LNIC Medicare Claims Processor
Claim processor job in Oklahoma City, OK
LifeShield National Insurance Company is seeking exceptional individuals to join our growing team as Medicare Claims Processor. We are searching for candidates who can review and evaluate routine and complex Medicare claims in accordance with company policies and quality standards.
As a member of the Claims Processing Team, you will:
Manage a large volume of work and meet deadlines.
Handle patient information professionally and confidentially.
Resolve simple issues and follow through with complex claims in collaboration with department leadership.
Position Requirements
Candidates must possess a minimum of 1 year prior medical claims processing experience to be considered. Those with knowledge of Medicare claims processing are strongly encouraged to apply.
Qualified candidates will also demonstrate:
Strong knowledge of ICD-10, CPT, and HCPCS coding.
Knowledge of Microsoft Office
Experience in 10 key
Understanding of HIPAA regulations.
Excellent attention to detail and time management skills.
Ability to work independently with minimal supervision.
Strong verbal and written communication skills.
Ability to collaborate effectively within a team environment.
Claims HMO - Claims Examiner 140-1031
Claim processor job in Tulsa, OK
The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency.
KEY RESPONSIBILITIES:
Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions.
Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed.
Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials.
Identify and communicate trends or problems identified during adjudication process.
Contribute to the creation of a pleasant working environment with peers and other departments.
Assist in investigating and solving claims that require additional research.
Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations.
Perform other duties as assigned.
QUALIFICATIONS:
Self-motivated and able to work with minimal direction.
Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures.
Ability to read and understand health benefit booklets.
Demonstrated learning agility.
Successful completion of Health Care Sanctions background check.
Knowledge in the contracted managed care plan terms and rates.
General understanding of unbundling methods, COB, and other over-billing methodologies.
Must have high attention to detail.
Proficient in Microsoft applications.
Ability to perform basic mathematical calculations.
Possess strong oral and written communication skills.
EDUCATION/EXPERIENCE:
High School Diploma or Equivalent required.
Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.
Field Auto Claims Rep I or II in Oklahoma
Claim processor job in Oklahoma
National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers' evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.
Job Description
Responsible for creating or auditing a comprehensive estimate of damages for 1st and 3rd party material damage claims in either the auto or specialty lines leading to the proper disposition. Responsible for training, mentoring, controlling quality and providing technical assistance on material damage claims.
*** This is a Field position for Oklahoma with an active P&C license for OK. The ideal candidate should be located in Moore, Norman, Ardmore, Pauls Valley and surrounding areas.***
Key Responsibilities
• Possesses strong estimating fundamentals in order to create or audit estimates of damages on 1st and 3rd party material damage losses of all severities
• Possesses a deep understanding of the content of all policy types written by the company
• Negotiates settlements, makes settlement payments and documents all activities in the most complex of files across multiple lines
• Evaluates settlement alternatives by reviewing regulatory compliance and fair claims practices; makes decisions on best option
• Builds mastered relationships with both internal and external customers across multiple lines
Experience
• 2 or more years of experience (Preferred)
Supervisory Responsibilities
• This job does not have supervisory duties.
#LI-LS2
Compensation
Base compensation offered for this role is $26.20 to $38.50 hourly and is based on experience and qualifications.
*** Total compensation for this role is comprised of several factors, including the base compensation outlined above, plus incentive pay (i.e. commission, bonus, etc.) as applicable for the role.
Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact.
National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A- (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
Companies & Partners
Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.
Benefits
National General Holdings Corp. is an Equal Opportunity (EO) employer - Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at **************.
Auto-ApplyClaims ExaminerTulsa, OK
Claim processor job in Tulsa, OK
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Kelly Services is currently working with our client in Tulsa, OK to hire Claims Examiners.
This is a temporary to hire opportunity that will be starting with a 16 week training program on August 14th.
· A Claims Examiner is responsible for processing insurance claims that have been flagged by the automated system and need manual intervention in order to process accurately.
· This position will work in an office setting, where you will be working on a computer majority of the day.
· There are times this position requires phone work to place outbound calls but it is not a call center position.
· The training offered for this position is very fast paced and it makes it unlikely for those who miss days to succeed.
· During this period of time, attendance is critical.
