business, Insurance or related field
Associate in General Insurance designation
Associate in Claims designation
This role has the opportunity to be a fully remote/work from home role. On occasion you may be asked to travel to an office location for in-person engagement activities such as team meetings, training and corporate events.
The salary range for this position is $59,872-$89,808.
The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate.
West Bend offers a comprehensive benefit plan including:
Medical & Prescription Insurance
Health Savings Account
Dental Insurance
Vision Insurance
Short and Long Term Disability
Flexible Spending Accounts
Life and Accidental Death & Disability
Accident and Critical Illness Insurance
Employee Assistance Program
401(k) Plan with Company Match
Pet Insurance
Paid Time Off
Bonus eligible based on performance
West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies.”
#LI-BW1
EEO
West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
Claims Processor
Claim Processor Job 20 miles from Cudahy
As a Claims Processor, you will support the achievement of member outcomes and goals by delivering exceptional support services to employees, providers, members, and other stakeholders. Your role will involve identifying and participating in efforts to continuously improve the quality of support services, while understanding and contributing to our member-centered culture.
Responsibilities
+ Accurately keys claims data into the claims processing system and resolves routine edits up to assigned complexity, according to established Claims Department policies and procedures.
+ Performs assigned workload within established timeframes to assure Claims turnaround time goals are met.
+ Resolves issues before claims payment to avoid re-adjudication.
+ Refers complex claims or claims falling out of standard policies and procedure guidelines to Team Leader.
+ Performs other duties as assigned.
+ Protects privacy and maintains confidentiality of sensitive employee, participant, and agency information.
+ Meets departmental performance goals, which are measured by meeting claims turnaround time, individual productivity, quality, and accuracy of work completed.
Essential Skills
+ Experience with healthcare, insurance, Medicaid, and Medicare.
+ Familiarity with electronic health records (EHR) and electronic medical records (EMR).
Additional Skills & Qualifications
+ Strong understanding of healthcare systems and insurance processes.
+ Ability to identify and implement improvements in operational processes.
+ Excellent data entry skills and attention to detail.
Pay and Benefits
The pay range for this position is $19.00 - $24.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Waukesha,WI.
Application Deadline
This position is anticipated to close on Feb 4, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
+ Hiring diverse talent
+ Maintaining an inclusive environment through persistent self-reflection
+ Building a culture of care, engagement, and recognition with clear outcomes
+ Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
Claims Examiner - Bodily Injury (hybrid)
Claim Processor Job 10 miles from Cudahy
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Claims Examiner - Bodily Injury (hybrid)
**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
+ Reports large claims to excess carrier(s).
+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.
**Experience**
Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
**Skills & Knowledge**
+ In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
+ Knowledge of medical terminology for claim evaluation and Medicare compliance
+ Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
+ Strong oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Strong organizational skills
+ Strong interpersonal skills
+ Good negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Service Expectations
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical:** Computer keyboarding, travel as required
**Auditory/Visual:** Hearing, vision and talking
**NOTE** : Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Taking care of people is at the heart of everything we do. Caring counts**
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)
Analyst, Claims Research
Claim Processor Job 10 miles from Cudahy
Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely.
Job Duties
· Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects
· Assists with reducing re-work by identifying and remediating claims processing issues
· Locate and interpret regulatory and contractual requirements
· Tailors existing reports or available data to meet the needs of the claims project
· Evaluates claims using standard principles and applicable state specific policies and 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
· Helps to improve overall claims performance to ensure claims are processed accurately and timely
· Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance
· Works closely with external departments to define claims requirements
· Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing
· Fields claims questions from Molina Operations teams
· 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
· Provides excellent customer services to our internal operations teams concerning claims projects
· Appropriately convey information and tailor communication based on the targeted audience
· Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members
· Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance
· Manages work assignments and prioritization appropriately
· Other duties as assigned.
