Innovairre - WE HELP PEOPLE WHO HELP PEOPLE We make great things happen for some of the world's most vibrant organizations. We are the worldwide leader in non-profit fundraising. The company serves more than 500 marketing agencies, non-profit organizations, and commercial clients, with 4000+ employees working across five different continents and 28 countries around the world. Our direct marketing services deliver results utilizing our in-house production, design capabilities, data and digital expertise, and fully integrated approach producing timely and cost-efficient direct mail packages for our worldwide clients.
Location: 528 Route 13, Milford, NH 03055
See what our Milford New Hampshire employees have to say about our Donation Processing Business!
Mailroom Clerk/Donation Processor:
Do you like working in a fast-paced, production/office-like environment without the stress of being on your feet!? We currently have multiple openings pat time 1st shift. Work supporting nonprofit organizations in our Milford, NH office.
Benefits include paid time off, as well as paid holidays.
We currently have the following hours available:
Full time (2nd Shift) 4:00pm-12:00am
We will train you, no experience needed!
Responsibilities:
Opens and scans mail that comes in from our nonprofits.
Learns and operates a Mail Opening Machine - on the job training! Easy to learn!
Reports mail issues and/or equipment problems to your supervisor.
Maintains accurate piece count and reports daily to the supervisor.
Meets production goals effectively to satisfy the deadlines of our clients while upholding a high level of quality and commitment to Innovairre.
EEO Statement
We are an equal opportunity employer. We recruit, employ, train, compensate, and promote regardless of race, religion, color, national origin, sex (including pregnancy and gender identity), sexual orientation, transgender status, disability, age, family or marital status, genetic information, military or veteran status, and other protected status as required by applicable law. At our Company, we have a clear vision: to foster and maintain a supportive and cooperative workplace that celebrates uniqueness and advances equity. We pride ourselves on helping people help people, and we know our company runs on the hard work and dedication of our passionate and creative employees. Diversity, Equity, and Inclusion is more than a commitment at our Company--it is in everything that we do.
Benefits
We are an equal opportunity employer. We recruit, employ, train, compensate, and promote regardless of race, religion, color, national origin, sex (including pregnancy and gender identity), sexual orientation, transgender status, disability, age, family or marital status, genetic information, military or veteran status, and other protected status as required by applicable law. At our Company, we have a clear vision: to foster and maintain a supportive and cooperative workplace that celebrates uniqueness and advances equity. We pride ourselves on helping people help people, and we know our company runs on the hard work and dedication of our passionate and creative employees. Diversity, Equity, and Inclusion is more than a commitment at our Company--it is in everything that we do.
$28k-38k yearly est. 5d ago
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Claims Examiner
Harris 4.4
Claim processor job in New Hampshire
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-74k yearly est. Auto-Apply 17d ago
Claims Examiner
Harriscomputer
Claim processor job in New Hampshire
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-58k yearly est. Auto-Apply 17d ago
Claim Examiner I
Amtrust Financial Services, Inc. 4.9
Claim processor job in Nashua, NH
AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Claims Adjuster I - WC. The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker's compensation insurance claims through effective research, negotiation and interaction with insures, and claimants, ensuring that company resources are utilized in a cost-effective manner in the process.
Responsibilities
Thoroughly investigating workers' compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable workers' comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans.
Reviewing and analyzing medical bills to confirm charges and treatment are workers' comp injury-related and in accordance with the treatment plan.
Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute
Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
Consult with attorneys regarding litigation management, settlement strategy and claim resolution
Qualifications
3+ years Workers Comp experience in New England States, preference Massachusetts or Connecticut. (NH, MA, NY, NJ, RI, or CT)
Licenses in NH, VT and RI
MS Office experience (Work, Excel, Outlook)
Effective negotiation skills
Strong verbal and written communication skills
Ability to prioritize work load to meet deadlines
Ability to manage multiple tasks in a fast-paced environment
This is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.
#LI-GH1
#LI-HYBRID
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Not ready to apply? Connect with us for general consideration.
$41k-59k yearly est. Auto-Apply 1d ago
Injection Mold Processor - 3rd Shift
Oatey 4.3
Claim processor job in Winchester, NH
75 Plumb Pak Drive, Winchester, New Hampshire 03470 United States of America **Why Oatey?** Since 1916, Oatey has provided reliable, high-quality products for the residential and commercial plumbing industries, with a commitment to delivering quality, building trust and improving lives. Today, Oatey operates a comprehensive manufacturing and distribution network comprised of industry leading family of companies: Oatey, Cherne, Keeney, Quick Drain, Hercules, Dearborn, Oatey Canada, William H. Harvey, Masters, Contact, Belanger, Lansas, and Durgo.
