Claims Analyst II
Claim processor job in Menasha, WI
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team.
We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:
Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
Resolve claims and related issues in compliance with policy provisions.
Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.
Process payments for claims that are approved.
This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday.
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
The target start date for this position is January 12, 2026.
Job Responsibilities:
Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.
Reviews claims to ensure compliance with proper billing standards and completeness of information.
Obtains additional information from appropriate person and/or agency as needed.
Maintains department quality standards.
Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards.
Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.
Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution.
Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.
Reviews home office claims for payment up to $18,000.00.
Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts.
Appropriately documents attributes and memos for pertinent information related to claims payment.
Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.
Performs other duties and responsibilities as assigned.
Job Requirements:
High school diploma or equivalent preferred.
2-4 years claims processing experience required
Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.
Past experience using QNXT™ Claims Workflow a plus
Prior experience with ACA, Medicaid, or similar health plans preferred.
Coding experience preferred.
Network Health is an Equal Opportunity Employer.
Stop Loss & Health Claim Analyst
Claim processor job in Milwaukee, WI
Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.
Job Description:
The Opportunity:
This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim.
The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources.
How you will contribute:
* Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
* The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions
* Maintain claim block and meet departmental production and quality metrics
* An awareness of industry claim practices
* Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records
* Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc.
* Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process
* Establish cooperative and productive relationships with professional resources
What you will bring with you:
* Bachelor's degree preferred
* A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing
* Demonstrated ability to work as part of a cohesive team
* Strong written and verbal communication skills
* Knowledge of Stop Loss Claims and Stop Loss industry preferred
* Demonstrated success in negotiation, persuasion, and solutions-based underwriting
* Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
* Overall knowledge of health care industry
* Proficiency using the Microsoft Office suite of products
* Ability to travel
Salary Range: $54,900 - $82,400
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Job Category:
Claims - Life & Disability
Posting End Date:
30/01/2026
Auto-ApplyClaims Representative - Auto
Claim processor job in New Berlin, WI
Please note, employment offered to residents in the following states only: Connecticut, Delaware, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont. At Preferred, we understand the importance of holistic health. To meet the diverse needs of our employees, we offer a comprehensive set of benefits:
Financial
* Short-term disability, long-term disability, and life insurance coverage are provided at no cost
* Optional benefits include enhanced life insurance and critical illness plans
* 401k plan with an employer contribution that you will receive regardless of your own contribution to the plan
* A cash-balance pension plan
* Student Loan Repayment Assistance
* A short-term incentive plan for all employees
Social
* Generous paid time off, offering of 25 days at hire (prorated based on start date for the first year)
* 7 days of paid sick leave
* 10 paid company holidays
* Personalized paid time off after 3 years!
Emotional
* Access to 26 sessions with a BetterHelp therapist each year for you and up to 5 dependents, as well as access to all of BetterHelps group and digital resources
* Access to Family First, a team of care experts who can provide you and your loved ones 1:1 assistance with a variety of caregiving solutions, from elder care to legal and financial challenges, insurance and Medicare navigation, and more!
Physical
* Medical, dental, and vision coverage options begin on the first day of employment
* Health Savings Accounts (with a generous employer contribution!)
YOUR PURPOSE AND FUNCTION IN OUR COMPANY:
Alleviate the impact of adversity during challenging life events by the prompt investigation and resolution of claims. Supports and contributes to the Claims Department and Companys missions, visions, values, and goals.
KEY CAPABILITIES FOR SUCCESS:
* Evaluate files for the accurate and timely reserving of claims in accordance with the Preferred Mutual reserving philosophy.
* Appropriately manage indemnity and loss expenses.
* Conduct thorough and timely investigation to determine liability and claim valuation.
* Treat customers in a proactive and responsible manner
* Adjust schedule as needed to accommodate customer needs and/or fluctuations in work volume.
* Leverage technology as a critical component in achieving efficiencies and delivering superior customer service.
* Handle claims of moderate severity and complexity, with authority up to $45,000
* Display an understanding of avenues of contribution and recovery by third parties and takes appropriate action when necessary.
* Resolve claims promptly and fairly in a manner that is reflective of coverage, liability, and damages.
