Claim processor jobs in Iowa City, IA - 28 jobs

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

UFG is currently hiring for a Workers' Compensation Claims Supervisor to be a team-oriented leader responsible for developing a high-performing team and coaching individuals to drive consistent, timely, and high-quality outcomes. This role supports the best overall resolution of workers' compensation claims through strong leadership, collaboration, and hands-on technical guidance across multiple jurisdictions. This includes partnering with technical leadership/leadership peers to design and implement individualized development plans for claims specialists with varying experience and competency levels, identifying barriers to success, and creating strategies to maximize individual and team contributions. The supervisor monitors performance trends, quality trends, and workload patterns, and provides coaching, feedback and reinforcement to support effective claims practices, proper file documentation, and ongoing skill development. The role maintains accountability for performance management of a diverse group of workers' compensation claim specialists, including hiring, onboarding, tentation, recognition, and reward practices, including salary administration within budget. The supervisor is responsible for perpetuating technical knowledge across the team through deliberate mentoring, cross-training, and succession planning to ensure depth of expertise across jurisdictions, claim types, and complexity levels. The supervisor leads team communication and change management, fostering a culture of collaboration engagement, and shared ownership. In partnership with the Claims Director and/or Claims Manager, this leader identifies process improvement opportunities, implements solutions and tools that enable claims specialist empowerment and consistency, and removes operational barriers impacting outcomes. This people-focused leader must have strong workers' compensation technical acumen and working knowledge of multi-state regulations, benefit systems, medical management, return-to-work strategies, litigation practices and compliance requirements. The supervisor may occasionally manage individual claims or assist with high-exposure, complex, litigated, or sensitive matters to ensure appropriate strategy, timely escalation, and accurate reserving. The Workers' Compensation supervisor collaborates with the Claims Director in establishing team goals and metrics and is responsible for facilitating, reinforcing, and aligning team members' individual goals to organizational priorities. The role may also include oversight of TPAs and key vendors, including service expectations, quality audits, and performance management. Ultimately this leader ensures regulatory compliance, consistent claim handling in line with Best Practices, and effective resolution strategies across multiple jurisdictions while promoting a constructive culture where team members contribute meaningfully to shared success. Essential Duties & Responsibilities: As a member of the claim's leadership team, the Workers' Compensation Claim Supervisor supports operational excellence and develops a high-performing team by: * Delivering a quality product and high level of service to support equitable, timely, and defensible resolution of workers' compensation claims ensuring we deliver on our promises and maintain a strong customer, injured employee, and employer experience. * Building an inclusive and constructive team culture where individuals are inspired to provide their maximum contribution, are accountable to best practices, and support one another through collaboration, peer learning, and shared ownership of outcomes. * Leading and developing a team of 10-15 direct reports (or as assigned) including Workers' Compensation claim specialists with varying experience, skills, authority levels, and jurisdictional knowledge and responsibilities, ensuring balanced workloads and appropriate complexity alignment. * Encouraging innovation, critical thinking, and collaboration to drive continuous improvement in claim outcomes, cycle time, accuracy, injured employee experience, and cost containment. * Owning all aspects of performance management including routine 1:1s, goal setting, coaching plans, corrective action when needed, and salary administration, partnering with our HR Business partner to ensure consistency, equity, and compliance. * Providing day-to-day leadership and communication, including team huddles, collaboration routines, training reinforcement, workload planning, and barrier removal, ensuring clarity of expectations and alignment to organizational priorities. * Partnering with Claims Excellence, Learning & Knowledge, and Corporate Claims to identify and execute opportunities for standardization, innovation, technical development and continuous improvement across workers' compensation handling practices. * Collaborating with the Director and/or Specialization Manager &/or Director of Claims