Claim Processor remote jobs

- 351 jobs

Experienced Claims Specialist
Geico 4.1
Remote job
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. What Makes This Opportunity Exciting? Are you a seasoned professional with a track record in insurance claims? As an Experienced Claims Specialist at GEICO, you'll leverage your expertise to manage cases and contribute to your team's success. You'll be at the heart of our commitment to outstanding customer service. You'll manage multiple steps impacting the claims life cycle, providing guidance, support, and solutions to policyholders during times of uncertainty. Your expertise and compassion will make a meaningful impact on their lives while contributing to GEICO's reputation for excellence. Claims Processing: Efficiently and accurately handle insurance claims, ensuring adherence to company policies and procedures. Customer Service: Communicate professionally and empathetically with customers, addressing concerns and questions about their claims. Investigation: Conduct thorough investigations to determine the extent of coverage and assess any potential fraud. Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction. Workplace Flexibility: After completing a comprehensive 5-month in-office training and orientation, transition to a hybrid work model with the best of both worlds-spend 80% of your time in the office and 20% working remotely. Plus, take advantage of the GEICO Flex Program, which offers up to four additional weeks of remote work annually for even greater flexibility. Professional Growth: Access GEICO's industry-leading training programs and development opportunities: Continuing education at no cost to you. Leadership development programs and hundreds of eLearning courses to enhance your skills. Access to GEICO Strive Program, providing associates with tuition assistance and access to high-quality education to advance their career. Incentives and Recognition: Pay Transparency: The starting salary for an Experienced Claims Specialist is between $31.62 per hour / $63,714 annually and $33.11 per hour / $66,736 annually. Sign-On Bonuses: $1,500 for active Florida All-Lines Adjuster License (6-20). Evening Shift Differentials: Earn a +10% pay differential for eligible shifts. Weekend Shift Differentials: Earn a +20% pay differential for eligible shifts. Additional Perks: Health & Wellness: Comprehensive healthcare and well-being support available on Day 1. 401(k) Match: From day one, you'll be automatically enrolled in our 401(k) plan with a 6% pre-tax contribution. We match 100% of your contributions, up to 6% of your eligible earnings, with employer contributions added to your account each paycheck and vesting immediately. What We're Looking For: A passion for providing outstanding customer service. Strong interpersonal, communication, and problem-solving skills. Adaptability and attention to detail in a dynamic environment. 2+ years of prior claims experience in the insurance industry. Active Florida All-Lines Adjuster License (6-20) required. High School Diploma required, College degree (2-4 year) preferred. Ability to prioritize and multi-task, while navigating through multiple business applications. Computer proficiency, including familiarity with Microsoft Office Suite. Flexibility to work evenings, weekends, and holidays as needed. #geico600 At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$63.7k-66.7k yearly Auto-Apply 5d ago
Viral - Content Claiming Specialist
Create Music Group 3.7
Remote job
Create Music Group is currently looking for self-described viral internet culture enthusiasts to join our Viral Department. Viral Content Claiming Specialist perform administrative tasks such as YouTube copyright claiming and asset onboarding, as well as scope out trending memes and social media videos on a daily basis. This position requires a regular workload of data entry/administration in order to carry out the most basic functions of our department but there are plenty of opportunities for more creative and ambitious pursuits if you are so inclined. This is a full time position which may be done remotely, however our office is located in Hollywood, California, and we are currently only looking for job candidates who are located in California. In the future, you may be encouraged to come into our office for meetings or company functions, so it is best if you are located in the Los Angeles/Southern California area. Through our Viral team, we collaborate with some of the most prominent viral talent from the TikTok and meme world including Supa Hot Fire (Deshawn Raw), Welven Da Great (Deez Nuts), Verbalase, KWEY B, Hoodnews, presidentofugly1, 10k Caash, dimetrees, Zackass, Supreme Patty, The Man with the Hardest Name in Africa, ViralSnare, Adin Ross, and more. YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for content creators, artists and labels. REQUIREMENTS: 1-3 years work experience Excellent communication skills, both written and verbal Internet culture and social media platforms, especially YouTube Conducting basic level research Organizing large amounts of data efficiently Proficiency with Mac OSX, Microsoft Office, and Google Apps PLUSES: Strong understanding of the online video market (YouTube, Instagram, TikTok) Bilingual - any language, although Spanish, Mandarin, and Russian is preferred RESPONSIBILITIES: We work directly with our clients and their team to help them break down the data and find potential opportunities to build their career. Daily responsibilities include but are not limited to the following. Watching YouTube videos for several hours daily Content claiming Uploading and defining intellectual assets Administrative metadata tasks Researching potential clients Staying on top of accounts for current client roster As this is a remote position, you are required to have your own computer and reliable internet connection. This position may require you to download a great deal of video files (files which may be deleted once onboarding tasks are completed) so please make sure that you have a computer that is up to the task. Laptops are preferable if you would like to come into our office to work (snacks, soft drinks, and Starbucks coffee are provided at our physical office). BENEFITS: Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included. TO APPLY: Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.
$45k-75k yearly est. Auto-Apply 60d+ ago
Claims Examiner III
All Care To You
Remote job
