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  • Manager, Liability Claims

    CRH 4.3company rating

    Claim processor job in Atlanta, GA

    CRH is a leading global diversified building materials group, employing over 75,800 people at more than 3,160 locations in 29 countries. CRH is the leading building materials company in North America and the world. We manufacture and distribute a diverse range of superior building materials, products, and solutions, which are used extensively in construction projects of all sizes. Job Summary CRH Americas, Inc., is seeking a Manager - Liability Claims to lead Auto Liability and General Liability claims' management for its US businesses. This newly created role, reporting to the Senior Manager, Risk Management Programs, will enhance consistency of Auto Liability and General Liability claims' management across the enterprise. Successful candidates will have the ability to provide strategic solutions for internal stakeholders and work closely with our advisors and partners while also being a hands-on member of the risk management team. Job Location This is a remote position, but candidates must be located in either the Central or Eastern US time zone. Job Responsibilities Navigating Liability claims through investigation, valuation, reserving, and ultimate resolution for non-litigated and litigated Liability claims Partnering with internal stakeholders, legal counsel, and third-party administrator (TPA) to drive Liability claims' resolution Securing Liability claims' resolution results throughout the organization through influence, persuasion, and leadership Job Requirements 10 or more years of experience managing Liability claims with an insurer, third-party administrator (TPA), or risk management function Demonstrated skills working with outside advisors, insurers, TPA, and legal partners Professional designation preferred Exposure to the building materials, construction or manufacturing sectors preferred Must be willing to travel and work away from home when required Strong ability to gain stakeholder trust Excellent communication skills (both oral and written) with strong problem-solving skills High ethical standards Complete work independently and collaborate within a team environment Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures and capabilities Ability to resolve issues under pressure Demonstrated sense of urgency Demonstrates strong analytical and problem-solving skills Compensation Base salary - $120,000-$127,000 per year 401k plan Short-Term/Long-Term Disability Opportunity for annual bonus What CRH Offers You Highly competitive base pay Comprehensive medical, dental and disability benefits programs Group retirement savings program Health and wellness programs An inclusive culture that values opportunity for growth, development, and internal promotion About CRH CRH has a long and proud heritage. We are a collection of hundreds of family businesses, regional companies and large enterprises that together form the CRH family. CRH operates in a decentralized, diversified structure that allows you to work in a small company environment while having the career opportunities of a large international organization. If you're up for a rewarding challenge, we invite you to take the first step and apply today! Once you click apply now, you will be brought to our official employment application. Please complete your online profile and it will be sent to the hiring manager. Our system allows you to view and track your status 24 hours a day. Thank you for your interest! CRH is an Affirmative Action and Equal Opportunity Employer. EOE/Vet/Disability CRH is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or any other characteristic protected under applicable federal, state, or local law.
    $120k-127k yearly 5d ago
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  • Settlement Processor

    Sage Title Group, LLC 3.6company rating

    Claim processor job in Richmond, VA

    can be based in either Richmond or Charlottesville, VA The Settlement Processor is responsible for pre-closing, coordinating with lenders, preparing closing statements, issuing title policies, preparation and recording of documents and making appropriate disbursements associated with the settlement and post-closing. Job Duties and Responsibilities (Essential Job Functions) Review and clear title; Identify underwriting concerns; Prepare the Closing Disclosure when applicable; Order bring downs and tax certifications; Obtain conveyancing; Prepare daily deposits; Process incoming and outgoing recordings and letters of indemnity; Other duties as required Performance Expectations Meet all performance and behavior expectations outlined in the company performance appraisal form or communicated by management. Perform responsibilities as directed achieving desired results within expected time frames and with a high degree of quality and professionalism. Establish and maintain positive and productive work relationships with all staff, customers and business partners. Demonstrate the behavioral and technical competencies necessary to effectively complete job responsibilities. Take personal initiative for technical and professional development. Follow the company HR Policy, the Code of Business Conduct and all subsidiary and department policies and procedures, including protecting confidential company information, attending work punctually and regularly, and following good safety practices in all Qualifications Education: College degree or experience equivalent. Experience: 2+ years of title specific or similar experience Prior experience in a settlement, escrow, or title role is a plus. Intermediate level Microsoft Office experience Knowledge and Skills: Title Industry Software Notary Public certification. If not currently certified; ability to obtain certification within 90 days Title Producer's license in applicable state or the ability to become licensed within 90 days. Ability to handle multiple transactions and meet deadlines in a fast-paced, sometimes stressful environment. Excellent communication and customer service skills Detail-oriented with strong organizational and problem-solving abilities. Occasional travel to client locations, lenders, or courthouse as needed. We offer a full suite of benefits including Medical, Health Savings Account, Dental, Vision, Life Insurance, Paid Vacation (PTO), 401(k) with employer match, Flexible Spending Account, and Employee Assistance Program (EAP) Equal Opportunity Employer
    $29k-36k yearly est. 4d ago
  • Claims Examiner