* Demonstrate an understanding of claim procedures and file administration for proper file documentation and claim reporting.
* Demonstrate an understanding of products and coverages offered by Preferred Mutual;
* Meet file quality standards as determined by internal and external audits.
* Maintain work load in accordance with Key Performance Driver standards.
* Develop an understanding of fraud indicators.
* Recognize Key data points within the claim management and other systems and utilizes the data to make informed decisions and reach better claim resolutions.
FUNCTIONAL AREA RESPONSIBILITIES:
* Handles low to moderately complex losses, including liability exposures, with a focus on soundness and promptness of coverage and liability investigation and verification
* Demonstrates independent and effective analysis and decision making when a scenario is not new
* Demonstrate a developed understanding of the policies with an ability to identify coverage concerns & red flags independently
* Researches then seeks help when a situation is new or complex
* Displays a high quality of damages verification and negotiation; subrogation investigation and preservation
* Demonstrates soundness and timeliness of liability and coverage denials
* Displays effective expense management and accurate file reserving
* Able to draft appropriate coverage letters/communications to customers with some intervention
* Demonstrates willingness to lead and direct their files with less oversight needed
QUALIFICATIONS:
* High School Diploma or Equivalent
* Bachelor's degree preferred
* 2 or more years of experience in claim processing
* Progress toward attaining one professional designation preferred (i.e., AIC, CPCU, SCLA).
* Exceptional active listening skills paired with effective oral and written communication skills.
* Make timely, definitive, and fact driven decisions.
* Strong time and project management skills that support continued process improvement.
* Skilled at collaboration, group decision making, problem solving and negotiation. Pursues duties and interactions with integrity.
* Proficient in technology platforms utilized by Preferred Mutual (including but not limited to Windows, Microsoft Office Suite, Outlook, and Internet-based applications).
ABOUT US: As a mutual company, we are independent by nature, so we think about insurance solutions a little differently. Through listening, problem solving, examining your challenges and collaborating on the right solutions for you, Preferred Mutual independent agents provide flexible solutions and adapt to your evolving needs. We do the same for our employees. We are process and domain experts, focused on the solutions that deliver results for our clients and our company. We offer a great work environment, professional development, challenging careers, and competitive compensation. With Preferred, there are no surprises. You can count on us to deliver on our promises and be there when you need us, as your insurance provider and your employer. Preferred Mutual is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law.
DISCLAIMER: This role (job) description indicates in general terms, the type and level of work performed as well as the typical responsibilities of employees in this classification. The duties described are not to be interpreted as being all-inclusive to any specific employee. Management reserves the rights to add, modify, change or rescind the work assignments of different positions and to make reasonable accommodations so that qualified employees can perform the essential functions of the job. Nothing in this position description changes the at-will employment relationship existing between Preferred Mutual Insurance Company and its employees.
The salary range for the role is $60,500 - $78,000 per year paid on a salaried basis. The rate offered to any candidate will be reflective of the candidates experience and any relevant education, certification, or qualifications related to their ability to perform the responsibilities of this position as permitted by law.
Associate Claims Examiner - Equine
Claim processor job in Milwaukee, WI
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills.
Job Responsibilities
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
* Conducts, coordinates and directs investigation into loss facts and extent of damages.
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
* Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents.
* Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting.
Required Qualifications
* This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred.
* Must have or be eligible to receive claims adjuster license.
* Successful completion of basic insurance courses or achievement of industry designations.
* Ability to be trained in insurance adjusting up to two years of claims experience.
* 2-4 years of experience in general liability, construction defect, or related liability lines preferred.
* Bachelor's degree preferred
* Excellent written and oral communication skills.
* Strong organizational and time management skills.
#LI-Hybrid
US Work Authorization
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
* We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
* All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
* We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
Are you ready to play your part?
Choose 'Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
* All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
* All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Auto-ApplyAssociate Claims Specialist - Workers Compensation - Central Region
Claim processor job in Wisconsin Dells, WI
Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region!
As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026.
This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations.
To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change.
Responsibilities
Manages an inventory of claims to evaluate compensability/liability.
Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
Performs other duties as assigned.