About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job purpose The Claims Examiner III is responsible for the processing and/or adjusting and the releasing of hospital or medical claims according to established policies and procedures. Must identify procedural and system inefficiencies and work with the appropriate entities to resolve issues. Examiners also perform research, analysis, reporting and special projects as assigned. Examiners must be able to meet production requirements and quality standards. Must be able to successfully perform all the duties of the Claims Examiner II. Duties and responsibilities Participate in claims workflow projects. Create and run Crystal /SQL reports for distribution to claims examiners, other department as needed to maintain claims turnaround time compliance. Processing claims for all lines of business including complex claims. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit preparation/activities. Responsible for the processing of claims that are either the financial responsibility of the assigned IPA or capitated Hospital. Must meet quantitative production standard of 100 - 150 claims per day. Must maintain an error accuracy of under 5%. Responsible for validating the diagnosis and procedure codes against the authorized services on Inpatient claims. Responsible for the resolution of Provider Disputes (PDR's) and their documentation (code driven) for required Acknowledgement and Resolution Letters to send to providers. Responsible for requesting additional information required to adjudicate claims, by correctly coding claims notes to generate Development Letters and or Notifications to providers. Responsible for accurately coding claims notes to generate Denial Letters for claims denied as member liability. Ability to resolve claims issues on identified processing errors and make recommendations for improvements to avoid error. Identify any overpayment/underpayment in a review and or history search. Follow department protocol for reporting and following up. Adjusts voids and reopens claims within guidelines to ensure proper adjudication. Resolve any grievances and complaints received through Customer Services, responds when needed to portal/email inquiries and initiates steps to assist regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims. Support the Claims Department as business needs require. May have customer/client contact. May assist with training of team members. Works without significant guidance. Identify claims payment errors and/or system configuration flaws during day-to-day operation, report to department manager to correct/resolve them. Able to assist with check run preparation as needed. All other duties as assigned. Qualifications Must have experience with EZ-Cap 10+ years or more experience in processing HMO claims in a managed care environment. Familiar with all regulatory requirements including CMS, DMHC and DHS. Proficient with all Federal and state requirements in claim processing. Knowledge of medical terminology and coding. Proficient in rate application for outpatient PPS & Inpatient DRG facility, ASC, APC, Interim Rate Payment methods to applicable lines of business. (Medicare, Commercial, Medi-Cal). Recognize the difference between Shared Risk and Full Risk claims. Proficient in and knows how to use and apply Health Plan Benefit Matrix and Division of Financial Responsibility. Proficient understanding of AB1324. Proficient understanding of AB1455 Claims Settlement Practice & Dispute and Resolution regulations. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills
$34k-58k yearly est. 60d+ ago
Claims Specialist
Virginpulse 4.1
Remote job
Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities The Claims Specialist is responsible for reviewing, analyzing, and processing healthcare claims to ensure accuracy, completeness, and compliance with policies and regulatory standards. They will have a strong understanding of health insurance guidelines and demonstrated experience working across multiple claims processing systems. What You'll Actually Do Maintain quality and procedure standards including compete review and examination of claim to ensure proper handling in accordance with company policies and procedures. Complete claims task in timely manner and maintain production requirement: Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup. Work stop loss renewal process, as directed by management. Complete all training requirements in a timely manner, as directed by management. Understand and enforce company procedures, polices and standards. Practice good follow up procedures to ensure completion of task and/or inquiries. Direct client contact, internal staff and vendor support to ensure customer and member satisfaction. Support management team with projects and special request Qualifications What You Bring to Our Mission High school diploma or equivalent required; associate or bachelor's degree in healthcare administration or related field preferred. Minimum of 2 years' experience in healthcare claims examination or adjudication. Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures. Expertise in multiple claims processing platforms a plus. Prior experience with both manual and automated claims processing. Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world while building the career you want? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $20 to $24 per hour. Note that compensation may vary based on location, skills, and experience. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.
$20-24 hourly Auto-Apply 4d ago
Claims Processor 3
Associated Administrators 4.1
Remote job
Title: Claims Processor 3 Department: Claims Union: UFCW 3000 Bothell Grade: 7 The Claims Processor 3 provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. One year of experience as Level 2 Claims Processor. Intermediate knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Possesses a strong work ethic and team player mentality. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third-party administrator. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $28.81/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!
$28.8 hourly Auto-Apply 6d ago
Casualty Claims Examiner
TWAY Trustway Services
Remote job
