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Claim processor jobs in Massachusetts - 116 jobs

  • Auto Claims Representative

    Beacon Hill 3.9company rating

    Claim processor job in Boston, MA

    Auto Claims Representative to $47K - Lauch Your Career! Our client, a leading insurance organization, is seeking an Auto Claims Representative to manage automobile property damage claims while delivering exceptional customer service. As part of a growth-oriented training program, you'll investigate claims, assess liability, and ensure timely resolution. Position Details: Location: Boston, MA Work Model: Hybrid Degree: Preferred Responsibilities include analyzing policy provisions to determine coverage; investigating auto accidents and gathering documentation; negotiating and settling claims within authority limits; maintaining accurate records and follow-up systems; coordinating with vendors and internal teams to resolve disputes; initiating subrogation processes when applicable; and managing phone and email communications to ensure timely updates. The ideal candidate possesses strong organizational and multitasking skills; excellent verbal and written communication abilities; proficiency in Microsoft Office Suite; ability to handle sensitive situations with professionalism; and a customer-focused mindset with adaptability to manage multiple priorities. Enjoy a role that offers comprehensive benefits, long-term career growth, and a supportive team environment committed to your success! Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply. California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. If you would like to complete our voluntary self-identification form, please click here or copy and paste the following link into an open window in your browser: ***************************************** Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for reporting purposes only and will be kept separate from all other records. Company Profile: Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement. Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs. Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting ************* Benefits Information: Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings. We look forward to working with you. Beacon Hill. Employing the Future (TM)
    $47k yearly 1d ago
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  • Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations

    Stout 4.2company rating

    Claim processor job in Boston, MA

    At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include: Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations. Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies. Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic. Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning. Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives. Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support. Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations. Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery. Continue developing technical, analytical, and consulting skills while building credibility with clients. Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement. Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team. What You Bring Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred. Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles. Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance. Epic Resolute or other hospital billing system experience preferred; Epic certification a plus. Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required. Additional certifications such as CHC, CFE, or AHFI preferred. Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization. Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred. Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act. Willingness to travel up to 25%, based on client and project needs. How You'll Thrive Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions. Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships. Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time. Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment. Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility. Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
    $36k-43k yearly est. 2d ago
  • Claims Examiner

    Harriscomputer

    Claim processor job in Massachusetts

    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.
    $31k-59k yearly est. Auto-Apply 34d ago
  • Casualty Claim Examiner

    Safety Insurance Company 4.6company rating

    Claim processor job in Boston, MA

    Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs. Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district. Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more! Qualifications We are located in Boston, but you can work from your home in this telecommuting position. You will be responsible for the fair and accurate disposition of the Company's most complex casualty claims through investigation, evaluation, and settlement or recommendation within the authority level granted by the Territorial Claim Manager. Duties Interprets and determines policy coverages under the personal lines and commercial lines classifications Investigates, analyzes, and evaluates liability and damages Develops and maintains case files that document all actions Establishes adequate and timely reserves in accordance with company guidelines Provides equitable evaluations and settlements through negotiations Directs and monitors defense counsel in the handling of cases in litigation, through conclusion by trial or settlement Identifies, investigates, and refers potential fraudulent claims to SIU Answers questions and resolves problems within established levels of authority Provides excellent customer service Assists in training and provides a resource to adjusters Performs other activities as required Qualifications College degree or commensurate casualty claims experience required 5+ years of experience handling MA auto bodily injury claims required Significant mediation and litigation experience required
    $54k-79k yearly est. 11d ago
  • Associate, Claims Receipt Processor

    Webster Bank Group 4.6company rating

    Claim processor job in Wilmington, MA

    If you're looking for a meaningful career, you'll find it here at Webster. Founded in 1935, our focus has always been to put people first--doing whatever we can to help individuals, families, businesses and our colleagues achieve their financial goals. As a leading commercial bank, we remain passionate about serving our clients and supporting our communities. Integrity, Collaboration, Accountability, Agility, Respect, Excellence are Webster's values, these set us apart as a bank and as an employer. Come join our team where you can expand your career potential, benefit from our robust development opportunities, and enjoy meaningful work! A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. What you will do Responsible for reviewing receipt submissions for required information. Outreach to providers, pharmacies, and members to obtain additional information as needed. Reviewing settlement documentation to determine whether a receipt is reimbursable. Keying in the necessary information to create a claim. Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor. Maintain the expected turnaround time for processing receipts. Performing other clerical tasks, as required. Demonstrates a commitment to service by consistent attendance and punctuality. Skills and Abilities Proficient in MS Office. Excellent critical thinking and decision-making skills. Good administrative and organizational skills. Excellent written and verbal communication skills with ability to adapt communication style depending on audience. Meticulous attention to detail. Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation. Ability to work independently and as part of a team. Education Qualifications H.S. Diploma or General Education Degree (GED) required Experience Qualifications 0-2 years experience as a Claims Processor or in a related role required The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation. #LI-BB1 #LI-HYBRID Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.
    $20-23 hourly Auto-Apply 10d ago
  • Claims Examiner