Qualifications
Effective interpersonal, analytical and negotiation abilities required
Ability to provide information in a clear, concise manner with an appropriate level of detail
Demonstrated ability to build and maintain effective relationships
Demonstrated success in a professional environment; success in a customer service/retail environment preferred
Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
Licensing may be required in some states
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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Auto-ApplyWC Sr. Claims Examiner
Claim processor job in Appleton, WI
Company Details
We're a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.
Responsibilities
Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.
Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
Document claim handling activities; create and document action plans.
Establish appropriate case reserves.
Actively manage medical treatment and disability while assisting the injured worker to return to work.
Comply with all performance guidelines.
Identify loss trends and communicate to supervisor and/or clients.
Use automated diary system to issue indemnity payments and for claims management
Investigate and manage claim subrogation and negotiate settlements.
Manage coverage B or conflict of interest cases as assigned.
Address customer complaints and inquiries in an exemplary and professional manner.
Participate in client claim reviews when scheduled or requested
May perform other functions as assigned
Qualifications
Demonstrated working knowledge of workers' compensation administration rules/laws in at least one of the following states: MN, IL or WI.
Excellent communication and presentation skills.
Must be able to interface with clients, legal counsel, health care professionals, etc.
Good math and analytical ability.
Excellent customer service skills.
Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.
Education
BA/BS degree with three years' experience. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years' experience in workers compensation claims management.
Additional Company Details ****************************
The Company is an equal employment opportunity employer.
We do not accept unsolicited resumes from third party recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary Range: $75k - $88k
• Benefits include Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans
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. Sponsorship Details Sponsorship not Offered for this Role
Auto-ApplyClaims Analyst II
Claim processor job in Menasha, WI
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team. We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:
* Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
* Resolve claims and related issues in compliance with policy provisions.
* Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.
* Process payments for claims that are approved.
This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday.
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
The target start date for this position is January 12, 2026.
Job Responsibilities:
* Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.
* Reviews claims to ensure compliance with proper billing standards and completeness of information.
* Obtains additional information from appropriate person and/or agency as needed.
* Maintains department quality standards.
* Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards.
* Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.
* Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution.
* Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
* Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.
* Reviews home office claims for payment up to $18,000.00.
* Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts.
* Appropriately documents attributes and memos for pertinent information related to claims payment.
* Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.
* Performs other duties and responsibilities as assigned.
Job Requirements:
* High school diploma or equivalent preferred.
* 2-4 years claims processing experience required
* Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.
* Past experience using QNXT Claims Workflow a plus
* Prior experience with ACA, Medicaid, or similar health plans preferred.
* Coding experience preferred.
Network Health is an Equal Opportunity Employer.
Reverse Processor I
Claim processor job in Wisconsin
Join the company defining what it means to be an Impact Lender!
Mortgages are what we do, but that doesn't define who we are. In 2008, Movement disrupted the industry with the innovative 6-7-1 mortgage process. In 2023, we pioneered again, helping launch Impact Lending - a new category of lending. Any mortgage lender that commits at least 10% of its profits to helping the neighborhoods it serves is an Impact Lender.
At Movement, we are Impact Lenders. We give 40%-50% of our profits to making an impact in our communities. For us, purpose and people have always come before profit.
ROLES AND RESPONSIBILITIES
(Duties and responsibilities may include, but are not limited to the following):
Processing Support
Completes order outs to third party vendors
Title/CPL/tax cert/wire instructions/preliminary HUD
Flood cert
Condo questionnaire and supporting documentation
FHA case number/CAIVRS
Orders payoff (refinance only)
Orders any and all necessary verifications (written VOE, VOD, VOR) for borrowers
Sends condo questionnaire to homeowners' association and obtain condo docs as necessary (if property is a condo or attached PUD)
Completes LDP/GSA checks only on loans that do not require Fraudguard
Requests hazard insurance with correct mortgagee clause (binder & paid receipt if purchase)
Communicates with title company, appraiser, and other vendors as required to obtains documentation needed to clear conditions
REQUIRED SKILLS AND QUALIFICATIONS
(To perform the job successfully, the candidate should demonstrate the following competencies to perform the essential functions of this job.)
Solid knowledge and understanding of customer service and intrapersonal best practices.