· You would be working full time hours, Monday through Friday from 8AM to 5PM for roughly the first 16 weeks.
· After training, this position allows a flex schedule, which means you are able to work an 8 hour shift of your choosing between the hours of 6AM and 6PM, Monday through Friday.
· Typically, Claims Examiners have the opportunity work overtime once they're trained.
· The pay rate is a range between $11.77 and $12.77 and will be determined by our client based on your experience.
· The position is a temporary to hire opportunity, which means our client has indicated they will hire on Kelly Temporary employees that qualify in performance and attendance.
· Usually we see our employees go full time between 6 and 12 months.
· This is a great way to get your foot in the door if you are seeking permanent employment with our client; however, it does start temporarily though Kelly Services.
Job Specific Qualifications:
• High School Diploma or GED
• Data Entry and/or typing experience
• Clear and concise written and verbal communication skills
• Ability to multi task and prioritize is required
• Social, verbal and written communication skills
• Ability to sit for long periods of time
• Strong problem-solving and analytical skills
• Dependable and flexible
Qualifications
Job Specific Qualifications:
• High School Diploma or GED
• Data Entry and/or typing experience
• Clear and concise written and verbal communication skills
• Ability to multi task and prioritize is required
• Social, verbal and written communication skills
• Ability to sit for long periods of time
• Strong problem-solving and analytical skills
• Dependable and flexible
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Contestable Claims Analyst
Claim processor job in Oklahoma City, OK
The Contestable Analyst reviews all aspects of a contestable claim and determines how to process. High exposure to a multitude of life claims is a norm for this position; Analyst needs to be able to identify claim benefits in regards to the specific policy and operates on multiple claims systems. The Analyst has a checklist of items to review before the claim can progress for further processing. Some of these items include; performing a name search to see if the insured has additional coverage, reinstating a policy if it has already been removed from the system, requesting various types of letters, reviewing application date versus effective date of policy, reviewing Medical Information Bureau reports, requesting recordings of contact with insured, ordering medical records, and reviewing medical records. The Contestable Analyst also determines if certain policies should be investigated by external third parties (i.e., RSB). Once the Analyst makes a claim determination, they either proceed with paying the claim or rescind the claim. A Contestable Analyst is responsible for keeping a claim moving through the processing procedures. Contestable Analyst is in contact with agents, funeral homes, coroners, medical providers, and police departments to gather and confirm information in regards to the claim.
Investigates all contestable life claims and processes in accordance with policy provisions and Company procedures.
Processes claims on a multiple claims system.
Contacts outside 3rd parties and obtains additional claim information needed. Third parties consist of agents, beneficiaries, funeral homes, coroners, medical providers and police departments.
Updates system notes with claim progress.
Orders and reviews medical information.
Responsible for claim movement and progression.
Maintains production data and must meet the production quota set by the department.
Other duties; as assigned by the supervisor.
Required Skills:
Must be PC/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Strong communication skills.
Detail oriented.
Ability to work in a fast paced environment.
Problem solving skills.
Physical Requirements; While performing the duties of the job, the employee is regularly required to sit for extended lengths of time. The employee is frequently required to reach with hands and arms, occasionally required to stand and walk, occasionally lift and or move up to 25 lbs.
Qualifications
Must be PC/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Strong communication skills.
Detail oriented.
Ability to work in a fast paced environment.
Problem solving skills.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Claims Representative (IAP) - Workers Compensation Training Program
Claim processor job in Oklahoma City, OK
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**
Claims Representative
Claim processor job in Tulsa, OK
Mid-Continent Group, a subsidiary of Great American, based in Tulsa, Oklahoma, specializes in commercial casualty coverages with an emphasis on general liability for the construction, energy, and difficult-to-place business in other industries. Mid-Continent Group provides a broad selection of General Liability, Commercial Auto, Inland Marine and Umbrella products.
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group, a Fortune 500 company, combines “small company” culture with “big company” expertise. Here, your ideas will be heard, and you'll have the support to succeed. With over 35 specialty and property and casualty operations, there are always opportunities to learn and grow.
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.
Mid-Continent Group is looking for a Claims Representative to join their Multi-Peril Claims team. This individual will work a hybrid schedule from one of our downtown corporate locations in Tulsa, Oklahoma or Cincinnati, Ohio. Remote opportunities will be considered.
