Claim processor jobs in Kentucky

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-Hybrid #IN-DNI

Claim Specialist needed to combat rising healthcare costs and empower health plans! The Phia Group is a service-oriented consultant that assists health plans nationwide. We provide our clients with innovative cost-cutting solutions and innovative service offerings. We continue to enjoy growth thanks to our most valuable resource - our talented and committed team. Until recently, surprise medical bills were a leading cause of financial distress and bankruptcy for American families. “Surprise” billing occurs when a patient presents to an out-of-network medical provider through no fault of their own - like in the case of an emergency - and the patient becomes responsible for amounts beyond what their insurance pays. Thankfully, beginning in 2022 with the implementation of the “No Surprises Act”, the legislature effectively banned surprise billing, instead prescribing a system of negotiation and arbitration that health plans and providers must follow to resolve billing disputes. The Claims Specialist will be responsible for supporting the team on all aspects of the No Surprises Act, including reviewing medical claims, keeping track of strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution, among many other tasks. The candidate will also be expected to support the team on balance billing and overpayment matters as needed. This position requires someone that is proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. The Phia Group is growing quickly and so the candidate must be comfortable in a dynamic fast-paced environment. Essential Duties and Responsibilities include the following. Other duties may be assigned. Manage a daily running inventory of unpaid claims or claim disputes. Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards. Contact facilities and providers to discuss charge adjustments and rationale. Contact facilities and explain benefits to resolve payment disputes. Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities. Capture detailed notes on calls for future reference. As needed, handle member inquires in accordance to their medical plan. Work with The Phia Group's legal department to ensure escalation of claims. Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process. Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Experience and Qualifications Preferred: Baccalaureate degree (BA/BS) from an accredited college or university. Preferred: Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting. Computer literate, including Microsoft Office products. Working Conditions / Physical Demands Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines. This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary. External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis. Salary: $50,000 - $65,000 / year

Job Description An Account Resolution Specialist I is responsible for researching and identifying unpaid, partially paid, incorrectly paid or denied claims. They must follow-up with insurance carriers verbally or via on-line tools and properly discuss the problem with the knowledge of how to negotiate payment/additional payments on all claims. In the event the needs arise, they will also resubmit a corrected claim and/or follow-up with patients regarding the issue(s) as needed. Minimum Education Must have a high-school diploma or a GED. Minimum Work Experience No prior work experience in this related field is required at this level. Required Skills Customer service Must have general Microsoft Office (Word, Excel, PPT, and Outlook) experience. Ability to manage their time in order to meet job requirements. Ability to review an account and come to a decision as to what the proper solution would be to resolve the account. Must be a team player. Screening Requirements: Drug Screen Tuberculosis Test Background Check Physical Exam Respirator Fit Eligible Benefits: Medical, Dental and Vision *Excellent Low Premiums!*- No copays or Deductibles when utilizing MCCH services! Life Insurance *ZERO premium* Retirement Plan Paid Time Off Bereavement Bridge Coverage *ZERO premium for self-coverage when enrolled in medical coverage Tuition Reimbursement Our Mission: To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals. Our Vision: To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors. Our Values: Competence, Excellence, Compassion, Respect and Integrity.

Summary/Objective This role focuses on minimizing loss and maximizing product credit by ensuring market inventory teams fully understand and accurately execute shipping claims processes across all shipping and vendor partners. Essential Functions Guide market inventory teams in following established shipping claims processes for all vendor and carrier partners in order to ensure compliance. Provide support and coaching to market inventory teams in order to improve their understanding and execution of claims procedures. Monitor claim submissions for accuracy and timeliness in order to minimize loss and maximize product credit. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Competencies Attention to Detail: Taking responsibility for a thorough and detailed method of working. Accountability: Accepting responsibility that results in anticipation/prevention of problem areas from actions, and problem solving inside and outside the department/organization. Planning and Organizing: Setting priorities and defining actions, time, and resources needed to achieve predefined goals. Results Orientation: Being persistent and showing perseverance on achieving concrete and tangible results out of personal responsibility; getting optimum results from situations and being ready to take action and show tenacity in case of obstacles or resistance. Customer Focus: Knowing the (internal and external) customer business needs and acting accordingly; anticipating customer needs and giving high priority to customer satisfaction and customer service. Initiative: Spotting opportunities within a circle of influence; anticipating threats and acting on them; self-starting rather than waiting passively until the situation demands action. Supervisory Responsibility This position has no supervisory responsibilities. Work Environment This job is in a back office/inventory environment. Physical Demands Must be able to perform repetitious hand/eye movement, Must be able to sit for long periods of time, Must be able to stand for long periods of time, Must be able to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Position Type/Expected Hours of Work This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. Travel 0-10% Required Education and Experience High school diploma or GED Must be comfortable with Microsoft Office products and able to work in an organized and efficient way. Preferred Education and Experience 4 Year Degree Experience with inventory, shipping claims, or reverse logistics processes would be beneficial. Additional Eligibility Qualifications (Knowledge, Skills, Abilities) Punctual with reliable transportation Good listening skills and ability to follow written and verbal instruction Consistently meet deadlines Self-starter with ability to work with minimal supervision as well as with a team AAP/EEO Statement Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other Duties 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 for this job. Duties, responsibilities and activities may change at any time with or without notice.

