Claim processor jobs in District of Columbia - 20 jobs

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

Owner's project management firm is seeking an experienced SENIOR CLAIMS ANALYST for work on construction claims. Candidates qualifications must include demonstrated experience with: Furnishes reports with supporting information necessary to resolve disputes or defend against the claims, Prepares and assembles appeal files, Participates in meetings or negotiations with claimants, Appears in legal proceedings, Prepares cost estimates for use in claims negotiations, Prepares risk assessments/analysis relative to claim exposures, Prepares findings of fact and other documentation required by the CO. Provides litigation support to include court boards, timelines, diagrams, static and electronic illustrations and three dimensional models. Candidates should have demonstrated ability to work cooperatively and productively as a member of a project or claims defense team. Candidates must have 15 years experience and a Bachelor's Degree in Engineering, or Construction/Project Management. CCM and either P.E. or CPA necessary though all three are preferred. Submit resumes and project list in MS Word or PDF format: Please No Calls

JOB TITLE: Claims Analyst This position is responsible for assisting with following up on administrative appeals and documentation submitted to health insurers and governmental payers; working well with attorneys and paralegals; maintaining the workload. DUTIES AND RESPONSIBILITIES: Works within the client's Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue. Determines action required to resolve the underpayment and initiate that action, including submitting appeals and reconsideration requests. Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal's/attorney's pursuit for additional reimbursement Quickly and efficiently prepares, reviews, and submits well-written claims correspondence and related documents to insurers Is skilled, aggressive, cordial, and professional on the telephone to follow up on submitted appeals. Performs other related duties as assigned by management. QUALIFICATIONS: Bachelor's Degree (BA/BS) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience. Other skills required : BA/BS with a GPA of 3.0 or higher. Interest in healthcare and healthcare law. Able to navigate through various computer systems and applications to find information about insurance claims. Ability to prioritize and multi-task. Excellent written and verbal communication skills. Proficiency in Microsoft Office, including Word and Excel. Excellent organizational and time management skills. High attention to detail. Clear, concise, and logical writing style. COMPETENCIES: Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures. Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals. Business Necessity - The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. External Working Relationships - Develops and maintains courteous and effective working relationships with clients, vendors and/or any other representatives of external organizations. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