    Arch Capital Group Ltd. 4.7company rating

    Claim processor job in Morristown, TN

    With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Claims Division is seeking a team member to join the Shared Services Team as a Claims Examiner. Responsibilities include investigating, evaluating and resolving various types of commercial first and third party low complexity claims. This requires accurate and thorough documentation, as well as completion of resolution action plans based upon the applicable law, coverage and supporting evidence. Responsibilities: * Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level * Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution * Review and analyze supporting damage documentation * Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions * Establish appropriate loss and expense reserves with documented rationale * Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines Experience & Qualifications * Hands-on experience and strong aptitude with Outlook, Microsoft Excel, PowerPoint, and Word * Knowledge of ImageRight preferred * Exceptional communication (written and verbal), influencing, evaluation, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines * Ability to take part in active strategic discussions and leverage technical knowledge to make cost-effective decisions * Strong time management and organizational skills; ability to adhere to both internal and external regulatory timelines * Ability to work well independently and in a team environment * Texas Claim Adjuster license preferred, but not required for posting. Upon employment candidate would be required to obtain Texas Claim Adjuster license within six months of hire date. Education * Bachelor's degree preferred * 3-5 years' experience handling the process of commercial insurance claims #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $71,900 - $97,110/year * Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. * Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.
    $71.9k-97.1k yearly Auto-Apply 3d ago
  • Associate Claims Examiner - Equine

    Markel 4.8company rating

    Claim processor job in Richmond, VA

    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 responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills. Job Responsibilities Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Conducts, coordinates and directs investigation into loss facts and extent of damages. Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure. Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents. Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting. Required Qualifications This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred. Must have or be eligible to receive claims adjuster license. Successful completion of basic insurance courses or achievement of industry designations. Ability to be trained in insurance adjusting up to two years of claims experience. 2-4 years of experience in general liability, construction defect, or related liability lines preferred. Bachelor's degree preferred Excellent written and oral communication skills. Strong organizational and time management skills. # LI-Hybrid US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. 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.
    $34k-49k yearly est. Auto-Apply 43d ago
  • Claims Specialist

    Parker's Kitchen 4.2company rating

    Claim processor job in Savannah, GA

    The Claims Specialist position is an on-site role based at our corporate headquarters in Savannah, Georgia. This role will play a key part in supporting and managing the claims process, working closely with cross-functional teams across the organization to help reduce and prevent accidents, injuries, and property damage involving both employees and customers, while promoting a proactive, safety-focused culture company-wide. ESSENTIAL DUTIES AND RESPONSIBILITIES Responsibilities: Will assist with the management process of claims for all lines of insurance to include property, general liability, auto, unemployment, and workers' compensation. Utilizes skills and trend-tracking to assist in reducing accidents, and occupational injuries. Coordinates claim notification with the insurance carriers and serves as a point of contact for all assigned claims with the insurance carriers. Contacts employees and customers with potential claims to assist in mitigating potential loss and further injuries. Assist with all Parker's Workers' Compensation (WC) Claims, Unemployment Claims, General Liability Claims, and all other from initial notification through to claim closure, including reviewing, analyzing, and approving authority amounts. Case management can include scheduling of appointments, obtaining current medical information, assisting managers with the transition of injured employees back to work, and assisting the injured employee. Ensure continued communication with injured parties to include customers, workers and leaders of the injured worker. May act as Parker's representative for depositions, informal conferences, mediations, and/or hearings pertaining to claims, working with assigned attorneys as necessary. Prepares Parker's written responses to unemployment claims based upon a summary of facts compiled from files, personnel records and interviews. May prepare cases for and represents Parker's at unemployment claim appeal hearings. Provides personnel employment information and verification, questions witnesses and claimant to ascertain facts of separation and presents a closing summary statement of the employer's position to the hearing officer. Prepares client witnesses for hearing appearances. Case preparation for hearings involves document gathering and organization, unemployment law research, and defense strategies. Maintains frequent telephone contact with management and leaders, gathering facts necessary to determine if unemployment claims are disputable and explaining unemployment rules, regulations, decisions and options. Refers information ascertained during investigations to the Claims team, Operations, and/or Human Resources, as necessary, when possible EEOC charges, wrongful discharge, or threatened litigation facts may have been uncovered. Other similar duties as required. Knowledge, Skills, and Abilities: Strong attention to detail Advanced skills in the use of Windows-based office software: Microsoft Office, Word, Excel, and PowerPoint and G-Suite products Must possess strong analytical and problem-solving skills Able to manage multiple priorities Able to research, collect, and analyze data and prepare written and oral reports Knowledge of claims processing techniques Able to analyze, classify, and rate risks, exposure, and loss expectancies Knowledge of workers' compensation laws and requirements, safety, loss control, and risk management principles Principles, practices, and procedures of general business including knowledge of the unemployment compensation system, filing appropriate unemployment responses, and personnel administration including legal aspects of hiring and firing; and the relationship of the Federal Unemployment Tax Act and the various state acts; knowledge of state and federal unemployment laws, rules and regulations. Highly organized and able to track a project from initial contact through the end of the project Ability to effectively communicate information and ideas in written and verbal format EDUCATION AND REQUIREMENTS Required: Associate or Bachelor's degree or equivalent experience 1-2 years' experience processing workers' compensation, general liability, and/or unemployment claims Experience in creating reports Preferred: ARM, CRM or similar designation 4+ years' experience processing workers' compensation, general liability, and/or unemployment claims TRAVEL As required PHYSICAL REQUIREMENTS Prolonged periods sitting/standing at a desk and working on a computer
    $38k-72k yearly est. 60d+ ago
  • Associate VB Claims Specialist