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR YCTGcj3095

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a medical claims representative trainee, you'll be instrumental in keeping the medical claims process efficient and supportive for our customers. Focusing on personal injury protection (PIP) medical coverage, you'll analyze accident details, medical records and terminology. You'll also adjust claims while maintaining solid relationships with customers. Bring your passion for helping others and we'll teach you the insurance stuff - allowing you to be confident when speaking with customers. This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like. Duties & responsibilities after training Research policy contract, regulation and cause of injury to make coverage decisions Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions Identify and research wage loss expenses and documentation for payment consideration Review and interpret policy language when subrogation demands are received Additional Qualifications/Responsibilities Must-have qualifications Three years of work experience OR Bachelor's degree OR Two years work experience and an associate degree Schedule: Monday-Friday, 8:00am-5:00pm Location: Louisville, Lexington, or Bowling Green, KY Compensation Once you complete training and pass any necessary testing requirements, your salary will range from $54,000-$57,500/year, however, during training, you'll be paid hourly based on your annual salary. Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Benefits 401(k) with dollar-for-dollar company match up to 6% Medical, dental & vision, including free preventative care Wellness & mental health programs Health care flexible spending accounts, health savings accounts, & life insurance Paid time off, including volunteer time off Paid & unpaid sick leave where applicable, as well as short & long-term disability Parental & family leave; military leave & pay Diverse, inclusive & welcoming culture with Employee Resource Groups Career development & tuition assistance