At Oatey, we're doing big things - and by joining us, you'll have the chance to do big things too. You can build a strong career in an innovative, inclusive, high-performance environment, with the confidence that your company cares - about you, our customers and our world. Ready to make an impact in a place where you matter?
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**Position Summary:** This position is responsible for the safe, accurate, and timely set-up, processing improvements, and troubleshooting of plastic injection molds, tooling and equipment (including auxiliary equipment) operation while ensuring that safety, quality and productivity goals are achieved on a daily basis.
**Position Responsibilities:**
+ Set-up molds, related tooling and equipment according to daily production schedules; verify equipment is running at required cycle time within specs and quality level prior to releasing for production.
+ Ensure tools and material are returned to proper locations before leaving workstation.
+ Issue and close work orders for maintenance and process activities.
+ Inspect and repair process equipment for potential problems and advise tool room of issues.
+ Perform routine preventative maintenance on equipment, keeping all in working order.
+ Work with suppliers and contractors to purchase required parts for servicing equipment.
+ Support other departments as needed.
+ Maximize communication flow for effective performance within the department and between shifts.
+ Follow all safety procedures in completion of job duties. Verify all safety-related devices, machine guarding, signage, etc. are in place and functioning prior to releasing equipment for production. Wear required PPE.
+ Participate in 6S events. Sustain 6S standards through good housekeeping and execution of standard work including knowledge of lock out, tag out procedures.
+ Perform first piece inspection and provide QA Tech part for approval after mold changeover.
+ Troubleshoot equipment processing problems related to product quality.
+ Complete all required production and quality assurance documentation.
+ Evaluate, recommend and execute continuous improvement suggestions to improve operating efficiency.
+ Utilize LEAN Thinking in formal and informal settings including participating in LEAN Events (Value Stream Mapping, Kaizen, Projects, Just-Do-It), submitting Suggestions, attending LEAN Training, and improving work cell/areas of responsibility daily.
+ Use visual tools and display boards and update them as appropriate.
+ Document all changes resulting from LEAN activities according to ISO guidelines.
+ Accept/embrace change for continuous improvement.
+ Establishes and maintains effective working relationships with co-workers by willingness to take on additional responsibility and/or support.
+ Substitute and back-up production line positions if and when necessary.
+ During 30-minute overlap clean-up workstation, supply next shift with materials needed, communicate issues & concerns for oncoming shift.
+ Other duties as assigned.
**Knowledge and Experience:**
+ One (1) to three (3) years of industrial manufacturing experience.
+ Tow motor, scissor lift and crane certification will be necessary within sixty (60) days.
+ Basic computer skills needed with solid understanding of equipment and mechanical aptitude.
+ Good organizational skills with strong attention to detail required.
+ Ability to work in fast-paced environment and meet operational deadlines.
+ Flexibility and dependability required to meet operational demands of 24-hour operation.
+ Knowledge of lockout/tagout, machine guarding and applicable OSHA/Oatey safety standards.
**Education and Certification:**
+ High School Diploma or equivalent preferred.
**Oatey Total Rewards**
+ Generous paid time off programs and paid company holidays to support flexibility and work-life balance
+ Annual Discretionary Cash Profit Sharing
+ Immediate eligibility and vesting in 401(k), including 100% company match, up to 5% of eligible compensation
+ Market leading health insurance including medical, dental, vision, and life insurance offerings for associates and qualified dependents
+ Significant company contribution to Health Savings Account with a High Deductible Health Plan (HDHP)
+ Short-Term and Long-Term Disability income protection coverage at no cost to associates
+ Paid Maternity and Paid Parental Leave
+ Tuition reimbursement
+ A strong set of complementary resources to support associate well-being, including resource groups, EAP, and dedicated mental health support.
**Equal Opportunity Employer**
The Oatey family of companies are an equal opportunity employer committed to Diversity, Equity, and Inclusion. We recruit, employ, promote, and offer competitive pay for all jobs without regard to race, color, creed, religion, sex, age, national origin, disability, sexual orientation, or any other characteristic protected by law.
At Oatey we are committed to help our Associates grow their career. Apply today and grow with Oatey!