    Unum Group 4.4company rating

    Claim processor job in Chattanooga, TN

    When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide: Award-winning culture Inclusion and diversity as a priority Performance Based Incentive Plans Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability Generous PTO (including paid time to volunteer!) Up to 9.5% 401(k) employer contribution Mental health support Career advancement opportunities Student loan repayment options Tuition reimbursement Flexible work environments *All the benefits listed above are subject to the terms of their individual Plans . And that's just the beginning… With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! General Summary:Minimum starting hourly rate is $22.60 This is an entry level position within the Voluntary Benefits Claims Organization. This position is responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims in conjunction with providing technical expertise regarding applicable regulations. This position is responsible for providing excellent customer service and interacts on a regular basis with employees, employers, health care providers and other specialized internal resources. Incumbents in this role are considered trainees and are assigned a formal mentor for 6-12 months until they are assessed as capable of independent work. Incumbents are primarily responsible for learning and developing the skills, knowledge, and behaviors necessary to successfully adjudicate assigned claims, in accordance with our claims philosophy and policies and procedures. Incumbent must demonstrate the ability to effectively manage an assigned caseload, exercise discretion and independent judgment, and appropriately render timely claim decisions while demonstrating strong customer service prior to movement to the exempt level claims specialist role. Principal Duties and Responsibilities: Maintain organizational service standards on all assigned claims demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity. Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including products, policies, procedures, and contracts. Develop an understanding of the applicable contract/policy definitions and relevant provisions, clauses, exclusions, riders, and waivers, as well as regulatory and statutory requirements for claim products administered. Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions, and benefits payee. Develop problem solving skills by demonstrating analytical and logical thinking resulting in the timely and accurate adjudication of a variety of simple to complex voluntary benefits claims. Develop a working knowledge of systems needed for claims adjudication. Provide excellent customer service and independently respond to all inquiries within service guidelines. Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (i.e., medical assessments, billing, etc.) as appropriate. Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively communicate determinations while ensuring compliance with Voluntary Benefits procedures and all legal requirements including state regulations. Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation, when appropriate. Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business, ensuring a coordinated and continuous claims experience for customers. Be familiar with specialized workflow requirements and performance standards for any assigned customers. May perform other duties as assigned. Job Specifications: 4-year degree preferred or equivalent work experience Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience Medical background, voluntary benefits claims and/or disability management experience preferred Possess strong analytical, critical thinking, and problem-solving skills Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decision and ongoing medical management. Able to effectively utilize a broad spectrum of resources, materials, and tools needed to assist with the decision-making process Strong service and quality orientation. Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc. Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness. Excellent communication skills, written and verbal Meets the standards for this position, as defined in the Talent Management framework ~IN3 #LI-LM2022 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $40,000.00-$75,600.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum
    $40k-75.6k yearly Auto-Apply 7d ago
  • Claims Specialist - Auto