    Harris Computer Systems 4.4company rating

    Claim processor job in Washington, MA

    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.
    $56k-76k yearly est. Auto-Apply 31d ago
  • Associate, Claims Receipt Processor

    Ametros Financial 4.0company rating

    Claim processor job in Wilmington, MA

    Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. What you will do Responsible for reviewing receipt submissions for required information. Outreach to providers, pharmacies, and members to obtain additional information as needed. Reviewing settlement documentation to determine whether a receipt is reimbursable. Keying in the necessary information to create a claim. Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor. Maintain the expected turnaround time for processing receipts. Performing other clerical tasks, as required. Demonstrates a commitment to service by consistent attendance and punctuality. Skills and Abilities Proficient in MS Office. Excellent critical thinking and decision-making skills. Good administrative and organizational skills. Excellent written and verbal communication skills with ability to adapt communication style depending on audience. Meticulous attention to detail. Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation. Ability to work independently and as part of a team. Education Qualifications H.S. Diploma or General Education Degree (GED) required Experience Qualifications 0-2 years experience as a Claims Processor or in a related role required The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation. #LI-BB1 #LI-HYBRID Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.
    $20-23 hourly Auto-Apply 10d ago
  • Analyst (Graduate Hire 2026) - Medical (Boston)

    Prescient Healthcare Group

    Claim processor job in Boston, MA

    Analyst (Graduate Hire 2026) - Medical Important Dates: * Application Deadline: February 13, 2026 * Start Date Range: August - September 2026 Application & Recruitment Process As part of your application, please submit a cover letter addressing the questions below. Candidates who do not submit a cover letter with responses to these questions will not be considered. Cover Letter Questions: * Why are you interested in Prescient Healthcare Group? What attracted you to this role? * What are your top three attributes that will make you a successful consultant? * How many times have you practiced a case with a peer? * What interests you most about working in the life sciences and pharmaceutical industry, and how have your academic experiences, internships, or other relevant exposure prepared you for this role? Recruitment Timeline: * February 16- February 27: Selected candidates will complete an introductory interview with a member of our Talent Acquisition team * February 27: All candidates will be notified of next steps. * March 4th: Final in-person assessment day (behavioral + case interviews) To ensure availability, candidates are encouraged to tentatively block March 4th for the in-person interview day. About You Do you have a passion for: * Understanding tomorrows emerging therapeutic areas? * Unlocking the full potential of new therapies and shaping successful future therapies? * Understanding why healthcare professionals and patients behave the way they do, and applying this to medical, clinical, and commercial strategies? * Are you a highly motivated professional interested in being part of a new and exciting team, working with global healthcare and pharmaceutical clients across the full product life cycle? About Prescient Healthcare Group (PHG) Our goal is a simple one: we solve exciting, real-world pharma challenges that ultimately make a meaningful difference in patients' lives. PHG is a unique global biopharma, insight-led strategy consultancy. Our core focus is helping biopharmaceutical clients create clinical and commercial strategies that deliver groundbreaking new treatments for patients. With offices in ten major cities across the world, we are a truly global enterprise and are still growing fast, offering our people endless opportunities, supporting rapid personal and professional development. We work with industry leading companies across the full product life cycle, to help them unlock the full potential of their brands. About the Opportunity The role will be varied, giving you the opportunity to develop and hone new skills whilst improving your knowledge of the healthcare industry. You will receive exposure to a broad mix of projects - varied therapeutic areas, a range of client sizes, and domestic vs. global reach. This will enable you to get the experience to decide if you want to take a more specialized route as your career progresses. Our onboarding and training program will provide the support and development you need to hit the ground running; a mix of formal classroom training, shadowing colleagues on projects and 'on the job' coaching will equip you with the capabilities you need to succeed at Prescient. Key Responsibilities: * Exhibit high degrees of professionalism across each aspect of working life, demonstrating respect, integrity and support for colleagues and in our interactions with clients * Take pride in and full responsibility for meeting high levels of performance in work process and output; take charge of own professional development and proactively seek opportunities for growth * Demonstrate a strong willingness to learn and a 'can-do' attitude; showcase ability to gain expert status on a new topic and create an impact within the team and with clients * Demonstrate an ability to thrive in an environment through efficient planning * Demonstrate an ability and willingness to take risks, work in a non-hierarchical