This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department's performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting staff as required for continually improved file handling. · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel. · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures. · Complete research pertaining to complex coverage issues, industry trends, and related topics. · May assist with targeted audits of a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management re-audits to verify calibration and accuracy of the first level reviews completed. · Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling Job Qualifications Formal Education & Certification Bachelor's degree or equivalent work experience Knowledge & Experience · A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty claims with high complexity. · Prior claims management experience and/or auditing preferred. Skills & Competencies · Communication and analytical ability at a level to interact with associates, managers, agents and vendors. · Demonstrated team building and coordination skills. · Must possess strong interpersonal skills and the ability to present critical information to Senior Management. · Ability to manage multiple priorities and work independently. · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts. · Must be able to work in a fast-paced automated production environment and possess solid planning and organizational skills including time management, prioritization, and attention to detail. · Must meet company guidelines for attendance and punctuality and professional appearance/decorum. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
$32k-51k yearly est. Auto-Apply 34d ago
Residential Claims Examiner
Renfroe
Remote job
SUMMARY DESCRIPTION: The Residential Claims Examiner is responsible for approving and settling residential property claims from the field where an estimate of damage has been prepared, or for preparing and settling estimates, or documenting claims decisions and settling those claims with the policyholder and claimants. The role's primary duties include phone scoping, reviewing coverage, determining settlement amounts, communicating with the policyholder or their representative, and documenting the claim file as outlined by the client or RENFROE. They are also responsible for documenting all activity, submitting required claims documentation, issuing settlement payments, settling and closing the claim using fair claims settlement practices, and ensuring compliance with legal and contractual obligations. REPORTS TO: Assigned RENFROE Manager ESSENTIAL JOB FUNCTIONS: · Follows RENFROE and clients' policies and procedures to handle all assigned property claims · Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills · Assigns task work for property inspections and interacts with field adjusters and estimators to determine the scope of loss · Oversees claims files for assigned claims and updates claims as new information becomes available using the client's proprietary software · Manages the progression of claims/tasks and claim inventories assigned to them · Contacts and interacts with the policyholder or their representative to obtain documents such as purchase receipts, bills, photographs, or other documents to establish the existence, ownership, and value of the items claimed damaged · Determines coverage and amounts for additional living expenses such as rental housing, travel, meals, etc. · Sets claim reserves following the client's guidelines · Calculates settlement amounts and, within their settlement authority or after receiving requested authority from the client's designee, issues settlement checks with supporting claim documentation · Writes closing reports, including recommendations for the pursuit of subrogation or the disposal of salvage · Reviews the claim file to support and draft coverage decision letters · Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE · Does not handle claims for which they do not have client authorization or for which they are not licensed · Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes · Makes suggestions on ways to improve process efficiency · Participates in special projects and completes other duties as assigned Non-Authorized Activities: Claims Examiners should not: · Communicate training requirements to client staff adjusters and non-affiliated firms · Communicate training requirements to any claim handler who is not deployed with RENFROE · Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE · Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind EXPERIENCE/QUALIFICATIONS: · Minimum of 1 year of property claims experience is preferred · Participation in technical insurance coursework is preferred, such as CPCU · Experience using various claims processing systems is preferred · Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes · Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others · Strong analytical skills and consistent attention to detail · Knowledge of ISO forms, and client policy coverage, procedures, and systems · Communicates clearly and effectively, both verbally and in writing · Strong customer service orientation and good rapport with the insured · Well-organized and hard-working, with the ability to thrive in a fast-paced work environment · Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact · Computer skills, including but not limited to practical knowledge of Word and Excel PHYSICAL DEMANDS: · Sitting in a chair for extended periods of time · Ability to operate a telephone, computer, mouse, keyboard, and other similar equipment for extended periods of time · Extended and varying work schedules, which may include work from home or work from a centralized office · Regular attendance required, working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays · Ability to work in a fast-paced, changing, and multi-tasking environment
$32k-51k yearly est. 60d+ ago
Litigation Claims Examiner, Rideshare
Reserv
Remote job
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role We are seeking a skilled Rideshare Bodily Injury Litigation Resolution Specialist to manage litigated files. The successful candidate will: Investigate all aspects related to assigned claims Evaluate coverage, liability and damages Negotiate and resolve claims Manage litigation related to auto accident claim disputes The Bodily Injury Litigation Resolution Specialist will also be responsible for maintaining electronic files, working with defense counsel's to drive performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Managing all aspects of litigated cases, including evaluation of the resolution process Analyzing auto claims to identify areas of dispute, investigating and gathering all necessary information and documentation, evaluating liability and damages and negotiating and resolving claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, communicating regularly with clients, attorneys, vendors and other stakeholders Reviewing legal documents and ensuring compliance with initial suit-handling plan of action. Analyzing policy language and reaching appropriate coverage decisions. Directing and controlling the activities and costs of outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Ride Share/TNC/Livery litigation is required. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical causation knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 60 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!
