Claim processor work from home jobs

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!

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is seeking an influential and dynamic Claims Examiner to join our Group Life Claims organization. Claims Examiner is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. Key Job Responsibilities Claims Management: Responsible for active case management of Life claims. Ensures claims are processed accurately within regulatory and company guidelines. Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved. Review and interpret medical records, utilizing resources as appropriate. Complete financial calculations specific to claims when applicable. Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication. Apply contract/policy provisions to ensure accurate eligibility and liability decisions. Demonstrate and apply analytical and critical thinking skills. Client and Customer Relationships: Foster strong relationships with customers to understand their needs and ensure high levels of satisfaction. Addresses and resolves any customer challenges or concerns promptly. Communication via telephone, email, and text with employees, employers, attorneys, and others. Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards. Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities. Work independently as well as within a team structure. The base salary range for this position is $53,000 - $62,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program Required Qualifications · 2+ years prior experience managing Life claim products. · Excellent client relationship management skills. · Strong verbal, written communication, and presentation skills. · Comfortable dealing with complexity and ambiguity and able to explore multiple solutions. Preferred Qualifications · Previous experience with FINEOS Claims software platform highly desired. · Exceptional customer service skills; Proven skills in positive and effective interaction with challenging customers. · Strong knowledge of regulatory requirements for Life claims. · Ability to handle sensitive information with confidentiality and professionalism. · Strong written and oral communication skills demonstrated in previous work experience. · Excellent organizational and time management skills with ability to multitask and prioritize deadlines. · Ability to manage multiple and changing priorities. · Detail oriented; able to analyze and research contract information. · Demonstrated ability to operate with a sense of urgency. · Experience in effectively meeting/exceeding individual professional expectations and team goals. · Demonstrated analytical and math skills. · Ability to exercise critical thinking skills, risk management skills and sound judgment. · Ability to adapt, problem solve quickly and communicate effective solutions. · High level of flexibility to adapt to the changing needs of the organization. · Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment. · Continuous improvement mindset · A commitment to support a work environment that fosters diversity and inclusion. · Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word. · Reliability and dependability throughout our extensive training program is crucial. Skills Analytical Thinking\: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations\: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems\: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities\: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving\: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. #LI-Remote ABOUT EQUITABLE At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. ********** Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE\: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.

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.

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

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!

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.

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.

Job Title: Claims Processor Department: Operations Supervisor: Manager, Claims Operations Summary: Position is responsible for the timely and accurate claims adjudication and regulatory reporting functions including associated processes and reporting of key performance indicators. Position is also responsible for responding to incoming inquiries and coordination with other internal and external stakeholders to resolve the issue, determine the underlying cause and make recommendations regarding system changes that may be relevant. Essential Duties and Responsibilities include the following. Other duties may be assigned. Utilizing consistent standards, practices, and processes focused on timely and accurate adjudication of claims to review, evaluate and/or quality control review and final adjudication of paper/electronic claims for inpatient, outpatient and professional medical claims Resolve claim edits, review history records and determine benefit applicability for service including the review of pricing at final payment determination Works closely with stakeholders including clinical, operations and finance teams during the development of key workflows to ensure alignment of overall objectives and key requirements Shall perform user acceptance testing for any impacted changes to claims processing as directed Meets or exceeds production and quality standards including maintaining accurate recording and calculations as required Takes corrective action steps in collaboration with other business units including enrollment and benefits configuration Monitors claim inventory levels Consistently researches procedural questions using supporting documentation while identifying incomplete adjudications instructions found within the supporting documentation, allowing for participatory suggestions for updating and correcting procedures, identifies training issues and appropriately checking with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization Monitors system and reporting for volume shifts Candidate Qualifications Education Education: High School Diploma or equivalent required Licenses/Certification: None required; CPC preferred Ability to work from home with appropriate internet access and a quiet and private workspace. Skills Minimum two (2) years of claims and health care administration and/or managed care experience Strong knowledge of health insurance industry with all product lines (Medicare, Medicaid, Commercial, ASO, DSNP, etc…) Extensive knowledge of claims policies and procedures including regulatory requirements and industry standards from AMA, CMS and CCI edits. Strong computer skills, specifically with Microsoft Office and Windows. A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact Must have a strong work ethic and a sense of responsibility to other team members and external stakeholders to meet all needs represented by a robust sense of accountability Adaptable and a quick learner, willing to change to meet shifting customer and business needs. Excellent verbal and written communication skills Extremely organized and detail-oriented. Ability to work independently on a variety of projects in a high volume, fast paced, and sometimes nebulous environment required

