Claim processor jobs in Hammond, LA

Job Title: Claims Analyst-Federal Construction ***Work Location: Panama City, FL (Tyndall AFB) *** Salary: Based on experience and will be discussed with manager in interview REQUIREMENT- Must be a US Citizen and must pass a federal background review and drug screen Responsibilities/Duties: Analyze contract terms, project schedules, and scope to identify potential claims or disputes. Prepare, evaluate, and document construction claims including Requests for Equitable Adjustment (REAs), time extensions, and cost impacts. Review subcontractor claims and coordinate analysis with project and legal teams. Maintain organized documentation related to claims, including correspondence, daily reports, meeting minutes, schedules, and cost records. Work closely with project managers, estimators, and schedulers to gather and validate data. Support negotiations and settlement of claims with clients and subcontractors. Provide recommendations for claim avoidance and risk mitigation. Ensure all claims comply with applicable contract clauses and federal regulations (FAR, DFARS, etc.). Assist in drafting position papers, presentations, and reports to support claim resolution or litigation support. Education/Experience: Bachelor's degree in Construction Management, Engineering, Business, or related field. Minimum of 5 years of experience in construction claims analysis, preferably in federal or military construction projects. Experience on U.S. Army Corps of Engineers (USACE) or NAVFAC projects. Certification in construction claims or contract management (e.g., CCP, PMP, AACE certifications). Working knowledge of construction law and dispute resolution processes. Strong understanding of federal contracting regulations and procedures (FAR, DFARS). Familiarity with scheduling techniques and tools (e.g., Primavera P6, Microsoft Project). Experience analyzing cost impacts and time delays using industry-standard methodologies. Excellent written and verbal communication skills. Highly organized with strong attention to detail. Ability to work independently and collaboratively with project teams. Proficient in Microsoft Office Suite (Excel, Word, Outlook). Benefits: Competitive salary based on experience. Comprehensive health, dental, and vision insurance. Retirement savings plan with company match. Paid time off and holidays. Professional development and career advancement opportunities. A supportive and collaborative work environment. Equal Opportunity Employer (U.S.) all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Accura uses E-Verify in its hiring practices to achieve a lawful workplace. *******************

Benefits: Paid time off Competitive salary Dental insurance Employee discounts Health insurance Vision insurance Position Overview As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. The Coordinator will be responsible to follow up daily with the OPS team to ensure and that all required documentation, estimates and procedures are followed according to required program guidelines.A successful Coordinator will possess tenacity and thrives in a fast-paced environment. The coordinator who is detail oriented and able to focus with many projects in varying degrees of completion will be most successful in this position. Job Responsibilities Understanding of the claims flow process - Water Mitigation, Reconstruction, Contents, and other Environmental work Manages data entry for each claim from First Notice of Loss through to completion of job in the CRM system Daily review of compliance tasks and all job tasks are completed on time Monitor and update jobs in required operating system making sure the job flows efficiently through the claims process requirements and cycle times Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call Creates and or assists with job estimate, reviews final estimate to ensure estimate is complete per company standards Manages Customer Service issues and complaints, documenting actions and resolution Understanding of all company cycle times and SLAs required for each job and phase Client Care Calls - ensure constant, often daily, communication with the customer, may communicate with adjuster Ensure daily notes are entered in all jobs, contacting relevant participants and escalating to the department manager as required May be responsible for creating job estimate and or assisting the Estimator/Project Manager with final estimate Job Requirements High school diploma/GED required Bachelor's Degree or applicable experience preferred, work experience will be considered IICRC Certifications preferred but not required: WTR, ASD, OCT, STC Exceptional Customer Service skills 1-3 years of Xactimate experience required- proficient use Xactimate Experience with Microsoft© Office application (Word, Outlook, PowerPoint, and Excel) required Personal time management and organizational skills Strong verbal and written communication skills Dependable and adaptable to operate within a fast-paced work environment Ability to manage highly confidential information Strong problem-solving skills Proficient at using Microsoft Office, Outlook, CRM software Experience do you have with customer interaction and conflict resolution Physical Demands and Working Conditions The physical demands are representative of those that must be met by an employee to perform the essential function to this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Incumbent must be prepared to: Move up to 20 pounds occasionally, by lifting, carrying, pushing, pulling, or otherwise repositioning objects. Sitting for long periods of time while using office equipment such as computers, phones etc. Fingering and Repetitive motions; such as movement of wrists, hands and fingers while picking, pinching and typing during your normal working environment. Express or exchange ideas with others quickly, accurately, and receive and act on detailed information. Close visual acuity to perform detail-oriented activities at distances close to the eyes, such as preparing and analyzing data, viewing computer screen and expansive reading. Be exposed to various inside working conditions: The change of building environment such as with or without air conditioning and heating. May be required to travel for short periods of time. Disclaimer The above statements are intended to describe the general nature and level of work being performed by associates assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. The Company reserves the right to modify this description in the future, with or without notice to the employee. This Job Description does not create an employment contract, implied or otherwise, and employment with the Company remains at will. These responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. Compensation: $15.00 - $20.00 per hour We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Built on a foundation of great brands and employees with a passion for service, our vision is to be the leading provider of essential services through empowered people, world-class customer service and convenient access. By joining ServiceMaster, you'll be part of a talented network of employees with a shared vision. Our environment is a diverse community where successful people work together to achieve common goals. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to The ServiceMaster Company, LLC.