Extensive knowledge and understanding of HECM loan program.
Solid knowledge and understanding of mortgage lending processes, procedures, and regulations.
PREFERRED QUALIFICATIONS
Demonstrated experience analyzing and interpreting data.
Demonstrated experience researching information, problem solving and making solid business decisions.
Demonstrated experience working in a fast paced and changing environment.
Demonstrated experience with MS Office products.
PREFERRED EDUCATION
High School or GED
PHYSICAL REQUIREMENTS
This position is primarily an in-office position. Normal office environment.
The expected salary range for this position is between:
$44,500.00 - $59,500.00
The range for the position in other geographies may vary based on market differences. The actual compensation will be determined based on experience and other factors permitted by law.
We also offer a benefits package that includes:
Competitive pay
Benefits Offered: Medical, Dental, Vision, Life, Disability, Critical Care, Hospitalization, HSA, FSA, DCFSA and QTE
Retirement plan: 401(k) and Roth
Paid Time Off: 16 days front loaded. Prorated based on the start date month
11.5 paid holidays per year
Employee assistance program
Excellent career growth opportunity
Fun, team-focused working environment
Employee driven community outreach program
Relocation packages available
The application window is anticipated to close on:
August 1, 2025
We're definitely not your average mortgage company. When you're ready to grow your career AND your impact, we're ready for you. We're also one of the nation's top lenders and are redefining corporate culture. We work hard, we have fun, we invest in our people and we make a difference. Sound like a plan? Good. Learn more at *****************
Auto-ApplyClaims Prevention Coordinator - Full Time - $19/Hour
Claim processor job in Green Bay, WI
Dohrn Transfer is a leading Midwest LTL Carrier providing less-than-truckload, truckload, and value-added services throughout our 10-state service area. Join our team and become a part of our new growth and bright future. We offer competitive salary and a great benefit package in an exciting, rewarding industry.
Dohrn is currently seeking a Full Time Claims Prevention Coordinator at our Green Bay, WI terminal.
Hours: Monday - Friday, 8:00am - 4:30pm
Pay: $19.00/Hour
Benefits: Health / Vision / Dental insurance, 401k matching, life insurance, short/long term disability and more.
POSITION SUMMARY:
Locating and correctly placing over, short, damaged, and missing freight as well as preventing claims.
Responsibilities
ESSENTIAL DUTIES
Daily telephone and written communication with internal and external customers
Locate missing freight and overages, shortages, and damaged freight
Monitor the OS&D webs 4.5 hours daily in addition to answering the OS&D and Driver lines
Review manifests, bills of lading, delivery receipts, and drivers' green sheets
Assist terminals in regards to all OS&D freight
Research miss-delivered freight and ensure it gets delivered correctly
Request dispositions, re-delivery charges, and re-consignment charges to ensure freight keeps moving to its destination
May assist with customer service/pick up calls and set appointments as needed
Other duties as needed
Qualifications
MINIMUM REQUIREMENTS
High School completion or equivalent
Computer skills including Microsoft Office
Ability to multi-task in a fast paced environment
Detail-oriented, problem-solver, self-motivated
Excellent verbal and written communication skills
Ability to establish and maintain great relationships with customers
Ability to work in a team as well as individually
Excellent attendance
WORKING CONDITIONS/PHYSICAL DEMANDS
Primarily sedentary work, which involves sitting most of the time
May be occasionally required to exert up to 20 pounds of force and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects
The general office environment is favorable; Lighting and temperature are adequate, and there are minimal hazardous or unpleasant conditions caused by noise, dust, etc;
Visual Acuity including regular use of items including a computer screen or monitor
Manual dexterity is regularly required including fingering, grasping, and typing; manual dexterity includes repetitive motion of the wrists, hands, and fingers
Talking and hearing required to communicate with and listen to others to share or receive information; May be occasionally exposed to noise including telephone, office machinery, and conversations of others
Dohrn Transfer Company, LLC is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, color, religion, age, sex, sexual orientation, gender, gender identity or expression, national origin, geographic background, physical and/or mental disability, protected veteran status, or any other classification protected by applicable law.