$32k-51k yearly est. Auto-Apply 6d ago
Claims Examiner
Harriscomputer
Remote job
Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.
$32k-51k yearly est. Auto-Apply 5d ago
Claims Processor
Arsenault
Remote job
Through our dedicated associates, Arsenault delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Remote Data Entry Associate Equipment Provided Temp with chance to convert to full time Salary: $15-$20 HR. Hours: 8:00 am to 4:30 pm EST, M-F Would you enjoy being part of a team that makes a difference in people's lives Do you love helping people solve complex problems and delivering solutions? About The Role As a member of the team, you will be processing FSA and HSA claims. You will review and research the claim and process them on a web-based application. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.We have 3 different classes with the 1st one starting in early October. A successful candidate will be computer literate, maintain good attendance, and have the right attitude and discipline to work from home. You will take pride in being a contributing member of a busy team. Meet your quality and volume requirements consistently. This starts as temporary position. You will receive fully paid training of 4-6 weeks. Based on performance and attendance you may be converted to a permanent employee with benefits. What You Will Be Doing Review and research claims Determine if the claim is valid to approve Process claims on a web-based application Completes assignments using multiple source documents to verify data or use additional information to do the work. Follows up on pending documents involving analysis. Requirements Be computer literate able to set up equipment and operate with ease Have own highspeed internet connection: 25 download and 5 upload Must be at least 18 years of age or older. Must have a high school diploma or general education degree (GED). Must be eligible to work in the Los Angeles, CA. Must be able to clear a criminal background check and drug test. Arsenault is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
$15-20 hourly 60d+ ago
Claims Examiner
Point C
Remote job
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market - to do more for clients - and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. Primary Responsibilities Adjudicate new claims and process adjustments, including denials upon receipt of additional information Review and resolve appeals and subrogation/third-party liability cases Manage individual inventory to ensure timely turnaround and production goals are met Ensure claims are processed in accordance with stop loss contract terms Respond to internal and external inquiries via email and other channels within established timeframes Follow up on missing or incomplete information to ensure claims can be accurately processed Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Minimum Qualifications Associate's degree preferred Experience with Third Party Administrator (TPA) or self-funded claims administration preferred At least 1+ year of experience in insurance claims processing Working knowledge of CPT and ICD-10 coding Basic understanding of medical terminology Strong communication and customer service skills Proficiency in Microsoft Office and general computer applications Ability to maintain confidentiality and comply with all company policies and procedures Able to work independently with minimal supervision Ability to prioritize, multitask, and work overtime as needed Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency$38,000-$41,000 USDBenefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business-and our society-stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
$38k-41k yearly Auto-Apply 1d ago
FACETS Claims Processor
Sourcedge Solutions
Remote job
5 Years Facets Claims Adjudication Experience The Claims Examiner must maintain production and inventory standards compliant with Claims Administration requirements High school diploma or equivalent required Must have 5+ years of relevant claim processing experience in healthcare industry (managed care or TPA Company) to support our clients Possess high productivity and quality standards within a claims processing automation environment Knowledge of CPT, HCPC, ICD-10 codes Knowledge of HMO, PPO, Medicare and Medicaid plans Knowledge of Medical terminology Computer with 2 Monitors High Speed Internet Connection Ability to work remote 8 hour day, Mon-Fri. Responsibilities: The claims examiner is responsible for accurate and timely adjudication of claims for the Health Plans lines of business Primary duties include analysis and resolution of claims, including reviewing pended claims and manually resolving based on client specified direction and criteria, including third-party liability claims The claims examiner must be able to work independently, effectively prioritizing work in a production environment that frequently changes to meet production standards and contractual requirements Success in this position will be based on the individual's ability to effectively prioritize work, identify, and resolve complex concerns in a professional manner, and work in a team environment to achieve and maintain production and audit standards Timely and accurate processing and adjudication of all types of claims from assigned workflow queues Compliance with state, federal and contractual requirements to Claims Administration Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications Demonstrates the ability to think analytically to resolve complicated claim issues and identify appropriately when to escalate issues for review Ability to review and apply Plan directives and desktop procedures to claims, following step by step guidelines Claim analysis of coding and billing compliance, potential third-party liability, accurate coordination of benefits (COB), benefit application including limitations and restrictions, pre-existing conditions, subrogation, medical necessity and other claim investigation as appropriate Complete all mandatory claims training/refresher courses Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives Complete all mandatory compliance and corporate training Must be able to adapt to a changing work priorities and requirements and perform other duties as directed to support the overall functions of Claims Administration and support of staff without boundaries within the Plan