    Philadelphia Insurance Companies 4.8company rating

    Claim processor job in Alpharetta, GA

    Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
    $82.8k-97.3k yearly Auto-Apply 60d+ ago
  • Claims Specialist

    Libra Solutions 4.3company rating

    Claim processor job in Huntersville, NC

    Job Description When life gets hard, we make it easier! Libra Solutions helps overcome the burdens created by slow-moving legal processes. Combining technical innovation and financial strength, we help speed cumbersome workflows and ease financial barriers for our customers. And our companies are leaders in their industries! Oasis Financial is the largest and most recognized national brand in consumer legal funding. Oasis helps consumers awaiting legal settlements to move forward with their lives. MoveDocs is a personal injury solutions platform that integrates and streamlines medical, financial, and professional services for personal injury cases. Our mission is to improve outcomes for plaintiffs, accelerate settlements for attorneys, and ensure timely payment for providers. We are proud of our mission and passionate about applying technology to the challenge of making healthcare more accessible. We also are the leading inheritance funding provider through Probate Advance, helping heirs access their inheritance immediately, without the lengthy process of probate. Together, under the Libra Solutions banner, we have relationships with over 40,000 attorneys and over 7,000 healthcare providers nationwide, which gives us an amazing platform to service our customers. MoveDocs is seeking a Claims Specialist to join our growing Operations team. The successful candidate will be highly motivated to deliver exceptional customer service to various parties within the medical and legal community. This position will function as the primary point of communication with our clients to stay up to date on existing cases and answer client questions. MoveDocs takes pride in providing excellent and expedient service to our clients and the qualified candidate must be self-motivated, able to work autonomously and enjoy working in a fast-paced, high-volume environment. This role is located in our Huntersville, NC office. Answers high volume of inbound calls from insurance companies, attorneys, clients and/or medical providers daily Statuses cases to get updates on pending and ongoing case litigation and/or medical treatment. Drafts correspondence to defense insurance companies and/or attorneys including demand letters, emails, and faxes Delivers customer satisfaction through timely, accurate communications Develops rapport with the attorneys, firms, insurance companies and medical providers Requirements High School or GED required Experience in a high-volume call environment preferred Knowledge or experience with personal injury, medical billing, or claims a plus Previous claims and/or personal injury case manager experience preferred Self-motivated with desire to build great relationships, and to meet and exceed goals Ability to multitask while on the phone and the computer is a must Able to adapt to change and pivot easily between tasks Ability to work quickly and accurately to meet tight deadlines Possess excellent verbal and written communication skills for communicating with insurance companies, attorneys, and medical providers Basic computer proficiency and Outlook experience Benefits MoveDocs offers competitive compensation, benefits that include medical, dental, vision and life insurance plans, plus 401(k) with company match and paid time off.
    $38k-67k yearly est. 7d ago
  • Claims Investigator - Experienced

    Command Investigations

    Claim processor job in Knoxville, TN

    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.
    $32k-43k yearly est. Auto-Apply 60d+ ago
  • Complex Liability Claims Specialist - Commercial General Liability

    Utica National Insurance Group 4.8company rating

    Claim processor job in North Carolina

    The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an “A” rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier. Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago. What you will do The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required. Key responsibilities Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions. Manage all claims in accordance with Utica National's established claim procedures. Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level. Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy. Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims. Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials. Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle. Achieve the service standard of “excellent” during all phases of claims handling. Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction. Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling. What you need Four year degree or equivalent experience preferred. Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims. Proven experience negotiating claims and active participation in alternative dispute resolution practices. Experience with general liability, additional insured considerations and complex coverage determinations. Licensing Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment. Salary range: $103,300 - $140,000 The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications. Benefits: We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following: Medical and Prescription Drug Benefit Dental Benefit Vision Benefit Life Insurance and Disability Benefits 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results) Health Savings Account (HSA) Flexible Spending Accounts Tuition Assistance, Training, and Professional Designations Company-Paid Family Leave Adoption/Surrogacy Assistance Benefit Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance Student Loan Refinancing Services Care.com Membership with Back-up Care, Senior Solutions Business Travel Accident Insurance Matching Gifts program Paid Volunteer Day Employee Referral Award Program Wellness programs Additional Information: This position is a full time salaried, exempt (non-overtime eligible) position. Utica National is an Equal Opportunity Employer. Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy. #LI-HL1
    $42k-64k yearly est. 40d ago
  • Medical Coding Appeals Analyst