Job Qualifications
REQUIRED EDUCATION:
Associate's degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
· 2-5 years of experience in medical claims processing, research, or a related field
· Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas
· Knowledge and experience using Excel
PREFERRED EDUCATION:
Bachelor's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
· Project management
· Expert in Excel and PowerPoint
· Familiarity with Salesforce and iServe for managing claims inquiries and adjustment requests
**PHYSICAL DEMANDS:**
Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $21.16 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Claim Examiner
Claim Processor Job 20 miles from Cudahy
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 responsible for the resolution of claims of average complexity and low to mid exposure claims. The primary purpose of this job is to investigate, evaluate, negotiate and settle assigned claims by collecting and analyzing data according to policy application and/or contract provisions. The position will have responsibility for decision making within their authority and work under the general direction from their manager.
Job Summary
This position will be responsible for the resolution of claims of average complexity and low to mid exposure claims. The primary purpose of this job is to investigate, evaluate, negotiate and settle assigned claims by collecting and analyzing data according to policy application and/or contract provisions. The position will have responsibility for decision making within their authority and work under the general direction from their manager.
Job Responsibilities
Typically handles low to moderate low exposure claims.
Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Analyzes coverage and communicates coverage positions.
Ability to draft coverage position letters independently
Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.
Conducts, coordinates, and directs investigation into loss facts and extent of damages
Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
Sets reserves within authority or makes recommendations concerning reserve changes to manager
Utilizes diary system to pro-actively resolve outstanding issues and to ensure timely processing and closure of the claim.
Negotiates and settles claims directly with claimant
Prepares reports by collecting and summarizing information
Participates in special projects or assists other team members as requested
Ability to travel to industry conferences or meetings, if required.
Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.
Identifies subrogation opportunities and fraud potential and makes appropriate referrals
Strong emphasis on customer service to both internal and external customers
Education
Bachelor's degree or equivalent work experience
Advanced degree, or focused technical degree a plus
Certification
Must have or be eligible to receive claims adjuster license
Successful completion of basic insurance courses or achievement of industry designation (INS, IEA, AIC, ARM, SCLA, CPCU) preferred
Work Experience
Minimum of 2 to 5 years of claims handling experience or equivalent combination of education and experience preferred
Substantive experience in handling marine liability, hull/yacht physical damage claims
Skill Sets
Excellent written and oral communication skills
Strong analytical and problem solving skills
Strong organization and time management skills
Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
Ability to work in a team environment
Strong desire for continuous improvement
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 national average salary for the Claims Examiner is $54,814 - $76,230 with 12% 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.
Claim Supervisor - Workers Compensation
Claim Processor Job 10 miles from Cudahy
Introduction Looking to join a vibrant organization that makes a difference? At Church Mutual, we Stand for Good: Our work is powerful, inspiring and meaningful because we serve those who serve others. We specialize in insuring purpose-driven organizations, leading the way in markets that include nonprofit and human services organizations, religious institutions of all denominations, schools, senior living communities, and camps and outdoor recreation facilities. We foster a workplace where all employees are treated with dignity and respect. Diversity, inclusion and belonging are woven into the fabric of our company through our customers, employees, leadership, business relationships and outreach programs.
What you'll be doing:
Accountable for the outcomes produced by direct reports and the financial exposure associated with the assigned team's claim volume. Review and authorize settlements within authority and escalate with recommended plan of action as appropriate. Champion department initiatives and change management. Develop fair solutions to meet the needs of Church Mutual and our policyholders. Supervisor responsibilities to include staffing, training and development, performance management, and work force planning.
On any given day, you'll:
I. Supervisor/manager responsibilities may include all of the following:
A. Staffing needs, to include interviewing and onboarding for new employees.
B. Training and development, as well as coaching and motivation, for staff.
C. Performance management, goal setting, employee engagement, and salary administration.
D. Work force management to include; unit equipment, software, and space needs, approving time off and overtime usage, and budget recommendations.
II. Accountable for the outcomes produced by direct reports and the financial exposure associated with the team's claim volume. Provide direction and coaching to facilitate positive results. Ensure unit is meeting expectations as defined by the Claim Unit's Best Practice guidelines.
III. Review and authorize settlements within Claim Supervisor authority and escalate with recommended plan of action as appropriate. Offer claim resolution techniques to complex claims including mediations, hearings, and settlement conferences.