$31k-58k yearly est. 60d+ ago
Experienced Claims Processor
Imagenetllc
Remote job
Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for this position. Job Overview: In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies. Job Type: Full-time - This is a fully remote position Pay: up to $19.00 per hour DOE Responsibilities: Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. Participate in ongoing training and professional development activities. Maintain accurate and detailed records of claims processing activities. Review claim forms and supporting documents Determine eligibility, verify data accuracy Request additional information when needed Process claims end-to-end Identify and escalate complex or unusual claims for further review or investigation. Participate in ongoing training and professional development activities. Handle more complex claims with multiple services, providers Experience: At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment. Understanding of health claims processing/adjudication Ability to perform basic to intermediate mathematical computation routines Medical terminology strongly preferred Understanding of ICD-9 & ICD-10 Basic MS office computer skills Ability to work independently or within a team Time management skills Written and verbal communication skills Attention to detail Must be able to demonstrate sound decision-making skills What We Offer: Remote work offered Equipment provided Paid training to set you up for success Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) Paid Time Off (PTO) 7 paid holidays A supportive team and a company that values internal growth Ready to Grow Your Career? We'd love to meet you! Click “Apply Now” and tell us why you'd be a great addition to the Imagenet team. About Imagenet, LLC Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.
$19 hourly 11d ago
Commercial Auto Claims Examiner | Remote
King's Insurance Staffing 3.4
Remote job
Our client is seeking to add a Commercial Auto Claims Examiner to their team. This individual will be responsible for handling commercial auto claims from initial intake through resolution. The position involves evaluating coverage, investigating losses, and negotiating settlements across various jurisdictions. This person will have the ability to work fully remote. Key Responsibilities: Investigate, evaluate, and resolve Commercial Auto and Trucking claims from first notice of loss through closure. Review liability, assess damages, and determine appropriate claim strategies. Establish timely and accurate reserves based on claim investigation and exposure. Collaborate with insureds, claimants, attorneys, and vendors to move claims toward resolution. Handle coverage analysis and issue coverage position letters as required. Maintain consistent communication with policyholders and stakeholders throughout the claim lifecycle. Ensure proper file documentation and compliance with company and regulatory standards. Negotiate settlements within authority and in accordance with company/client expectations. Stay current on state-specific laws and regulations related to commercial auto claims. Requirements: 3 - 5+ years of Commercial Auto/Trucking claims handling experience. Active Adjuster's License required. Strong analytical, negotiation, and communication skills. Ability to draft detailed claim reports and correspond professionally with stakeholders. Highly organized, proactive, and able to manage workload independently. Proficient in Microsoft Office and relevant claims management systems. Salary & Benefits: $65,000 - $75,000 annually (depending on experience) Comprehensive Medical, Dental, and Vision coverage 401(k) with company match Paid Time Off and holiday benefits Professional development and career growth opportunities
$65k-75k yearly 60d+ ago
Claims Specialist II
Healthcare Management Administrators 4.0
Remote job
HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ***************** How YOU will make a Difference: As a Claims Specialist, you'll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you'll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members. Your role goes beyond handling claims, you'll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful. What YOU will do: Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments with precision. This ensures financial accuracy and builds trust with both clients and members. Manage high-importance claims and vendor billing with urgency and attention to detail. Review and reply to appeals, inquiries, and other communications related to claims. Work with third-party organizations to secure payments on outstanding balances. Process case management and utilization review negotiated claims Spot potential subrogation claims and escalate them appropriately. Actively contribute to team success by assisting colleagues when workloads peak, sharing knowledge, and fostering a collaborative environment. Requirements High school diploma required 3-5+ years of claims processing experience 2+ years of BCBS claims processing experience Strong interpersonal and communication skills Strong attention to detail, with high degree of accuracy and urgency Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving Previous success in a fast-paced environment Benefits Compensation: The base salary range for this position in the greater Seattle area is $28/hr - $32/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.) HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit: *****************
$28 hourly Auto-Apply 11d ago
Patient Claims Specialist - Bilingual Only
Modmed 4.5
Remote job
We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates Input and update patient account information and document calls into the Practice Management system Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: High School Diploma or GED required Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST Minimum of 1-2 years of previous healthcare administration or related experience required Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) Manage/ field 60+ inbound calls per day Bilingual is a requirement (Spanish & English) Proficient knowledge of business software applications such as Excel, Word, and PowerPoint Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone Ability and openness to learn new things Ability to work effectively within a team in order to create a positive environment Ability to remain calm in a demanding call center environment Professional demeanor required Ability to effectively manage time and competing priorities #LI-SM2 ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.