Essential Job Functions and Responsibilities
Manage an inventory of General Liability claims with some litigation.
Investigate and maintain claims:
Evaluate coverage and liability.
Secure necessary information (i.e.: reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims.
Actively work toward the resolution of claim files.
Attend arbitrations, mediations, depositions, or trials as necessary.
Affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
Convey the complex information (coverage, decisions, outcomes, negotiations, etc.) to all appropriate parties while maintaining a professional demeanor in all situations.
Ensure compliance of claims handling pursuant to all state, legal, statutory, and regulatory bodies to comply with all company procedures and requirements.
Evaluate and make recommendations to executive management on internal and external issues of strategic importance to a product(s) and/or line of business.
Job Requirements
Generally, 2+ years of experience handling commercial General Liability claims and auto experience is required. Previous legal experience will be considered.
Bachelor's Degree or equivalent experience is required. A Juris Doctor degree is encouraged.
A successful candidate will be able to demonstrate strong writing, analytical, communication, and organizational skills.
Ability to travel as needed.
Company:
MCC Mid-Continent Casualty Company
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
Auto-ApplyClaims Follow-Up Representative
Claim processor job in Tulsa, OK
Job Details Parkside Hospital - Tulsa, OK Full TimeClaims Follow-Up Representative Job Description
Do you enjoy making a difference in a patient's life? Do you enjoy making a difference in your community? Come work at Parkside! Where healing happens. Every day.
Parkside Psychiatric Hospital & Clinic is a comprehensive mental healthcare system providing acute in-patient care, residential treatment, and outpatient therapy. With a focus on society's most vulnerable population, Parkside provides world-class mental health services focused on children and young people, ages 5 to 26. For over 65 years, Parkside's physicians, therapists, and staff have provided state of the art, patient-centered care that propel families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time.
The Claims Follow-Up Representative is responsible for monitoring and managing outstanding insurance claims to ensure timely and accurate reimbursement. This role involves investigating and resolving denied or delayed claims, communicating with insurance providers, and maintaining compliance with industry regulations. The ideal candidate has strong analytical skills, attention to detail, and a thorough understanding of healthcare billing processes.
Key Responsibilities:
• Claims Follow-Up: Track and follow up on outstanding insurance claims to ensure prompt payment.
• Denial Management: Analyze claim denials, identify root causes, and take appropriate corrective actions to appeal or resubmit claims.
• Insurance Communication: Contact insurance carriers via phone, email, or online portals to resolve claim issues and obtain payment status.
• Documentation: Maintain accurate records of claim statuses, communications, and resolution efforts in the billing system.
• Compliance: Ensure adherence to HIPAA regulations, payer policies, and industry guidelines.
• Collaboration: Work closely with billing specialists, coders, and other revenue cycle team members to address claim discrepancies.
• Reporting: Generate and review aging reports to prioritize follow-up efforts and track claim resolution progress.
• Process Improvement: Identify trends in denials and delays, providing feedback to management for process enhancements.
• Other duties as assigned.
Claims Follow-Up Representative Qualifications
• High school diploma or equivalent (Associate's or Bachelor's degree in healthcare administration or a related field is a plus).
• 1-2 years of experience in healthcare claims follow-up, medical billing, or revenue cycle management.
• Knowledge of insurance guidelines, claims processing, and medical terminology.
• Familiarity with Electronic Health Records (EHR) and billing software.
• Strong communication and problem-solving skills.
• Ability to work independently and meet deadlines in a fast-paced environment.
Benefits include:
Medical, Dental, and Vision
Generous Paid Time Off and Holidays
401K and match start immediately, and includes a generous match
Company Paid Life Insurance and Disability and more!
We are an Equal Opportunity Employer!
Certification Specialist
Claim processor job in Oklahoma City, OK
Reports to: Community Manager
is eligible for overtime.
The Certification Specialist will receive general supervision, direction and guidance from the Community Manager.
CRM Residential requires a background and drug screening as a condition of employment.
Certification Specialist will be required to travel to all necessary training sessions. A valid driver's license and reliable transportation are required.
Qualifications:
Education: High School diploma or equivalent education required.