IV. Monitor performance of team through the use of claim audits, work product review, and dialogue with direct reports. Assist and support the creation and implementation of audit action plan with suggested goals and training opportunities. Conduct coaching and mentoring interactions with team members. Provide meaningful career development guidance to direct reports.
V. Communicate effectively to team members, peers, and business partners. Champion department initiatives and change management through effective written and verbal communications. Initiate and implement process and procedural changes effectively to maintain productivity.
VI. Guide strategies for resolving customer concerns, providing oversight to claim handler or responding directly to customer as appropriate. Develop fair solutions to meet the needs of Church Mutual and our policyholders.
VII. Analyze management reports to ensure workloads are consistent with the skill level and experience of direct reports. Propose staffing solutions that align with unit and department goals and metrics.
VIII. Collaborate with claims management in the hiring process to ensure selection of qualified candidates for open positions. Maximize a positive onboarding/training experience through partnership with Learning and Development.
Here's what we expect
1. Prior Experience:
* Three to five years of commercial lines claims experience is required.• Prior supervisory or leadership experience is preferred.
2. Education:
* Bachelor's degree, or equivalent in related insurance experience, is required.• Leadership or supervisory training is desirable.• Completion of either AIC, AIM, or SCLA designations is a plus.
3. Necessary Knowledge and Abilities:• Strong leadership qualities and demonstrated leadership skills.• Understanding of claim handling standards and strong knowledge of state and other regulatory requirements.• Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.• Ability to effectively listen to others and collaboratively share ideas and communicate effectively throughout all levels of the organization.• Effective interpersonal skills in order to coach and lead individuals to their full potential to meet company objectives, and to work cohesively in a team environment.• Ability to develop a comprehensive and thorough understanding of the claims system(s) and related sub-systems and its functions.• Strong judgment, decision-making skills, and organizational abilities.• Ability to approach problem-solving systematically and creatively.• Knowledge of work-processing procedures and ability to recognize potential improvement opportunities.• Knowledge and ability to work with various systems, software, applications, programs, and databases.• Knowledge of the concepts of best practices, continuous improvement strategies, operational efficiency, and change management practices.
Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Exact compensation will vary based on consideration of a variety of factors including education, skills, experience, and location.
#LI-hybrid
Minimum Compensation
USD $80,800.00/Yr.
Maximum Compensation
USD $121,100.00/Yr.
Subrogation Claim Representative Trainee
Claim Processor Job 15 miles from Cudahy
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$44,200.00 - $72,800.00
**Target Openings**
5
**What Is the Opportunity?**
This is an entry level position that requires satisfactory completion of required training to advance to the Claim Representative, Recovery position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
**What Will You Do?**
+ Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
+ The on the job training includes practice and execution of the following core assignments:
+ Investigates each claim to obtain relevant facts necessary to evaluate recovery potential, identify the cause of loss, identify responsible party targets and their carriers, and develops theories of liability, through prompt and strategically-appropriate contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts); obtains necessary statements as strategically appropriate; adhering to Claim Best Practices and Special Account Communication instructions.
+ Delivers consistent service quality and effective diary management to ensure all claims are handled timely throughout the claim life cycle to achieve optimal outcome.
+ Directs the preservation of evidence; hires experts and identifies resources for specific activities to properly investigate, such as Risk Control, nurse consultants, fire or fraud investigators, and other experts. Verifies the nature and extent of the loss.
+ Evaluates liability and damages to assess Subrogation potential including consideration of jurisdictional statutes, case law and bodily injury value, where applicable. Updates as new information is presented.
+ Develops and employs creative resolution strategies.
+ Negotiates subrogation recoveries with responsible party, their carriers and other legal representatives/attorneys.
+ Recognizes and implements alternate means of resolution including arbitration, while controlling expenses.
+ Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
+ Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy. Tracks and controls legal expenses to assure cost-effective resolution.
+ Manages both allocated and unallocated loss adjustment expenses.
+ Updates appropriate party as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
+ Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in optimal resolution.
+ Recognizes cases, based on severity/ complexity protocols that should be transferred to another level of subrogation professional and refers on a timely basis.