$66k-101k yearly est. Auto-Apply 6d ago
Coding Claim Review Specialist (IP/OP)
Corrohealth
Remote job
About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. (AHIMA CCS, COC or AAPC CPC certification required) Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. QUALIFICATIONS · 5+ years of directly related experience · Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I) · Medical Terminology and anatomy knowledge is required · Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. · Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines. · Strong Microsoft Excel, PowerPoint, Word and OneNote skills · Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS) · Strong analytical capability, independent thinker and good decision-making skills · Excellent written and verbal communication and presentation skills · Strong computer and technology knowledge and skills · Highly professional demeanor, great client satisfaction skills ESSENTIAL DUTIES AND RESPONSIBILITIES · Become proficient in the use of the PARA Data Editor, our proprietary software; · Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. · Audit all aspects of claim including (but not limited to): o Omitted or incorrect charges, o Review OPPS and CAH charges and apply guidelines. o CMS/Payer specific guidelines o Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) o Departmental review for inaccuracies, omitted data/documentation and charges o NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, o Units of services o E/M Profee/Facility o Units of services o Documentation improvement. · Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries. · Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing. · Participate in presentations to clients and prospective clients, typically over web meetings. · Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant. · Maintain current certifications and accreditations (as applicable). · Research new guidelines, data elements, payer specifications, etc. · Other duties may be assigned as necessary. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
$34k-54k yearly est. Auto-Apply 21d ago
Commercial Casualty Claims Specialist (Remote)
Aaaie
Remote job
External candidates: In order for your application to be correctly processed please sign-in before you apply Internal candidates: Please go to Workday and click "Find Jobs" link under Career Thank you for considering opportunities with us! Job Title Commercial Casualty Claims Specialist (Remote) Requisition Number R7504 Commercial Casualty Claims Specialist (Remote) (Open) Location Colorado - Home Teleworkers Additional Locations Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers {+ 20 more} Job Information We're Mobilitas, a commercial insurance company created by CSAA Insurance. Our mission is to reinvent commercial insurance in the mobility space by providing technologically advanced solutions for today's way of doing business. At Mobilitas, we believe in what's possible and we use our inventive skills to meet the demands of modern mobility with tailored solutions. We're looking for motivated, innovative individuals who think big, move fast and are dedicated to creating a company from the ground up, without the constraints of a traditional insurance company. We're excited to push the boundaries of commercial insurance and are looking for enthusiastic team members to help us reimagine insurance. We are actively hiring for a Commercial Casualty Claims Specialist! Your role: As a Commercial Casualty Claims Specialist, you will be responsible to resolve all aspects of 1st and 3rd party injury claims of low to moderate complexity for personal lines as well as our commercial claims. Your duties will require you to become licensed in several states as you will be handling claims in a multitude of regions across the nation. Your work: Manage all claims efficiently and effectively to an appropriate resolution with minimal supervision. Handle all aspects of liability injury claims of low to moderate complexity to include all coverage, liability and damage concerns. Handle 1st party exposures to include Medical Payment coverage, PIP, Uninsured Motorists, Under-insured Motorists claims as well as ADB (Auto-Death Benefit) claims. Assist in taking first notice of loss calls (FNOL) and participate in the department phone queue as needed. Make coverage determinations and conduct investigative work of a complex nature, advising customers as to accurate course of action related to coverage issues. Make appropriate liability determinations based upon the evidence gathered. Evaluate any potential for subrogation and initiate an initial notice of subrogation request. Develop negotiation strategies to resolve claims effectively and efficiently with insureds, claimants, or representatives of the injured parties. Communicate pertinent case facts to a supervisor, manager or committee when appropriate. Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.). Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.). Travels as needed for role, including divisional / team meetings and other in-person meetings. Fulfills business needs, which may include investing extra time, helping other teams, etc. Required experience, education, and skills: 2+ years of Casualty claims experience OR a minimum of 2 years of claims experience including 1+ year of Commercial claims experience. High School / GED or a minimum of 3 years experience in a Casualty claims role within P&C insurance industry. Required to acquire and/or maintain multiple Adjuster's Licenses (state-specific) within the first 90 days of employment and/or job transfer. What would make us excited about you: 3+ years of Casualty claims handling experience. Prior experience with Commercial policies. BA/BS in business, insurance or related area. Flexibility to work any shift during the operating hours of 5:30 a.m. to 7 p.m. in your time zone, which may include evenings and/or weekends. Capability to complete training and perform the job in a remote setting as required. Outstanding interpersonal and strong computer navigation abilities. Ability to handle several tasks simultaneously. Shows respect for differences through