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

**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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **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** $67,000.00 - $110,600.00 **Target Openings** 1 **What Is the Opportunity?** Come learn more about this role at our Open House Event on 1/14! Click here to register - ************************************************************************************** This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington DC. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred. + General knowledge of estimating system Xactimate preferred. + Two or more years of previous outside property claim handling experience preferred. + Interpersonal and customer service skills - Advanced + Organizational and time management skills- Advanced + Ability to work independently - Intermediate + Judgment, analytical and decision making skills - Intermediate + Negotiation skills - Intermediate + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate + Investigative skills - Intermediate + Ability to analyze and determine coverage - Intermediate + Analyze, and evaluate damages -Intermediate + Resolve claims within settlement authority - Intermediate + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED required. + A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. + Valid driver's license required. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. 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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $67,000.00 - $110,600.00 This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington DC. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. What Will You Do? Handles 1st party property claims of moderate severity and complexity as assigned. Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May provides mentoring and coaching to less experienced claim professionals. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. Perform other duties as assigned. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's Degree preferred. General knowledge of estimating system Xactimate preferred. Two or more years of previous outside property claim handling experience preferred. Interpersonal and customer service skills - Advanced Organizational and time management skills- Advanced Ability to work independently - Intermediate Judgment, analytical and decision making skills - Intermediate Negotiation skills - Intermediate Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate Investigative skills - Intermediate Ability to analyze and determine coverage - Intermediate Analyze, and evaluate damages -Intermediate Resolve claims within settlement authority - Intermediate Valid passport preferred. What is a Must Have? High School Diploma or GED required. A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. Valid driver's license required.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance PL CLAIM SPECIALIST **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **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 _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ 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. 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.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. 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$67,000.00 - $110,600.00Target Openings1What Is the Opportunity?Come learn more about this role at our Open House Event on 1/14! Click here to register - ************************************************************************************** This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington DC. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.What Will You Do? Handles 1st party property claims of moderate severity and complexity as assigned. Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May provides mentoring and coaching to less experienced claim professionals. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred. General knowledge of estimating system Xactimate preferred. Two or more years of previous outside property claim handling experience preferred. Interpersonal and customer service skills - Advanced Organizational and time management skills- Advanced Ability to work independently - Intermediate Judgment, analytical and decision making skills - Intermediate Negotiation skills - Intermediate Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate Investigative skills - Intermediate Ability to analyze and determine coverage - Intermediate Analyze, and evaluate damages -Intermediate Resolve claims within settlement authority - Intermediate Valid passport preferred. What is a Must Have? High School Diploma or GED required. A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. Valid driver's license required. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Job Description SGI Global is seeking a Records Examiner to provide data entry, records and data analysis support for the Executive Office for the United States Attorneys' Office. The position is based in Washington DC. The Records Examiner position will support the client by providing a wide variety of clerical and administrative assistance services. The work requires knowledge of processes, procedures, and practices associated with accessing databases, data entry, administrative office skills, attention to detail, quality control techniques to ensure accuracy, and the ability to work independently. Responsibilities The Records Examiner/Analyst contract position will support the FLPs by performing data entry services as well as evaluation and analytical services, including, but not limited to, the following: Perform functions of Data Analyst as stated herein. Analyze debtor's ability to pay a debt based upon Government collection standards and asset and liability information provided by third party information searches. Based on analysis, make recommendations to the FLP regarding collectability of a debt. Create and manipulate spreadsheets to report completed work and/or support analysis. Produce a variety of written documents and materials utilizing a wide range of office software applications. Assignments may include integrating output from different database applications, charts, and graphs into word processing documents, presentations, or spreadsheets. Ensure proper format, spelling, punctuation, capitalization, and grammar of all written documents. Establish high dollar complex civil debts in the debt collection database in accordance with guidance provided by the FLPs and the Government Program Manager and information on the official internal office referral form. This work includes adding all appropriate payee information for both federal and non-federal payees, ensuring that amounts allocated to payees are accurate and match amounts on the referral form. Process transfer debts from other DOJ litigating divisions in accordance with guidance provided by the FLPs and the Government Program Manager. This work includes a review of information as well as generating and emailing instructions for FedWire or Pay.gov. Assume administrative responsibilities for special assessment only debts and low dollar debts (i.e., $2,500 and lower). This time sensitive and critical work requires monthly monitoring of cases. Monitor the status of debtor payment plans to identify deficiencies and call or send delinquent payment reminders to debtors. Communicate in a professional and courteous manner with the Office of Legal Programs management, Government officials, and/or delinquent judgment debtors. Perform other duties as assigned. The Contractor shall provide Records Examiner/Analyst support positions with the following knowledge, skills, and abilities to perform the duties as specified herein. Possess a four-year undergraduate degree, with a minimum of three (3) years of professional work experience, including data entry responsibilities. Four-year degree may be substituted with two (2) years of work experience as a Data Analyst. Work independently and efficiently, with the ability to multi-task and prioritize a shifting workload. Retrieve and analyze data and information from multiple sources. Attention to detail and quality control techniques to ensure accuracy. Excellent written and oral communication skills. A good working knowledge of legal procedures as well as civil and criminal case terminology. Proficient in Microsoft Office software programs (i.e., Word, PowerPoint, Excel, and Outlook) and in accessing, learning, and maintaining various databases and on-line resource search engines. Operate a variety of office equipment, including personal computers, photocopiers, telephone systems, and scanners. Perform editing, reformatting, and generating written and electronic documents using MS Word and other document generation software. SGI Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Job Posted by ApplicantPro

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

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. + **This is a Remote role** **- Full-Time: Monday- Thursday 6:00 AM - 5:00 PM** **- Comfortable working in a high-volume production environment.** **- Processing medical record requests by taking calls from patients, insurance companies and attorneys to provide medical record status** **- Documenting information in multiple platforms using two computer monitors.** **- Proficient in Microsoft office (including Word and Excel)** **We offer:** **Comprehensive onsite/virtual training program followed by job shadowing with an assigned mentor** **Company equipment will be provided to you (including computer, monitor, virtual phone, etc.)** **Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and tuition Assistance** Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $15-$18.32 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion. This job is not eligible for employment sponsorship. Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here (************************************************** . Know Your Rights (*********************************************************************** , explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way. Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, (************************************************************** Id=**********48790029&layout Id=**********48795462) by selecting the 'Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here (******************************************************************************************************* . Requests for reasonable accommodations will be reviewed on a case-by-case basis. For more information about how we collect and use your data, please review our Privacy Policy (**************************************** .

