Claim processor jobs in Little Rock, AR - 31 jobs

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

Responsibilities & Duties:Claims Processing and Assessment: * Evaluate incoming claims to determine eligibility, coverage, and validity. * Conduct thorough investigations, including reviewing medical records and other relevant documentation. * Analyze policy provisions and contractual agreements to assess claim validity. * Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: * Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. * Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. * Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: * Ensure compliance with company policies, procedures, and regulatory requirements. * Maintain accurate records and documentation related to claims activities. * Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: * Identify opportunities for process improvement and efficiency within the claims department. * Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. * Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: * Generate reports and provide data analysis on claims trends, processing times, and outcomes. * Contribute to the development of management reports and presentations regarding claims operations.

Company:ClaimsPro LP - International Programs GroupTransportation Claims Examiners - Full Time, Remote (Anywhere in the US) Claims Examiner - Transportation IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability. Overview: Reporting to a Claims Supervisor, the Claims Examiner is responsible for investigating and settling transportation and first party claims and third-party claims, with an emphasis on strong communication and customer service, while utilizing state specific guidelines. Role Responsibilities: Initiate the investigation of new claims Make liability/coverage decisions Evaluate and negotiate settlements of collision, specified perils, property damage, and transportation losses as appropriate. Manage and oversee the work of outside adjusters, appraisers and experts. Establish contact with the insured and claimant within established protocol. Recognize coverage issues and bring them to the attention of the supervisor. Develop basic understanding of liability and coverage principles. Recognize state specific laws and claims regulations throughout the United States to insure proper compliance in claims investigation including sending and securing proper documentation. Complete research to determine market value on automobiles and heavy equipment to make recommendations on total loss settlement values using proper state valuation methods. Summarize and make recommendations for disposition of claims in excess of the individual settlement authority. Respond to time sensitive material including but not limited to intercompany arbitration hearings, and department of insurance complaints. Manage a diary system to systematically review and resolve claims within the specified state compliance guidelines. Maintain state license by completing continuing education coursework and/or work towards a claims designation. Handle small claim suits as needed. Other duties as assigned by the claims supervisor Duties may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing. Qualifications: High School Diploma or Equivalent required; Bachelor's degree is preferred Experience with Lloyd's of London is considered an asset Proficient in Microsoft Office ; Experience with Xactimate Able to be licensed in states, countries where necessary AIC designation preferred Competencies: Use of clear, rational, thinking supported by evidence to audit fees of independent adjusters, appraisers, and other vendors in order to properly manage and pay expense invoices. Strong writing skills and proper use of grammar to prepare written status reports for the principal. Document claim file notes clearly with all communications and activities that occur during of handling the claim using factual and objective information. Ability to plan and exercise conscious control over the amount of time spent on specific activities. Strong Communicator (verbal and written) Ability to multi-task and handle high volume of concurrent tasks Work collaboratively with others inside and outside the company Environment/Working Conditions: Dynamic environment with tight deadlines, number and changing priorities All prospective employees must pass a background check Office environment including prolonged periods of computer use Location: Remote working but may require some travel to home office, etc. Only US Residents will be considered SCM Insurance Services and affiliates welcome and encourage applications from people with disabilities. Accommodations are available on request for candidates throughout the recruitment and assessment process. SCM Insurance Services (SCM) and its affiliated companies will not accept unsolicited resume submittals from third- party recruiters and hereby request agencies to not contact SCM employees or managers directly to present candidates. Be advised SCM will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. SCM welcomes resumes submitted directly from candidates.

