Claims Examiner
Claim Processor Job 133 miles from Marion
It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
As a Claims Examiner at Gainwell, you will be part of a team dedicated to supporting the accurate and timely processing of claims. In this role, you will analyze claims data, review and process claims, and work directly with healthcare providers to ensure compliance with claims guidelines and service standards. This position requires onsite work 5 days per week at our Madison, WI office located at 313 Blettner Blvd, Madison, WI 53784.
Your role in our mission:
Review and process healthcare claims in alignment with policies and regulations, ensuring accuracy and compliance.
Communicate with providers and healthcare professionals to clarify claims issues and obtain additional information as needed.
Document claim status, decisions, and follow-up actions, maintaining organized records for audit and reporting.
Participate in quality control processes, ensuring claims are processed in a timely and accurate manner.
Identify claim discrepancies and work with relevant teams to resolve issues efficiently.
Maintain up-to-date knowledge of claims policies, industry regulations, and service requirements.
What we're looking for:
Previous experience in claims processing or a related field.
Strong organizational skills with attention to detail and accuracy.
Excellent written and verbal communication skills to interact effectively with team members and providers.
Ability to manage time and prioritize tasks effectively in a high-paced environment.
Proficiency in Microsoft Office Suite and claims processing software.
What you should expect in this role:
Onsite position at our Madison, WI office, located at 313 Blettner Blvd, Madison, WI 53784, working 5 days per week.
Collaborate with internal teams to improve claims processing workflows and resolve claim discrepancies.
Opportunity to contribute to quality improvement initiatives in claims processing.
Maintain a professional approach while interacting with healthcare providers and team members.
Regularly report claim processing metrics and issues to leadership.
Stay informed of industry updates and best practices for claims examination.
Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
Large Loss Claims Representative
Claim Processor Job 201 miles from Marion
Job Title
Large Loss Claims Representative (property focused)
Home Department:
Claims
Employment Status:
Exempt; Full-Time with flexible scheduling options
Position Location:
Field Employee - Chicago Metropolitan Area
Overview
Protecting our policyholders' dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.
Society Insurance is seeking an experienced Large Loss Claims Representative (property focused) to service our policyholders in the greater Chicago Metropolitan area. This position will investigate and resolve large and significantly complex commercial property claims by conducting on-site field investigations, determining coverage, and documenting loss by use of estimating software.
About the Role
Settles large and significantly complex commercial property claims by determining policy coverages; evaluation of damages and handling claim negotiations with insureds, contractors, attorneys, and public adjusters.
Conducts extensive investigations into causes and origins of all major property claims.
Determines coverage by meeting with insureds, securing evidence, inspecting losses, investigating incidents, interpreting policy coverages, explaining coverages, and determining subrogation and salvage opportunities.
Maintains expertise in a specified line(s) of business through attending training courses and participating in continued education coursework/classes.
Provides departmental support by serving as a mentor and subject matter expert for less experienced adjusters.
Documents required repairs by scoping property losses, hiring experts, obtaining costs and prices, preparing estimates, and obtaining an agreed scope of work and cost of repair with contractor and/or policyholder.
Completes claims by obtaining, providing, and exchanging information and agreements with contractors, attorneys, or other parties.
Prepares reports by collecting, analyzing, and summarizing claim information.
Provides claims information by documenting claims transactions of assigned files in compliance with company and state requirements, preparing loss development reports.
Assists all adjusters on claims in coverage territories.
Contributes to team effort by participating on catastrophe teams.
About You
You enjoy communicating and building relationships with others.
You are composed, cool under pressure, and can negotiate without damaging relationships.
You hold yourself accountable and accept ownership for your scope of responsibility.
You enjoy analyzing, investigating, and using the facts to make decisions.
You are naturally curious and have a desire to know more.
You enjoy negotiating and identifying win-win solutions.
What it Will Take
Bachelor's Degree and 7 years of claims-handling experience to include 5 years of complex commercial property claims OR High School or GED and a minimum of 8 years working in the licensed trades such as carpentry, plumbing, electrical, or similar field, and the ability to obtain technical proficiency in commercial property claims.
Familiarity with technology to include Microsoft Office, spreadsheets, and Internet.
Ability to obtain and maintain proper licensing prior to handling a state that requires it.
Valid driver's license and a satisfactory driving record.
Successful completion of an accepted property estimating training program.
Physical ability to climb a ladder to access a roof and ability to lift up to 10 pounds.
Professional designations of AIC, ARM, CIC, CPCU or equivalent coursework highly preferred.
Benefits
Comprehensive Benefits Package: Salary with Bonus Plan; Health, Dental, Life, and Vision Insurance
Retirement: Traditional or Roth 401(k); Defined Contribution Plan; PLUS Profit-Sharing Plan
Work-Life Balance: Company-Paid Holidays; Flexible Scheduling; PTO; and Telecommuting Options
Education: Career Coaching; Company-Paid Courses; Student Loan and Tuition Reimbursement
Community: Charitable Match; Paid Volunteer Time; and Team Sponsorships
Wellness: Employee Assistance Program; Wellness Initiatives/rewards; Health Coaching; and more
Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws.
Society Insurance is a drug-free workplace. Any candidate who receives an offer of employment from Society will be required to undergo a pre-employment drug test for controlled substances. All offers of employment are contingent upon successful completion of the pre-employment drug test, which is conducted in accordance with Society's substance abuse policy.
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Bodily Injury Claims Specialist
Claim Processor Job 180 miles from Marion
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to:
Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss.
Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage.
Follow claims handling procedures and participate in claim negotiations and settlements.