excellent communication skills with people from an array of backgrounds. Mobilitas Careers At Mobilitas, we're proudly devoted to protecting our customers, our employees, our communities, and the world at large. We are on a climate journey to continue to do better for our people, our business, and our planet. Taking bold action and leading by example. We are citizens for a changing world, and we continually change to meet it. Join us if you… BELIEVE in a mission focused on building a community of service, rooted in inclusion and belonging. COMMIT to being there for our customers and employees. CREATE a sense of purpose that serves the greater good through innovation. Recognition: We offer a total compensation package, performance bonus, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at careers.mobilitasinsurance.com. In most cases, you will have the opportunity to choose your preferred working location from the following options when you join us: remote, hybrid, or in-person. Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don't miss important updates from us. If a reasonable accommodation is needed to participate in the job application or interview process, please contact *************************** As part of our values, we are committed to supporting inclusion and diversity. We actively celebrate colleagues' different abilities, sexual orientation, ethnicity, and gender. Everyone is welcome and supported in their development at all stages in their journey with us. We are always recruiting, retaining, and promoting a diverse mix of colleagues who are representative of the U.S. workforce. The diversity of our team fosters a broad range of ideas and enables us to design and deliver a wide array of products to meet customers' evolving needs. Mobilitas is an equal opportunity employer. If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education. Must have authorization to work indefinitely in the US Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska. #LI-CH1 .
$32k-51k yearly est. Auto-Apply 6d ago
Claims Processing Specialist
Independence Pet Group
Remote job
Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Pets Best, a subsidiary of IPH, is building a digital first pet e-commerce platform with the aim of connecting key market services such as adoption, lost pet and insurance to make pet care easy. Job Summary: Pets Best is seeking a Claims Processing Specialist who will report to the Supervisor, Claims. Claims Processing Specialists are responsible for reviewing invoices and pet medical documents and determining coverage in compliance with the current Underwriter's policy. Job Location: Remote - USA Main Responsibilities: Review individual policies to make an eligibility determination with high degree of accuracy Contact with internal departments as well as veterinarians and clinic staff Ensure compliance guidelines are met with both internal policies and procedures and contractual commitments Work independently and with others on a virtual team Drive a “Great Place to Work” culture, attend and participate in team meetings as well as engagement events Use PC based programs to enter data into claims system, communicate with leaders and teammates, and organize information Create and issue claim decisions to pet parents using proper spelling, grammar, and punctuation in line with the policy terms Calculate invoice totals, discounts, and tax rates Perform other duties and/or special projects as assigned Qualifications: High school diploma or equivalent 3+ years recent clinical veterinary experience (dog and cat) as a veterinary assistant, veterinary technician or veterinarian Knowledge of veterinary terms, abbreviations and conditions. Knowledge of medical conditions and associated symptoms, procedures, treatments, secondary conditions and pharmaceuticals used in veterinary medicine Knowledge of canine and feline breeds, anatomy and associated predispositions to illness. Ability to read and interpret medical diagnoses via medical records review both written and digital. Ability to work cross functionally with our internal and external resources Ability to handle multiple projects concurrently Ability to navigate Windows OS, Google Chrome, and corresponding applications Demonstrable Microsoft Office proficiency: Word, PowerPoint, Excel, Outlook, Teams Strong writing skills: organization, spelling, grammar and punctuation Strong mathematical and problem-solving skills #LI-Remote #petsbest All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)
$30k-38k yearly est. Auto-Apply 14d ago
Claiming Specialist- HAAWK (Remote)
Sesac Rights Management, Inc. 3.6
Remote job
HAAWK is looking for a Claiming Specialist to join our team. In this role you will be responsible for accuracy and integrity of music assets within YouTube's Content Management System (CMS), and play a critical part in ensuring proper monetization, rights enforcement, and conflict resolution across digital content platforms. The ideal candidate is highly detail-oriented, technically proficient, and possesses a strong understanding of YouTube's platforms and policies. What You Will Be Doing: Monitoring and troubleshooting issues related to claims, monetization, and policy enforcement within YouTube CMS. Investigating and resolving disputed claims, reference overlaps, and ownership conflicts to ensure proper asset management. Maintaining accurate metadata, confirming correct ownership, and applying appropriate policies across music assets. Serving as a point of contact for clients and partners, providing timely assistance with content-related issues and conflict resolution. Stay up-to-date and informed on YouTube platform developments, Content ID tools, and industry best practices. What Makes You Qualified: Proficiency in organizing and analyzing data using tools such as Microsoft Excel or Google Sheets. Strong attention to detail, with excellent organizational and analytical problem-solving abilities. Comfortable working with and learning new technologies. Proven ability to work collaboratively in a team environment with a positive, solutions-oriented attitude and a willingness to support others to achieve shared goals. Hands-on experience with YouTube CMS or similar content management systems. Background in music, digital rights management, or copyright is a plus. Solid understanding of popular music and awareness of current and emerging trends in the music industry. Exceptional communication skills with the ability to interact professionally in client-facing situations.
$30k-46k yearly est. Auto-Apply 60d+ ago