Experience: Previous certification experience. Experience level may vary due to the special needs of the property.
Skills: The position requires the ability to deal well with people and get them to feel comfortable quickly. Proficiency in MS Office (MS Excel and MS PowerPoint, in particular).
Must be fluent in Spanish.
Attendance: Due to the property staffing limitations, it is extremely critical that the individual be able to work their scheduled hours plus any other hours necessary to complete the job.
In addition, the position requires the following:
Professional image
Be able to multi-task
Excellent communication skills and upbeat attitude
Strong customer service orientation
Good organizational and time management skills
Strong administrative ability
The Certification Specialist will comply with established policies and authorized approval. Certification Specialist responsibilities include, but are not limited to the following:
1. Resident selection and orientation. In accordance with the Resident Selection Plan.
2. The assistance of leasing of vacant apartments in an expeditious manner per company policy striving for 100% occupancy.
3. The timely recertification and interim recertifications of residents in accordance with HUD regulation and Low Income Housing Tax Credit Program.
4. Maintaining the waiting list book and keeping it up to date in the computer following
HUD regulations.
5. Assist with the development of goals and objectives for the property.
6. Resident Files
Maintain resident files according to policy outlined in CRM's Occupancy Manual
Assist Property Manager in preparation of various file reviews such as:
Management Review
Mortgagee Inspection
7. Accept daily resident requests and write up corrective work orders as directed by the
Maintenance Plus program.
8. Daily management of office duties
Open office at prescribed time
Immediately handles daily work orders that come in
Take applications for prospective residents
Compute applications for eligibility, with supporting documents
Send out billing notices
Greet in-coming guests, respond to mail and handle all incoming telephone calls
9. Additional Skills and Responsibilities
Have strong time-management skills
Strong communication skills
Maintain a professional demeanor
Attend required training
10. In absence of the Community Manager, enforcement of the lease and the rules and
regulations.
11. Attend training courses as required by CRM Residential.
12. Completion of all required reports as directed by various departments of CRM Residential.
13. Required to observe all federal and local Fair Housing Laws
14. Perform other related duties, as assigned.
Job Descriptions are intended to present an illustrative description of the range of duties, the scope of responsibility and the required level of knowledge, skills and abilities necessary to describe the primary functions of the job; they are not intended to reflect all duties performed by those assigned to this classification.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.
This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.
Requirements
HUD Background required
Salary Description $19.00
Certification Specialist - Charles Atkins
Claim processor job in Oklahoma City, OK
Job Description
CRM Residential has been a trusted name in the property management industry for over 46 years specializing in affordable housing. Our success story is a testament to the dedicated and talented individuals who have chosen to build their careers with us. We take great pride in our values, and we live and breathe them every day.
Working at CRM Residential is so much more than a job, it is a career with purpose. No matter what department or level of the company you join, our mission is to provide a comfortable and reliable home environment for those who need it most and to provide excellent service to our customers. You will make a difference.
Why Join the CRM Residential Team:
Comprehensive Health Coverage
Retirement Savings with employer contribution
Bonus Potential
Paid Time Off (PTO)
Company Paid Holidays
Once eligible for enrollment, the company will contribute a Safe Harbor match of 3% of your compensation to your 401(k) account, regardless of whether you choose to make your own contributions.
Pay Rate: $16-$19 per hour
What You'll Get To Do:
The Compliance Specialist will be responsible for keeping abreast of all HUD, state agency, and tax credit rules and regulations concerning occupancy, recertifications, and tax credit related issues. The Compliance Specialist will deal directly with HUD and state agencies in reference to Section 8 contract renewals. This role will be responsible for but not limited to:
Prepare monthly, quarterly, and annually reports for Tax Credit Properties
Prepare Company Occupancy Reports weekly and for properties and owners
Review and critique recertification move in packages at tax credit properties
Prepare handouts for training classes and an assist in allocating the cost to each property that attended training
Site visits may be required from time to time to offer assistance to onsite staff pertaining to occupancy, file compliance or other tax credit specific areas
Attend educational seminars relating to tax credit compliance & other affordable housing
Monitor the timely completion of annual recertifications for all sites. Advise Regional Manager of any potential problems
Written correspondence with owners and agencies, relating to affordable housing
Requirements:
High School diploma or equivalent education required. 3-4 years of experience can offset minimum educational requirements for this position.