$33k-39k yearly est. 60d+ ago
Benefit and Claims Analyst
Highmark Health 4.5
Claim processor job in Concord, NH
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 17d ago
Branch Claims Clerk
Concord General Mutual Insurance Company 4.5
Claim processor job in Bedford, NH
This position is responsible for assisting the Claims Department with servicing and processing of policyholder claims. The purpose of this position is to provide clerical support to help ensure claims resolve accurately and timely.
Responsibilities
Demonstrate customer service skills and managing FNOL intake
Managing a high volume of incoming calls
Scanning and indexing claim file documentation
Ability to multitask in a fast-paced environment
Ability to learn basic insurance fundamentals
Other related duties as assigned by supervisor
Requirements
High school diploma or GED required
General clerical skills
Professional telephone manner
Excellent interpersonal and organizational skills
Proficient in a PC Windows environment
Demonstrate experience in Microsoft Excel
Accuracy in spelling and grammar
Ability to work together in a team setting on shared tasks
Experience working in a paperless environment preferred
Benefits
At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness.
Why Concord Group Insurance
Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont.
At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do.
Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve.
Compensation
We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities.
Equal Employment Opportunity
The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state, or local law.
The Concord Group participates in E-Verify.
$33k-40k yearly est. Auto-Apply 11d ago
Billing Claims Specialist
Reliable Respiratory 3.9
Claim processor job in Merrimack, NH
Equal Opportunity Employer/Disability/Veterans
Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.
Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.
The Billing C laims Specialist focuses on claims and procurement of authorizations and medical documentation to ensure Reliable is reimbursed in accordance with the procedures provided. This position reports to the Billing Manager, but will perform duties that pertain to customer service, documentation retrieval, medical billing and coding, and reimbursement. The primary purpose of this position is to identify reasons for claim denials and take all corrective action to resubmit the claim and obtain full reimbursement for the services rendered. Additional duties include:
Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services.
Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures).
Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins)
Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice
Issue invoices and bills and send them to customers through various channels (mail, e-mail etc.)
Receive payments through various methods (cash, online payments etc.) and check for credibility.
Answer questions and handle complaints from customers and payors regarding claims
Reconcile deposits and invoices posted.
Basic Qualifications
18 years of age or older
Must be eligible to work in the United States and not require work authorization from us now or in the future
Bachelor's Degree required
At least 2 years of medical billing, coding, reimbursement or health insurance experience preferred
Required Skills
Strong health insurance knowledge of New England payers and Massachusetts ACO plans
Proficient in obtaining authorizations in the most efficient manner (portal, fax form, phone in submission)
Ability to learn Billing functions and be adaptable to the needs of the position.
Strong interdepartmental communication
Effective and professional verbal and written communication abilities
Professional computer experience (especially Microsoft Office Suite)
Ability to investigate problems and make decisions independently.
Strong analytical skills
Competencies
Computer skills
Interpersonal skills
Product expertise
Communication skills
Results driven
Conflict management
Customer service
Organizational skills
Work Environment & Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
This role routinely uses standard office equipment such as computers, phones, and printers/scanners
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
This job operates in a professional office environment
The noise level in the work environment is usually moderate to loud
Direct Reports - None
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.
$38k-67k yearly est. Auto-Apply 6d ago
Senior Claims Analyst
Riverstone Resources 4.7
Claim processor job in Manchester, NH
Job Title
Senior Claims Analyst
Reporting the Unit Manager, this role will be responsible for direct handling of multi-line commercial claims with a focus on New York Labor Law. Duties include investigation and evaluation of coverage, liability and damages issues. The role will be responsible for claim evaluation, establishment/recommendation of adequate reserves, litigation management, case resolution and transaction processing in alignment with the Company's and Client's Strategic Vision.
Essential Functions
In addition to the essential functions of a Complex Claim Analyst, the Senior Claim Analyst handles more complex cases and/or industry specific cases that include higher exposure with an increase in severity and complexity.
Mastery of the Complex Claim Analyst functions and Company's and Client's systems.
Anticipates and identifies risks and opportunities on coverage and liability.
Mentors and guides less experienced claim analysts.
Assists the Unit Manager with departmental problem solving.
Manage external relationships including third party administrative oversight.
Serves on Companywide committees and projects assigned.
Directly handles and/or assists in monitoring, reviewing, and coordinating the activities involving commercial and personal lines insurance claims, including analysis of coverage issues, establishment of adequate reserves, and the resolution and closure of claims.