Auto-ApplyProgram Claims Specialist (Madison, WI - Hybrid)
Claim processor job in Madison, WI
At TruStage, we're on a mission to make a brighter financial future accessible to everyone. We put people first, and work hand in hand with employees and customers to create a diverse and inclusive environment. Passionate about building insurance and financial services solutions, we push the boundaries of what's possible. We need you to help us shape what's next. You'll be encouraged to share your experiences, ideas and skills to help others take control of their financial future.
Join a team that has received numerous awards for being a top place to work: TruStage awards and recognition
This position is responsible for oversight of assigned Program Third Party Administrators (TPA's) and handling new and existing litigation claims. Ensure timely and effective application of policies and processes. Accountable for team goals related to customer service and compliance with best practices. Provide claim file direction and assistance with complex claim issue resolution. Maintain effective communication with internal and external business partners. Participate in quality assurance reviews and work on special projects to best meet the needs of the department. Contribute to the development of functional/team strategy. The position will also oversee complex professional and general liability litigated claims.
Job Responsibilities:
Serve as the primary point of contact and relationship manager for program claims.
Oversee proactive litigation management on assigned claims including investigating, evaluating, and negotiating to resolution.
Coordinate operational and leadership responsibilities to ensure consistent claim results, quality, and customer service.
Develop protocols to aid in the establishment and maintenance of claim strategies and appropriate claim handling authority providing education and training as required.
Collaborate with business partners vetting and onboarding new Programs and TPA's.
Develop/maintain tools to monitor and improve the communication of essential claim information to ensure that monthly data collection and information sharing practices support TruStage Corporate standards.
Work in close collaboration with cross-functional teams including Underwriting, Actuarial, Product, Finance, and Treasury to analyze and structure existing and new Program Business.
Conduct in-person or remote claim file reviews and audits on multiple TPA claim systems.
Identifies emerging claim trends as warranted.
Monitor and document claim processes/guidelines for effectiveness and efficiency, identifying and implementing process improvements.
Participate in Claim organization strategy initiatives and projects in collaboration with the Claim Operations team.
Collaborate with Claim Operations leaders regarding the selection and ongoing management of TPA's and other outside vendors.
The above statement of duties is not intended to be all inclusive and other duties will be assigned from time to time.
Job Requirements:
Bachelor's Degree in Business Administration, Insurance, Finance, Economics, or related field of study is strongly preferred.
7+ years of P&C Insurance claims experience.
CPCU, AIC, ASLI, or other industry designations or certifications are highly desirable.
Adjuster license and continuing education as needed.
Proven ability to clearly and effectively communicate information to internal/external clients remotely or in person.
Strong critical thinking and analytical skills.
Demonstrated experience in progressively senior claim roles with strong technical skills.
Experience in a range of Property and Casualty lines of business and products including Property, General Liability, Automobile Liability and Physical Damage Liability, and Professional Liability.
Strong interpersonal and consultative skills.
Creativity, flexibility, emotional intelligence, adaptability, and problem-solving skills.
Ability to manage and develop existing and new industry relationships with Program Managers, Brokers, and Reinsurance partners.
Ability to travel ~10%.
If you're ready to help make a difference, apply today. A resume is required to apply. TruStage may process applicant information using an Artificial Intelligence (AI) tool. This tool automatically generates a screening score based on how well applicant information matches the requirements and qualifications for the position. TruStage recruiters use the screening score as a guide to further evaluate candidates; the score is one component of an application review and does not automatically determine whether a candidate moves forward. Candidates may choose to opt out of this process.
Compensation may vary based on the job level, your geographic work location, position incentive plan and exemption status.
Base Salary Range:
$102,200.00 - $153,300.00
At TruStage, we believe a sound, inclusive benefits program is of vital importance, along with a flexible workplace that allows for work-life balance, career growth and retirement assistance. In addition to your base pay, your position may be eligible for an annual incentive (bonus) plan. Additional benefits available to eligible employees include medical, dental, vision, employee assistance program, life insurance, disability plans, parental leave, paid time off, 401k, and tuition reimbursement, just to name a few. Beyond pay and benefits, we also recognize that flexibility, including working in a place you prefer, is essential to caring for our employees. We will continue to strive to offer flexibility and invest in technology and other tools that will make hybrid working normal rather than an exception, so that when “life happens,” you can focus on what's most important.