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

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

22112145 County: Pulaski Anticipated Starting Salary: $39,170 DMS The Department of Human Services is a place for people passionate about serving others and changing lives for the better. We care for Arkansans of all ages and ensure places like child care centers and nursing homes are safe. We are the safety net for the most vulnerable Arkansans. Whether you answer the phones, take applications, protect children, or help care for residents or patients at one of our facilities, you make a difference by working at DHS. Plus, working for the State has great perks, including a pension, maternity leave, paid state holidays, and much more. At DHS, we take care of our employees so you can help care for others. Position Information Job Series: Program Operations - Claims Review Classification: Claims Review Specialist Class Code: PCR02P Pay Grade: SGS03 Salary Range: $39,171 - $57,973 Job Summary The Claims Review Specialist plays a critical role in supporting the insurance claims process by reviewing and evaluating claims for accuracy, completeness, and compliance with pre-determined agency policies and regulatory standards. This classification involves verifying claim documentation, investigating discrepancies, and ensuring the timely and efficient resolution of claims. Primary Responsibilities Assess insurance claims to ensure all required information is accurate and complete. Verify claim documentation against policy terms and conditions. Identify missing or inconsistent information and coordinate with the appropriate personnel to resolve issues. Document findings and actions taken for each claim in an organized manner. Communicate claim outcomes and provide necessary explanations to policyholders or internal personnel. Support fraud detection and prevention efforts by reporting unusual patterns or inconsistencies. Stay informed on agency policies, industry practices, and relevant regulations. Collaborate with senior team members and managers to improve claims processing workflows. Knowledge and Skills Strong analytical and problem-solving skills, attention to detail, good written and verbal communication. Willingness to learn and adapt to new tools, technologies, and processes. Experience with using standard office software (e.g., Microsoft Excel, Word). A proactive and team-oriented approach to work. Familiarity with department related programs. Minimum Qualifications High school diploma or GED. Two years of experience in clerical or administrative functions. Satisfaction of the minimum qualifications, including years of experience and service, does not entitle employees to automatic progression within the job series. Promotion to the next classification level is at the discretion of the department and the Office of Personnel Management, taking into consideration the employee's demonstrated skills, competencies, performance, workload responsibilities, and organizational needs. Licensure/Certifications N/A OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE. The State of Arkansas is committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, pregnancy, age, disability, citizenship, national origin, genetic information, military or veteran status, or any other status or characteristic protected by law. Nearest Major Market: Little Rock

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Great American Employer Health Solutions combines financial stability with innovative underwriting. Through our team's deep expertise and flexible program design, we make premium healthcare coverage accessible to small and midsize businesses. Great American Employer Health Solutions is a member of Great American Insurance Group, a trusted name in the insurance industry for over 150 years. Headquartered in Cincinnati, Ohio, and backed by its parent company, American Financial Group (NYSE: AFG), Great American brings strategic insight and stability to its specialty solutions. Essential Job Functions and Responsibilities * Receive, log, and validate incoming stop-loss claims and related documentation; request missing information as needed. * Verify eligibility, plan benefits, and stop-loss policy provisions; accurately enter claim details into the system of record. * Maintain electronic claim files for audit and compliance purposes. Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims; Identify cost-containment opportunities and implement strategies with carriers and TPAs. * Document audit findings and maintain accurate records in the system. * Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams; provide clear updates on claim status and documentation requirements. * Offer guidance to clients on claims procedures and coverage issues. * Ensure adherence to regulatory requirements, internal controls, and fraud prevention policies. * Stay current on industry trends, regulations, and best practices; participate in special projects, reporting, and process improvement initiatives. * Identify opportunities to streamline claim intake and processing workflows. * Train and mentor junior claims processors on best practices. * Perform other duties as assigned. Job Requirements: * Experience: Minimum 10 years in medical stop-loss claims processing or related health insurance claims roles. * Technical Skills: Proficiency in medical coding (ICD-10, CPT, HCPCS); advanced Excel skills; expertise with claims processing systems. * Knowledge: Strong understanding of stop-loss insurance, plan documents, and claims handling practices * Soft Skills: Exceptional analytical ability, attention to detail, and strong written and verbal communication skills. Business Unit: Medical Stop Loss Salary Range: $80,000.00 -$106,000.00 Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits. Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at **************************** * Excludes seasonal employees and interns.