Reviews loss notices; confirms and interprets policy coverage; establishes adequate reserves; and investigates and handles claims involving primary, umbrella and excess policies.
Manages litigation with Preferred Counsel under Alternative Fee Arrangements or other defense fee structures.
Pursues and maximizes all risk transfer opportunities by contract or by insurance policy language.
Assigns and manages work of defense counsel, assignment of expert witnesses and interfacing with peer carriers including design and execution of defense and indemnity contracts, evaluation of liability and damages and participation in settlement negations.
Ensures proper file setup, reserving, general handling and application of company procedure.
Participates in developing claims handling strategies, including defense coordination, litigation strategy and budgets, and expense control.
Records specific claims information and reports as appropriate to a manager relative to pertinent financial and general statistical records.
Maintains diary control, investigates, analyzes, and reports to ensure maintenance of proper reserves to reflect the company's exposure and reports to our Reinsurance Department to assist in providing notice to reinsurers and the Reinsurance Department's recovery of specific amounts when payment exceeds the company's retention.
Handles large volume of diverse and dynamic claims effectively.
Empowered to make decisions within job description and authority. Seeking guidance where appropriate.
Develop creative ideas and solutions to real-time business problems and /or business opportunities; Takes reasonable, calculated risks even if failure is possible.
Empowers self and teammates to continuously improve Company's business processes/systems and develops and escalates ideas and solutions.
Seeks continuous development by identifying areas for growth and improvement. Works with team to implement process and technical improvements.
Consistently delivers superior customer service to both internal and external business partners.
Understands Key Performance Indicators and manages towards those priorities.
Perform special projects and assignments related to area of authority as necessary.
Maintains confidentiality.
Establishes and maintains professional relationships.
Assists in Due Diligence inquiries as assigned.
Obtains and maintains claims adjuster licenses in those states requiring them.
Experience
Minimum of 5 years of claims handling experience or a related field.
Required Education
Four-year college degree required or equivalent work experience.
Preferred Education or Certification
JD, CPCU, SCLA, CCLA
Supervisory Role
Schedule, assign, and review the work of others in compliance with specific instructions.
Travel
As required, based upon business needs.
Work Environment / Physical Demands
This position operates in a professional based collaborative environment and must have the ability to timely produce thorough, accurate work with many competing demands, deadlines, and distractions. The position uses standard equipment such as phones, computers, copiers/printers and filing cabinets. Noise level is moderate.
Diversity, Equity, Inclusion & Belonging
RiverStone Resources, LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, LGBTQ+, national origin, gender identity, disability, protected veteran status, or any other characteristic protected by law.
Privacy Notice for California Residents
https://www.trg.com/california-consumer-privacy-notice/
$103k-125k yearly est. 9d ago
SIU / Claims Investigator
Security Director In San Diego, California
Claim processor job in Salem, NH
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.
Will require Claims and Surveillance investigations as needed to ensure a full schedule
Must possess a valid driver's license with at least one year of driving experience
RESPONSIBILITIES:
Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance
Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed
Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct
Run appropriate database indices if necessary and verify the accuracy of results found
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.
Proficient in utilizing laptop computers and cell phones.
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
Familiarity with California SIU regulations
One or more of the following professional industry certifications:
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID 2025-1502906
$46k-57k yearly est. Auto-Apply 11d ago
SIU / Claims Investigator
Allied Universal Compliance and Investigations
Claim processor job in Salem, NH
Overview
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.
Will require Claims and Surveillance investigations as needed to ensure a full schedule
Must possess a valid driver's license with at least one year of driving experience
RESPONSIBILITIES:
Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance
Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed
Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct
Run appropriate database indices if necessary and verify the accuracy of results found
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.
Proficient in utilizing laptop computers and cell phones.
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
Familiarity with California SIU regulations
One or more of the following professional industry certifications:
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID
2025-1502906
$46k-57k yearly est. 11d ago
Outbound Processor FFI
Littleton Coin Company 4.1
Claim processor job in Littleton, NH
Outgoing Order Fulfillment, Littleton, NH
Accurately and efficiently select and organize product for customer orders, and pack for shipment, while strongly focusing on customer service.