Claims Processor needs 1+years experience Claims Processor requires: Ability to learn and adopt new processes quickly and with ease Ability to work remotely and autonomously Data entry test Onsite, 5 days Accustomed to working in a high-paced, high-volume environment Strong attention to detail Medium-Advance level of expertise with Microsoft Excel Proficient with Outlook Familiar with Cloud-based applications (i.e. OneDrive) Ability to multi-task and perform duties using multiple sources or systems; Data Entry experience Ability to clearly articulate findings, issues or concerns requiring resolution Claims Processor duties: Responsible for the timely and accurate completion of key tasks supporting the successful implementation Monitor team shared Outlook mailbox for incoming membership documents sent from clients, brokers or Third Party Administrators Review incoming membership documents (Microsoft Excel and Word) to confirm accuracy in formatting and validity of data; includes communicating when updates are needed for successful membership enrollment and/or submission for processing.

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.

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.

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.

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.

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: *****************

SOLV Energy is an engineering, procurement, construction (EPC) and solar services provider for utility solar, high voltage substation and energy storage markets across North America. The Property & Casualty Claim Specialist is responsible for managing and processing insurance claims related to property and casualty losses. This role involves investigating claims, assessing damages, claim reporting, and ensuring timely and accurate claim resolution. The ideal candidate will have a strong understanding of insurance policies, excellent analytical skills, and a commitment to providing outstanding service. : *This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned Position Responsibilities and Duties: Investigate and evaluate property and casualty claims to determine coverage, liability, and damages. Communicate with carriers, adjusters, claimants, and other stakeholders to gather necessary information and documentation. Analyze policy terms and conditions to determine claim eligibility. Coordinate with adjusters, contractors, and other professionals to assess and estimate damages. Work with carrier(s) in settlement negotiations with claimants and ensure fair and equitable claim resolution. Maintain accurate and detailed claim files and documentation. Provide regular internal updates on the status of claims. Ensure compliance with company policies, procedures, and regulatory requirements. Identify and report potential fraud or suspicious activities. Participate in training and development programs to stay current with industry trends and best practices. Minimum Skills or Experience Requirements: Bachelor's degree in a related field or equivalent work experience. Recommended heavy knowledge in Commercial Auto and Builders Risk coverages. Minimum of 5-10 years of experience in property and casualty claims handling - whether at a carrier, broker or with a construction client. Strong knowledge of insurance policies, coverage, and claim processes. Excellent analytical and problem-solving skills. Effective communication and negotiation abilities. Ability to work independently and as part of a team. Strong attention to detail and organizational skills. Customer-focused with a commitment to delivering high-quality service. SOLV Energy Is an Equal Opportunity Employer At SOLV Energy we celebrate the power of our differences. We are committed to building diverse, equitable, and inclusive workplaces that improve our communities. SOLV Energy prohibits discrimination and harassment of any kind against an employee or applicant based on race, color, age, religion, sex, sexual orientation, gender identity or expression, marital status, national origin, or ethnicity, mental or physical disability, veteran status, parental status, or any other characteristic protected by law. Benefits: Employees (and their families) are eligible for medical, dental, vision, basic life and disability insurance. Employees can enroll in our company's 401(k) plan and are provided vacation, sick and holiday pay. Compensation Range: $65,133.00 - $81,416.00 Pay Rate Type: Salary SOLV Energy does not accept unsolicited candidate introductions, referrals or resumes from third-party recruiters or staffing agencies. We require all third-party recruiters to communicate exclusively with our internal talent acquisition team. SOLV Energy will not pay a placement fee to any third-party recruiter or agency that has not coordinated their recruiting activity with the appropriate member of our internal talent acquisition team. In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. Any unsolicited candidate introductions, referrals or resumes sent by third-party recruiters to SOLV Energy or directly to any of our employees, or received through our website or career portal, will be considered property of SOLV Energy and will not be eligible for a placement fee. In the event a third-party recruiter submits a resume or refers a candidate without a previously signed vendor agreement, SOLV Energy explicitly reserves the right to pursue and hire the candidate(s) without financial liability to such third-party recruiter. Job Number: J11771 If you're interested in a meaningful career with a brighter future, join the SOLV Energy Team.