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Fayetteville, Arkansas. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $55,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $62,000 - $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

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

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance PL CLAIM SPECIALIST **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

TITLE: Processor - Referral CLASSIFICATION: FT / Regular / Hourly / Non-Exempt DEPARTMENT: Foreclosure Due to the nature and responsibilities of this position it is imperative that the individual in this position be available to work during the firm's office hours. The individual schedule will be determined by the department manager based on business needs. Reliability is critical. PRIMARY RESPONSIBILITY: Accurate and timely entry of data in the firm's case management system; Correspond with debtors and firm clients through telephone and written communication; Respond to client inquiries and provide counseling to clients regarding setup of foreclosure, eviction and bankruptcy referrals; Access client websites to request documents, upload documents and update the client's website with accurate information regarding status of case setup of foreclosure, eviction and bankruptcy referrals. SECONDARY RESPONSIBILITY: Serve as a backup to other team members in the non-judicial foreclosure, judicial foreclosure and eviction processes; Assist with special projects as they become available. PRINCIPAL ACCOUNTABILITIES: 1. Answer debtor inquiries via telephone or email and respond in a timely, accurate and professional manner. 2. Provide timely and accurate responses to client inquiries. 3. Ensure all required information is properly entered into the firm's case management system and client websites in a timely and efficient manner. 4. Identify and request from the client any missing documents and/or data needed for the referral intake process. 5. Follow-up timely on previous missing document or data requests that are needed for the referral intake process. 6. Performs all other duties as requested. REQUIRED SKILLS / EXPERIENCE: · High school diploma or equivalent. · Must be able to conduct professional communication via telephone and email. · Ability to accurately enter data and draft documents in a high-volume environment. · Must be PC literate and able to adapt to a variety of data base systems. · Excellent verbal and written communications skills. PREFERRED SKILLS / EXPERIENCE: · Experience in the mortgage banking industry, preferably in the area of default. · Experience in real estate title or real estate law. · Experience with CaseAware, Black Knight LPS, Vendorscape, Clarifire, and Tempo. CHARACTERISTICS: · Ability and desire to learn. · Present a professional image and demeanor at all times. · Be reliable and on-time. · Positive attitude and professional image at all times. · Good listener and communicator. · Be dependable (work hours and work performance). · Desire to improve on quality and efficiency. · Competent in multi-tasking, prioritization, and maintaining confidentiality of information.

Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to improve the health and well-being of people around the world. We are leaders in plasma-derived medicines and transfusion medicine and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions. Plasma Processor (Customer Service) - We train You are a fit for us if you have: * Superior customer service standards * A High School diploma or GED * Ability to work a flexible schedule * An interest in making a difference in the world Plasma Processor Our ideal Plasma Processor has great organizational, computer, and trouble-shooting skills, and feels comfortable being exposed to extreme temperatures. Handles responsibilities in many operational areas of the plasma center such as maintaining accurate donor files, shipping, and inventory control. Primary Responsibilities: * Collects and processes donor samples for processing and testing. * Records weight of product and samples. * Labels samples and freezes units for final packing within required timeframe. * Packs units for final shipment; packs samples and prepares shipping box to send samples to the testing lab. * Monitors stored products and reports working conditions of equipment. * Maintains active communication and quality. We're Grifols, a global healthcare company that produces essential plasma-derived medicines for patients and provides hospitals and healthcare professionals with the tools, information and services they need to deliver expert medical care. Occupational Demands Form # 76: Work is performed in a plasma center. Exposure to biological fluids with potential exposure to infectious organisms. Exposure to electrical office and laboratory equipment. Exposure to extreme cold below 32 degrees F while working in plasma freezer. Personal protective equipment required such as protective eyewear, garments, gloves and cold-gear. Work is performed standing for 4 to 6 hours per day. Bending and twisting neck and waist for 1-2 hours per day. Frequent hand movement of both hands with the ability to make fast, simple, movements of the fingers, hands, and wrists. Ability to make precise coordinated movements, of the fingers to grasp and manipulate objects. Frequent foot movement; may infrequently squat, crouch or sit on one's heels. May walk up to 1-2 hours per day. Light lifting of 15lbs.on occasion, lifting from 25 to 35 lbs from 1-2 hours per day, with a maximum lift of 50lbs. May reach below shoulder height. Hearing acuity essential. Color perception/discrimination, near vision and far vision correctable in one eye to 20/30 and to 20/100 in the other eye. Able to comprehend and follow instructions to complete assigned tasks. must possess the ability to listen to and understand information and ideas presented through spoken words and sentences. Must perform within the guidance of both oral or written instructions. #biomatusa Third Party Agency and Recruiter Notice: Agencies that present a candidate to Grifols must have an active, nonexpired, Grifols Agency Master Services Agreement with the Grifols Talent Acquisition Department. Additionally, agencies may only submit candidates to positions that they have been engaged to work on by a Grifols Recruiter. All resumes must be sent to a Grifols Recruiter under these terms or they will be considered a Grifols candidate. Grifols provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability. We will consider for employment all qualified applicants in a manner consistent with the requirements of all applicable laws. Location: NORTH AMERICA : USA : AR-Little Rock:USNC0414 - Little Rock AR-Col GlennRd-TPR