About our company: now 100% employee owned with a successful 74 year history, Littleton Coin Company is one of the largest direct response companies in the nation to sell coins, paper money and supplies to enthusiastic collectors. We are also one of the largest employers in Northern New Hampshire. We offer competitive pay and great benefits, including a 401(k) plan with up to a 6% match, Employee Stock Ownership Plan, onsite wellness programs and a friendly, pleasant work environment. Position is located at company headquarters in Littleton, NH.
In this fast-paced, important evening-shift position, you'll accurately process and select items from our inventory to fill customer orders. You'll then package the orders for shipment. Training will be provided. Primary responsibilities include:
Efficiently and accurately selecting items from inventory
Packaging orders for shipment (including those items needing special packaging)
Replenishing product on a daily basis
Operating computer-based systems to scan and return product to inventory
Performing within established quality and production standards
Qualified applicant will have:
High school diploma or equivalent
Knowledge of basic math
Ability to work in a team environment
Ability to lift up to 35 pounds, more with assistance
Good eyesight and number perception
Flexibility to bend and stretch, perform repetitive tasks using shoulders, elbows and wrists
Ability to work overtime as needed
Able to climb ladders and work at slightly elevated levels
$29k-36k yearly est. 21d ago
Claims Representative (IAP) - Workers Compensation Training Program
Sedgwick 4.4
Claim processor job in Concord, NH
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative (IAP) - Workers Compensation Training Program
Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
+ A stable and consistent work environment in an office setting.
+ A training program to learn how to help employees and customers from some of the world's most reputable brands.
+ An assigned mentor and manager who will guide you on your career journey.
+ Career development and promotional growth opportunities through increasing responsibilities.
+ A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs.
**PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due.
**ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field.
**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**
+ Attendance and completion of designated classroom claims professional training program.
+ Performs on-the-job training activities including:
+ Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims.
+ Adjusting low and mid-level liability and/or physical damage claims under close supervision.
+ Processing disability claims of minimal disability duration under close supervision.
+ Documenting claims files and properly coding claim activity.
+ Communicating claim action/processing with claimant and client.
+ Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
+ Participates in rotational assignments to provide temporary support for office needs.
**QUALIFICATIONS**
Bachelor's or Associate's degree from an accredited college or university preferred.
**EXPERIENCE**
Prior education, experience, or knowledge of:
- Customer Service
- Data Entry
- Medical Terminology (preferred)
- Computer Recordkeeping programs (preferred)
- Prior claims experience (preferred)
Additional helpful experience:
- State license if required (SIP, Property and Liability, Disability, etc.)
- WCCA/WCCP or similar designations
- For internal colleagues, completion of the Sedgwick Claims Progression Program
**TAKING CARE OF YOU**
+ Entry-level colleagues are offered a world class training program with a comprehensive curriculum
+ An assigned mentor and manager that will support and guide you on your career journey
+ Career development and promotional growth opportunities
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$31k-40k yearly est. 11d ago
Records Processor
Primetime Research
Claim processor job in Manchester, NH
Are you looking for a great opportunity in a culture that truly values its employees? Come join our team!
PT Research, Inc., is one of the nation's leading providers of pre-employment criminal and civil court research services. Our data is used by thousands of employers across the country to make swift, educated hiring decisions.
We recognize that our success is entirely due to our talented workforce. We reward hard work and loyalty with a competitive starting salary, comprehensive benefits package, 401K with a generous employer contribution, and a welcoming work environment.
We are looking for a few people that will learn to do the following:
Conduct internet-based research to complete criminal background checks and various public records searches.
Review and analyze criminal and civil searches, sex offender searches, and motor vehicle record searches identifying key information and entering it into a common format
Organize assigned work to be completed in priority order, within an assigned time frame.
Communicate with Vendors, Local Courts, and Government Agencies to obtain needed information to ensure accurate results are reported to Clients
Monitor pending work levels to ensure timely completion of Client background reports
Maintain Strict Quality Standards.
Ensure client guidelines are followed.
Contribute to the team effort by accomplishing additional related tasks as needed.
To be successful in this role, the ideal candidate must have the following skills:
Excellent written communication skills (spelling/grammar)
Demonstrated ability to complete sequential tasks in an efficient and accurate manner
Ability to work in a fast-paced atmosphere with a fluctuating workload
Work independently and/or in a team environment as needed
Data entry/word processing skills and a high degree of comfort navigating the internet and using web-based applications
Typing/keyboarding skills of at least 35-45 words/minute
$28k-38k yearly est. 60d+ ago
Processor
Pitco Frialator LLC 3.4
Claim processor job in Bow, NH
Job DescriptionDescription:
Located conveniently at the 89 & 93 junction in Bow, NH Pitco manufactures some of the best commercial restaurant equipment available in the market. Pitco began in 1918 and continues to grow and expand. Part of the Middleby Corporation, Pitco Brands are engineered and manufactured under one roof bringing top of the line fryers, pasta cookers and rethermalizers to customers around the globe. From your favorite local haunt to the largest global chain restaurant, our products are beloved for their innovation, ease of use and reliability.