: Short Description:Client helps is looking to add to its Client Technical Support. The candidate should have 6-10 years of experience. They will respond to and diagnose problems through discussion with users. 100% Onsite and will need to be comfortable with getting around DC. Complete Description: Job Responsibilities: Resolve technical issues and closing out assigned · Service/Incidents requests within the agency's Service Level Agreements.· Adhere to all Enterprise-wide security policies related to security and integrity of Districtowned Resources iii. Provide assistance with installation, operation, and maintenance of District-owned desktop software, including operating systems (both· Windows and Apple), off-the-shelf products (e.g. Microsoft Office, Project, Visio, Outlook) and endpoint management tools.· Log and route service requests and incidents in an incident management system.· Provide a high level of customer service to end users on a daily basis.· Provide technical expertise related to Microsoft Products, such as Microsoft Office, Windows operating systems, as well as other related Microsoft applications.· Troubleshoot issues related to agency specific applications and web applications.· Provide technical support for mobile devices, such as iPads, iPhones, Android devices and tablets.· Collaborate with the IT leadership team to test and implement cost effective technology for District.· Maintain service level agreements related to Desk Side support Service/Incident requests.· Work with other technical teams to coordinate multi-tiered technical support for outages, widespread security incidents. CONTRACT JOB DESCRIPTIONResponsibilities:· Responds to and diagnoses problems through discussion with users.· Ensures a timely process through which problems are controlled, including problem recognition, research, isolation, resolution, and follow-up steps.· Supervises operation of help desk and serves as focal point for customer concerns.· Provides support to end users on a variety of issues.· Identifies, researches, and resolves technical problems.· Responds to telephone calls, emails, and personnel requests for technical support.· Documents, tracks, and monitors the problem to ensure a timely resolution.· Provides second-tier support to end users for either PC, server, or mainframe applications or hardware.· Interacts with network services, software systems engineering, and/or applications development to restore service and/or identify and correct core problem.· Simulates or recreates user problems to resolve operating difficulties.· Recommends systems modifications to reduce user problems. Skills:· 6 yrs installing and configuring system hardware/software in an enterprise environment Required 6 Years· 6 yrs installing operating system Required (OS) patches and upgrades. Required 6 Years · Expertise in supporting desktop operating systems (Windows 10 Mac OSX 10.10.X) Required 3 Years· Bachelor's degree in IT or related field or equivalent experience. Required 6 Years · Experience using an endpoint management tool to provide remote support Required 3 Years· Strong Customer Service Skills. Required 3 Years · Experience providing administrative support in an IT environment. Required 6 Years · Proficient time management skills Required and detail oriented organizational skills Required 5 Years· Microsoft Certifications: MCP. Desired · Experience managing service requests for IT support in ServiiceNow or a similar ITSM platform. Required 3 Years · Expertise in troubleshooting hardware related issues. Required 6 Years · Expertise in troubleshooting complex software related issues. Required 3 Years · Can demonstrate experience making nontechnical users comfortable with complex technology concepts. Required 3 Years · Knowledge of Microsoft Office Suite (Office 2010+ and Office 365). Required 2 Years Compensation: $25.00 - $28.00 per hour About Us AHU Technologies INC. is an IT consulting and permanent staffing firm that meets and exceeds the evolving IT service needs of leading corporations within the United States. We have been providing IT solutions to customers from different industry sectors, helping them control costs and release internal resources to focus on strategic issues. AHU Technologies INC. was co-founded by visionary young techno-commercial entrepreneurs who remain as our principal consultants. Maintaining working relationships with a cadre of other highly skilled independent consultants, we have a growing number of resources available for development projects. We are currently working on Various projects such as media entertainment, ERP Solutions, data warehousing, Web Applications, Telecommunications and medical to our clients all over the world.