Deliver a high level of customer service to our agents, insureds, and others.
Devise alternative approaches to provide appropriate service, dependent upon the circumstances.
Meet with people involved with claims, sometimes outside of our office environment.
Handle investigations by telephone, email, mail, and on-site investigations.
Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute.
Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials.
Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule.
Assist in the evaluation and selection of outside counsel.
Maintain punctual attendance according to an assigned work schedule at a Company approved work location.
Desired Skills & Experience
A minimum of three years of insurance claims related experience.
The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision.
The ability to effectively understand, interpret and communicate policy language.
The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues.
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
Auto Claims Specialist
Claim Processor Job 189 miles from Marion
Role overview: Rarely adjusting, more managing our vendors. Example - driver accident, they call, report, we get the alert, set up the claim in the system. Review call w/ safety department and complete investigation confirming all information. Send to a third party who handles damages & injury. Some subrogation, overseeing all auto claims, approve reserves and settlements.
Years of experience: 3-5 of auto claims management experience
Claims Supervisor
Claim Processor Job 201 miles from Marion
The Casualty Claims Supervisor will be responsible for the direct supervision of the Casualty Claims unit. Scope of the position includes ensuring compliance with State mandated claims handling guidelines and assuring proper investigation and conclusions of claims. Monitor production, staff development and the quality of files assigned to the Unit.
Seeking local candidates to work in the Bedford Park location, approximately one mile south of Chicago Midway Airport. Hybrid Opportunities Available.
DUTIES & RESPONSIBILITIES:
Lead, motivate, and provide direction to the Casualty Unit
Conduct file and diary reviews for the purpose of monitoring adjuster's work and to assure appropriate documentation is available, fair claim settlement practices are followed, and company quality standards are maintained.
Place appropriate authority level on claim files based upon investigation of facts and approve settlement checks within authority.
Review reports, design and support the implementation of procedures which improve claim settlement and customer service levels, and ensure that desired quality and quantity levels are maintained.
Oversee the implementation and monitoring of procedures to assure effectiveness and compliance.
Determine training needs of the department and establish and participate in programs to ensure training needs of personnel and processes.
Work with staff relative to any suits drawn on cases with respect to litigation handling.
Develop and manage a cost effective defense strategy.
Identify Systems issues/problems/suggestions for enhancements.
Manage the administrative functions of the unit which include:
Review, provide direction and assign new losses
Screening and selecting candidates
Setting performance objectives and monitoring performance results
Conduct performance appraisals
Complete reports as necessary
Daily review of files for payment approvals over adjuster authority and the transfer of files to appropriate areas (SIU, Litigation, Total Loss, Subrogation, etc.)
Conduct unit meetings
Review and respond to Department of Insurance complaints
Review and direct claim activity on customer inquiries
Complete special projects as assigned.
QUALIFICATIONS REQUIRED:
5+ years auto liability claims and supervisory experience.
5+ years managing litigated personal auto files.
Strong technical and administrative background in auto claims handling.
Ability to work independently on technical and administrative matters in accordance with company policy and procedures.
Good leadership, training and development skills.
Excellent communication, interpersonal and organizational skills.
Ability to pass written examinations where required by state statutes to become a licensed claim.
Claims Examiner
Claim Processor Job 189 miles from Marion
Temp To Full-Time
We are looking to hire multiple Claims Examiners in our Oakbrook Terrace location. We are looking for people to start in the next 2 weeks.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Review and accurately input all information and supporting documentation, determine eligibility, and calculate retirement and death claims and voluntary additional benefits.
Calculate and prepare manual benefit estimates.
Contact other departments to obtain information, request corrections in an effort to resolve most internal conditions preventing payment of benefits.
Contact employers, employees, beneficiaries, and financial institutions to resolve most external conditions preventing payment of benefits.
Provide customer service to employers, employees, beneficiaries, and other IMRF departments by answering questions concerning procedures and benefits, either in writing or by telephone.
Maintain a work in progress that meets service goals.
Process Voluntary Additional Refund applications and Separation Refund applications as a back-up to the Staff Assistant as assigned.
Review various internal reports including the suspended benefit report, the un-confirmed death report and the cash receipts report for items to be researched and resolved on a monthly basis.
Other duties may be assigned.
EDUCATION and/or EXPERIENCE
Associates degree (AA) or equivalent from two-year college or technical school; or two years related experience and/or training; or equivalent combination of education and experience.
$48k-$51k/year DOE.
Claims Specialist
Claim Processor Job 201 miles from Marion
About Everest Everest Group, Ltd. (Everest), is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in North America, Latin America, the UK & Ireland, Continental Europe and Asia Pacific regions. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Our most critical asset is our people. We offer dynamic training & professional development to our employees. We also offer generous tuition/continuing education reimbursement programs, mentoring opportunities, flexible work arrangements, and Colleague Resource Groups.
Everest is a growth company offering Property, Casualty, and specialty products among others, through its various operating subsidiaries located in key markets around the world. Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.
Everest has an opportunity for an entry level Claims professional to join our Casualty Claims team in one of our Everest offices. This individual should possess the ability to evaluate Casualty claims and litigation for potential escalation to our Fast Track, Mainstream or Complex claim teams.
Duties and responsibilities include, but are not limited to:
* Serve as point of contact for policy holders and brokers on recently reported claims.
* Review documentation submitted when the claim was reported.
* Summarize the facts that support what happened and the extent of the injuries alleged. Follow up with involved parties for additional clarification as needed.
* Review relevant policies to confirm coverage details and limits.
* Enter loss details into the claim system and send template correspondence as needed.
* Use the facts collected to assess the potential severity of alleged injuries.