environment and take step-up/step-down roles to support strong outcomes * Act as a role model in line with company and client codes of ethics and processes; represent the company and promote its reputation to a high standard Desired Experience and Skills * Bachelors in a relevant field (e.g., Life Sciences, Biotechnology, Neuroscience, Pharmacology, Business, Economics, Marketing, or Psychology). * Demonstrated passion for the life sciences and pharmaceutical industry, supported by academic research, industry exposure, or relevant coursework. * Ability to rapidly synthesize, analyse, and apply new information, demonstrating intellectual agility and a proactive approach to problem-solving. * Exceptional verbal and written communication abilities, with a track record of delivering clear, concise, and impactful presentations and reports. * A drive for self-improvement - the best consultants are those that seek out and action on feedback to improve themselves. * Entrepreneurship - The ability to lead and drive outcomes, particularly in situations that have some ambiguity. * Consulting is a team sport so a demonstrated willingness and enthusiasm to collaborate with others is required. What We Offer * Highly competitive base salary plus performance-related bonus, 401K matching and Health & Dental benefits. * A strong values-based culture that promotes respect, inclusion and teamwork, encouragement to contribute and influence on the business - where everybody has a voice. * Leaders who are accessible, truly listen, are ambitious for our teams, and committed to coaching & sharing their expertise. * A high-growth, entrepreneurial environment where our thinking and our work are innovative, imaginative and bright. * Endless and tailored career development that stretches you and is based on your ambition, abilities and interests - not just box-ticking. * Flexible working, recognition for going the extra mile, and a flat hierarchy. More about Prescient Healthcare Group Prescient is a pharma services firm specializing in dynamic decision support and product and portfolio strategy. We partner with our clients to turn science into value by helping them understand the potential of their molecules, shaping their strategic plans and allowing their decision-making to be the biggest differentiating factor in the success of their products. When companies partner with Prescient, the molecules in their hands have a greater potential for success than the same science in the hands of their competitors. Founded in 2007, Prescient is a global firm with a footprint in ten cities across three continents. Our team of nearly 475 experts partners with 27 of the top 30 biopharmaceutical companies, the fastest-growing mid-caps and cutting-edge emerging biotechs, including some of the biggest and most innovative brands. More than 70% of our employees hold advanced life sciences degrees, and our teams deliver an impressive depth of therapeutic, clinical and commercial expertise. The annual full time base salary range for this role is ($75,000 - $85,000). Specific compensation is determined through interviews and a review of relevant education, experience, training, skills, geographic location and alignment with market data. Additionally, positions may be eligible to receive a discretionary bonus as determined by bonus program guidelines. Prescient offers PTO and paid holidays, the terms of which are set forth in the program policies. All full-time employees also are eligible to participate in various benefit plans, including medical, dental, vision, life, disability insurance and 401K; in each case in accordance with the terms of the applicable plans. Prescient has been a portfolio company of Bridgepoint Development Capital since 2021 and Baird Capital since 2017. For more information, please visit: ******************** We are an equal opportunity employer and fully comply with applicable legislation in all the geographies in which we operate. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable national, federal, state or local laws.
    $75k-85k yearly 6d ago
  • Outside Property Claim Representative

    Travelers 4.8company rating

    Claim processor job in Barnstable Town, MA

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$67,000.00 - $110,600.00Target Openings1What Is the Opportunity?Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in Southeastern, South Shore and Cape Cod areas of Massachusetts . The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory.What Will You Do? Handles 1st party property claims of moderate severity and complexity as assigned. Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May provides mentoring and coaching to less experienced claim professionals. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree. General knowledge of estimating system Xactimate. Two or more years of previous outside property claim handling experience. Interpersonal and customer service skills - Advanced. Organizational and time management skills- Advanced. Ability to work independently - Intermediate. Judgment, analytical and decision making skills - Intermediate. Negotiation skills - Intermediate. Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate. Investigative skills - Intermediate. Ability to analyze and determine coverage - Intermediate. Analyze, and evaluate damages -Intermediate. Resolve claims within settlement authority - Intermediate. Valid passport. What is a Must Have? High School Diploma or GED. One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. Valid driver's license. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************
    $67k-110.6k yearly Auto-Apply 7d ago
  • Analyst (Graduate Hire 2026) - Medical (Boston)