1st Shift: 5:00am-2:30pm Monday-Friday $18.00/hour
2nd Shift: 2:30pm-12:00am Monday-Friday $18.00/hour plus $3.00/hour shift differential
Monday-Friday with overtime, including Saturdays may be worked regularly and are an expectation of employment.
This is an entry level position.
This position is located in the welding or sheet metal department. Responsibilities are as follows.
Grinding, re-graining, buffing, and finishing commercial cooking equipment for any one of the processing stations.
Stamping flat material using a brake press for the welding department.
Painting a heat resistant coating on the inside of burner tubes.
Spot welding of copper studs onto finished tanks.
Operating a manual blast cabinet.
Acid washing welded parts to give the material a uniform finish without any heat marks or weld imperfections.
Maintain clean and safe work area.
Requirements:
While performing the duties of this job, the employee is regularly required to walk; sit; talk; hear; use hands to finger, handle, or feel. The employee must also be able to stand in one position and move their body, from the waist up, for increments of up to one hour consistently. The employee is frequently required to stand and reach with hands and arms. The employee must occasionally lift and/or move up to 50 pounds at a time, with or without mechanical aids, with frequent lifting or carrying of objects weighing up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
*This is a safety sensitive position therefore a drug test is a requirement of employment.
$18 hourly 31d ago
Injection Mold Processor - 3rd Shift
Oatey Supply Chain Services 4.3
Claim processor job in Winchester, NH
75 Plumb Pak Drive, Winchester, New Hampshire 03470 United States of America
Why Oatey?
Since 1916, Oatey has provided reliable, high-quality products for the residential and commercial plumbing industries, with a commitment to delivering quality, building trust and improving lives. Today, Oatey operates a comprehensive manufacturing and distribution network comprised of industry leading family of companies: Oatey, Cherne, Keeney, Quick Drain, Hercules, Dearborn, Oatey Canada, William H. Harvey, Masters, Contact, Belanger, Lansas, and Durgo.
At Oatey, we're doing big things - and by joining us, you'll have the chance to do big things too. You can build a strong career in an innovative, inclusive, high-performance environment, with the confidence that your company cares - about you, our customers and our world. Ready to make an impact in a place where you matter?
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Position Summary: This position is responsible for the safe, accurate, and timely set-up, processing improvements, and troubleshooting of plastic injection molds, tooling and equipment (including auxiliary equipment) operation while ensuring that safety, quality and productivity goals are achieved on a daily basis.
Position Responsibilities:
Set-up molds, related tooling and equipment according to daily production schedules; verify equipment is running at required cycle time within specs and quality level prior to releasing for production.
Ensure tools and material are returned to proper locations before leaving workstation.
Issue and close work orders for maintenance and process activities.
Inspect and repair process equipment for potential problems and advise tool room of issues.
Perform routine preventative maintenance on equipment, keeping all in working order.
Work with suppliers and contractors to purchase required parts for servicing equipment.
Support other departments as needed.
Maximize communication flow for effective performance within the department and between shifts.
Follow all safety procedures in completion of job duties. Verify all safety-related devices, machine guarding, signage, etc. are in place and functioning prior to releasing equipment for production. Wear required PPE.
Participate in 6S events. Sustain 6S standards through good housekeeping and execution of standard work including knowledge of lock out, tag out procedures.
Perform first piece inspection and provide QA Tech part for approval after mold changeover.
Troubleshoot equipment processing problems related to product quality.
Complete all required production and quality assurance documentation.
Evaluate, recommend and execute continuous improvement suggestions to improve operating efficiency.
Utilize LEAN Thinking in formal and informal settings including participating in LEAN Events (Value Stream Mapping, Kaizen, Projects, Just-Do-It), submitting Suggestions, attending LEAN Training, and improving work cell/areas of responsibility daily.
Use visual tools and display boards and update them as appropriate.
Document all changes resulting from LEAN activities according to ISO guidelines.
Accept/embrace change for continuous improvement.