    Carebridge 3.8company rating

    Claim processor job in Richmond, VA

    Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law This position is not eligible for employment based sponsorship. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. PRIMARY DUTIES: * Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. * Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. * Translates medical policies into reimbursement rules. * Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. * Coordinates research and responds to system inquiries and appeals. * Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. * Perform pre-adjudication claims reviews to ensure proper coding was used. * Prepares correspondence to providers regarding coding and fee schedule updates. * Trains customer service staff on system issues. * Works with providers contracting staff when new/modified reimbursement contracts are needed. Minimum Requirements: Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. Preferred Skills, Capabilities and Experience: * CEMC, RHIT, CCS, CCS-P certifications preferred. 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.
    $33k-49k yearly est. Auto-Apply 60d+ ago
  • Auto Claim Representative, I

    The Travelers Companies 4.4company rating

    Claim processor job in Morristown, TN

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $55,200.00 - $91,100.00 Target Openings 4 What Is the Opportunity? This role is eligible for a sign on bonus up to $10,000 Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner. In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. What Will You Do? * Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations. * Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates. * Determine claim eligibility, coverage, liability, and settlement amounts. * Ensure accurate and complete documentation of claim files and transactions. * Identify and escalate potential fraud or complex claims for further investigation. * Coordinate with internal teams such as investigators, legal, and customer service, as needed. * Insurance License: In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. What Will Our Ideal Candidate Have? * Bachelor's Degree. * Three years of experience in insurance claims, preferably Auto claims. * Experience with claims management and software systems. * Strong understanding of insurance principles, terminology with the ability to understand and articulate policies. * Strong analytical and problem-solving skills. * Proven ability to handle complex claims and negotiate settlements. * Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. What is a Must Have? * High School Diploma or GED required. * A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is required. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************
    $26k-35k yearly est. 17d ago
  • Auto Claims Specialist I (Manheim)

    Cox Enterprises 4.4company rating

    Claim processor job in Atlanta, GA

    Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $16.59 - $24.86/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program. Job Description This position facilitates the resolution of customer claims and concerns (includes all physical and digital/online transactions) after a sale and is responsible for the timely and successful arbitration of vehicles between buyer and seller in accordance with auction and NAAA policies. The role will work to gain familiarity with fundamental arbitration concepts, procedures, standards, policies and systems. This position requires organization and management of sale day activities including post sale inspections and sale day arbitrations. Job Responsibilities: Basic Functional Duties * With guidance, performs basic Arbitrator duties, including: * Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines. * Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision making. * Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases. * Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution. * Uses appropriate levels/limits of financial approval authority to resolve cases. * Evaluates claims by obtaining, comparing, evaluating, and validating various forms of information. * Prepares and facilitates communications for resolution via telephone, email, and in-person discussion. * Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold. * Monitors and maintains accurate files for each arbitration case, verifying accuracy of all required documentation, including invoices and settlement agreements. * Engages with supervisor/manager to determine if escalation is required. Knowledge & Subject Matter Milestones * Demonstrates an understanding of investigating claims and negotiating and influencing others while maintaining a positive client experience. * Gains familiarity and understanding of Arbitration concepts and procedures. * Gains foundational understanding of auction-specific operational and administrative processes. * Learns and adheres to National Auto Auction Association (NAAA) arbitration standards, Manheim Marketplace Policies, and relevant legal requirements. Client Interaction/Communication Responsibilities * Advises clients of the arbitration claim process, company policies, any auction- or account-specific guidelines, and NAAA guidelines. * Facilitates both written and verbal communications between buyers, sellers, and various auction team members and third parties to actively gather information necessary to guide parties toward agreement and resolution, while maintaining an awareness of goals and objectives. * Provides relevant information such as claim status to clients. Other Duties * Demonstrates safety commitment by following all safety and health procedures and modeling the appropriate behaviors. * Participates in support of all safety activities aligned with Safety Excellence. * Performs other duties as assigned. Qualifications and Experience * Education * High School Diploma or equivalent required. * Bachelor's degree preferred. * Experience * Previous experience in claims management and/or problem and conflict resolution preferred. Claim adjuster experience is a plus. * 1-2 years of experience in areas of responsibility. * 1+ years of automotive, mechanical, and/or body shop experience preferred. * Skills and Abilities * Active Listening * Accuracy and Attention to Detail * Resilience/Adaptability * Demonstrates Empathy * Verbal and Written Communication * Decision Making * Customer Focus * Time Management * Conflict Resolution * Builds Positive Relationships Drug Testing To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited. Benefits Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship. Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.
    $16.6-24.9 hourly Auto-Apply 7d ago
  • Medical Coding Appeals Analyst