Litigation to develop and execute strategies for specialization, caseload segmentation (med-only v lost-time), litigation handling, catastrophe/volume response, and resource allocation across jurisdictions. * Hiring, retaining, and developing talent aligned to our culture and technical expectations, including perpetuation planning, succession development, and identification of team members with leadership potential. * Coaching and developing team members through workers' compensation technical guidance, including (but not limited to): * Compensability decisions and timely investigation * Benefit accuracy and compliance with jurisdictional requirements * Medical management strategy and treatment direction * Return-to-work practices and collaboration with employers * Claim strategy documentation and action plans * Settlement evaluations (including MSA considerations when applicable) * Litigation and defense counsel management strategies * Assigning appropriate authority level and file complexity based on skill, tenure, results, and demonstrated technical capability, ensuring escalations occur at the right time and align with reserve/settlement authority expectations * Ensuring adherence to claim best practices and compliance requirements, including accurate and timely application of reserving philosophy and expectations, and strict attention to multi-state rules around: * Reporting and filing requirements * Benefit rates and calculations * Timeliness standards (payments, notices, forms) * Documentation expectations * Claim handing and communication standards * Promoting fiscal responsibility and expense awareness, including management of internal/external costs such as: * Medical and bill review leakage * Nurse case management utilization * Defense counsel spend and litigation management * Expense allocation and budget alignment * Building and maintaining relationships with key internal and external partners, including underwriting, risk control, premium audit, claims advocacy partners, agents, policyholders, and employers, occasionally participating in agency visits, claims reviews, presentations, and stewardship activities as needed. * Acting as a workers' compensation subject matter expert (SME) or identifying appropriate team members as SMEs to support organizational initiatives, training, process refinement, change implementation, and continuous improvement efforts. * Overseeing third-party administrators (TPAs) and workers' compensation vendors when assigned, including performance monitoring, escalation support, service expectations, audit/quality review processes, and accountability for timely/appropriate resolution. Job Specifications: Education: * HS diploma or equivalent required. * 4-year college degree preferred. Certifications/Designations: * Industry certifications such as AIC, SCLA of the AEI, CPCU, or WRP (WC) are preferred. * Must have or be willing to work to obtain within 3 years post-hire, CPCU designation (or other advanced designation as agreed upon with leader). * Meet the appropriate state licensing requirements (or obtain required licensing). Experience: * 5+ years of Workers' Compensation insurance industry experience. * 3+ years of claims handling experience in multiple jurisdictions. * Formal or informal leadership or mentorship experience desired. Working Conditions: * General office environment. * Occasionally this job requires working irregular hours, evenings, and weekends with occasional overnight travel. * Occasionally the job requires work in the field with exposure to heat, cold, noise, dust, smoke, and soot. * This leader deals with large amounts of company money and is charged with the responsibility to handle wisely. Knowledge, skills & abilities: * Excellent people & communication skills, including collaboration. * Adaptable & Resilient. * Ability to coach others to successful outcomes, including successful adoption of change. * Ability to assess skills of individual team members and to implement plans to develop skills and to share knowledge. * Ability to appropriately empower others via delegation. * Ability to motivate and inspire others to achieve desired outcomes. * Ability to analyze data to identify trends and to resolve problems. * Strong understanding of legal, regulatory and compliance requirements and of the legal process. * Ability to adjust to varied jurisdictions and legal environments. Pay Transparency Statement: UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $103,221 - $136,105 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data. In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes: * Annual incentive compensation * Medical, dental, vision & life insurance * Accident, critical Illness & short-term disability insurance * Retirement plans with employer contributions * Generous time-off program * Programs designed to support the employee well-being and financial security. This pay range disclosure is provided in accordance with applicable state and local pay transparency laws.