+ Represents the company as a technical resource, may at times attend legal proceedings as needed, act within established professional guidelines as well as applicable state laws.
+ Shares accountability with all business partners to achieve and sustain quality results.
+ Determines settlement value by assessing extent of liability of the responsible party, determining legally recoverable damages.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred.
+ Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
+ Verbal and written communication skills -Intermediate
+ Attention to detail ensuring accuracy - Basic
+ Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
+ Analytical Thinking - Basic
+ Judgment/ Decision Making - Basic
**What is a Must Have?**
+ High School Diploma or GED.
+ A minimum of one year work experience required.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
Liability Claims Analyst (On-Site)
Claim Processor Job 19 miles from Cudahy
About the Role As Liability Analyst, you will compile facts and investigate customer injury claims to evaluate and negotiate resolution of complex non-litigated liability claims (moderate to highly severe injuries) to protect the interests of the company.
What You'll Do
* Correspond with claimants, witnesses, internal partners to document event statements
* Investigate and verify customer injury statements and facts, compiles evidence, video and claim data to document according to written procedures
* Conduct recorded statements from claimant and as needed, witnesses
* Evaluate liability based on verifiable and disputed evidence to create action plan
* Evaluate liability to set financial reserves
* Follow written procedures to reports claims that meet specific criteria to excess insurers and/or escalate claims internally
* Communicate with excess insurance carrier on escalated claim status and current action plans
* Assist panel counsel defense attorneys with claim positioning and evaluation, as appropriate
* Deny, settle or authorize payment directly with claimants and/or claimant attorneys to resolve complex non-litigated moderate to highly severe injuries
* Additional task may be assigned as necessary
What Skills You Have
Required
* Minimum 2-4 Years related claims experience and experience adjusting general liability claims
* Working knowledge of general liability insurance
* Proficient experience in investigations, resolution of injury complaints including negotiation and settlement
* Must have good presentation, written and oral communication skills
* Must be able to multitask, be well organized and detail oriented
* Proficient working with database and processing software, Excel, Word and similar systems
* Must have strong analytical, problem solving, critical thinking and negotiating skills
Preferred
* Bachelor's degree or equivalent experience
* 3+ years of multi-state or national experience for an Insurance carrier and/or self-insured company
* Knowledge of medical terminology and procedures
* Professional designation in claims and/or insurance
* Experience using RisKonnect or other RMIS
* Retail experience
Special Requirements
* Ability to travel infrequently
Claims Processor
Claim Processor Job 20 miles from Cudahy
As a Claims Processor, you will support the achievement of member outcomes and goals by delivering exceptional support services to employees, providers, members, and other stakeholders. Your role will involve identifying and participating in efforts to continuously improve the quality of support services, while understanding and contributing to our member-centered culture.
Responsibilities
* Accurately keys claims data into the claims processing system and resolves routine edits up to assigned complexity, according to established Claims Department policies and procedures.
* Performs assigned workload within established timeframes to assure Claims turnaround time goals are met.
* Resolves issues before claims payment to avoid re-adjudication.
* Refers complex claims or claims falling out of standard policies and procedure guidelines to Team Leader.
* Performs other duties as assigned.
* Protects privacy and maintains confidentiality of sensitive employee, participant, and agency information.
* Meets departmental performance goals, which are measured by meeting claims turnaround time, individual productivity, quality, and accuracy of work completed.
Essential Skills
* Experience with healthcare, insurance, Medicaid, and Medicare.
* Familiarity with electronic health records (EHR) and electronic medical records (EMR).
Additional Skills & Qualifications
* Strong understanding of healthcare systems and insurance processes.
* Ability to identify and implement improvements in operational processes.
* Excellent data entry skills and attention to detail.
Pay and Benefits
The pay range for this position is $19.00 - $24.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Waukesha,WI.
Application Deadline
This position is anticipated to close on Feb 14, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
* Hiring diverse talent
* Maintaining an inclusive environment through persistent self-reflection
* Building a culture of care, engagement, and recognition with clear outcomes
* Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.