    Elevance Health

    Claim processor job in Norfolk, VA

    Sign On Bonus: $1,000 **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. **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. This position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. + Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. + Translates medical policies into reimbursement rules. + Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. + Coordinates research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre-adjudication claims reviews to ensure proper coding was used. + Prepares correspondence to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when new/modified reimbursement contracts are needed. **Minimum Requirements:** Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. **Preferred Skills, Capabilities and Experience:** + CEMC, RHIT, CCS, CCS-P certifications preferred. 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.
    $31k-49k yearly est. 4d ago
  • Claim Specialist // Memphis TN 38134

    Mindlance 4.6company rating

    Claim processor job in Memphis, TN

    Business Claim Specialist Visa GC/Citizen Division Pharmaceutical Contract 6 Month Timings Mon - Fri between 8.00AM - 5.00PM Qualifications The primary function/purpose of this job. Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed. Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency. Moderate knowledge of drugs and drug terminology used daily. Process claims according to client specific guidelines while identifying claims requiring exception handling. Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues. Adhere to strict HIPAA regulations especially when communicating to others outside the client. Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met. Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing. Analyze claims for potential fraud by member or pharmacy. May be required to work on special projects for claims team. ESSENTIAL FUNCTIONS: The 6-10 major responsibility areas of the job. Weight: (%) (Total = 100%) 1. Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 % 2. Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 % 3. Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 % 4. Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 % 5. Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 % 6. Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 % 7. Variety of other miscellaneous duties as assigned 5 % SCOPE OF JOB Provide quantitative data reflecting the scope and impact of the job - such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc. Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph). MINIMUM QUALIFICATIONS TO ENTER THE JOB: Formal Education and/or Training: High school diploma or equivalent required, some college or technical training preferred Years of Experience: Two years' experience in P.B.M. environment is helpful but not required. Computer or Other Skills: Strong data entry, 10-key skills, general PC skills and MS Office experience Knowledge and Abilities: • Strong data entry and 10-key skills • Retail pharmacy, customer service experience helpful but not required • PC and MS Office literate • Strong attention to detail • Excellent retention and judgment ability • Proficient written and oral communication skills • Ability to work in fast-paced, production environment • Reliable, self-motivated with excellent attendance • Team player who has the ability to stay on task with little supervision If you are available and interested then please reply me with your “ Chronological Resume” and call me on ************** . Additional Information Thanks & Regards, Ranadheer Murari | Team Recruitment | Mindlance, Inc. | W : ************ *************************
    $29k-38k yearly est. Easy Apply 18h ago
  • Intermediate Medical Imaging Analyst (PACS and Radiology Applications)

    Baptist Anderson and Meridian

    Claim processor job in Memphis, TN

    Analyze, plan, design, maintain, and provide ongoing optimization and support of medical imaging systems. Perform workflow assessments, capture business needs and analyze internal business systems to determine functional requirements for optimal utilization. Possess proficient clinical, technical, or application knowledge and experience. Perform system builds, upgrades, and system enhancements as needed. Support application through all phases of implementation, optimization, and maintenance. Work with cross-functional teams and end users to achieve application integration to meet clinical and/or business needs. Contributes to project teams and collaborates to ensure system functionality and user satisfaction. Exercise discretion and judgment in the performance of original, creative, intellectual work. Incumbent is subject to callback and on-call as required. Perform other duties as assigned. Job Responsibilities • Assist in implementation and serve as point person on assignments related to all phases of implementation of medical imaging systems and new projects used in corporate-wide Epic-related information system solutions to meet project milestones. • Analyzes problems, recommends improvement, and develops appropriate action plans utilizing Baptist Management System tools to promote transformation and ensure successful implementation. • Completes testing of software applications using established standards and protocols. • Provides ongoing support of medical imaging systems and other applications under area of responsibility. • Supports system configuration and maintenance tasks, ensuring alignment with clinical workflows and operational requirements. • Collaborates with end users and stakeholders to gather and document requirements, facilitating effective system integration. • Assists in troubleshooting and resolving technical issues in medical imaging systems, escalating complex problems as needed. • Completes assigned goals Experience Minimum Required 5 yrs. of relevant experience Education Minimum Required Bachelor Degree in either Radiology, Computer Engineering or Information Technology. Training Minimum Required None Special Skills Minimum Required Skill and proficiency in communicating and performing the techniques of information systems and/or telecommunications assessment.
    $31k-46k yearly est. Auto-Apply 15d ago
  • Medical Claims Analyst - Veterans Affairs (On-site)