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

**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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **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** $52,600.00 - $86,800.00 **Target Openings** 3 **What Is the Opportunity?** Come learn more about this role at our Open House Event on 1/14! Click here to register - ************************************************************************************** LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington, DC. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **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: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience. + 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. + Valid passport. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. + Valid driver's license. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

This position is responsible for investigating claim denials; performing claim rebills; scanning & mailing documents; handling large volumes of documents; researching using hospital and insurance portals; opening, sorting, and importing incoming correspondence; contacting health insurance companies in order to obtain the status of previously submitted appeals. DUTIES AND RESPONSIBILITIES: Investigates Claims Denials. Handles large volumes of documents, including accurately scanning and mailing documents. Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal's/attorney's pursuit for additional reimbursement. Works within the client's Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue. Is comfortable, skilled, assertive, cordial, and professional on the telephone to follow up on submitted appeals. Opens, sorts, and imports incoming correspondence into the office database. Navigates through various computer systems and applications to find information about insurance claims. Greets and assists onsite guests. Answers calls for Claim status and Appeal status. Performs any other administrative duties as may be necessary. Performs other related duties as assigned by management. QUALIFICATIONS: Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience. Other skills required : Previous experience in office administration or another related field. Basic working knowledge of the US healthcare system. Ability to prioritize and multitask. Excellent written and verbal communication skills. Proficiency in Microsoft Office, including Word and Excel. Highly attentive to detail. Excellent organizational and time management skills. Clear, concise, and logical writing style. Computer-savvy, able to learn new applications/software quickly. Please remove paragraph before using in Workplace COMPETENCIES: Select which competency categories are necessary for this position. We strongly recommend diversity and ethics to be included in each . Then select an additional 3-5 of the most critical competencies for the specific job title. Please note: You may remove complete statements and complete sub-title sections however the verbiage/content may not be altered nor can wording be inserted as this is standard in all ADP Job Descriptions and are compliant. COMPETENCIES: Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures. Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals. Business Necessity - The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. 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$52,600.00 - $86,800.00Target Openings3What Is the Opportunity?Come learn more about this role at our Open House Event on 1/14! Click here to register - ************************************************************************************** LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington, DC. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.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: Handles 1st party property claims of moderate severity and complexity as assigned. Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience. 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. Valid passport. What is a Must Have? High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. Valid driver's license. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. **You will:** + Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. + Maintain confidentiality and security with all privileged information. + Maintain working knowledge of Company and facility software. + Adhere to the Company's and Customer facilities Code of Conduct and policies. + Inform manager of work, site difficulties, and/or fluctuating volumes. + Assist with additional work duties or responsibilities as evident or required. + Consistent application of medical privacy regulations to guard against unauthorized disclosure. + Responsible for managing patient health records. + Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. + Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. + Ensures medical records are assembled in standard order and are accurate and complete. + Creates digital images of paperwork to be stored in the electronic medical record. + Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. + Answering of inbound/outbound calls. + May assist with patient walk-ins. + May assist with administrative duties such as handling faxes, opening mail, and data entry. + Must meet productivity expectations as outlined at specific site. + May schedules pick-ups. + Other duties as assigned. **What you will bring to the table:** + High School Diploma or GED. + Ability to commute between locations as needed. + Able to work overtime during peak seasons when required. + Basic computer proficiency. + Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. + Professional verbal and written communication skills in the English language. + Detail and quality oriented as it relates to accurate and compliant information for medical records. + Strong data entry skills. + Must be able to work with minimum supervision responding to changing priorities and role needs. + Ability to organize and manage multiple tasks. + Able to respond to requests in a fast-paced environment. **Bonus points if:** + Experience in a healthcare environment. + Previous production/metric-based work experience. + In-person customer service experience. + Ability to build relationships with on-site clients and customers. + Comfortable bringing new ideas, process improvement suggestions, and feedback to internal stakeholders. We are committed to building a diverse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks and industry best practices. We're building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated _salary range_ for this role is $15.00 - $18.32. _Comp target_ is between $16.00 - $17.00 for this role _At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your responses will be_ _anonymous and_ _used to help us identify areas of improvement in our recruitment process._ _(_ _We can only see aggregate responses, not individual responses. In fact, we aren't even able to see if you've responded or not_ _.)_ _Responding is your choice and it will not be used in any way in our hiring process_ _._ Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $15-$18.32 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion. This job is not eligible for employment sponsorship. Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here (************************************************** . Know Your Rights (*********************************************************************** , explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way. Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, (************************************************************** Id=**********48790029&layout Id=**********48795462) by selecting the 'Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here (******************************************************************************************************* . Requests for reasonable accommodations will be reviewed on a case-by-case basis. For more information about how we collect and use your data, please review our Privacy Policy (**************************************** .