* Flag issues and escalate urgent matters to management.
* Monitor incoming correspondence for material updates to reassess potential severity.
* Respond to inquiries on assigned claims and accounts in a timely and professional manner.
* Investigation, analysis and evaluation of assigned claim.
* Comply with all relevant state and federal regulations, as well as company policies and procedures.
Work Experience & Qualifications:
* A minimum of 2 years of claims/legal experience and working knowledge of the civil litigation legal process.
* Strong oral and written communication skills.
* Strong analytical, organizational and investigation skills.
* Currently holds or readily can obtain all required Adjuster Licenses.
* Knowledge of the insurance industry, claims and the legal and regulatory environment.
* Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency.
Education:
* Bachelor's degree or equivalent work experience required.
* Insurance industry designation(s)/certification(s) preferred.
For NY & CA only: The base salary range for this position is $65,000-$100,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location.
Our Culture
At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture.
* Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion.
* Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.
All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.
#LI-Hybrid
#LI-VP1
Type:
Regular
Time Type:
Full time
Primary Location:
Warren, NJ
Additional Locations:
Atlanta, GA, Boston, MA, Chicago, IL - South Riverside, Hartford, CT, Houston, TX, Los Angeles, CA, New York, NY, San Francisco, CA
Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************.
Everest U.S. Privacy Notice | Everest (everestglobal.com)
Billing and Claims Specialist
Claim Processor Job 224 miles from Marion
Job Title: Billing and Claims Specialist Reports to: Director of Operations Description: The Billing and Claims Specialist will work with clinicians, administrative staff, patients, and insurance companies to submit and process insurance claims for mental health services at Behavioral Health Clinic (BHC). Duties and Responsibilities:
Oversee coding of services using ICD-10 and DSM-5 Coding
Submit claims using the Electronic Health Record and claims processing software
Enter Payments (ERA, EFT, & Other Payments)
Prepare Billing Statements
Research and Resolve billing issues by working with insurance companies
Run Billing Cycle Reports
Research Coding Rules and Regulations with Contracted Payers to help guide best business practice
Patient Collection Duties (collecting copays and patient allowed amounts, creating refunds, managing collections process etc.)
Other duties as assigned
Qualifications:
Compassionate and Confidential
Efficient with computer software systems (with training)
Working knowledge of Microsoft Office and Google products (Documents, Sheets, etc.)
Ability to work effectively both independently and as part of a team
Willingness to learn and adapt
Strong organization and time management skills
Skilled in verbal and written communication including good phone skills
Experience in medical coding and billing preferred but not required;
3-5 years of work experience (preferred)
Willingness to work occasional overtime
Benefits:
Starting pay $22.00 - $26.00 per hour
Healthcare Benefit Package - Including Dental, Vision, STD, LTD, and Retirement Plan Options
Supportive and collaborate team environment & Opportunities for advancement and leadership
Paid Time Off (PTO) and Holidays
*In accordance with legal requirements and company policies, successful candidates for this position will be required to complete the form I-9, Employment Eligibility Verification, as part of the BHC Onboarding Process*
Claim Specialist- Property Field Inspection
Claim Processor Job 27 miles from Marion
US-IA-Iowa City Job ID: 8 Type: Regular Full Time # of Openings: 1 Iowa City, IA
Build your career at one of the top companies for professional growth in the U.S.! Khakis optional
At State Farm we invest in our employees by providing a competitive Total Rewards package:
Starting Salary is $59,059.65 ($29.31/hr) - $79,230.63 ($39.32/hr) annually. Because work-life-balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! Salary offered is dependent on skills and qualifications, with the high end of the range limited to applicants with significant relevant experience.
You are also eligible for:
An annual bonus based on individual and enterprise performance
Annual merit increases
401(k) contribution
Paid Time Off (PTO), plus: 5 days of Life Leave to take care of yourself and your family, Paid Volunteer Time, and an Annual Celebration Day to celebrate what's important to you!
Industry leading Tuition Assistance Programs
Wellnessand mental health programs
Discounts from hundreds of retailers through our Perks at Work program
And more!
Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a team and do some good!
Responsibilities
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Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accidental and weather-related claims for homeowners, commercial properties, and large losses.
We are looking for an experienced and highly skilled professional to contribute to our dynamic team. You will be the first point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process while providing Remarkable service.
Where you'll work:
This position is located in Iowa City/Cedar Rapids, IA. Competitive candidates should reside within this zip code territory:
Key Responsibilities:
Conduct on-site inspections and assessments of property damages for both residential and commercial claims
Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently
May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions
Provide exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally
Gather necessary evidence, document findings, and prepare detailed reports to support the claims handling process
Investigate and adjust both personal and commercial property claims with exposures up to $500,000
Evaluate coverage and policy terms to determine the validity of claims and ensure compliance with local regulations
Negotiate and settle claims within the authorized limits, considering policy provisions, industry standards, and company guidelines
Although the primary work location is in the field, with a commutable distance from home, there will be opportunities for virtual work to be completed at home. Additionally, there may be occasions where you will be required to travel to assist in other territories
Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible schedules and may be asked to work overtime and/or irregular hours. Candidates may be asked to work outside of their assigned territory as business needs dictate
Qualifications
Bachelor's degree in a related field is preferred or equivalent work experience
Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims
Strong knowledge of property insurance policies, coverage and claim handling practices
Demonstrated knowledge of both residential and commercial building construction
Familiarity with local regulations and compliance requirements in Iowa
Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders
Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus
Proven ability to assess damages, estimate repair costs, and negotiate settlements
Detail-oriented with strong organizational and analytical skills
Proficient in using claims management software and other relevant tools
Physical Requirements:
Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces
A valid driver's license is required
Preferred Skills:
Experience in handling complex or high-value claims
Construction background
Water mitigation inspection
Xactimate, XactContents
Employees must successfully complete all required training, including applicable licensing exam(s), MVRs and background checks required of various state(s).