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $20/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

Job Title: Casualty Claims Examiner I Department: Insurance Country: United States of America State/Province: Arkansas City: Lowell Full/Part Time: Full time Under general supervision, this position is responsible for the investigation and resolution of moderately complex claims. This incumbent will work closely with internal and external contacts to investigate claims, negotiate settlements, and prepare reports to ensure accurate and timely processing of casualty claims. : Key Responsibilities: Utilize independent knowledge and experience to conduct claims investigations to determine liability exposure of each assigned claim. This investigation includes analysis of state and federal laws, retaining services of field investigators, outside legal counsel to obtain a full picture of exposure and documentation of all findings for each claim within the claims matter management system for management review as well as internal and external audit processes. Manage moderately complex claims involving alleged property damage and bodily injury through the interview of key witnesses, securing evidence, reviewing applicable statutes and laws, and analysis of estimates of repair, analyzing medical reports Handle all monetary aspects of assigned claims through the calculation of financial exposure analysis leading to the establishment of reserves at proper levels within assigned approval levels. And, by keeping management aware of claims with exposures above approved levels for continuous timely and efficient resolutions of assigned claims. Manage negotiations with claimants, claimant's legal representatives or third parties by utilizing strong communication and negotiation skills in sharing investigative results and rationale, listening to claimant perspective and arguments, and influencing claimant perspective to achieve consensus on appropriate and final resolution of assigned claims Utilize strong communication skills to keep all stakeholders aware of findings, decisions, and resolutions to support plans and initiatives to meet business unit needs while establishing accountability in achieving results and identifying and addressing improvement opportunities Prioritize and manage assigned claims workload to keep all involved parties informed and provide timely claims status updates Initiate prompt contact with claimants to obtain information and establish the claims process; process incoming calls, emails, and notifications to support workload surges and/or extenuating situations including the creation of accident reports from the accident hotline Collect and analyze data from internal departments and third-parties to create repair estimates for company equipment to subrogate against adverse parties; present collected data to adverse party for collection or reimbursement of damages Ensure compliance with company and departmental policies and procedures that support the mission, values, and standards of ethics and integrity of the company Pursue continual education in the practice of transportation claims management through internal training, seminars, and other educational materials to stay abreast of the changing claims and legal environment Qualifications: Minimum Qualifications: High School Diploma/GED with 1-2 years of experience in Auto/General Liability Claims, Insurance, or related field, or suitable combination of education, experience, and training AND/OR Demonstration of the following skills and abilities through education, certifications, military, or other experiences: Ability to uphold a professional demeanor in all customer interactions, demonstrating empathy and patience in the face of challenging situations Ability to accurately analyze situations and reach productive decisions based on informed judgment Ability to adapt to a dynamic work environment and shifting priorities and directives Ability to effectively transmit, receive, and accurately interpret ideas through various mediums Ability to work with a variety of individuals and groups in a constructive and collaborative manner Ability to capture and document relevant business information in an auditable, organized, and easily retrievable manner Ability to process information with high levels of accuracy Preferred Qualifications: Bachelor's Degree with 1 year of experience in Auto/General Liability Claims, Insurance, or related field Experience in a call center, particularly within the Insurance industry Ability to maintain composure under pressure Ability to type at least 30 words-per-minute Knowledge of claim investigation procedures Knowledge of approaches and techniques for recognizing, anticipating, and resolving problems Proficiency in documenting case details accurately and assessing payment eligibility This position is not eligible for employment-based sponsorship. Compensation: Factors which may affect starting pay within this range may include skills, education, experience, geography, and other qualifications of the successful candidate. This position may be eligible for annual bonus and incentives based on profitability or volumes in accordance with the terms of the Company's bonus and incentive plans, as applicable and in effect from time to time. Benefits: The Company offers the following benefits for full-time positions, subject to applicable eligibility requirements, as may be in effect from time to time: medical benefit, dental benefit, vision benefit, 401(k) retirement plan, life insurance, short-term and long-term disability coverage, paid time off commensurate with tenure (includes vacation and sick time), six weeks of paid maternity leave along with two weeks of paid parental leave, and six paid holidays annually. Education: Bachelors: Law, GED (Required), High School (Required) Work Experience: Loss Prevention/Claims Management Job Opening ID: 00608423 Casualty Claims Examiner I (Open) “This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.” J.B. Hunt Transport, Inc. is committed to basing employment decisions on the principles of equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, persons with disabilities, protected veterans or other bases by applicable law.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists. - Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- New York Independent Adjuster License- Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- 18+ months of medical claim processing experience- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