UFG is currently hiring for a Claims Specialist II to work with our Workers Compensation team. This individual's primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to occasional high complexity claims to resolution in accordance with claims best practices. The Claims Specialist II - Workers Compensation role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with low to moderate levels of supervision. A strong desire to advance one's professional development is essential to this role. Essential Duties & Responsibilities: Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers' compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action. Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes. Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution. Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Develop knowledge of how to conduct medical and legal research. Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery. Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions. Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction. Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution. Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Develop knowledge of Medicare settlement obligations. Assess and periodically re-assess the nature and severity of injury or illness. Design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate with others on plans of action to mitigate impacts. Assess and periodically re-assess claim file reserves adequacy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs. Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses. Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Emphasis is placed on seeking opportunities to overcome resolution barriers. Comply with statute specific claims handling practices and reporting requirements. Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure. Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities. Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers. Demonstrate interest in one's own career development and interest in supporting peers with their development. Job Specifications: Education: High school diploma required. Post-Secondary education or Bachelor's degree preferred. Licensing/Certifications/Designations: Meet the appropriate state licensing requirements to handle claims. Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program. Within 3 years of hire, complete the Workers' Compensation Law Associate (WCLA) certification program. Willingness to pursue other professional certifications or designations requested. Experience: 3+ years of general work experience. 5+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field. Knowledge: General knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing. Skills and Abilities: Service-Oriented Mindset Clear and Concise Communication Analytical and Critical Thinking Attitude of Collaboration and Curiosity Proactive Decision-making and Problem-solving Time management and Sense of Service Urgency Demonstrate mentorship within the team Actively demonstrate engagement in executing on claims initiatives Working Conditions: Working remote from home or general office environment. Occasionally the job requires working irregular hours. Infrequent overnight travel and weekend hours may be required. Pay Transparency Statement: UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $59,622 - $78,637 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data. In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes: Annual incentive compensation Medical, dental, vision & life insurance Accident, critical Illness & short-term disability insurance Retirement plans with employer contributions Generous time-off program Programs designed to support the employee well-being and financial security. This pay range disclosure is provided in accordance with applicable state and local pay transparency laws. The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and skills required. Additional tasks and requirements may be assigned, as necessitated by business need. UFG retains the right to modify the description of this job at any time.

Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities. Job Summary When employees are injured on the job, they need someone who can guide them through the process with care and expertise. As a Workers' Compensation Claims Representative at West Bend, you'll guide injured employees through the recovery process, ensure fair and timely claim resolution, and help businesses stay compliant. If you thrive on problem-solving, negotiation, and making a real impact, this is your opportunity to lead with confidence. Work Location This position offers a hybrid schedule with three in-office collaboration days for team meetings and other events. In certain cases, highly qualified candidates with strong jurisdictional experience may be considered for a remote arrangement. The internal deadline to apply is 2/3/2026. External applications will be accepted on a rolling basis while the position remains open. Responsibilities & Qualifications As a Claims Representative, you will manage claims of varying complexity using current claim technology and best practices. You will conduct thorough investigations to determine coverage, evaluate damages/benefits, and assess liability/compensability. You will negotiate settlements with insureds, claimants, and attorneys while maintaining proactive file management, accurate reserving, and adherence to audit and regulatory standards. This role collaborates closely with internal partners and external stakeholders, with the scope of responsibility (including field work and regional liaison duties) increasing with experience level. Key Responsibilities Investigate and resolve claims within assigned authority Determine coverage, damages, and liability Negotiate settlements with insureds, claimants, and attorneys Maintain accurate documentation and reserving Communicate promptly and professionally with all stakeholders Collaborate with internal teams and external partners Adhere to audit and compliance standards Participate in training and team initiatives Preferred Experience and Skills Prior experience managing claims at the appropriate level of complexity (from low/moderate to high-exposure/complex) Proficiency with computers and current claim technology Interpersonal, oral, and written communication skills with customer-focused professionalism Negotiation, problem-solving, and conflict resolution skills Time management and organizational discipline with proactive file handling Independent decision-making ability (higher levels) and results orientation Technical expertise in coverage analysis, compensability, and damages evaluation (higher levels) Prior experience managing claims across multiple jurisdictions (higher levels) with preferred jurisdictions of Minnesota and Iowa Preferred Education and Training Bachelor's degree in Business, Insurance or related field Associate in General Insurance (AINS) designation Associate in Claims (AIC) designation CPCU coursework or other continuing education Licensure in jurisdictions where required Salary Statement The salary range for this position is $67,000 - $100,000. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate. Benefits West Bend offers a comprehensive benefit plan including but not limited to: Medical & Prescription Insurance Health Savings Account Dental Insurance Vision Insurance Short and Long Term Disability Flexible Spending Accounts Life and Accidental Death & Disability Accident and Critical Illness Insurance Employee Assistance Program 401(k) Plan with Company Match Pet Insurance Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates Bonus eligible based on performance West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies. #LI-LW1 EEO West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to: Investigate, evaluate, and settle entry-level insurance claims Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products Learn and comply with Company claim handling procedures Develop entry-level claim negotiation and settlement skills Build skills to effectively serve the needs of agents, insureds, and others Meet and communicate with claimants, legal counsel, and third-parties Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements Desired Skills & Experience Bachelor's degree or direct equivalent experience with property/casualty claims handling Ability to organize data, multi-task and make decisions independently Above average communication skills (written and verbal) Ability to write reports and compose correspondence Ability to resolve complex issues Ability to maintain confidentially and data security Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Continually develop product knowledge through participation in approved educational programs Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-KC1 #LI-Hybrid