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be the acknowledged technical expert and be responsible for the resolution of high complexity and high exposure claims. The position will have significant responsibility for decision making and work autonomously within their authority. Responsibilities: * High complexity coverage interpretation, liability investigation, multiple vehicles, potential extra-contractual, litigation or significant injuries. * Direct involvement in litigation claims management to reach desired outcomes and minimize expenses * Investigate, negotiate and settle complex liability cases. Maintain and make sure alignment to Markel's guidelines and procedures. * Ensure proper adherence to internal large loss reporting requirements. * Promptly communicate with Claims Manager on case developments and provide information on issues affecting the lines of business * Chip in and assist in the implementation of a range of initiatives, discussion and action plans brought forth by the Claims Manager * Connect with underwriting as needed to handle claims and to alert of any significant developments * Participate in agent related functions and meetings as required Requirements: * 7-10+ years of Liability claims handling experience with a commercial insurance company * Successful Liability claim handling experience is critical * College degree and/or professional designation preferred * Sound comprehension of personal and commercial liability coverages. * Excellent written and oral communication skills. * Experience in resolving contractual obligations, coverage analyses, and investigations. * Ability to run sophisticated large liability exposures, set loss and expense reserves and evaluate settlement values. * Ability to proactively self-manage an active caseload. * Ability to analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form. * Travel required as necessary (less than 15%). * Adjuster license in multiple states or across the US strongly preferred. US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Pay information: The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $97,520 - $134,000 with a 25% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $20.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: Monday - Friday; 8:30am-5:00pm Eastern Time The Subrogation Examiner is responsible for researching and examining routine health claims that may be related to Third Party Liability, Workers' Compensation and other subrogation/reimbursement recovery cases. How you will make an impact: Initiates calls to groups, insurance companies, attorneys, members and others as necessary to determine if claims have potential for reimbursement from another party. Responds to inquiries regarding information on injury claims. Utilizes various research methods and vendor systems to gather information. Works with subrogation staff, other departments and outside clients to assist with the recovery process. Prepares written communications. Reviews diagnostic and procedure codes to determine claims relevant to each case. Reviews internal systems/applications for various information needs. Assists with small scale special projects. Minimum Requirements: Requires a minimum of 1 year of inbound or outbound call experience; or any combination of education and experience, which would provide an equivalent background. Job Level: Non-Management Non-Exempt Workshift: Job Family: AFA > Financial Operations Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: Monday - Friday; 8:30am-5:00pm Eastern Time The Subrogation Examiner is responsible for researching and examining routine health claims that may be related to Third Party Liability, Workers' Compensation and other subrogation/reimbursement recovery cases. How you will make an impact: Initiates calls to groups, insurance companies, attorneys, members and others as necessary to determine if claims have potential for reimbursement from another party. Responds to inquiries regarding information on injury claims. Utilizes various research methods and vendor systems to gather information. Works with subrogation staff, other departments and outside clients to assist with the recovery process. Prepares written communications. Reviews diagnostic and procedure codes to determine claims relevant to each case. Reviews internal systems/applications for various information needs. Assists with small scale special projects. Minimum Requirements: Requires a minimum of 1 year of inbound or outbound call experience; or any combination of education and experience, which would provide an equivalent background. Job Level: Non-Management Non-Exempt Workshift: Job Family: AFA > Financial Operations Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: Monday - Friday; 8:30am-5:00pm Eastern Time The Subrogation Examiner is responsible for researching and examining routine health claims that may be related to Third Party Liability, Workers' Compensation and other subrogation/reimbursement recovery cases. How you will make an impact: * Initiates calls to groups, insurance companies, attorneys, members and others as necessary to determine if claims have potential for reimbursement from another party. * Responds to inquiries regarding information on injury claims. * Utilizes various research methods and vendor systems to gather information. * Works with subrogation staff, other departments and outside clients to assist with the recovery process. * Prepares written communications. * Reviews diagnostic and procedure codes to determine claims relevant to each case. * Reviews internal systems/applications for various information needs. * Assists with small scale special projects. Minimum Requirements: * Requires a minimum of 1 year of inbound or outbound call experience; or any combination of education and experience, which would provide an equivalent background. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Re-certification Specialist Duties/Responsibilities: • Conduct file reviews for compliance with the applicable subsidy type (S8, LIHTC, etc.). • Prepares reports that summarizes items of non-compliance and works in conjunction with property staff to correct identified deficiencies. • Meets with residents and applicants to perform Initial, Annual or Interim interviews for the applicable subsidy type (S8, LIHTC, etc.). • Processes required verifications that are necessary to complete resident and applicant certifications. • Provides Senior Property Manager with file reviews and suggests items for employee training deficiencies. • Reviews quarterly/monthly EIV reports for accuracy and assist property staff with resolving discrepancies. • Prepare monthly/quarterly/annual LIHTC reports (i.e. qualified basis tracking) as required by state monitors and syndicators for submission to the Director of Compliance. • Reviews asset verifications for certifications that involve real estate and/or investment income for submission and final review • Assists staff with monthly voucher submissions, HAP payment errors and posting/reconciling within One Site. • Other duties as assigned. Qualifications: • Strong knowledge of affordable housing programs, to include Section 8/236; LIHTC; EIV and HUD Secure Systems; Fair Housing & Section 504 compliance. • Affordable Housing certifications; COS (or equivalent), C3P, HCCP or nationally recognized certification is required. • Three to five years of directly related experience as a property manager or compliance analyst/monitor required. • Strong written and verbal communication skills are required. • High level of organization and attention to detail is a must. • Ability to manage multiple priorities and deadlines. • Good Microsoft Office (Word, Excel) skills are required. Strong knowledge of OneSite, Yardi or Boston Post software highly desired.

Job DescriptionDescription: We are seeking a detail-oriented and proactive Insurance Pre-Certification Specialist to join our team. This role is responsible for managing insurance pre-certifications, verifying patient benefits and deductibles, and ensuring timely follow-up to support surgical scheduling and billing accuracy. Key Responsibilities: Manage and follow up on all pre-admission and pre-certification processes for multiple provider and office locations. Submit pre-certification requests via insurance portals (e.g., Humana, UnitedHealthcare) and through direct communication with insurance providers. Verify and input accurate procedure codes to ensure correct pre-certification for scheduled surgeries. Assess patient deductibles, including HSA accounts, and determine pre-surgical financial responsibilities. Maintain organized and up-to-date records of all pre-certified cases, including necessary updates and changes. Communicate regularly with insurance companies, patients, and internal staff to ensure timely approvals. Send deductible letters and follow up on outstanding or pending cases. Reprocess pre-certifications when surgical procedures differ from initial expectations. Qualifications: Proven experience in insurance pre-certification within a medical or surgical setting. Strong understanding of medical billing and coding (CPT/ICD codes preferred). Excellent organizational and multitasking skills. Ability to work independently and collaboratively within a team. Professional phone etiquette and effective communication skills (oral and written). Familiarity with insurance providers and their authorization processes. Proficiency in computer systems and electronic health records (EHR). Associate degree or equivalent college coursework preferred. Why Join Us? Be part of a dedicated team in a fast-paced, patient-focused environment where your attention to detail and insurance expertise directly contribute to successful surgical outcomes and patient satisfaction. Requirements:

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-Hybrid#IN-DNI

The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and we later discover someone else should have paid those medical bills, The Phia Group - on behalf of the health plan - will seek to recover the funds. The Case Investigator plays an important role in this effort, by determining whether another proper payer exists, and obtaining the details needed to pursue fund reimbursement. The Health Claim Investigation Representative is responsible for communicating with plan members (insured participants) to determine potential sources of recovery (i.e. auto insurance, workers compensation, first party coverage, third party coverage, etc.). You will also be in contact with insurance carriers to collect adjuster and claim information while balancing communication with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email. At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their families, you can look forward to not only unparalleled benefits for yourself but also being immersed in a company that was named one of USA Today's Top Workplaces for 2025. Meanwhile, from a regional perspective, both The Boston Globe and Louisville Business First also recognized our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work in 2025. Note: This is a hybrid position. Essential Duties and Responsibilities Calling members for accident details Drafting, mailing & faxing correspondence Calling insurance carriers for claim information (claim #, adjuster name, phone, fax & mailing address) Providing clients with accident details, payment ledgers, police reports, etc. Reviewing plan documents for possible exclusions Verifying first party, workers' compensation, third party and/or attorney representation and properly promoting and/or transferring the file to the appropriate CRS Will be responsible for consistency and accuracy on time-sensitive documents. Working on a team to efficiently handle tasks and keep the team up to date. Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents Experience and Qualifications Excellent attention to detail with the ability to multi-task Excellent communication skills High level of proficiency using Microsoft Word and Excel required Outstanding organizational, interpersonal, and administrative skills Excellent telephone, writing, and communication skills Must be self-motivated and able to meet deadlines under pressure Must have the ability to work as part of a team, as well as to work independently The Phia Group's Commitment to Diversity The Phia Group is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Phia Group is also committed to compliance with all fair employment practices regarding citizenship and immigration status. Working Conditions / Physical Demands Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines. This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary. External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis. Salary: $47,000 - $50,000

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Summary/Objective This role focuses on minimizing loss and maximizing product credit by ensuring market inventory teams fully understand and accurately execute shipping claims processes across all shipping and vendor partners. Essential Functions Guide market inventory teams in following established shipping claims processes for all vendor and carrier partners in order to ensure compliance. Provide support and coaching to market inventory teams in order to improve their understanding and execution of claims procedures. Monitor claim submissions for accuracy and timeliness in order to minimize loss and maximize product credit. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Competencies Attention to Detail: Taking responsibility for a thorough and detailed method of working. Accountability: Accepting responsibility that results in anticipation/prevention of problem areas from actions, and problem solving inside and outside the department/organization. Planning and Organizing: Setting priorities and defining actions, time, and resources needed to achieve predefined goals. Results Orientation: Being persistent and showing perseverance on achieving concrete and tangible results out of personal responsibility; getting optimum results from situations and being ready to take action and show tenacity in case of obstacles or resistance. Customer Focus: Knowing the (internal and external) customer business needs and acting accordingly; anticipating customer needs and giving high priority to customer satisfaction and customer service. Initiative: Spotting opportunities within a circle of influence; anticipating threats and acting on them; self-starting rather than waiting passively until the situation demands action. Supervisory Responsibility This position has no supervisory responsibilities. Work Environment This job is in a back office/inventory environment. Physical Demands Must be able to perform repetitious hand/eye movement, Must be able to sit for long periods of time, Must be able to stand for long periods of time, Must be able to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Position Type/Expected Hours of Work This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. Travel 0-10% Required Education and Experience High school diploma or GED Must be comfortable with Microsoft Office products and able to work in an organized and efficient way. Preferred Education and Experience 4 Year Degree Experience with inventory, shipping claims, or reverse logistics processes would be beneficial. Additional Eligibility Qualifications (Knowledge, Skills, Abilities) Punctual with reliable transportation Good listening skills and ability to follow written and verbal instruction Consistently meet deadlines Self-starter with ability to work with minimal supervision as well as with a team AAP/EEO Statement Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other Duties 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 for this job. Duties, responsibilities and activities may change at any time with or without notice.