Visit State Farm Careers for more information on our benefits, locations, and the hiring process.
State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing.
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Claims Specialist, Lawyers Professional Liability
Claim Processor Job 201 miles from Marion
Do you have experience handling Lawyers Professional Liability or other Professional Liability claims? Are you motivated by working in a collaborative environment? If so, this role may be for you! We are looking for a strategic thinker with leadership skills to join our U.S. Lawyers Claims team.
About the Role
This role has responsibility for handling Lawyers Professional Liability claims while also supporting internal and external customers. You will manage a caseload of claims from receipt to final resolution. Our team works closely with the U.S. Agents Claims team, and you may have the opportunity to handle Agents Claims, as well.
Additional key responsibilities include:
* Maintain strong client focus by aggressively and proactively analyzing issues, providing support, and assuring client satisfaction in a timely fashion.
* Complying with legal and regulatory requirements, investigate, evaluate, and settle claims, applying technical knowledge and people skills to reach fair and prompt claim resolution.
* Complete detailed reviews of claim related issues, including coverage, liability, and damage assessments, and document the claim file appropriately.
* Set and maintain appropriate and timely indemnity and expense reserves.
* Formulate and execute negotiation and resolution strategies.
* Evaluate claims data to assist with identifying claim trends.
* Support Underwriting in connection with Claims information and consultation on coverages.
In this role, you will be working with other Claims Handlers dedicated to working on Lawyers Professional Liability Claims. Our team also handles other types of claims, including U.S. Agents claims, and has a strong emphasis on quality and customer service.
About You
Focused, self-motivated, and a confident professional with a hardworking sales mindset to develop insights, propose solutions, and build growth opportunities for clients and Swiss Re. You are a proactive and well-organized decisionmaker who works well both independently and as part of a team. You also have the following:
* Bachelor's degree or equivalent industry experience.
* 3+ years' Claims handling experience or equivalent industry experience.
* Possess solid coverage, liability, damage investigation, evaluation, and claims resolution skills.
* Excellent negotiation skills.
* Excellent customer service skills and experience collaborating with underwriters, clients, brokers, and internal and external business partners.
* Strong data analytic skills.
* Experience with handling claims in a paperless environment.
* Interest in developing leadership and management skills.
* Possess, or willing to obtain, adjuster licenses as needed for various jurisdictions.
* Ability to successfully deliver the Swiss Re Claims Commitment.
Some travel may be required.
The estimated base salary range for this position is $84,000 to $150,000. The specific salary offered for this or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.
About Swiss Re Corporate Solutions
Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer. We anticipate and manage risks, from natural catastrophes and climate change to cybercrime.
Swiss Re Corporate Solutions is the commercial insurance arm of the Swiss Re Group. We offer innovative insurance solutions to large and midsized multinational corporations from our approximately 50 locations worldwide. We help clients mitigate their risk exposure, whilst our industry-leading claims service provides them with additional peace of mind.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. Swiss Re Corporate Solutions embraces a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.
Swiss Re is an equal opportunity employer. It is our practice to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled.
During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed.
Keywords:
Reference Code: 132685
Nearest Major Market: Chicago
Job Segment: Liability, Claims, HR, Law, Underwriter, Insurance, Human Resources, Legal
Claims Processor - Patient Financial Services
Claim Processor Job 195 miles from Marion
Come work at a place where innovation and teamwork come together to support the most exciting missions in the world! Job Title: Claims Processor - Patient Financial Services Cost Center: 101651259 Prof Billing And Follow Up Scheduled Weekly Hours: 40 Employee Type:
Regular
Work Shift:
Mon-Fri; 8:00 am - 5:00 pm (United States of America)
Job Description:
JOB SUMMARY
The Claims Processor - Patient Financial Services (PFS) investigates held claims. Resolves and releases held claims from worklist. Completes various screens on system applications to successfully release paper and electronic claims. Interacts as necessary with coworkers to research complicated held claims, solving problems to release claims. Reports and discusses difficult problems with management for resolution and possible system enhancements. Assists department with backlogs, special projects, and performs various duties as necessary.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: None
Preferred/Optional: One year technical degree or higher education.
EXPERIENCE
Minimum Required: One year experience in business office, healthcare setting, or comparable experience.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: None
Preferred/Optional: None
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Claims Specialist II - Major Case
Claim Processor Job 3 miles from Marion
The Claims Specialist II - Major Case position is primarily responsible for investigating, evaluating, negotiating and settling moderate to high complexity claims within our construction defect team. This position requires extensive experience in claims handling. This position is responsible for conducting timely and thorough investigations, verifies applicable coverages, analyzes liability, evaluates damages for reserve and settlement, and negotiates claims to resolution in accordance with claims best practices.
The Claims Specialist II position promotes a positive work environment encouraging their team members to be the best they can be and are willing to take on additional challenges as needed. They buy into a strong service mentality for both internal and external customers. This position requires a high EQ, strong soft skills and technical skills, strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively.
UFG is willing to consider hiring at Claims Specialist I, II, or III dependent upon experience and technical expertise.
Responsibilities:
Review new claims assignments to determine the nature of the claim and action required.
Review and interpret applicable policy coverages. If coverage issues are present, draft detailed coverage disclaimer or Reservation of Rights.