EGA Associates a service-disabled Veteran owned small business, SDVOSB, with a big impact! We work with schools, hospitals, state facilities, VA medical centers, and Department of defense facilities nationally. We are hiring Licensed Psychologist Examiner for an intermediate care facility. Responsibilities Administer and scores psychological tests, interprets and evaluates test results, and determines an individualized behavioral management/treatment program. Provide psychological counseling, cognitive behavior and psychosocial skills instruction, and behavior modification/management recommendations. Monitor behavior management and treatment programs, documents progress or regression, modifies programs, as necessary, and prepares and maintains progress reports on each client. Attend staff/professional meetings and workshops as scheduled to discuss progress/problems of clients and make recommendations regarding behavior management. conduct in-service training for direct care staff on implementation of behavior management procedures or may train family members on treatment methods to be continued at home. Supervise professional staff by interviewing, recommending for hire, assigning and reviewing work, training, and evaluating performance. Qualifications: Licensed as a Psychologist Examiner by the Arkansas State Board Independent Psychological Examiner (LPE-I) Benefits! EGA Associates, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

The Claims Denial Specialist works within the organization's revenue cycle to investigate, resolve, and appeal denied insurance claims. By identifying the root causes of denials, correcting errors, and communicating with insurance companies, they help prevent revenue loss and secure proper reimbursement for services. Core responsibilities Denial analysis and resolution: Research denied or rejected claims by reviewing insurance correspondence, billing and coding documentation, and patient medical records. Appeals processing: Prepare and submit detailed, well-argued appeals to insurance payers, often citing clinical documentation, payer-specific policies, and contractual language. Investigative follow-up: Follow up on appeals and resubmitted claims with insurance companies, typically by phone or through payer portals, to resolve outstanding issues and ensure timely reimbursement. Process improvement: Identify trends and patterns in claim denials to help prevent future errors. This often involves collaborating with other departments, such as billing and coding, to improve processes. Documentation and reporting: Accurately document all communication and actions taken on a claim within the patient accounting system. Create and deliver reports to management on denial trends and recovery efforts. Compliance monitoring: Stay up-to-date with changing regulations, payer guidelines, and billing rules for government programs (like Medicare and Medicaid) and commercial insurance. Essential qualifications and skills Healthcare knowledge: A strong understanding of the healthcare revenue cycle, medical terminology, and medical coding systems. Experience with electronic health record (EHR) systems and billing software. The ability to conduct root-cause analysis, recognize patterns in denial data, and use critical thinking to build effective appeal strategies. Excellent written communication for drafting persuasive appeal letters and verbal communication for interacting with payers, providers, and patients. Professional certifications such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) are often preferred or required. Meticulous attention to detail is necessary to review complex documentation, catch errors, and ensure all resubmissions are accurate and compliant.