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** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. **Required Qualifications** - New York Independent Adjuster License - Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience - DG system knowledge **Education** **-** High School Diploma required - Preferred Associates degree or equivalent work experience. **Anticipated Weekly 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: 02/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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

UFG is currently hiring for a Claims Specialist II to work with our Workers Compensation team. This individual's primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to occasional high complexity claims to resolution in accordance with claims best practices. The Claims Specialist II - Workers Compensation role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with low to moderate levels of supervision. A strong desire to advance one's professional development is essential to this role. Essential Duties & Responsibilities: * Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers' compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action. * Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes. * Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution. * Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Develop knowledge of how to conduct medical and legal research. * Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery. * Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions. * Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction. * Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution. * Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Develop knowledge of Medicare settlement obligations. * Assess and periodically re-assess the nature and severity of injury or illness. Design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate with others on plans of action to mitigate impacts. * Assess and periodically re-assess claim file reserves adequacy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs. * Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses. * Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Emphasis is placed on seeking opportunities to overcome resolution barriers. * Comply with statute specific claims handling practices and reporting requirements. * Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure. * Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities. * Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers. * Demonstrate interest in one's own career development and interest in supporting peers with their development. Job Specifications: Education: * High school diploma required. * Post-Secondary education or Bachelor's degree preferred. Licensing/Certifications/Designations: * Meet the appropriate state licensing requirements to handle claims. * Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program. * Within 3 years of hire, complete the Workers' Compensation Law Associate (WCLA) certification program. * Willingness to pursue other professional certifications or designations requested. Experience: * 3+ years of general work experience. * 5+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field. Knowledge: * General knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing. Skills and Abilities: * Service-Oriented Mindset * Clear and Concise Communication * Analytical and Critical Thinking * Attitude of Collaboration and Curiosity * Proactive Decision-making and Problem-solving * Time management and Sense of Service Urgency * Demonstrate mentorship within the team * Actively demonstrate engagement in executing on claims initiatives Working Conditions: * Working remote from home or general office environment. * Occasionally the job requires working irregular hours. * Infrequent overnight travel and weekend hours may be required. Pay Transparency Statement: UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $59,622 - $78,637 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data. In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes: * Annual incentive compensation * Medical, dental, vision & life insurance * Accident, critical Illness & short-term disability insurance * Retirement plans with employer contributions * Generous time-off program * Programs designed to support the employee well-being and financial security. This pay range disclosure is provided in accordance with applicable state and local pay transparency laws. The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and skills required. Additional tasks and requirements may be assigned, as necessitated by business need. UFG retains the right to modify the description of this job at any time.