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

**Claims Auditor I, II and Senior** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ The **Claims Auditor I** is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The **Claims Auditor II** is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The **Claims Auditor Senior** is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. **How you will make an impact :** + Performs audits of high dollar claims. + Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. + Contacts others to obtain any necessary information. + Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. + Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. + Refers overpayment opportunities to Recovery Team. + **Claims Auditor II** - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. + **Claims Auditor Senior** - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. **Minimum Requirements :** + **Claims Auditor I :** Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. + **Claims Auditor II :** Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. + **Claims Auditor Senior :** Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities & Experiences:** + Stop loss claims experience highly preferred. + Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. + Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. + Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. 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.

Administers and resolves non-complex short term claims of low monetary amounts, including Fast Track and Incident Only claims. Documents and monitors open case inventory to ensure proper/timely closing and billing of files. Makes decisions on claims within delegated limited authority.

About Us At ENFRA, we blend a rich history with a forward-looking vision. With over 100 years of experience, we are a pillar of stability in the energy infrastructure industry and a leader in innovative energy solutions. Our commitment to leveraging emerging technologies ensures that we remain at the forefront of the Energy-as-a-Service sector. We believe in growth-not just for our business, but for our people. Our team members have the opportunity to advance their careers in a supportive environment that values continuous learning and development. We embrace innovation and encourage creative problem solving to tackle the energy infrastructure and energy challenges of tomorrow. Inclusion is at the heart of our culture. We strive to create a workplace where every voice is heard and valued, fostering a collaborative environment where diverse perspectives drive our success. Join us to be part of a legacy of excellence and a future of groundbreaking advancements. At ENFRA, stability, innovation, and growth are more than just values-they are the pillars of our continued success. Overview The Claims Specialist II is responsible for the overall administration of property and casualty claims (General Liability, Auto Liability, and Worker's Compensation). Works closely within the Risk Management team (Claims, Legal, and Operations Senior Leadership) to mitigate losses and communicate claim progress with various levels of management (Business Unit Managers, Project Managers, President) from inception through closure. Responsibilities Review applicable lines of insurance coverage to determine possible coverage, exclusion, and deductibles. Calculates and reports projections, final cost, and the anticipated impact of the claim to the Team. Provide outstanding customer service to Operations, while also collaborating successfully with the carriers, brokers, and TPAs in the handling of construction casualty claims. Review claims for coverage and when applicable, submit claims to the insurance carrier. Maintains updated records and prepares required reports. Lead in claims cost control. Contact applicable employees regarding their claims to provide counsel regarding the explanation of benefits. May provide leadership, coaching, and/or mentoring to a subordinate group. Performs work under minimal supervision. Handles moderately complex issues and problems, and refers more complex issues to higher-level staff. Qualifications Required Education, Experience, and Qualifications Bachelor's degree. 3-5 years of claims experience. Construction, Risk, and Insurance Specialist (CRIS), Associate in Claims (AIC), or Associate in Risk Management (ARM). If not, must obtain within the first six (6) months of employment. Possesses comprehensive knowledge of the subject matter. Problem-solving skills. Organizational skills. Effective written and verbal communication skills. Preferred Education, Experience, and Qualifications Certified Worker's Compensation Professional (CWCP) Travel Requirements 0-5% of time will be spent traveling to job site/office location. Physical/Work Environment Requirements Office Environment - remaining in a stationary position, often sitting for prolonged periods. Quiet and noisy environment. Pay Range USD $50,500.00 - USD $67,470.00 /Yr. ENFRA is proud to be an Equal Opportunity Employer of Minorities, Women, Protected Veterans, and Individuals with Disabilities, and participates in the e-Verify program. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, age, sexual orientation, gender identity, national origin, veteran status, disability, or any other classification protected by law.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Responsibilities * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. Qualifications * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Experience: 3 years of medical revenue cycle experience Education: High School Diploma Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Analysis and Collaboration Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Experience: 3 years of medical revenue cycle experience Education: High School Diploma Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Analysis and Collaboration Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis.