Learn more about claim processor jobs

Work from home and remote claim processor jobs

Nowadays, it seems that many people would prefer to work from home over going into the office every day. With remote work becoming a more viable option, especially for claim processors, we decided to look into what the best options are based on salary and industry. In addition, we scoured over millions of job listings to find all the best remote jobs for a claim processor so that you can skip the commute and stay home with Fido.

We also looked into what type of skills might be useful for you to have in order to get that job offer. We found that claim processor remote jobs require these skills:

Customer service
Data entry
Medical terminology
Cpt
Claims processing

We didn't just stop at finding the best skills. We also found the best remote employers that you're going to want to apply to. The best remote employers for a claim processor include:

AmeriHealth Caritas
Prudential Financial
Sutter Health

Since you're already searching for a remote job, you might as well find jobs that pay well because you should never have to settle. We found the industries that will pay you the most as a claim processor:

Insurance
Finance
Government

Top companies hiring claim processors for remote work

Most common employers for claim processor

Rank	Company	Average salary	Hourly rate	Job openings
1	BERKLEY TECHNOLOGY SERVICES	$67,626	$32.51	21
2	Tech Providers	$57,767	$27.77	0
3	Sutter Health	$53,137	$25.55	0
4	Arch Capital Group	$51,905	$24.95	55
5	AmeriHealth Caritas	$49,367	$23.73	1
6	Belcan	$48,192	$23.17	0
7	Prudential Financial	$45,891	$22.06	0
8	State Of Texas Office	$44,358	$21.33	4
9	ICONMA	$42,539	$20.45	0
10	The Cincinnati Insurance Companies	$41,485	$19.94	15

Updated December 22, 2025

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Work from home and remote claim processor jobs

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