UFG is currently hiring for a Workers' Compensation Claims Supervisor to be a team-oriented leader responsible for developing a high-performing team and coaching individuals to drive consistent, timely, and high-quality outcomes. This role supports the best overall resolution of workers' compensation claims through strong leadership, collaboration, and hands-on technical guidance across multiple jurisdictions. This includes partnering with technical leadership/leadership peers to design and implement individualized development plans for claims specialists with varying experience and competency levels, identifying barriers to success, and creating strategies to maximize individual and team contributions. The supervisor monitors performance trends, quality trends, and workload patterns, and provides coaching, feedback and reinforcement to support effective claims practices, proper file documentation, and ongoing skill development. The role maintains accountability for performance management of a diverse group of workers' compensation claim specialists, including hiring, onboarding, tentation, recognition, and reward practices, including salary administration within budget. The supervisor is responsible for perpetuating technical knowledge across the team through deliberate mentoring, cross-training, and succession planning to ensure depth of expertise across jurisdictions, claim types, and complexity levels. The supervisor leads team communication and change management, fostering a culture of collaboration engagement, and shared ownership. In partnership with the Claims Director and/or Claims Manager, this leader identifies process improvement opportunities, implements solutions and tools that enable claims specialist empowerment and consistency, and removes operational barriers impacting outcomes. This people-focused leader must have strong workers' compensation technical acumen and working knowledge of multi-state regulations, benefit systems, medical management, return-to-work strategies, litigation practices and compliance requirements. The supervisor may occasionally manage individual claims or assist with high-exposure, complex, litigated, or sensitive matters to ensure appropriate strategy, timely escalation, and accurate reserving. The Workers' Compensation supervisor collaborates with the Claims Director in establishing team goals and metrics and is responsible for facilitating, reinforcing, and aligning team members' individual goals to organizational priorities. The role may also include oversight of TPAs and key vendors, including service expectations, quality audits, and performance management. Ultimately this leader ensures regulatory compliance, consistent claim handling in line with Best Practices, and effective resolution strategies across multiple jurisdictions while promoting a constructive culture where team members contribute meaningfully to shared success. Essential Duties & Responsibilities: As a member of the claim's leadership team, the Workers' Compensation Claim Supervisor supports operational excellence and develops a high-performing team by: Delivering a quality product and high level of service to support equitable, timely, and defensible resolution of workers' compensation claims ensuring we deliver on our promises and maintain a strong customer, injured employee, and employer experience. Building an inclusive and constructive team culture where individuals are inspired to provide their maximum contribution, are accountable to best practices, and support one another through collaboration, peer learning, and shared ownership of outcomes. Leading and developing a team of 10-15 direct reports (or as assigned) including Workers' Compensation claim specialists with varying experience, skills, authority levels, and jurisdictional knowledge and responsibilities, ensuring balanced workloads and appropriate complexity alignment. Encouraging innovation, critical thinking, and collaboration to drive continuous improvement in claim outcomes, cycle time, accuracy, injured employee experience, and cost containment. Owning all aspects of performance management including routine 1:1s, goal setting, coaching plans, corrective action when needed, and salary administration, partnering with our HR Business partner to ensure consistency, equity, and compliance. Providing day-to-day leadership and communication, including team huddles, collaboration routines, training reinforcement, workload planning, and barrier removal, ensuring clarity of expectations and alignment to organizational priorities. Partnering with Claims Excellence, Learning & Knowledge, and Corporate Claims to identify and execute opportunities for standardization, innovation, technical development and continuous improvement across workers' compensation handling practices. Collaborating with the Director and/or Specialization Manager &/or Director of Claims Litigation to develop and execute strategies for specialization, caseload segmentation (med-only v lost-time), litigation handling, catastrophe/volume response, and resource allocation across jurisdictions. Hiring, retaining, and developing talent aligned to our culture and technical expectations, including perpetuation planning, succession development, and identification of team members with leadership potential. Coaching and developing team members through workers' compensation technical guidance, including (but not limited to): Compensability decisions and timely investigation Benefit accuracy and compliance with jurisdictional requirements Medical management strategy and treatment direction Return-to-work practices and collaboration with employers Claim strategy documentation and action plans Settlement evaluations (including MSA considerations when applicable) Litigation and defense counsel management strategies Assigning appropriate authority level and file complexity based on skill, tenure, results, and demonstrated technical capability, ensuring escalations occur at the right time and align with reserve/settlement authority expectations Ensuring adherence to claim best practices and compliance requirements, including accurate and timely application of reserving philosophy and expectations, and strict attention to multi-state rules around: Reporting and filing requirements Benefit rates and calculations Timeliness standards (payments, notices, forms) Documentation expectations Claim handing and communication standards Promoting fiscal responsibility and expense awareness, including management of internal/external costs such as: Medical and bill review leakage Nurse case management utilization Defense counsel spend and litigation management Expense allocation and budget alignment Building and maintaining relationships with key internal and external partners, including underwriting, risk control, premium audit, claims advocacy partners, agents, policyholders, and employers, occasionally participating in agency visits, claims reviews, presentations, and stewardship activities as needed. Acting as a workers' compensation subject matter expert (SME) or identifying appropriate team members as SMEs to support organizational initiatives, training, process refinement, change implementation, and continuous improvement efforts. Overseeing third-party administrators (TPAs) and workers' compensation vendors when assigned, including performance monitoring, escalation support, service expectations, audit/quality review processes, and accountability for timely/appropriate resolution. Job Specifications: Education: HS diploma or equivalent required. 4-year college degree preferred. Certifications/Designations: Industry certifications such as AIC, SCLA of the AEI, CPCU, or WRP (WC) are preferred. Must have or be willing to work to obtain within 3 years post-hire, CPCU designation (or other advanced designation as agreed upon with leader). Meet the appropriate state licensing requirements (or obtain required licensing). Experience: 5+ years of Workers' Compensation insurance industry experience. 3+ years of claims handling experience in multiple jurisdictions. Formal or informal leadership or mentorship experience desired. Working Conditions: General office environment. Occasionally this job requires working irregular hours, evenings, and weekends with occasional overnight travel. Occasionally the job requires work in the field with exposure to heat, cold, noise, dust, smoke, and soot. This leader deals with large amounts of company money and is charged with the responsibility to handle wisely. Knowledge, skills & abilities: Excellent people & communication skills, including collaboration. Adaptable & Resilient. Ability to coach others to successful outcomes, including successful adoption of change. Ability to assess skills of individual team members and to implement plans to develop skills and to share knowledge. Ability to appropriately empower others via delegation. Ability to motivate and inspire others to achieve desired outcomes. Ability to analyze data to identify trends and to resolve problems. Strong understanding of legal, regulatory and compliance requirements and of the legal process. Ability to adjust to varied jurisdictions and legal environments. Pay Transparency Statement: UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $103,221 - $136,105 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data. In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes: Annual incentive compensation Medical, dental, vision & life insurance Accident, critical Illness & short-term disability insurance Retirement plans with employer contributions Generous time-off program Programs designed to support the employee well-being and financial security. This pay range disclosure is provided in accordance with applicable state and local pay transparency laws.