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 Claims Examiner - Liability (MUST RESIDE IN LOUISIANA) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **ARE YOU AN IDEAL CANDIDATE?** To analyze liability claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE:** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. + Negotiating settlement of claims within designated authority. + Communicating claim activity and processing with the claimant and the client. + Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. **QUALIFICATIONS** Education & Licensing: At least 3-5 years of claims management experience or equivalent combination of education and experience required. + High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. + Professional certification as applicable to line of business preferred. Licensing / Jurisdiction Knowledge: **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Opportunity to work in an agile environment. [IF APPLICABLE] + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. Work environment requirements for entry-level opportunities include - Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines 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**

About Us: Struction Solutions is an innovative Independent Adjusting, Building Consultant, and Disaster Recovery Firm, known for our commitment to delivering innovative and tailored solutions to our clientele. Our team of professionals work tirelessly to ensure accuracy, efficiency, and customer satisfaction. As we continue to grow and expand, we're seeking talented individuals who share our dedication to excellence and are eager to make a meaningful impact in our industry. Position Details: Resolves insurance claims involving marine casualties. Their role includes investigating, evaluating, and negotiating claims to determine the extent of the insurance company's liability. This role requires a thorough understanding of maritime laws, insurance policies, and handling procedures. Investigation: They conduct thorough investigations of marine incidents, such as collisions, groundings, sinkings, fires, or cargo damage. This includes gathering evidence, interviewing witnesses, and inspecting vessels and cargo. Assessment: They assess the extent of the damage and determine the cause of the incident. This may involve working with marine surveyors, engineers, and other experts to evaluate the condition of the vessel and cargo. Documentation: They collect and review relevant documents, such as ship logs, maintenance records, cargo manifests, and insurance policies, to support the claim. Evaluation: They evaluate the claim to determine whether it is covered under the insurance policy and to what extent. This involves interpreting policy terms and conditions, as well as applicable laws and regulations. Negotiation: They negotiate settlements with claimants, which can include shipowners, charterers, cargo owners, and other affected parties. The goal is to reach a fair and equitable resolution while minimizing the financial impact on the insurance company. Reporting: They prepare detailed reports and recommendations for the insurance company, documenting their findings, the extent of the damage, and the proposed settlement. Liaison: They act as a liaison between the insurance company and other parties involved in the claim, such as legal representatives, regulatory authorities, and other stakeholders. Compliance: They ensure that all claims are handled in compliance with relevant laws, regulations, and industry standards. Risk Management: They may also be involved in risk management activities, helping to identify and mitigate potential risks to reduce the likelihood of future claims. Qualifications: Proven experience in insurance claims adjustment, preferably in marine insurance. Strong knowledge of maritime laws and regulations. Excellent analytical, negotiation, and communication skills. Ability to manage multiple claims efficiently under tight deadlines. Proficiency in claim management software and Microsoft Office Suite. Location: New Orleans, LA area Marine casualty claim adjustment specialists need a strong understanding of maritime law, insurance principles, and the technical aspects of marine operations. They also require excellent analytical, communication, and negotiation skills. Join us at Struction Solutions, and let's redefine the future of the Independent Adjusting industry together! View all jobs at this company