Make prompt, meaningful contact with insureds, claimants, witnesses and other parties of interest.
Conduct a timely and thorough investigation to identify liability exposures and damages through securing recorded
statements, compiling and reviewing investigation reports, reviewing property damage estimates and/or proofs, and securing and reviewing other evidence where the investigation leads you and in accordance with claims best practices.
Document all file activity through detailed file notes and prepare reports for the claim file per claims best practice guidelines.
Evaluate damages and recommend reserves per reserve timeliness and accuracy guidelines.
Develop and execute negotiation strategies and proactively push claims towards resolution.
Actively identify subrogation potential and posture claim for successful subrogation recovery.
Identify risk transfer opportunities and exposures.
Draft tender letters and place all potential parties on notice.
Vet, select and retain experts when necessary and approved. Remain aware of and apply expense management initiatives.
Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers.
Mentor other Claims Specialists to further their development and technical skills
Complete initial and subsequent case reviews, review of the allegations, and policy language in order to determine if there is coverage. Keep apprised of changes in legal climate, case law and court procedures in the subject jurisdictions.
Identify coverage issues, and send corresponding appropriate ROR, declination or other coverage-related written communications to the insured(s) and agency.
Recognize and pursue risk transfer opportunities and exposures as appropriate, i.e. contractual defense/indemnity and additional insured defense/indemnity. Understand and be able to determine priority of coverage and allocation issues including consecutive, primary vs. excess and concurrent coverage.
Actively pursue co-carrier contribution and subcontractor participation, including by issuing tenders and pursuing cost sharing arrangements. Pursue subrogation if appropriate.
Investigate and evaluate liability by considering, identifying and applying available defenses i.e. statutes of limitation and repose, comparative negligence, comparative/pure comparative fault laws, allocation, contribution, immunity laws, anti-indemnification statutes, collateral source laws, and other legal doctrines, as appropriate.
Complete exposure evaluation to include an allocation of the insured's respective share of liability for the incident, and the evaluation of damages attributable to it, as well as the extent of covered damages.
Complete timely reserve evaluation in accordance with UFG's Gold Standard of claims.
Complete settlement/negotiation plan, giving objective and well-considered weight to the strengths or weaknesses of case, anticipated rebuttal and counter-arguments, venue climate, verdict potential, and/or projected future costs.
Notify insured of key developments and demands throughout the case, and communicate with agency and UW departments regarding substantial high-dollar shift in financial exposure.
Actively drive case resolution momentum and progression and provide a “road map” and explanation for case decisions. Ensure that outcome-based plan and strategy are included in file handling.
On litigated files, collaborate with defense counsel on a fluid and dynamic basis to explore and identify efficient, cost effective resolution alternative and strategies.
Direct negotiation, settlement conference, and/or mediation efforts. Assertively create and pursue early settlement opportunities.
Direct retention of experts and other high-dollar vendors, consistent with documented strategy/objectives.
Qualifications:
Education:
High school diploma.
College degree preferred.
Certifications / Designations:
Meet the appropriate state licensing requirements to handle claims.
CPCU, AIC, SCLA or Legal Principles, CCLA and PCLA of the AEI series preferred, or to be completed within 2 years of hire.
Experience:
5+ years experience in claims handling and 2+ years in CD.
Knowledge, skills & abilities:
Knowledge of the law (civil, contractual), construction and building repair, good knowledge of the various construction trades.
Strong negotiation skills.
Working Conditions:
General Office Environment.
Occasional travel may be required.
Disclaimer:
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and skills required. Additional task and requirements may be assigned, as necessitated by business need. UFG retains the right to modify the description of this job at any time.
Compensation and Benefits:
UFG pays on a geographic salary structure commensurate with skills, credentials and experience of the candidate. The salary range listed of $80,000 - $120,000 is the standard pay structure. Roles in various locations (such as California) may provide an increase on the standard pay structure based on location.
This position is also eligible for an Annual Bonus based on Company/Individual Performance and is at company discretion. Full-time employees are eligible to receive benefits including medical, dental, and vision coverage; 401k, Cash-balance pension, Discretionary Time Off (DTO), paid holidays and more
Medicaid Billing - Denied Claims Specialist
Claim Processor Job 3 miles from Marion
/Objective
We are seeking a detail-oriented and proactive Medicaid Billing- Denied Claims Specialist to manage and resolve denied insurance claims efficiently and accurately. The ideal candidate will have a strong understanding of medical billing, Medicaid coverage and insurance policies, and payer regulations. This role is crucial in ensuring prompt reimbursement and maintaining the financial health of the healthcare provider.
Essential Duties and Responsibilities
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The duties include, but are not limited to, the following:
Funding Validation:
Regularly monitor Medicaid eligibility for member services and benefits.
Track authorization status to ensure timely and accurate support for members.
Coordinate maintenance of necessary funding sources for services and procedures.
Denied Claims Management:
Review and analyze Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to identify denial reasons.
Investigate and resolve denied claims through corrections, resubmissions, and appeals.
Appeals and Follow-Up:
Draft and submit appeal letters with supporting documentation to insurance payers.
Monitor and track the status of denied claims and appeals to ensure timely resolution.
Communicate with insurance companies to clarify denial reasons and obtain resolution.
Claim Review and Corrections:
Verify patient and insurance information for accuracy and completeness.
Identify and correct errors in coding, demographic information, and claim submission processes.
Collaborate with coders, providers, and other departments to resolve documentation and coding discrepancies.
Compliance and Documentation:
Maintain accurate records of denial resolutions, appeals, and payer communications.
Ensure compliance with HIPAA and payer-specific regulations.