    Prescient 4.6company rating

    Claim processor job in Boston, MA

    Analyst (Graduate Hire 2026) - Medical Important Dates: Application Deadline: February 13, 2026 Start Date Range: August - September 2026 Application & Recruitment Process As part of your application, please submit a cover letter addressing the questions below. Candidates who do not submit a cover letter with responses to these questions will not be considered. Cover Letter Questions: Why are you interested in Prescient Healthcare Group? What attracted you to this role? What are your top three attributes that will make you a successful consultant? How many times have you practiced a case with a peer? What interests you most about working in the life sciences and pharmaceutical industry, and how have your academic experiences, internships, or other relevant exposure prepared you for this role? Recruitment Timeline: February 16- February 27: Selected candidates will complete an introductory interview with a member of our Talent Acquisition team February 27: All candidates will be notified of next steps. March 4th: Final in-person assessment day (behavioral + case interviews) To ensure availability, candidates are encouraged to tentatively block March 4 th for the in-person interview day. About You Do you have a passion for: Understanding tomorrows emerging therapeutic areas? Unlocking the full potential of new therapies and shaping successful future therapies? Understanding why healthcare professionals and patients behave the way they do, and applying this to medical, clinical, and commercial strategies? Are you a highly motivated professional interested in being part of a new and exciting team, working with global healthcare and pharmaceutical clients across the full product life cycle? About Prescient Healthcare Group (PHG) Our goal is a simple one: we solve exciting, real-world pharma challenges that ultimately make a meaningful difference in patients' lives. PHG is a unique global biopharma, insight-led strategy consultancy. Our core focus is helping biopharmaceutical clients create clinical and commercial strategies that deliver groundbreaking new treatments for patients. With offices in ten major cities across the world, we are a truly global enterprise and are still growing fast, offering our people endless opportunities, supporting rapid personal and professional development. We work with industry leading companies across the full product life cycle, to help them unlock the full potential of their brands. About the Opportunity The role will be varied, giving you the opportunity to develop and hone new skills whilst improving your knowledge of the healthcare industry. You will receive exposure to a broad mix of projects - varied therapeutic areas, a range of client sizes, and domestic vs. global reach. This will enable you to get the experience to decide if you want to take a more specialized route as your career progresses. Our onboarding and training program will provide the support and development you need to hit the ground running; a mix of formal classroom training, shadowing colleagues on projects and ‘on the job' coaching will equip you with the capabilities you need to succeed at Prescient. Key Responsibilities: Exhibit high degrees of professionalism across each aspect of working life, demonstrating respect, integrity and support for colleagues and in our interactions with clients Take pride in and full responsibility for meeting high levels of performance in work process and output; take charge of own professional development and proactively seek opportunities for growth Demonstrate a strong willingness to learn and a 'can-do' attitude; showcase ability to gain expert status on a new topic and create an impact within the team and with clients Demonstrate an ability to thrive in an environment through efficient planning Demonstrate an ability and willingness to take risks, work in a non-hierarchical environment and take step-up/step-down roles to support strong outcomes Act as a role model in line with company and client codes of ethics and processes; represent the company and promote its reputation to a high standard Desired Experience and Skills Bachelors in a relevant field (e.g., Life Sciences, Biotechnology, Neuroscience, Pharmacology, Business, Economics, Marketing, or Psychology). Demonstrated passion for the life sciences and pharmaceutical industry, supported by academic research, industry exposure, or relevant coursework. Ability to rapidly synthesize, analyse, and apply new information, demonstrating intellectual agility and a proactive approach to problem-solving. Exceptional verbal and written communication abilities, with a track record of delivering clear, concise, and impactful presentations and reports. A drive for self-improvement - the best consultants are those that seek out and action on feedback to improve themselves. Entrepreneurship - The ability to lead and drive outcomes, particularly in situations that have some ambiguity. Consulting is a team sport so a demonstrated willingness and enthusiasm to collaborate with others is required. What We Offer Highly competitive base salary plus performance-related bonus, 401K matching and Health & Dental benefits. A strong values-based culture that promotes respect, inclusion and teamwork, encouragement to contribute and influence on the business - where everybody has a voice. Leaders who are accessible, truly listen, are ambitious for our teams, and committed to coaching & sharing their expertise. A high-growth, entrepreneurial environment where our thinking and our work are innovative, imaginative and bright. Endless and tailored career development that stretches you and is based on your ambition, abilities and interests - not just box-ticking. Flexible working, recognition for going the extra mile, and a flat hierarchy. More about Prescient Healthcare Group Prescient is a pharma services firm specializing in dynamic decision support and product and portfolio strategy. We partner with our clients to turn science into value by helping them understand the potential of their molecules, shaping their strategic plans and allowing their decision-making to be the biggest differentiating factor in the success of their products. When companies partner with Prescient, the molecules in their hands have a greater potential for success than the same science in the hands of their competitors. Founded in 2007, Prescient is a global firm with a footprint in ten cities across three continents. Our team of nearly 475 experts partners with 27 of the top 30 biopharmaceutical companies, the fastest-growing mid-caps and cutting-edge emerging biotechs, including some of the biggest and most innovative brands. More than 70% of our employees hold advanced life sciences degrees, and our teams deliver an impressive depth of therapeutic, clinical and commercial expertise. The annual full time base salary range for this role is ($75,000 - $85,000). Specific compensation is determined through interviews and a review of relevant education, experience, training, skills, geographic location and alignment with market data. Additionally, positions may be eligible to receive a discretionary bonus as determined by bonus program guidelines. Prescient offers PTO and paid holidays, the terms of which are set forth in the program policies. All full-time employees also are eligible to participate in various benefit plans, including medical, dental, vision, life, disability insurance and 401K; in each case in accordance with the terms of the applicable plans. Prescient has been a portfolio company of Bridgepoint Development Capital since 2021 and Baird Capital since 2017. For more information, please visit: ******************** We are an equal opportunity employer and fully comply with applicable legislation in all the geographies in which we operate. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable national, federal, state or local laws.
    $75k-85k yearly Auto-Apply 6d ago
  • Medicare Advantage and DSNP Claims Analyst