Claims Investigator (Part-Time) New Orleans, LA area Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continues its expansion into all areas of investigations, allowing continual growth for its employees. Responsibilities/ Requirements Responsibilities: Duties and responsibilities include essential functions of positions assigned to this classification. Depending on assignment, the employee may perform a combination of some or all the following duties: Ability to conduct multiple types of complex claims investigations Daily submission of updates regarding work performed on each case Ability to manage time Maintain a sufficient level of client billable hours Write and record detailed statements Conduct scene investigations Submit professional and client ready investigative reports Conduct background/activity checks and courthouse research Due to driving, constant state of alertness in a safe manner is an essential function of this position Requirements: Must be licensed as a Private Investigator in Louisiana and eligible to be licensed in surrounding states 1 year or more of full time report writing experience on field investigations cases Field investigations experience - face to face statements Ability and willingness to travel within a multi-state coverage area (as necessary) Experienced in investigation of product/auto/general liability claims, Workers Compensation, disability claims, life insurance and contestable death claims Flexibility to work varied/irregular hours and days including nights, weekends Reliable and fuel efficient vehicle with minimum of auto liability insurance Possess or is willing to purchase: digital recording device and laptop computer with Windows Operating System with access to Microsoft Word and other necessary equipment for position Educational/Experience Qualifications: Associate or Bachelor's Degree in Criminal Justice or related field Experience as a Private Investigator or detective Military or Law Enforcement background Comprehensive knowledge of insurance law and underwriting Self-starter who holds themselves accountable for results and performance Strong attention to detail with commitment to accuracy and quality Ability to adapt and work under stressful and sensitive situations Can type 50 words or more a minute Benefits CoventBridge offers the most premiere compensation package in the industry. Flexibility to self-schedule Ability to work from home-based office Competitive pay Monthly vehicle allowance Company fuel card Company cell phone Company matching 401(k) Travel and report writing compensation Company paid investigator licensing fees Paid ongoing career advancement training Timely expense reimbursement with very minimal out-of-pocket expenses About Us: CoventBridge Group is the global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************. At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.) CoventBridge (USA) Inc. Louisiana License # 8064-022513-LA

Thank you for your interest in The University of New Orleans. Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting. You must complete all required portions of the application and attach the required documents in order to be considered for employment. Department OPH-Bureau of Emergency Medical ServicesJob SummaryJob Description Serves on a psychomotor exam team as an examiner, professional partner, patient, or other role as needed for the Office of Public Health (OPH) Bureau of Emergency Services (BEMS). Responsible for conducting unbiased examination activities for all candidates. Participates in the examination process by acting in any one of three defined positions as follows: Skill Examiner - provides specific and consistent instructions to each candidate. Records, totals and documents all performances as required on skill evaluation forms and submit to the National Registry Representative and/or Exam Coordinator. EMT Assistant - serves as the trained partner for all candidates testing. Simulated Patient - effectively acts out the role of an actual patient in a similar hospital situation; assists the skill examiner when reviewing a candidate's performance, and verifies completion of a procedure or treatment. Arrives at the examination site at the time indicated on the communication received from the Exam Coordinator to meet with the National Registry Representative and/or Exam Coordinator and receive assignments. Thoroughly reads the specific essay for the assigned skill before the actual evaluation begins, and role-play if necessary. Checks all equipment, props, and moulage before and during the examination. Assures professional conduct of all personnel involved with the particular skill throughout the examination. Maintains the security and integrity of all examination material. Maintains confidentiality of candidates and their performance results. Fairly and accurately completes all skill evaluation forms. Spotlights common areas of weakness to the National Registry Representative and/or Exam Coordinator. Other tasks as assigned. QUALIFICATIONS REQUIRED: Bachelor's degree, or Associate's degree plus 3 years of professional experience, or 6 years of professional work experience. Minimum 2 years professional experience in the Emergency Medical Services (EMS) profession. National certification from the National Registry of EMTs. Licensed Louisiana EMS Clinician. Excellent analytical and critical thinking skills; effective organizational and time management skills. Great attention to detail and follow up. Ability to manage projects, assignments, and competing priorities. Proficient in the use of Zoom, Teams, and Microsoft Office, including but not limited to Outlook, Word, and Excel. DESIRED: Advanced degree. Minimum 6 years professional experience in the Emergency Medical Technician (EMT) profession. Minimum 2 years performing administrative functions within an office environment or health care field. Minimum 1 year professional experience working as an EMS examiner. Additional relevant industry certifications or training. Required Attachments Please upload the following documents in the Resume/Cover Letter section. Detailed resume listing relevant qualifications and experience; Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems; Names and contact information of three references; Applications that do not include the required uploaded documents may not be considered. Posting Close DateThis position will remain open until filled. Note to Applicant: Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials. References will be contacted at the appropriate phase of the recruitment process. This position may require a criminal background check to be conducted on the candidate(s) selected for hire. As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks. The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.