Establishes and maintains effective working relationships with co-workers by willingness to take on additional responsibility and/or support.
Substitute and back-up production line positions if and when necessary.
During 30-minute overlap clean-up workstation, supply next shift with materials needed, communicate issues & concerns for oncoming shift.
Other duties as assigned.
Knowledge and Experience:
One (1) to three (3) years of industrial manufacturing experience.
Tow motor, scissor lift and crane certification will be necessary within sixty (60) days.
Basic computer skills needed with solid understanding of equipment and mechanical aptitude.
Good organizational skills with strong attention to detail required.
Ability to work in fast-paced environment and meet operational deadlines.
Flexibility and dependability required to meet operational demands of 24-hour operation.
Knowledge of lockout/tagout, machine guarding and applicable OSHA/Oatey safety standards.
Education and Certification:
High School Diploma or equivalent preferred.
Oatey Total Rewards
Generous paid time off programs and paid company holidays to support flexibility and work-life balance
Annual Discretionary Cash Profit Sharing
Immediate eligibility and vesting in 401(k), including 100% company match, up to 5% of eligible compensation
Market leading health insurance including medical, dental, vision, and life insurance offerings for associates and qualified dependents
Significant company contribution to Health Savings Account with a High Deductible Health Plan (HDHP)
Short-Term and Long-Term Disability income protection coverage at no cost to associates
Paid Maternity and Paid Parental Leave
Tuition reimbursement
A strong set of complementary resources to support associate well-being, including resource groups, EAP, and dedicated mental health support.
Equal Opportunity Employer
The Oatey family of companies are an equal opportunity employer committed to Diversity, Equity, and Inclusion. We recruit, employ, promote, and offer competitive pay for all jobs without regard to race, color, creed, religion, sex, age, national origin, disability, sexual orientation, or any other characteristic protected by law.
$33k-39k yearly est. Auto-Apply 13d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Claim processor job in Concord, NH
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss Claims Analyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**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:**
$22.71
**Pay Range Maximum:**
$35.18
_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: J273755
$22.7-35.2 hourly 12d ago
Senior GL Claims Analyst
Riverstone Resources 4.7
Claim processor job in Manchester, NH
Job DescriptionSummaryReporting to the Unit Manager, this role will be responsible for direct handling of commercial claims specific to General Liability and/or Excess General Liability. Familiarity with SME (small to midsize enterprises) involving premises liability, including but not limited to lessor's risks, franchisees, hotels, and restaurants/entertainment, and some contractors and serving risks. Duties include investigation and evaluation of coverage, liability, risk transfer (i.e. indemnification and/or tender application), and damages issues. The role will be responsible for claim and coverage evaluation, establishment/recommendation of adequate reserves, litigation management, liability and damage analysis in detail, case resolution and best claims outcome, and transaction processing in alignment with the Company's and Client's Strategic Vision. Essential Functions
Direct handle commercial and business general liability claims.
Mentors and guides less experienced claim analysts.
Anticipates and identifies risks and opportunities on coverage and liability.
Anticipates and identifies transfer of risk, tender and/or indemnification.
Manage timely reporting of large losses and potential large loss exposures, coverage issues, time limit and policy limit demands, mediations, and pre-trial reports to Manager for distribution to internal and external clients
Directly handles and/or assists in monitoring, reviewing, and coordinating the activities involving commercial and/or personal lines insurance claims, including analysis of coverage issues, establishment of adequate reserves, and the resolution and closure of claims.
Reviews loss notices; confirms and interprets policy coverages; establishes adequate reserves; and investigates and handles claims involving primary, umbrella, and/or excess policies.
Manages litigation with Preferred Counsel under Alternative Fee Arrangements or other defense fee structures.
Pursues and maximizes all risk transfer opportunities by contract or by insurance policy language.
Assigns and manages of work of defense counsel, assignment of expert witnesses and interfacing with peer carriers including design and execution of defense and indemnity contracts, evaluation of liability and damages and participation in settlement negations.
Participates in developing claims handling strategy, including defense coordination, litigation strategy and budgets, and expense control.
Records specific claims information and reports as appropriate to a manager relative to pertinent financial and general statistical records.
Maintains diary control, investigates, analyzes, and reports to ensure maintenance of proper reserves to reflect the company's exposure and reports to our Reinsurance Department to assist in providing notice to reinsurers and the Reinsurance Department's recovery of specific amounts when payment exceeds the company's retention.