Company:ClaimsPro LP - International Programs GroupProperty Claims Supervisor - Full Time, Remote (Little Rock, Arkansas) IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability. Overview: Reporting to the Head of Claims, US, the Claims Supervisor is responsible for supervising all claim activity and team of employees. Role Responsibilities: Review, assign, and provide supervision of all claim activity for designated claims to ensure compliance with IPG standards, client specific handling instructions and in accordance with applicable laws. Oversee investigation, evaluation and adjustment of assigned claims in accordance with established claim handling standards and laws. Reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels. Conduct file reviews to oversee coverage review, ensure proper claims handling, and provide feedback on steps to move file to conclusion. Review and approve payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority. Negotiate settlements in accordance within IPG standards, client specific handling instructions and state laws, when appropriate. Assist designated claim staff in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.) Provide education, training and assist in the development of claim staff Supervision of all claim activity for specified team. Compliance with IPG standards and special client handling instructions as established Maintain state license by completing continuing education coursework and/or work towards a claims designation. Uses various metric driven tools such as diaries and the UAP to evaluate performance and identify problem areas in advance of them becoming service issues Reviews findings with team member to jointly develop a plan for corrective action Defines team goals and communicates those goals to assigned team. Motivate team to perform at the highest level Ensures receipt and maintenance of appropriate licenses and/or certifications for themselves and all assigned staff for all states in which states are being handled Communicates with clients, carriers, and brokers in a professional, positive and proactive manner Works collaboratively across all internal departments Must adhere to all company and department personnel policies and procedures This job description is not intended to be all-inclusive, and you will also perform other responsibilities as assigned by your immediate supervisor or other management as directed Duties may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing Qualifications: High School Diploma or Equivalent required; Bachelor's degree is preferred Experience with Lloyd's of London is considered an asset Minimum of 3-5 years claim handling experience Proficient in Microsoft Office Experience with variety of insurance policies a plus Able to be licensed in states, countries where necessary AIC designation preferred Competencies: Use of clear, rational, thinking supported by evidence to audit fees of independent adjusters, appraisers, and other vendors to properly manage and pay expense invoices. Strong writing skills and proper use of grammar to prepare written status reports for the principal. Document claim file notes clearly with all communications and activities that occur during the of handling the claim using factual and objective information. Ability to plan and exercise conscious control over the amount of time spent on specific activities. Strong Communicator (verbal and written) Ability to multi-task and handle high volume of concurrent tasks Work collaboratively with others inside and outside the company Environment/Working Conditions: Dynamic environment with tight deadlines, numbers, and changing priorities Only US residents will be considered All prospective employees must pass a background check Office environment including prolonged periods of computer use Location: Remote work but may require some travel to home office, etc. SCM Insurance Services and affiliates welcome and encourage applications from people with disabilities. Accommodations are available on request for candidates throughout the recruitment and assessment process.

The Claims Denial Specialist works within the organization's revenue cycle to investigate, resolve, and appeal denied insurance claims. By identifying the root causes of denials, correcting errors, and communicating with insurance companies, they help prevent revenue loss and secure proper reimbursement for services. Core responsibilities Denial analysis and resolution: Research denied or rejected claims by reviewing insurance correspondence, billing and coding documentation, and patient medical records. Appeals processing: Prepare and submit detailed, well-argued appeals to insurance payers, often citing clinical documentation, payer-specific policies, and contractual language. Investigative follow-up: Follow up on appeals and resubmitted claims with insurance companies, typically by phone or through payer portals, to resolve outstanding issues and ensure timely reimbursement. Process improvement: Identify trends and patterns in claim denials to help prevent future errors. This often involves collaborating with other departments, such as billing and coding, to improve processes. Documentation and reporting: Accurately document all communication and actions taken on a claim within the patient accounting system. Create and deliver reports to management on denial trends and recovery efforts. Compliance monitoring: Stay up-to-date with changing regulations, payer guidelines, and billing rules for government programs (like Medicare and Medicaid) and commercial insurance. Essential qualifications and skills Healthcare knowledge: A strong understanding of the healthcare revenue cycle, medical terminology, and medical coding systems. Experience with electronic health record (EHR) systems and billing software. The ability to conduct root-cause analysis, recognize patterns in denial data, and use critical thinking to build effective appeal strategies. Excellent written communication for drafting persuasive appeal letters and verbal communication for interacting with payers, providers, and patients. Professional certifications such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) are often preferred or required. Meticulous attention to detail is necessary to review complex documentation, catch errors, and ensure all resubmissions are accurate and compliant.