Update systems and logs to reflect claim status and outcomes.
Prevention and Analysis:
Analyze denial trends to identify root causes and implement preventative measures.
Provide feedback and training to staff on common denial reasons and payer guidelines.
Stay updated on changes in payer policies and industry regulations.
Competencies/Qualifications/Education
Education:
High school diploma or equivalent required. Associate's degree in healthcare administration, medical billing, or related field preferred.
Experience:
Minimum of 2-3 years of experience in medical billing, claims processing, or denial management.
Claims Specialist II, Excess BI and Property Damage
Claim Processor Job 190 miles from Marion
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 investigation and resolution of lower to medium complexity and lower to medium exposure claims. These claims will consist of non-litigated and litigated matters. Under general supervision, this position will be able to manage a full claim workload with minimal assistance and be responsible for making sound decisions within delegated authority. Adheres to Fair Claims Practices regulations as applicable in various states. Minimal travel required.
* Analyzes coverage and communicates coverage positions
* Conducts, coordinates, and directs investigation into loss facts and extent of damages
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims
* Drafts coverage position letters
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
* Handles claims in all jurisdictions
* Handles litigated and non-litigated property damage claims with values up to $250,000
* Handles non-litigated bodily injury claims with values up to $250,000 in all jurisdictions;
* Handles smaller product liability and/or construction defect claims.
* Identify losses which should be reported to SIU.
* Participates in special projects or assists other team members as requested
* Provides excellent and professional customer service to insureds while maintaining a high level of production.
* Represents Markel in mediations, as required
* Sets reserves within authority or makes recommendations concerning reserve changes to manager
Qualifications
* Bachelor's degree or equivalent work experience
* Must have or be eligible to receive claims adjuster license
* Successful completion of basic insurance courses or achievement of industry designation (INS, IEA, AIC, ARM, SCLA, CPCU)
* Minimum of 2-3 years experience in commercial construction or equivalent combination of education and experience
* Knowledge of insurance industry or claims handling preferred.
* Markel offers hybrid working schedules of 3 days in the office and 2 days remote.
US Work Authorization
* US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Pay information:
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The national average salary for the Claims Specialist II is $61,857 - $76,230 with 20% bonus potential.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
* We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
* All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
* We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
Are you ready to play your part?
Choose 'Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
* All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
* All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Legal Claims Specialist
Claim Processor Job 108 miles from Marion
The Weitz Company is growing our Legal team! We are hiring a Legal Claims Specialist to be responsible for the facilitation of construction claims. This highly detailed individual will review incoming claims and gather documentation while coordinating with stakeholders. The Legal Claims Specialist will also monitor ongoing claims and close out claims in a timely manner. If you take pride in executing high quality work in an efficient and accurate manner, this could be a great role for you!
The Weitz Company has been Building a Better Way since 1855. We are a full-service construction company, general contractor, design-builder, and construction manager with office locations throughout the United States. We believe our employees to be our most valuable asset, and we are committed to growing a diverse and inclusive culture that inspires, motivates, and continuously improves.
What You'll Do:
* Review, assess, and process incoming claims
* Verify information and ensure accuracy of documentation
* Track and monitor claim status to provide regular updates to appropriate parties
* Prepare and submit necessary documentation to insurance carriers, attorneys, and internal stakeholders
* Coordinate with project teams and stakeholders to obtain necessary information to process claims
* Prepare detailed reports/summaries on the status/outcome of claims
* Update and maintain accurate records in claims management system
* Analyze data to identify processing trends and provide recommendations for process improvement
* Serve as the primary point of contact for insurance carriers, attorneys, and consultants to provide updates and facilitate discovery responses/requests
* Ensure policies, procedures, and practices are compliant with regulations
* Investigate and review discrepancies/issues related to claims
* Provide additional administrative support to Legal, Risk, and Claims Management as needed
What We're Looking For:
* Experience:
* 5+ years of experience in a legal-related role or facilitation of claims processing
* Degree required - an equivalent combination of education and experience may be considered
* Skills:
* Detail-oriented and a high level of accuracy
* Critical thinker who is comfortable asking questions and digging deeper
* Comfortable working in a fast-paced environment
* Excellent written and verbal communication skills
* High level of confidentiality and professionalism
* Extremely organized and skilled at multi-tasking
* Firm but fair approach in all business dealings to protect the interests of the organization
* Strong work ethic with a desire to provide excellent customer service
* Technology:
* Proficient in Microsoft Office including Word, Excel, PowerPoint, and Outlook
* Ability to learn specific job-related software upon hire
* Additional Requirements:
* Ability to travel quarterly
What We Offer:
* Competitive Pay
* Rewarding Bonus Program
* Comprehensive Benefits Package with Tax-Advantaged HSA and FSA offerings
* Employer-Paid Short- and Long-Term Disability Programs
* Employer-Paid Life Insurance
* Generous Paid Time Off Provisions
* 401K Retirement Savings Plan with Company Match
* Tuition Reimbursement
* Fully Paid Parental Leave
* Voluntary Products Including: Critical Illness Insurance and Accident Insurance
* Corporate Wellness Program with Wellness Time Off and Rewards
Visa sponsorship is not available for this position at this time.
The Company does not accept unsolicited resumes from search firms or agencies. Any resume submitted to any employee of the Company without a prior written search agreement will be considered unsolicited and the property of the Company. Please, no phone calls or emails.
The Company is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment (minorities, females, veterans, individuals with disabilities, sexual orientation, gender identity, or other protected categories in accordance with state and federal laws). The Company is a drug and alcohol-free workplace and background checks are required if applicable. Click here to review our Privacy Notice.