All Job Postings will close at 12:01a.m. CST (1:01a.m. EST) on the specified Closing Date (if designated). If you close the browser or exit your application prior to submitting, the application progress will be saved as a draft. You will be able to access and complete the application through "My Draft Applications" located on your Candidate Home page. Job Posting Title: Claims Coordinator Position Type: Professional / Unclassified Department: LSUAM FA - Ops - RIS - RM - Data (Tiffany Mason (00065406)) Work Location: 0310 LSU Student Union Pay Grade: Professional : Job Summary: The Claims Coordinator provides administrative and clerical support for the Office of Risk Management's claims management program. This position assists in the intake, tracking, and documentation of claims across Workers' Compensation, Liability, Property, International Travel, and other specialty coverages. The Claims Coordinator ensures accurate record keeping, timely communication with departments and third-party administrators (TPAs), and assists in processing payments and reports. The position also provides limited departmental administrative support, including asset inventory, supply management, and general office coordination. Job Responsibilities: 50%-Claims Administration Support: Maintains claim files and records for all lines of coverage. Assists with claims intake, data entry, correspondence, and report preparation. Ensures timely submission of claims documentation to TPAs, insurers, and internal stakeholders. Tracks claim status and follows up on outstanding items. 15%- Communication and Coordination: Serves as a primary point of contact for departmental claim inquiries. Coordinates with faculty and staff to obtain needed claim information and assists in responding to requests from university departments, TPAs, and insurers. 15%- Financial and Payment Processing: Assists with processing claim payments, reimbursements, and account reconciliations. Prepares payment documentation and verifies transaction accuracy under the direction of the Assistant Director of Claims Management. 10%-Reporting and Data Entry: Maintains claims databases and updates reports with current claim information. Assists in compiling data for internal reports, dashboards, and audits. 5%-Departmental Administration: Provides general administrative support to the Office of Risk Management, including property inventory, supply ordering, scheduling, and other clerical duties. 5%-Training and Office Support: Assists with scheduling meetings, preparing training materials, and supporting departmental initiatives. Performs other duties as assigned to support risk management operations. Minimum Qualifications: Bachelor's degree. Experience in an office setting or detail-oriented environment. LSU values skills, experience, and expertise. Candidates who have relevant experience in key job responsibilities are encouraged to apply- a degree is not required as long as the candidate meets the required years of experience specified in the . This position is emergency and operation essential and may be required to report to campus in times of emergency and/or closure or asked to work during an official closure. Preferred Qualifications: Bachelor's degree with 1 year of experience. Experience in claims administration, insurance, or risk management support desirable. Experience handling confidential information and working in a fast-paced, detail-oriented environment is required. Familiarity with database systems, spreadsheets, and financial reconciliation preferred. Preferred Certifications/Licenses: Associate in Claims, Associate in Risk Management Certified Risk Management Charter Property and Casualty Underwriter. Additional Job Description: Special Instructions: Please submit cover letter, resume, transcripts, any licenses required for the position and 3 references. For questions or concerns regarding the status of your application or salary range, please contact Tiffany Mason at ************ or ****************. Posting Date: December 3, 2025 Closing Date (Open Until Filled if No Date Specified): April 2, 2026 Additional Position Information: Background Check - An offer of employment is contingent on a satisfactory pre-employment background check. Benefits - LSU offers outstanding benefits to eligible employees and their dependents including health, life, dental, and vision insurance; flexible spending accounts; retirement options; various leave options; paid holidays; wellness benefits; tuition exemption for qualified positions; training and development opportunities; employee discounts; and more! Positions approved to work outside the State of Louisiana shall be employed through Louisiana State University's partner, next Source Workforce Solutions, for Employer of Record Services including but not limited to employment, benefits, payroll, and tax compliance. Positions employed through Employer of Record Services will be offered benefits and retirement as applicable through their provider and will not be eligible for State of Louisiana benefits and retirement. Essential Position (Y/N): Y LSU is an Equal Opportunity Employer. All candidates must have valid U.S. work authorization at the time of hire and maintain that valid work authorization throughout employment. Changes in laws, regulations, or government policies may impact the university's ability to employ individuals in certain positions. HCM Contact Information: For questions or concerns related to updating your application with attachments (e.g., resumes, RS:17 documents), date of birth, or reactivating applications, please contact the LSU Human Resources Management Office at ************ or email **********. For questions or concerns regarding the status of your application or salary ranges, please contact the department using the information provided in the Special Instructions section of this job posting.

Claims Auditor I, II and Senior Location : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Claims Auditor I is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The Claims Auditor II is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The Claims Auditor Senior is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. How you will make an impact : * Performs audits of high dollar claims. * Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. * Contacts others to obtain any necessary information. * Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. * Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. * Refers overpayment opportunities to Recovery Team. * Claims Auditor II - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. * Claims Auditor Senior - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. Minimum Requirements : * Claims Auditor I : Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. * Claims Auditor II : Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. * Claims Auditor Senior : Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: * Stop loss claims experience highly preferred. * Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. * Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. * Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CLM > Claims Support 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.