Accommodation request
TruStage is a place where everyone can bring their best self and thrive. If you need application or interview process accommodations, please contact the accessibility department.
Auto-ApplyWorkers Compensation Claim Representative
Claim processor job in Brookfield, WI
**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?**
Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery The injured worker is working modified duty and receiving ongoing medical treatment. The injured worker as returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. With close to moderate supervision, may handle claims of greater complexity where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and there has been a change in the current position. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.
**What Will You Do?**
+ Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability
+ Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions.
+ Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment.in collaboration with internal nurse resources where appropriate.
+ Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
+ Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Prepare necessary letters and state filings within statutory limits.
+ Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud.Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
+ Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.
+ Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction.
+ 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.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ 2 years Workers Compensation claim handling experience.
+ Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
+ Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology.
+ Ability to effectively present file resolution to internal and/or external stakeholders.
+ Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
+ General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
+ Principles of Investigation: Intermediate investigative skills including the ability to take statements.
+ Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
+ Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
+ Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
+ Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
+ Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
+ WC Technical:
+ Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims.
+ Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
+ Intermediate knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
+ Customer Service:
+ Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
+ Teamwork:
+ Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
+ Planning & Organizing:
+ Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
+ Maintain Continuing Education requirements as required or as mandated by state regulations.
**What is a Must Have?**
+ High School Diploma or GED.
+ 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program.
**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 ******************************************************** .
Records Processor
Claim processor job in Milwaukee, WI
For a description, see file at: ************ alverno. edu/files/galleries/Records_Processor-0001.
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Grinding/Scrap Processor - 1st shift (5:45 a - 2 p)
Claim processor job in Mazomanie, WI
Plastic Ingenuity is committed to providing innovative, high-quality packaging for the food, healthcare, and consumer goods industries. At the company's heart are five core values that define who we are and why we have sustained success since 1972. We are friendly and genuine, fostering authentic connections with colleagues and clients alike. Resourcefulness defines our approach, allowing us to turn challenges into opportunities. Collaboration is ingrained in our process, uniting diverse perspectives to identify creative solutions. Total customer focus drives us; we listen intently, respond promptly, and consistently exceed expectations. Lastly, we are dependable doers, letting our actions speak louder than words. These values are the cornerstone of Plastic Ingenuity.
Role Summary:
Scrap processor is responsible for plant wide scrap grinding operation. All work is performed in a climate-controlled environment.
Personality and Interest Profile:
You may enjoy this role if you:
Working independently while fulfilling a critical role in plant production.
Can be adaptable, flexible and enjoy doing work that requires standing and walking while retrieving and grinding products.
Accountable for:
Grinding up scrap plastic produced during manufacturing process.
Coordinate with production and warehouse to maintain an orderly scrap grinding operation.
Maintain the proper identification of scrap and regrind.
Follows good manufacturing practices to ensure product safety.
Train team members in marking and grinding scrap properly.
Keep grinder area clean.
Ensure grinders are properly cleaned between materials.
Work with maintenance personnel to keep equipment operating properly.
Operates forklift when needed (will require certification).
Performs other duties as required.
Desired Qualifications:
High School Diploma or equivalent, preferred
High degree of accuracy and attention to detail.
1 year of experience within the company or equivalent work experience.
Good understanding of plastic materials.
Good interpersonal and verbal communications skills.
Physical Demands:
Frequent lifting of 15-25 lbs/Occasional lifting up to 50 lbs/More than 50 lbs requires a team lift
Frequent repetitious tasks with upper extremities
Prolonged periods of standing on concrete floor
Ability to correctly wear/use personal protective equipment including long sleeves as required
Work involves exposure to high temperatures
Attention to detail
Field Claims Representative
Claim processor job in Appleton, WI
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to:
* Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
* Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
* Become familiar with insurance coverage by studying insurance policies, endorsements and forms
* Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
* Ensure that claims payments are issued in a timely and accurate manner
* Handle investigations by phone, mail and on-site investigations
Desired Skills & Experience
* Bachelor's degree or direct equivalent experience handling property and casualty claims
* A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
* Field claims handling experience is preferred but not required
* Knowledge of Xactimate software is preferred but not required
* Above average communication skills (written and verbal)
* Ability to resolve complex issues
* Organize and interpret data
* Ability to handle multiple assignments
* Ability to effectively deal with a diverse group individuals
* Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
* Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
* Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-DNP #LI-Hybrid
#IN-DNI
Auto-ApplyEmbedded ROI Processor
Claim processor job in Madison, WI
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, 6am to 5pm.** **- 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 (**************************************** .