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Hill Physicians Care Solutions (HPCS) is a wholly owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage claims for the full risk line of business. Under the leadership of the HPCS Supervisor, the Full Risk Claims Analyst is responsible for ensuring Full Risk claims and disputes are processed accurately and timely pursuant to health plan coverage and Hill Physicians' reimbursement policies as well as within CMS and AB1455 regulations. The analyst will be Responsible for resolving/responding to complex issues for members, health plans and physicians by conducting detailed research and by interfacing with appropriate departments and management to ensure that the standards for claims resolution processes are met. Analyst must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Essential Responsibilities Adjudicating and/or adjusting claims, specifically for the full risk line of business, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Ensure these full risk claims are handled accurately, timely and appropriately. Claim contains pertinent and correct information for processing. Services have the required authorization. Accurate final claims adjudication/adjustment by using pricing system and provider contracts. Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims. Adjudicate claims on Epic Tapestry according to HPCS and HPMG guidelines. Navigate and decipher pricing rules using Optum Prospective Pricing System. Review, interpret and process MS DRG rules, Home Health and ASC groupings, DME and ambulance claims. Ensure all claim lines post to the appropriate fund. Maintain departmental productivity goal. Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate in Claims Services Determine benefits using automated-system controls, policy guidelines, and HMO Fact Sheets. Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Review and process out of network claims according to the guideline/out of network claims research protocol in order to contain out-of-network cost Conduct second-level review of all Medicare denials for Not Authorized and/or Not A Covered Benefit. Research, resolve, and respond to claim resubmission disputes and inquires Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Provide claims contact resolution to the call center. Complete special projects as assigned to meet department and company goals. Document follow-up information on the system and generate appropriate letters to member and providers. Skills and Experience Required Minimum years of experience required - 3 Minimum level of education required - High School/GED Licenses and certifications required - None. Must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Working knowledge of CPT, Revenue codes, PDGM Home Health, ICD-10 codes, Red Book, MS DRGs, HCPC codes and ASC groupings. Three years' experience in claims-payment adjudication at a Health Maintenance Organization (HMO) Health Plan or IPA. (Internal applicants are expected to have one year of experience in claims-payment adjudication). Ability to process all claim types on UB-04 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology. Ability to understand member benefits and patient cost-shares. Ability to calculate and convert standard drug measurements. Knowledge of CMS and the DMHC rules and regulations. Excellent problem solving, organizational, research and analytical skills. Strong written- and verbal-communication skills. Strong Microsoft application skills. Strong interpersonal skills and the ability to interact with employees and others in a professional manner. Strong judgment, decision-making and detailed oriented skills. Ability to work independently or as a team. Ability to work in a fast- paced environment. Additional Information Remote - Multiple Positions Available Salary: $28 - $32 hourly Hill Physicians is an Equal Opportunity Employer

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 .

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.

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)