#LI-KD1
Warranty Claims Specialist
Claim Processor Job 184 miles from Marion
at Parts Town
Warranty Claims Specialist
See What We're All About
As the fastest-growing distributor of restaurant equipment, HVAC and residential appliance parts, we like to do things a little differently. First, you need to understand and demonstrate our Core Values with safety being your first priority. That's key. But we're also looking for unique enthusiasm, high integrity, courage to embrace change…and if you know a few jokes, that puts you on the top of our list!
Do you have a genius-level knowledge of original equipment manufacturer parts? If not, no problem! We're more interested in passionate people with fresh ideas from different backgrounds. That's what keeps us at the top of our game. We're proud that our workplace has been recognized for its growth and innovation on the Inc. 5000 list 15 years in a row and the Crain's Fast 50 list ten times. We are honored to be voted by our Chicagoland team as a Chicago Tribune Top Workplace for the last four years.
If you're ready to roll up your sleeves, go above and beyond and put your ambition to work, all while having some fun, let's chat - Apply Today
Perks
Parts Town Pride - check out our virtual tour and culture!
Quarterly profit-sharing bonus
Hybrid Work schedule
Team member appreciation events and recognition programs
Volunteer opportunities
Monthly IT stipend
Casual dress code
On-demand pay options: Access your pay as you earn it, to cover unexpected or even everyday expenses
All the traditional benefits like health insurance, 401k/401k match, employee assistance programs and time away - don't worry, we've got you covered.
The Job at a Glance
Our Warranty Claims Specialist (internally known as Warranty Wizards) support our customers and manufacturers by providing an exceptional customer experience throughout the entire warranty process. Working closely with the customer support team and Fulfillment Center, this specialist is responsible for ensuring all warranty claims are submitted promptly. If you're courageous and it's your destiny to become a Warranty Wizard, apply today!
A Typical Day
Working with customer support team, customers and Manufacturers on warranty process and transferring that information to a variety of different forms and portals for payment
Generate account adjustments and warranty invoices in the company's ERP system (Syspro)
Learn and comprehend defective part process to address customer and manufacturer questions
Transfer tech service calls and corresponding invoice into warranty websites
Interpret and process warranty and defective part documents
Produce monthly Warranty spreadsheets in Excel
Deliver exceptional customer service through phone calls and e-mails to internal teams, our customers, and our manufacturer partners
To Land This Opportunity
You have experience using Excel, Esker, Sales Force and Syspro
You possess stellar customer service, high attention to detail, data entry, and organizational skills
You enjoy working independently to achieve weekly and monthly deadlines
You have strong data entry, communication, and interpersonal skills
About Your Future Team
As an important part of our culture, we take huge pride in having fun. At Parts Town we are passionate about celebrating anniversaries, enjoy team lunches, giving appreciation, a memorable first day warm welcome, decorate desks and most importantly, we love to spice it up by playing our teams playlists!
Claims Litigation Specialist
Claim Processor Job In Iowa
Responsible for handling litigation claims in a multi-state territory. Direct and review litigation strategy and actions of defense counsel. Other responsibilities include the evaluation of coverage and exposure. Travel to mediations, settlement conferences, and trials may be required.
RESPONSIBILITIES
Demonstrate proficiency in analyzing coverage, determining liability, and evaluating damages.
Ability to document all pertinent file activity and ensure claims coding is correct adequately and accurately.
Demonstrate proficiency in applying appropriate insurance principles, statutory and case law, and in other jurisdictional issues.
Ability to retain defense counsel and work with the attorney to develop a strategy and action plan and manage the litigation process to an appropriate and cost-effective resolution.
Demonstrate proficiency in evaluations and negotiations.
Exhibit superior verbal and written communication skills.
Demonstrate a positive attitude, adaptability, high level of motivation, and excellent interaction in a team environment.
Possess strong organizational and time management skills.
JOB REQUIREMENTS
Four-year college degree or relevant work experience preferred. A high school diploma or general equivalency degree (GED) is required.
A minimum of five (5) years handling litigation claims.
Excellent analytical and interpretive skills.
Excellent written and verbal communication skills.
Computer proficiency with the ability to learn new applications.
Must possess or be able to obtain applicable adjuster licenses.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to do manual tasks, which may include the use of hands to finger and handle controls. Tasks may also require the ability to talk or hear. The employee will frequently sit, bend, and reach with hands and arms and is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus. Other abilities include breathing, protecting oneself, and possessing the capacity to learn, concentrate, think, and read. Oftentimes the employee will be communicating and interacting with others while working.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed 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.
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and perform any other job-related duties requested by anyone authorized to give instructions or assignments.
As a Team Member at First Acceptance Insurance Company, you will be part of a growing organization that continues to evolve and positively impacts the lives of our team members and customers.
We are looking for team members that engage - who take responsibility for themselves and take care of their customers and colleagues. Ideal candidates can compose themselves under pressure, have a “make It right” mindset, and focus their energies on solving problems. This means you'll be supported by a team with all these qualities, too. If this sounds like the kind of team you'd like to join, we want to hear from you!
First Acceptance Insurance Company offers a full line of benefits including: Health Insurance, Dental, Vision, Paid Vacation, Disability Insurance and Employer Matching 401(k) Program.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants are considered for position and are evaluated without regard to mental or physical disability, race, religion, sexual orientation, color, gender, national origin, age, marital status, military or veteran status or any other protected local, state or federal status unrelated to the performance of the work involved.
Workers' Compensation Claims Specialist
Claim Processor Job 122 miles from Marion
We are looking to add a Workers' Compensation Claims Specialist to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in MA, NH, NJ, PA, RI, WV, CT, and ME. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes!