Administers and resolves non-complex short term claims of low monetary amounts, including Fast Track and Incident Only claims. Documents and monitors open case inventory to ensure proper/timely closing and billing of files. Makes decisions on claims within delegated limited authority. College degree or the equivalent education and experience. Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Demonstrates a thorough working knowledge of claim processing and claim policies and procedures. Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions Demonstrates effective and diplomatic oral and written communication skills. Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others. Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level. Must possess a valid driver's license. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license. #LI-EM3 Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim. Identifies applicable wage loss expenses and wage exposures. Documents receipt and contents of claim documents including medical reports, police reports etc. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients. Approves payments within scope of payment authority Evaluate claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Keep Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refer matters beyond limits of authority and expertise to Team Manager for direction. With the team managers' guidance, provides input on the completion of status reports, initiate's activity checks and/or widow's statement of dependency forms. Completes all reporting forms and file documentation. Adheres to client and carrier guidelines and prepares written updates for supervisor to review. Develops subrogation/third party recovery potential and follows recovery procedures Participates in claim reviews as applicable. Performs other related duties as required or requested.

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 Claims Representative (IAP) - Workers Compensation Training Program Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? + A stable and consistent work environment in an office setting. + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities. + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. **ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Attendance and completion of designated classroom claims professional training program. + Performs on-the-job training activities including: + Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. + Adjusting low and mid-level liability and/or physical damage claims under close supervision. + Processing disability claims of minimal disability duration under close supervision. + Documenting claims files and properly coding claim activity. + Communicating claim action/processing with claimant and client. + Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. + Participates in rotational assignments to provide temporary support for office needs. **QUALIFICATIONS** Bachelor's or Associate's degree from an accredited college or university preferred. **EXPERIENCE** Prior education, experience, or knowledge of: - Customer Service - Data Entry - Medical Terminology (preferred) - Computer Recordkeeping programs (preferred) - Prior claims experience (preferred) Additional helpful experience: - State license if required (SIP, Property and Liability, Disability, etc.) - WCCA/WCCP or similar designations - For internal colleagues, completion of the Sedgwick Claims Progression Program **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum + An assigned mentor and manager that will support and guide you on your career journey + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more _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 25.65/hr. 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. #claims #claimsexaminer #entrylevel #remote #LI-Remote_ 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**

. Excellent Crawford Benefits. Generous Employee Referral Bonus Program. Multiple Employee Discounts. Under direct supervision, performs a variety of claim clerical support duties for the Service Center or for the Claim Office. High school diploma or GED; or the equivalent in related work experience. Minimum 5 years of experience in the claims/liability environment or the equivalent, demonstrating a basic knowledge of computer operations and of claim file systems and procedures. Must demonstrate basic knowledge of computer operations and of claim file systems and procedures. Proficient in the Microsoft suite of products and like systems. Must be capable of working in a fast paced environment. Must be flexible, adaptable, and have excellent multi-tasking skills. Must be technically proficient. Excellent oral and written communication skills are essential. #LIEM3 Matches proper file and/or claim number on unidentified correspondence by use of the various automated systems for mail delivered by USPS/ACS/Unmatched mail queue in ODM. Types a variety of material such as letters, benefit notices, or memorandums for medical appointment, attorneys, or external clients. Performs control operator functions for various Service Center or Claim Office data systems. Retrieves and/or re-files items from central storage facility and maintains accurate records of file activity. Receives dock and messenger service deliveries and verifies accuracy of delivered material. Prepares outgoing mail for shipment which includes the necessary attachments, wrapping, and sealing. This will include shipping/receiving computer equipment. Performs a variety of clerical duties such as answering telephones, taking messages, dispersing faxes, making payments, sort/preparing files, and data entry. Assists in updating jurisdictional notices and manuals used in the office. Pulls files from storage for in-house state audits. Prepares files in electronic form for state audits (payment history, file notes, and gathering medical reports). Contacts agents and insured on routine claims to obtain coverage information or obtains through the various systems. Issues payments, requests wage information for the adjusters, orders surveillance, and completes medical calls to obtain the current work status. Schedules medical appointments and sends all appropriate correspondence relating to that appointment. Performs other related work as required or requested. Upholds the Crawford Code of Conduct.