    Aspirion

    Claim processor job in Columbus, GA

    Full-time Description For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers' compensation, Veterans Affairs, and out-of-state Medicaid. At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, “Our teammates are the foundation of our success.” United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time. We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor. We are seeking an engaging and professional Medical Claims Analyst to join our growing team in Columbus, GA. The primary responsibilities are working with patients, attorneys, and insurance carriers to increase revenue for our hospital partners. You will ensure accurate and efficient daily coordination of motor vehicle claim accounts in a fast-paced work environment. PLEASE NOTE: This is a on-site position in Columbus, GA Key Responsibilities Set-up and process new accounts daily. Effectively use company systems and technologies to successfully enter content information and verify information received. Effectively communicate with patients, attorneys, and insurance carriers. Establish and maintain a positive working relationship with internal and external partners. Display quality work, integrity, and ethical decision making during all work assignments. Display the ability to problem-solve. Work in a team environment handling complex high-volume work. Adhere to high standards of accountability, confidentiality (HIPAA compliant), and professionalism while dealing with medical and financial information. Requirements Excellent communication and interpersonal skills Upbeat personality Ability to problem solve and think on your feet Strong computer skills Ability to multi-task and prioritize work in a high production environment Punctuality and strong work ethic a must. Education and Experience Bachelor's Degree or equivalent experience preferred Prior experience with medical billing, patient access, healthcare front office preferred Benefits At Aspirion we invest in our employees by offering a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, advancement opportunities, and incentive programs. The US base pay range for this position starts at $16.11 hourly. Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered. In addition to base salary, a competitive benefits package is offered. AAP/EEO Statement Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to. Please note that this position is contingent upon the successful completion of a pre-employment drug screening and background check. These steps are part of our standard hiring process to ensure a safe and compliant workplace. Salary Description $16.11 - $19.00/hr
    $16.1-19 hourly 32d ago
  • Claims Specialist

    PRG 4.4company rating

    Claim processor job in Charlotte, NC

    Project Resources Group (PRG) is seeking a Claims Recovery Specialist for our Charlotte, NC office. Be part of our expanding team focused on recovering third-party property and utility damage claims, primarily in a B2B setting. We're looking for motivated, detail-oriented professionals with strong negotiation skills. Experience in collections or insurance adjusting is highly relevant and transferable. We offer a competitive base salary plus commission. Key Responsibilities Resolve and negotiate claims recovery of repair and replacement costs on third-party cable/fiber and utility damages across multiple state lines, via phone, email, and letters. Work directly with liable parties' insurance providers to defend and negotiate claims settlements. Collaborate with claims departments and management of liable parties, from small businesses to large corporations to municipalities. Learn, understand, and be able to utilize state dig laws and statutes, 811 excavator requirements, NESC standards, CGA guidelines, etc. Develop a professional working relationship with damaging parties, on-site field investigators, management, and other personnel. Conduct 40-50 inbound/outbound calls daily, approximately 2-2.5 hours of total talk time throughout the day. Enter notes and documentation throughout the recovery process into the company's proprietary Claims Database Tool. Use a calendar and diary system to coordinate handling claims to be worked twice weekly. Follow advanced claim handling procedures as detailed by the OPD Claims Manager. Use photographs, narratives, job costs, site sketches, locate tickets, and other components on-site field investigators provide to visualize and understand the damage scene to defend liability accurately. Participate in weekly department meetings to discuss individual and team recovery tactics, strategies, and goals. Maintain a working knowledge of the entire PRG claims recovery process. Preferred Qualifications Strong proficiency in Microsoft Word, Outlook, and Excel. Tech-savvy with the ability to quickly adapt to new software and systems. Excellent written and verbal communication skills, with an emphasis on professional phone and email correspondence. Familiarity with the construction, cable, or utility locate industries is advantageous. Understanding of B2B construction, claims management, recovery, or insurance claim negotiation and settlement processes is preferred. Ideally, 3-5 years of experience in claims, recovery, and/or the insurance industry. College education is preferred. Bilingual in Spanish is a plus. Compensation and BenefitsWe offer a competitive hourly pay ($19-$23/hour based on experience), plus the potential to earn substantial commissions up to $4,000-$10,000 monthly based on performance. Along with a comprehensive benefits package, including: Medical, dental, and vision coverage for employees and dependents 401(k) retirement plan, with company match after 1 year Short-term disability coverage after 1 year Paid time off and holidays Additional perks such as company-paid life insurance, and other supplemental insurances available About PRG Since 2001, PRG has been a leader in construction management and outside plant damage recovery for the telecommunications and utility industries. With 20+ offices and 800+ employees nationwide, we deliver industry-leading solutions with speed, accuracy, and expertise. Equal Opportunity EmployerPRG is proud to be an Equal Opportunity Employer. PRG does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state, or local law and ordinances.
    $19-23 hourly Auto-Apply 12d ago
  • Claims Specialist II

    Verida Inc.