    Brigham and Women's Hospital 4.6company rating

    Claim processor job in Somerville, MA

    Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Responsible for extracting knowledge and insights from data in order to investigate business/operational problems through a range of data preparation, modeling, analysis, and/or visualization techniques. Essential Functions * Collects, monitors and analyzes Medicare Advantage and D-SNP Claims reporting to ensure timeliness, accuracy and compliance internally to support decisions on day-to-day operations, strategic planning, and/or specific business performance issues. * Reviews, tracks, and communicates key performance indicators (KPIs) related to regulatory compliance, timeliness, and accuracy. * Performs data validation of source-to-target data for data visuals and dashboards. * Creates and updates claim reports. * Collates, models, interprets, and analyzes data. * Identifies trends and explains variances and trends in data, recommends actions, and escalates to leaders as appropriate. * Identifies and documents enhancements to modeling techniques. * Completes thorough quality assurance procedures, ensuring accuracy, reliability, trustworthiness, and validity of work. * Provides audit support, both internal and external, which includes supporting the monthly Claims Compliance Monitoring and Organization Determination, Appeals, and Grievances (ODAG/ODR) reporting processes for all Medicare Advantage and D-SNP contracts. * Works closely with internal departments, including but not limited to Enrollment, Customer Service, Reimbursement Strategy, Benefits, Product, Configuration, IT, and Digital Services to ensure seamless coordination and integration for claims data analysis. * Collaborate with vendor partners to monitor and analyze claims reporting. * Identifies operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member and provider satisfaction. * Assist with the implementation and management of new medical health plan products or changes to existing plans. * Support the creation and maintenance of medical health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements. * Performs other duties as assigned * Complies with all policies and standards Qualifications Education * Bachelor's Degree required; experience can be substituted for degree Experience * At least 2-3years of medical claims processing and/or data analysis within the health insurance or healthcare industry experience required * Medicare experience required. * Massachusetts Medicaid experience required. Knowledge, Skills, and Abilities * Healthcare knowledge, particularly as it pertains to medical claims processing data, is preferred but not required. * Working knowledge of relational databases, SQL, Power BI, data visualization, and business intelligence tools such as Tableau. * Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred. * Project management skills and/or experience are a plus. * Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint. Additional Job Details (if applicable) Working Conditions * This is a remote role that can be done from most US states * This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 5:00 pm Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $62.4k-90.8k yearly Auto-Apply 16d ago
  • Benefit and Claims Analyst