Claims Rep II-General Liability (Bodily Injury focused)
Claim processor job in Fond du Lac, WI
Job Information
Job Title
Claims Representative II-General Liability (Bodily Injury focused)
Home Department:
Claims
Employment Status:
Exempt; Full-time
Schedule:
40 hours/week with Flexible Scheduling Opportunities
Position Location:
Home Office, Telecommuting, and Remote Opportunities in CO, GA, IL, IN, IA, MN, TN, TX, & WI
Overview
Protecting our policyholders' dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.
Society Insurance is seeking a Claims Representative II to join our Claims team. This position has a general liability focus. This position will resolve mildly complex general liability claims by investigating losses and negotiating out-of-court settlements.
About the Role
Settles mildly complex claims by determining insurance carrier's liability and reaches agreement with claimant according to policy provisions and authority level.
Handles mediations, arbitrations, subrogation, and recorded settlement agreements.
Determines coverage through investigations by examining claim forms, policies, and other records; interviewing claimants, insureds, and witnesses; consulting police and hospital records; inspecting damages; and consulting with experts when appropriate.
Mentors and trains claims representatives in claims expertise by assisting in identifying training needs and opportunities.
May be involved with litigation by analyzing negotiated settlement options; evaluating evidence, and overseeing attorney in the handling of discovery and settlement.
Resolves questionable claims by investigating the claim and comparing claims information with evidence.
Ensures proper file documentation of assigned files by complying with company and state requirements.
Prepares reports by collecting, analyzing, and summarizing claim information.
Contributes to team effort by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed.
About Yo u
You enjoy communicating and building relationships with others.
You are composed, cool under pressure, and can negotiate without damaging relationships.
You hold yourself accountable and act in accordance with rules and regulations.
You enjoy analyzing, investigating, and using the facts to make decisions.
You are naturally curious and have a desire to know more.
What it Will Take
Bachelor's Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience.
Proficiency in general liability claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.
Ability to obtain and maintain proper licensing prior to handling a state that requires it.
Professional insurance designations highly desirable.
Experience using Guidewire Claims System preferrable.
What Society Can Offer
Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
Community: Charitable Match; paid volunteer time; team sponsorships
Wellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more
Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws. Society Insurance is a drug-free workplace.
Auto-ApplyClaims Rep II-General Liability (Bodily Injury focused)
Claim processor job in Fond du Lac, WI
Job Information
Job Title
Claims Representative II-General Liability (Bodily Injury focused)
Home Department:
Claims
Employment Status:
Exempt; Full-time
Schedule:
40 hours/week with Flexible Scheduling Opportunities
Position Location:
Home Office, Telecommuting, and Remote Opportunities in CO, GA, IL, IN, IA, MN, TN, TX, & WI
Overview
Protecting our policyholders' dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.
Society Insurance is seeking a Claims Representative II to join our Claims team. This position has a general liability focus. This position will resolve mildly complex general liability claims by investigating losses and negotiating out-of-court settlements.
About the Role
Settles mildly complex claims by determining insurance carrier's liability and reaches agreement with claimant according to policy provisions and authority level.
Handles mediations, arbitrations, subrogation, and recorded settlement agreements.
Determines coverage through investigations by examining claim forms, policies, and other records; interviewing claimants, insureds, and witnesses; consulting police and hospital records; inspecting damages; and consulting with experts when appropriate.
Mentors and trains claims representatives in claims expertise by assisting in identifying training needs and opportunities.
May be involved with litigation by analyzing negotiated settlement options; evaluating evidence, and overseeing attorney in the handling of discovery and settlement.
Resolves questionable claims by investigating the claim and comparing claims information with evidence.
Ensures proper file documentation of assigned files by complying with company and state requirements.