Obtains and maintains claims adjuster licenses in those states requiring them.
Required ExperienceMinimum of seven (7) years of commercial, business, and high value premises liability claims handling experience.Required EducationFour-year college degree required or equivalent work experience.Preferred Education or CertificationJD, CPCU, SCLA, CCLA, state(s) adjuster license, including New York.Supervisory RoleSchedule, assign, and review the work of others in compliance with specific instructions.TravelAs required, based upon business needs.Work Environment / Physical DemandsThis position operates in a professional based collaborative environment and must have the ability to timely produce thorough, accurate work with many competing demands, deadlines, and distractions. The position uses standard equipment such as phones, computers, copiers/printers and filing cabinets. Noise level is moderate. Company retains the right to change or assign other duties to this position as needed.Diversity, Equity, Inclusion & BelongingRiverStone Resources, LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, LGBTQ+, national origin, gender identity, disability, protected veteran status, or any other characteristic protected by law.Privacy Notice for California Residentshttps://www.trg.com/california-consumer-privacy-notice/
$103k-125k yearly est. 6d ago
Outbound Processor FFI
Littleton Coin Company, Inc. 4.1
Claim processor job in Littleton, NH
Job Description
Outgoing Order Fulfillment, Littleton, NH
Accurately and efficiently select and organize product for customer orders, and pack for shipment, while strongly focusing on customer service.
About our company: now 100% employee owned with a successful 74 year history, Littleton Coin Company is one of the largest direct response companies in the nation to sell coins, paper money and supplies to enthusiastic collectors. We are also one of the largest employers in Northern New Hampshire. We offer competitive pay and great benefits, including a 401(k) plan with up to a 6% match, Employee Stock Ownership Plan, onsite wellness programs and a friendly, pleasant work environment. Position is located at company headquarters in Littleton, NH.
In this fast-paced, important evening-shift position, you'll accurately process and select items from our inventory to fill customer orders. You'll then package the orders for shipment. Training will be provided. Primary responsibilities include:
Efficiently and accurately selecting items from inventory
Packaging orders for shipment (including those items needing special packaging)
Replenishing product on a daily basis
Operating computer-based systems to scan and return product to inventory
Performing within established quality and production standards
Qualified applicant will have:
High school diploma or equivalent
Knowledge of basic math
Ability to work in a team environment
Ability to lift up to 35 pounds, more with assistance
Good eyesight and number perception
Flexibility to bend and stretch, perform repetitive tasks using shoulders, elbows and wrists
Ability to work overtime as needed
Able to climb ladders and work at slightly elevated levels
$29k-36k yearly est. 23d ago
Processor
Pitco Frialator 3.4
Claim processor job in Bow, NH
Full-time Description
Located conveniently at the 89 & 93 junction in Bow, NH Pitco manufactures some of the best commercial restaurant equipment available in the market. Pitco began in 1918 and continues to grow and expand. Part of the Middleby Corporation, Pitco Brands are engineered and manufactured under one roof bringing top of the line fryers, pasta cookers and rethermalizers to customers around the globe. From your favorite local haunt to the largest global chain restaurant, our products are beloved for their innovation, ease of use and reliability.
1st Shift: 5:00am-2:30pm Monday-Friday $18.00/hour
2nd Shift: 2:30pm-12:00am Monday-Friday $18.00/hour plus $3.00/hour shift differential
Monday-Friday with overtime, including Saturdays may be worked regularly and are an expectation of employment.
This is an entry level position.
This position is located in the welding or sheet metal department. Responsibilities are as follows.
Grinding, re-graining, buffing, and finishing commercial cooking equipment for any one of the processing stations.
Stamping flat material using a brake press for the welding department.
Painting a heat resistant coating on the inside of burner tubes.
Spot welding of copper studs onto finished tanks.
Operating a manual blast cabinet.
Acid washing welded parts to give the material a uniform finish without any heat marks or weld imperfections.
Maintain clean and safe work area.
Requirements
While performing the duties of this job, the employee is regularly required to walk; sit; talk; hear; use hands to finger, handle, or feel. The employee must also be able to stand in one position and move their body, from the waist up, for increments of up to one hour consistently. The employee is frequently required to stand and reach with hands and arms. The employee must occasionally lift and/or move up to 50 pounds at a time, with or without mechanical aids, with frequent lifting or carrying of objects weighing up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
*This is a safety sensitive position therefore a drug test is a requirement of employment.