    Highmark Health 4.5company rating

    Claim processor job in Boston, MA

    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
    $21.5-32.3 hourly 34d ago
  • Senior Claim Benefit Specialist

    CVS Health 4.6company rating

    Claim processor job in Massachusetts

    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 Summary** Reviews 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 Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This 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 ***************************************** We anticipate the application window for this opening will close on: 02/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
    $18.5-42.4 hourly 7d ago
  • Outside Property Claim Representative

    Travelers Insurance Company 4.4company rating

    Claim processor job in Plymouth, MA

    **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $67,000.00 - $110,600.00 **Target Openings** 1 **What Is the Opportunity?** Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in Southeastern, South Shore and Cape Cod areas of Massachusetts . The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + General knowledge of estimating system Xactimate. + Two or more years of previous outside property claim handling experience. + Interpersonal and customer service skills - Advanced. + Organizational and time management skills- Advanced. + Ability to work independently - Intermediate. + Judgment, analytical and decision making skills - Intermediate. + Negotiation skills - Intermediate. + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate. + Investigative skills - Intermediate. + Ability to analyze and determine coverage - Intermediate. + Analyze, and evaluate damages -Intermediate. + Resolve claims within settlement authority - Intermediate. + Valid passport. **What is a Must Have?** + High School Diploma or GED. + One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. + Valid driver's license. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .
    $67k-110.6k yearly 8d ago
  • Outside Property Claim Representative - Plymouth, MA

    Msccn

    Claim processor job in Plymouth, MA

    ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $67,000.00 - $110,600.00 What Is the Opportunity? Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in Southeastern, South Shore and Cape Cod areas of Massachusetts . The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory. What Will You Do? Handles 1st party property claims of moderate severity and complexity as assigned. Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May provides mentoring and coaching to less experienced claim professionals. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. Perform other duties as assigned. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's Degree. General knowledge of estimating system Xactimate. Two or more years of previous outside property claim handling experience. Interpersonal and customer service skills - Advanced. Organizational and time management skills- Advanced. Ability to work independently - Intermediate. Judgment, analytical and decision making skills - Intermediate. Negotiation skills - Intermediate. Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate. Investigative skills - Intermediate. Ability to analyze and determine coverage - Intermediate. Analyze, and evaluate damages -Intermediate. Resolve claims within settlement authority - Intermediate. Valid passport. What is a Must Have? High School Diploma or GED. One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. Valid driver's license. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
    $67k-110.6k yearly 6d ago
  • Insurance Claim Analyst