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

United Fire Group is seeking an inside claims representative for the central plains region in our Cedar Rapids office. This position will investigate, evaluate, negotiate and settle commercial and personal property and casualty claims. This position is eligible for telecommuting. Relocation assistance is provided. Job Functions • Review assignments to determine severity, coverages and appropriate action. • Conduct phone interviews and take recorded statements from all parties possessing facts regarding the claim. • Review and interpret policy coverage to determine whether the claim is payable under the policy, deductible, actual cash value or replacement cost. • Write reports for the claim file to document all activity related to loss. • Evaluate the loss/damages. • Prepare files for arbitration. • Negotiate with contractors or repair facilities regarding extent of damage and method of repair. Recover salvage and sell to appropriate salvage buyer. • Keep current on court cases, changes in law, values and prices of property and materials. • Promote positive working relationships with agents. • Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends. • Perform other job duties as assigned. • Regular attendance. United Fire Group is seeking an inside claims representative for the central plains region in our Cedar Rapids office. This position will investigate, evaluate, negotiate and settle commercial and personal property and casualty claims. This position is eligible for telecommuting. Relocation assistance is provided. Job Functions • Review assignments to determine severity, coverages and appropriate action. • Conduct phone interviews and take recorded statements from all parties possessing facts regarding the claim. • Review and interpret policy coverage to determine whether the claim is payable under the policy, deductible, actual cash value or replacement cost. • Write reports for the claim file to document all activity related to loss. • Evaluate the loss/damages. • Prepare files for arbitration. • Negotiate with contractors or repair facilities regarding extent of damage and method of repair. Recover salvage and sell to appropriate salvage buyer. • Keep current on court cases, changes in law, values and prices of property and materials. • Promote positive working relationships with agents. • Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends. • Perform other job duties as assigned. • Regular attendance. The ideal candidate will have two to five years of property and casualty claims experience. A four year college degree preferred. Must have knowledge of the law (civil, traffic, contractual), construction, medicine, auto and building repair, math, mechanical aptitude, repair techniques, labor and material prices. Must be able to read, comprehend and interpret policy language and apply to loss. Possess analytical ability to determine reserves. Must possess negotiation skills, human relations skills, analytical skills, organizational skills, as well as oral and written communication skills. Must be able to work with little guidance or direction. Equal Opportunity Employer United Fire Group has a policy to provide equal opportunity for all. We continue to take positive action to recruit, hire, train, transfer and promote persons in all job categories based on the individual's ability to perform the job and without regard to race, color, religion, creed, sex, age, national origin, sexual orientation, disability or genetics. Skills & Requirements The ideal candidate will have two to five years of property and casualty claims experience. A four year college degree preferred. Must have knowledge of the law (civil, traffic, contractual), construction, medicine, auto and building repair, math, mechanical aptitude, repair techniques, labor and material prices. Must be able to read, comprehend and interpret policy language and apply to loss. Possess analytical ability to determine reserves. Must possess negotiation skills, human relations skills, analytical skills, organizational skills, as well as oral and written communication skills. Must be able to work with little guidance or direction. Equal Opportunity Employer United Fire Group has a policy to provide equal opportunity for all. We continue to take positive action to recruit, hire, train, transfer and promote persons in all job categories based on the individual's ability to perform the job and without regard to race, color, religion, creed, sex, age, national origin, sexual orientation, disability or genetics.

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

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. Job Duties * Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects * Assists with reducing re-work by identifying and remediating claims processing issues * Locate and interpret regulatory and contractual requirements * Expertly tailors existing reports or available data to meet the needs of the claims project * Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error * Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. * Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. * Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. * Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. * Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. * Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. * Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. * Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. * Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. Job Qualifications REQUIRED QUALIFICATIONS: * 5+ years of experience in medical claims processing, research, or a related field. * Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. * Advanced knowledge of medical billing codes and claims adjudication processes. * Strong analytical, organizational, and problem-solving skills. * Proficiency in claims management systems and data analysis tools * Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. * Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. * Microsoft office suite/applicable software program(s) proficiency PREFERRED QUALIFICATIONS: * Bachelor's Degree or equivalent combination of education and experience * Project management * Expert in Excel and PowerPoint * Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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

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

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

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