Essential Responsibilities:
Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner.
Investigates, evaluates, and resolves lost time Workers' Compensation claims, including litigated claims.
Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues.
Enters and maintains accurate information on a computer system during the claim process, to include final settlement information.
Generates checks for indemnity and medical payments daily.
Develops and monitors consistency in procedural matters of claims handling process within CRS.
Willingness to become licensed if required in jurisdiction where claims are handled.
Qualifications:
Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU.
Experience: 3-5 years claims experience with strong background in Workers' Compensation claims handling.
Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Jurisdictional expertise and required licensing in MA, NH, NJ, PA, RI, WV, CT, and ME.
Skills: An ideal candidate will have proficient knowledge of Workers' Compensation insurance coverage and claims processing procedures. They will possess the ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs.
Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience.
Here's a little bit about us:
Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies.
In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members.
Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as:
Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey!
Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow.
401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for.
Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first.
Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you.
DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish!
Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing.
Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?!
Holmes Murphy & Associates is an Equal Opportunity Employer.
#LI-EG1
Billing and Claims Specialist
Claim Processor Job 63 miles from Marion
JOIN OUR TEAM! As a part of our team, the Billing and Claims Specialist is responsible for following up on receivables from third-party payers and performing patient collection activities. This position requires a solid working knowledge of patient collections, payer requirements, appeals, denial codes, corrected claims, and speaking with patients about their balances.
WHAT YOU'LL DO:
- Patient Collections
- Research patient account disputes and billing discrepancies and follow up with patients as needed. Maintaining professional communication is critical.
- Set up patient payment plans via phone and in-person; obtain and process client payments by credit card and/or check.
- Process returned patient statements due to bad address.
- Identify patients with upcoming appointments who have delinquent accounts. Attempt to reach the patient prior to their appointment to collect payment.
- Assist patients with setting up payment arrangements and with completing funding applications for Iowa Medicaid and Eastern Iowa Mental Health Region, as needed.
- Make collection calls to patients and document daily collection activities. Track all calls and conversations; maintain documentation sufficient to prevail through collection process.
- Identify delinquent accounts requiring external collection efforts, compile list to upload to external collection agency, and monitor collection status.
- Identify bad debt or financial exposure and submit information/report to the Revenue Cycle Manager no less than bi-weekly.
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- Insurance Receivables
- Work with payers (Medicaid, Medicare, commercial insurance, worker's compensation, VA/Tricare, county offices, etc.) to ensure timely claim payment. Responsible for follow-up on unpaid claims and EOB review to ensure correct payment and/or denial. Take prompt action as necessary to obtain payment on unpaid/underpaid claims.
- Stay abreast of Medicare and other payer requirements and guidelines for continued successful reimbursements. Resolve account non-payment issues resulting from invalid coding, missing documentation, and/or other miscellaneous reasons for non-payment of claim.
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- Other Functions
- Perform other functions of the billing team as necessary to ensure adequate back-up and to ensure all essential functions are performed. Performs eligibility verifications at the first of the month with other team members.
- Billing team members may change areas of focus as work/receivables evolve; any of the functions of the team: eligibility verification, preparing charges and submitting them, posting payments, receivable collections, reporting, deposit preparation, testing the system or any other function that falls within the billing team duties may be assigned to any team member.
WHAT YOU'LL NEED:
- High School Diploma or GED required,
Associates degree, coding certification, or equivalent experience with medical claims processing preferred
- Minimum 1 - 2 years of relevant medical claims processing, accounting, or accounts receivable experience
- Strong communications and interpersonal skills are essential; extremely good telephone manners are necessary
- High level of attention to detail and accuracy
- Exhibits a high level of professionalism and ethical behavior. Demonstrated ability to handle confidential information in a professional, time sensitive manner
Share Our Values:
We are united by our shared values of community service, compassion, empowerment, respect, resourcefulness and professionalism.
Make an Impact:
Our mission is to enhance the mental health of all in our community by providing quality, accessible and comprehensive care.
Learn and Grow:
Vera French offers various in-house training opportunities CPR, Medication Management and other trainings through our learning management system. To encourage our staff to continue their education, Vera French also offers a Tuition Reimbursement and Loan Repayment program for all employees after one year of employment.
WHAT WE OFFER:
Group Health, Dental and Vision insurance
- Wellmark Blue Cross/Blue Shield health insurance
- Delta Dental - dental and vision insurance
Employer paid life Insurance, ADandD, LTD through Mutual of Omaha
S
Environmental Claims Specialist
Claim Processor Job 24 miles from Marion
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Environmental Claims Specialist
** Summary**
To analyze complex or technically difficult environmental 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 environmental liability 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 to include complete coverage review and provides report of investigation pertaining to new events, claims and legal actions.
+ Analyzes applicable complex liability insurance coverage and policies
+ 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 are required. Professional certification as applicable to line of business preferred.
**Experience**
Ten (10) years of claims management experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ In-depth knowledge of appropriate environmental liability insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim duration, cost containment principles application procedures as applicable to line-of-business. In the absence of experience with environmental claims, consideration will be given to candidates with equivalent experience with professional liability, complex coverage and litigation/DJ claims, products liability, marine, class action and multi-district litigation (MDL) claims, asbestos and silica, and other high-exposure claims handling of a complex nature.
+ 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
**NOTE** **:** Credit security clearance, confirmed via a background credit check, is required for this position.
_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_ **_$110,000- $120,000_** _. 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.
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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.**
**Taking care of people is at the heart of everything we do. Caring counts**
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)