    Knitwellgroup

    Claim processor job in Hingham, MA

    About us Talbots is a leading omni-channel specialty retailer of women's clothing, shoes and accessories. Established in 1947, we are known for modern classic style that's both timeless and timely, fine quality craftsmanship and gracious service. At Talbots relationships are the key to our business, we hire individuals who bring new ideas to the table, understand smart risk taking and can enhance an already thriving culture. With a commitment to offer modern classic style for every body type, through a full range of sizes, inclusive to every woman in your life. Insurance Claim Analyst - KnitWell Group About the role Working as part of an integrated strategic claims oversight team, this position is responsible for administering the Company's casualty claims processes (workers comp, general liability & auto), while assisting in the identification and assessment of related exposures/risks. The impact you can have Operational effectiveness of claims process and strategy across workers comp, general liability and auto claims. Develop and maintain strong partnerships with peers across the organization and primary contact for internal and external contacts on all casualty claims. Recommend and help to maintain day-to-day claim processes that drive Insurer/TPA performance. Monitors compliance with company policy regarding loss-reporting and claim handling standards and works collectively with Asset Protection to identify non-compliant reporting trends and drive improved reporting across field, DC and office locations. Monitors all open claims for proper reserving and adjuster performance and assist the Sr. Mgr. of Claims with achieving optimal claim service deliverables and working claims toward final resolution. Monitors claim frequency and/or severity within locations and communicates concerns across the Insurance, Store Facilities and Asset Protection Teams. Assist Mgr of Occ Health with the tracking and documentation of disability periods associated with workers comp claims in the internal rmis system. Assist with tracking and documentation of information required for the Y/E Dept of Labor/Osha recordkeeping process. Track and document litigation data in rmis system. Provides back-up to Sr. Claim Manager on all claim related invoicing. Performs with an eye toward timeliness and sense of urgency. Adapts well to and initiates change. You'll bring to the role Experience in the insurance industry as an adjuster or in a corporate insurance capacity a plus Strong written and oral communication skills necessary Proficient in Excel Knowledge of Oracle and SAP a plus Knowledge of insurance or workers comp terminology and concepts a plus Benefits You will be eligible to receive a merchandise discount at select KnitWell Group brands, subject to each brand's discount policies. Support for your individual development plus opportunities for career mobility within our family of brands. A culture of giving back - local volunteer opportunities, annual donation and volunteer match to eligible nonprofit organizations, and philanthropic activities to support our communities.* Medical, dental, vision insurance & 401(K).* Employee Assistance Program (EAP). Time off - paid time off & holidays.* The target salary range for this role is: $67,000 - 75,000* *Any job offer will consider factors such your qualifications, relevant experience, and skills. Eligibility of certain benefits and associate programs are subject to employment type and role. This position works in a hybrid model, with required days worked in the Talbots office location in Hingham, MA as defined by business needs. Applicants to this position must be authorized to work for any employer in the US without sponsorship. We are not providing sponsorship for this position. #LI-MJ1 Location: Hingham Corporate OfficePosition Type:Regular/Full time Equal Employment Opportunity The Company is an equal opportunity employer and welcomes applications from diverse candidates. Hiring decisions are based upon a candidate's qualifications as they relate to the requirements of the position under consideration and are made without regard to sex (including pregnancy), race, color, national origin, religion, age, disability, genetic information, military status, sexual orientation, gender identity, or any other category protected by applicable law. The Company is committed to providing reasonable accommodations for job applicants with disabilities. If you require an accommodation to perform the essential duties of the position you are seeking or to participate in the application process, please contact my ***************************. The Company will make reasonable accommodations for otherwise qualified applicants or employees, unless such accommodations would impose an undue hardship on the operations of the Company's business. The Company will not revoke or alter a job offer based on an applicant's request for reasonable accommodation.
    $67k-75k yearly Auto-Apply 52d ago
  • Claims Specialist - Massachusetts

    Corvel Career Site 4.7company rating

    Claim processor job in Massachusetts

    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote
    $51.8k-83.6k yearly 36d ago
  • Analyst, Claims