Prepares reports by collecting, analyzing, and summarizing claim information.
Contributes to team effort by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed.
About Yo u
You enjoy communicating and building relationships with others.
You are composed, cool under pressure, and can negotiate without damaging relationships.
You hold yourself accountable and act in accordance with rules and regulations.
You enjoy analyzing, investigating, and using the facts to make decisions.
You are naturally curious and have a desire to know more.
What it Will Take
Bachelor's Degree and 3+ years of claims handling experience OR 5+ years of claims handling experience.
Proficiency in general liability claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.
Ability to obtain and maintain proper licensing prior to handling a state that requires it.
Professional insurance designations highly desirable.
Experience using Guidewire Claims System preferrable.
What Society Can Offer
Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
Community: Charitable Match; paid volunteer time; team sponsorships
Wellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more
Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws. Society Insurance is a drug-free workplace.
Auto-ApplyTeam Uniform Processor - Full & Part Time
Claim processor job in Brookfield, WI
Join a FAST-paced, high-ENERGY team BUILD & ASSESS amazing, high-quality team uniforms Assure QUALITY of each uniform we build construction PREPARE uniforms for delivery Have FUN while making money
Stefans Soccer is looking for a enthusiastic Team Uniform Processor to join our fast-paced and high-energy team. In this position you will be responsible for building and assessing amazing, high-quality team uniforms. You may be responsible for printing uniforms, assuring the quality of each uniform, and/or preparing uniforms for delivery. We are looking for someone who takes pride in their work and wants to have fun while making money.
No experience necessary, paid training. We will figure out what best suits you! Extraordinary Attention to detail - must have the patience, acumen and determination to work with many details at the same time
Requirements
Able to work under pressure in a fast-paced environment
Team player - works well in a group environment
Able to lift boxes up to 30 pounds
Able to stand for long periods of time
Responsibilities
Accountability - Ability to accept responsibility and account for his/her actions
Communication, Oral-Ability to communicate effectively with others using the spoken word
Honesty/Integrity - Ability to be truthful, maintain high level of confidentiality and be seen as credible in the workplace
Time Management - Ability to utilize the available time to organize and complete work within given deadlines
Compensation & Benefits
Wage ranges:
Full-time:
Part-time:
Full-time employees will receive:
Company-contributed health insurance, dental and vision
401K program with generous company match
Paid Personal Time Off and Holidays
All employees will receive
Great work environment with a high energy team in a family business and exciting industry
No experience necessary, paid training
Quick opportunities for raises as experience, reliability and job performance dictates
Employee discount at our retail stores
Auto-ApplySubrogation Examiner
Claim processor job in Waukesha, WI
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Schedule: Monday - Friday; 8:30am-5:00pm Eastern Time
The Subrogation Examiner is responsible for researching and examining routine health claims that may be related to Third Party Liability, Workers' Compensation and other subrogation/reimbursement recovery cases.
How you will make an impact:
* Initiates calls to groups, insurance companies, attorneys, members and others as necessary to determine if claims have potential for reimbursement from another party.
* Responds to inquiries regarding information on injury claims.
* Utilizes various research methods and vendor systems to gather information.
* Works with subrogation staff, other departments and outside clients to assist with the recovery process.
* Prepares written communications.
* Reviews diagnostic and procedure codes to determine claims relevant to each case.
* Reviews internal systems/applications for various information needs.
* Assists with small scale special projects.
Minimum Requirements:
* Requires a minimum of 1 year of inbound or outbound call experience; or any combination of education and experience, which would provide an equivalent background.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyAssociate Claims Specialist - Workers Compensation - Central Region
Claim processor job in Wisconsin Dells, WI
Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region! As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026.
This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations.
To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change.
Responsibilities
* Manages an inventory of claims to evaluate compensability/liability.
* Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
* Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
* Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
* Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
* Performs other duties as assigned.
Qualifications
* Effective interpersonal, analytical and negotiation abilities required
* Ability to provide information in a clear, concise manner with an appropriate level of detail
* Demonstrated ability to build and maintain effective relationships
* Demonstrated success in a professional environment; success in a customer service/retail environment preferred
* Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
* Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
* Licensing may be required in some states
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco
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