    Claim processor job in Villa Rica, GA

    SUMMARY: Responsible for processing and researching claims with a thorough knowledge of the company structure and claims processing procedures. Audit claims and provides feedback to both team and providers where necessary. Run, review and reconcile reports and advise leadership and Finance department of balance status. This position also reviews process trends and alerts leadership when additional training is needed. ESSENTIAL FUNCTIONS• Resolve all complex telephone and written requests requiring additional information or research and analyze situations.• Respond to provider requests within 24 hours of receipt by written correspondence (letter/email).• Interacts with all internal and external customers in a caring and respectful manner.• Understands and interprets all contracts, agreements, policies and procedures pertaining to reimbursement structure.• Provide Peer review, tutorials, and recommendations• Audit and report on claims that are processed by Claims Specialist I's and Claims Account Representatives to management weekly.• Executes timely and accurate processing of all allocated claims.• Process a minimum of 500 claims per day• Refers questions not specifically covered in manuals or daily operations to the Team Lead.• Maintains confidentiality of patient and provider information.• Maintains protected health information in accordance with HIPAA privacy guidelines.• Train and assist Specialists by relaying instructions, messages and other information as requested by management.• Maintains a current working knowledge of all company policies, procedures, rules, regulations, memorandums and operational software.• Responsible and accountable for updating management on changes and/or extraordinary circumstances affecting the company and/or transportation provider.• Monitor and report uncommon denial analysis trends• Responsible for generating and reviewing all closing reports and prepare it for management review• Other duties as assigned REQUIRED SKILLS AND ABILITIES• Listens and communicates clearly, professionally, and empathetically.• Excellent communications skills in both oral and written.• High Level of Professionalism, attention to detail.• Professional telephone etiquette including excellent verbal communication skills and use of proper grammar.• Strong work ethic and self-starter, able to effectively manage multiple priorities and adapt to change within a fast-paced business environment.• Excellent listening skills and the ability to ask probing questions, understand concerns, and overcome objections.• Ability to foster positive working relationships across all departments• Highly organized, displays strong attention to detail and accuracy.• Intermediate level proficiency in Windows (Microsoft Word and Excel is a must)• Must have 8,000 kspm• Able to function effectively in demanding situations• Knowledge of Southeastrans Reconciliation Process, Claims policies and procedures• Knowledge of Medicaid Non-Emergency Transports• Able to handle multiple tasks simultaneously• Able to lift and/or move items up to 25 pounds• Able to work with a group or independently QUALIFICATION• High School diploma or equivalent• Associate Degree preferred• Two or more years' experience processing claims
    $31k-53k yearly est. Auto-Apply 7d ago
  • Claims Processing Expert

    The Strickland Group 3.7company rating

    Claim processor job in Raleigh, NC

    Join Our Dynamic Insurance Team - Unlock Your Potential! Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for our next leaders-those who want to build a career or an impactful part-time income stream. Is This You? ✔ Willing to work hard and commit for long-term success? ✔ Ready to invest in yourself and your business? ✔ Self-motivated and disciplined, even when no one is watching? ✔ Coachable and eager to learn? ✔ Interested in a business that is both recession- and pandemic-proof? If you answered YES to any of these, keep reading! Why Choose Us? 💼 Work from anywhere - full-time or part-time, set your own schedule. 💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month. 📈 No cold calling - You'll only assist individuals who have already requested help. ❌ No sales quotas, no pressure, no pushy tactics. 🧑 🏫 World-class training & mentorship - Learn directly from top agents. 🎯 Daily pay from the insurance carriers you work with. 🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Ownership opportunities - Build your own agency (if desired). 🏥 Health insurance available for qualified agents. 🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom. 👉 Apply today and start your journey in financial services! ( Results may vary. Your success depends on effort, skill, and commitment to training and sales systems. )
    $27k-34k yearly est. Auto-Apply 60d+ ago

Learn more about claim processor jobs

How much does a claim processor earn in Knoxville, TN?

The average claim processor in Knoxville, TN earns between $24,000 and $60,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average claim processor salary in Knoxville, TN

$38,000
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