    East Boston Neighborhood Health Center Corporation 4.5company rating

    Claim processor job in Revere, MA

    Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center! As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities. Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly - every role at NeighborHealth is vital. Together, we're advancing medicine and delivering the best care experience for our patients and community! Interested in this position? Apply online and create a personal candidate account! Current Employees of NeighborHealth- Please use our internal careers portal to apply for positions. To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page. Time Type: Full time Department: PACE Health Plan Management All Locations: 300 Ocean Avenue - Revere Position Summary: Position Summary: The Claims Analyst, under the direction of the Manager of PACE Claims, is responsible for the overall claims adjudication and insurance validation process. This includes: Claims Department: • Maintaining up-to-date knowledge of fee schedules for both Medicare and MassHealth. • Ensuring the fee schedules are updated and are priced correctly in the Tapestry module. • Auditing adjudicated claims to ensure payments are made in accordance with their contracts. • Analyzing claims data to ensure accruals are reported to Finance in a timely and accurate manner. • Ensuring accuracy of claims-related cost reports. • Analyzing claims data for trends (e.g., referral matching). • Reporting any findings to PACE leadership. • Coordinating with IT to enhance and refine the claims adjudication process. • Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to provide utilization reports to other departments. Insurance Department: • Must maintain up-to-date knowledge of Coordination of Benefits. • In conjunction with the Supervisor of Business Services, responsible for assisting with and developing workflows to maintain overall compliance of the Insurance Department. Schedule: Monday - Friday 8:00am - 5:00pm Insurance Department Serves as the department Medicare expert. This includes auditing enrollment files to ensure compliance with the Part D requirements: EOBs, COB follow-up is completed timely and accurately, as well as documentation in EPIC regarding MSP surveys and TrOOP. Ensures primary insurance coverage is documented in EPIC and that insurance billing is appropriate. Responsible for the timely completion and documentation of CMS Part D reports: COB, MSP. Serves as back-up for Business Services Supervisor. Expense Management/Claims Monitors monthly expense reports to ensure that all expenses are correctly categorized and reported. Oversees the referral authorization process as it relates to timely and accurate claims payment and improvements to utilization management. Responsible for maintaining up-to-date knowledge of fee schedules and works with IT to ensure timely upload into Tapestry. Coordinates with the Manager of PACE Claims in an effort to improve the processes to manage claims payment and expenses based on trends analysis. Acts as the department claims expert regarding adjudication. Audits claims work queues to ensure timely and appropriate payment to vendors; suggests process improvements (e.g., referral matching table edits). Coordinates with Finance to ensure appropriate accruals on a monthly basis. Reviews IBNR data with Finance in an effort to ensure all claims are received. Works closely with the Contracts Department to review reimbursement. Information Technology Serves as a liaison with IT, specifically regarding Tapestry (fee schedule development, claims processing, referrals) and reports and workflows related to ESP (Elder Service Plan) Business Office processes. Other Duties Regularly reports to work on time and follows attendance and call-in procedures. Works cooperatively and respectfully with others at all levels of the organization. Takes the initiative to perform a wide variety of activities and be flexible in terms of work assignments based on operational needs, contributing to the smooth functioning of the department. Displays outstanding customer service skills when interacting with all NH customers according to the PACE model. Creates and/or revises policies and procedures, workflows, and guidelines, as appropriate, in any respective areas under the Business Office or as requested by Manager. Other duties as required. PACE AND GENERAL REQUIREMENTS: KNOWLEDGE, SKILLS AND ATTITUDES (This section not applicable to initial assessment; all ESP employees and contractors attain these competencies through participation in PACE and TJC orientation programs.) Demonstrates commitment to the PACE mission by actively promoting the autonomy and dignity of PACE program participants. Demonstrates commitment to a holistic approach to care by actively engaging in interdisciplinary team planning and communication processes. Demonstrates commitment to participant-centered care by actively engaging participants and/or Health Care Proxies in discussion about self-management goals. Understands ESP's organizational structure. Actively participates in NH programs and committees. Demonstrates the ability to communicate effectively and respectfully through verbal and written skills. Documents in accordance with protocol. Demonstrates knowledge of Participant Rights by: actively protecting rights to privacy; always treating participants with respect; encouraging and assisting participants in filing of complaints and grievances; helping to maintain a clean and safe environment; helping to ensure that restraint and involuntary seclusion are never used as a means of coercion, discipline, punishment, retaliation, or for the convenience of staff; and that those restraints, when required by extraordinary circumstance, are always applied and monitored in accordance with policy/procedure. Promotes a sense of “teamwork” through demonstration of self-direction and self-motivation. Solves problems independently or knows when to seek consultation. Provides leadership to other support staff on the practice team. Works cooperatively and respectfully with others at all levels of the organization. All ESP employees participate in the orientation, training, and mentoring of new employees and in providing input for continuous improvement. Displays outstanding customer service skills when interacting with ESP participants, family members, outside providers, potential ESP members, referral sources, or others. Interacts with participants in a professional and respectful manner that reflects the needs and concerns of the individual. Maintains a positive attitude. Uses communication devices appropriately. Demonstrates commitment to performance improvement by reporting incidents and other data used in ESP Performance Improvement activities, and by actively participating in one or more performance improvement committees or making a minimum of two suggestions for program or other improvements over the course of the year. Responsible for continued professional growth and development. Pay Range: Starting at $26/hr up to $39/hr based on experience EEO & Accommodation Statement: NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to **************************** or call ************ to let us know the nature of your request Federal Trade Commission Statement: According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or “apps.” Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment. E-Verify Program Participation Statement: NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.
    $26-39 hourly Auto-Apply 21d ago
  • Stop Loss & Health Claim Analyst

    Sun Life Financial 4.6company rating

    Claim processor job in Wellesley, MA

    Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026
    $54.9k-82.4k yearly Auto-Apply 11d ago
  • Employment Practice Liability Claim Manager

    Questor Consultants, Inc.

    Claim processor job in Boston, MA

    Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.
    $45k-119k yearly est. 25d ago

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