This position is responsible for investigating claim denials; performing claim rebills; scanning & mailing documents; handling large volumes of documents; researching using hospital and insurance portals; opening, sorting, and importing incoming correspondence; contacting health insurance companies in order to obtain the status of previously submitted appeals. DUTIES AND RESPONSIBILITIES: Investigates Claims Denials. Handles large volumes of documents, including accurately scanning and mailing documents. Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal's/attorney's pursuit for additional reimbursement. Works within the client's Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue. Is comfortable, skilled, assertive, cordial, and professional on the telephone to follow up on submitted appeals. Opens, sorts, and imports incoming correspondence into the office database. Navigates through various computer systems and applications to find information about insurance claims. Greets and assists onsite guests. Answers calls for Claim status and Appeal status. Performs any other administrative duties as may be necessary. Performs other related duties as assigned by management. QUALIFICATIONS: Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience. Other skills required: Previous experience in office administration or another related field. Basic working knowledge of the US healthcare system. Ability to prioritize and multitask. Excellent written and verbal communication skills. Proficiency in Microsoft Office, including Word and Excel. Highly attentive to detail. Excellent organizational and time management skills. Clear, concise, and logical writing style. Computer-savvy, able to learn new applications/software quickly. Please remove paragraph before using in Workplace COMPETENCIES: Select which competency categories are necessary for this position. We strongly recommend diversity and ethics to be included in each . Then select an additional 3-5 of the most critical competencies for the specific job title. Please note: You may remove complete statements and complete sub-title sections however the verbiage/content may not be altered nor can wording be inserted as this is standard in all ADP Job Descriptions and are compliant. COMPETENCIES: Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures. Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals. Business Necessity - The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

SUMMARY: This position is responsible for investigating claim denials; performing claim rebills; scanning & mailing documents; handling large volumes of documents; researching using hospital and insurance portals; opening, sorting, and importing incoming correspondence; contacting health insurance companies in order to obtain the status of previously submitted appeals. DUTIES AND RESPONSIBILITIES: Investigates Claims Denials. Handles large volumes of documents, including accurately scanning and mailing documents. Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal's/attorney's pursuit for additional reimbursement. Works within the client's Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue. Is comfortable, skilled, assertive, cordial, and professional on the telephone to follow up on submitted appeals. Opens, sorts, and imports incoming correspondence into the office database. Navigates through various computer systems and applications to find information about insurance claims. Greets and assists onsite guests. Answers calls for Claim status and Appeal status. Performs any other administrative duties as may be necessary. Performs other related duties as assigned by management. QUALIFICATIONS: Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience. Other skills required: Previous experience in office administration or another related field. Basic working knowledge of the US healthcare system. Ability to prioritize and multitask. Excellent written and verbal communication skills. Proficiency in Microsoft Office, including Word and Excel. Highly attentive to detail. Excellent organizational and time management skills. Clear, concise, and logical writing style. Computer-savvy, able to learn new applications/software quickly. Please remove paragraph before using in Workplace COMPETENCIES: Select which competency categories are necessary for this position. We strongly recommend diversity and ethics to be included in each . Then select an additional 3-5 of the most critical competencies for the specific job title. Please note: You may remove complete statements and complete sub-title sections however the verbiage/content may not be altered nor can wording be inserted as this is standard in all ADP Job Descriptions and are compliant. COMPETENCIES: Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures. Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals. Business Necessity - The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.