Valid driver's license and reliable transportation
Ability to work with a variety of people and make them feel comfortable quickly
Strong customer service skills required
Must have strong organizational and time management skills
Valid driver's license
Proficiency at multi-tasking
Organizational skills
Working knowledge of Microsoft Office software
Experience with verifications and renewals
Other administrative duties as assigned
Onsite Monday-Friday 8:30am-5:00pm
Bi-lingual Spanish required
About CRM Residential:
CRM Residential is an award-winning full-service property management company which professionally manages 11,000+ apartments valued in excess of one billion. We are exclusively third-party so there is no conflict of interest between the properties that we manage for our clients and our own properties, because we do not own any properties. Our focus is dedicated to our clients.
We are an equal opportunity employer and welcome applicants from all backgrounds to apply. If you have a passion for property management and a desire to work for a reputable company, we encourage you to apply for this exciting opportunity.
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Veterans Certification Specialist, Veteran Affairs
Claim processor job in Lawton, OK
POSTED JOB TITLE: Veterans Certification Specialist
The Veterans Certification Specialist provides services related to the certification of students to the Department of Veterans Affairs (DVA) for Educational Benefits. This position is responsible for administrative duties associated with the administration and coordination of student certification and providing assistance to students. The Veterans Certification Specialist reports to the Coordinator of Veterans Affairs.
Job Duties include, but are not limited to:
Professional and efficient execution of Cameron University's commitment to student success
KNOWLEDGE RESPONSIBILITIES
Understand and comply with rules and regulations of the Department of Veterans Affairs as they relate to the GI Bill and student accessibility.
Maintain student confidentiality in accordance with FERPA regulations.
Maintain knowledge of policies of other departments (Registrar, Business Office, Admissions, etc.) and understand the impact on a student's GI Bill eligibility.
Maintain knowledge academic program requirements.
FUNCTIONAL RESPONSIBILITIES
Accurately enter certification information in compliance with Federal regulations.
Accurately calculate adjustments to certifications.
Complete and/or file information to meet end of semester reporting requirements.
Accurately calculate and reconcile tuition and fee costs for certifications and adjustments and disseminate information as appropriate with the Business office, including Debt Letter tracking.
Accurately track Tungsten system approvals and associated notifications and tasks.
Work collegially with all internal and external stakeholders.
Assist with preparation and execution of any events hosted by the Veterans Affairs office.
Assist with supervision of student staff, duties associated with the student staff and outstanding delivery of student customer assistance.
Participate on university committees as assigned.
Perform other related duties necessary to support the mission of Cameron University.
CUSTOMER SERVICE RESPONSIBILITIES
Ensure that students are served efficiently with courtesy and respect.
Assist students, and their families, with maximizing student aid, entitlements, and other financial resources to make college attendance as affordable as possible.
Coordinate Parent School Letter approvals and assist students with the tracking elements.
MINIMUM QUALIFICATIONS:
Bachelor's degree from a regionally accredited college or university.
Proven track record of excellence in customer service.
Ability to communicate diplomatically, clearly, and effectively, both verbally and in writing.
Strong interpersonal and communication skills
Demonstrated skills in Microsoft Office
PREFERRED QUALIFICATIONS:
Prior experience processing VA education benefits
Military Affiliation
Three years of Accounting Experience
One or more years directly related experience with Oracle and Ellucian (Banner) system.
Demonstrated understanding of educational, administrative and personnel policy and practices within higher education as well as the regional university mission and unique needs of Veterans.
Bilingual: Spanish
SALARY: Position funded at $30,500/annually plus benefits. Opportunity for performance compensation subject to approval and budgetary availability.
PHYSICAL REQUIREMENTS: Ability to lift objects under 15 pounds including using the upper body to raise objects from a lower position to a higher position; ability to reach including extending the arm and hand; ability to stand for short or extended periods of time; ability to engage in repetitive motions including finger dexterity; ability to speak, hear and see. Ability to crouch, climb and walk stairs.
INSTITUTION: Cameron University (**************** is a state-supported regional institution located in Lawton, Oklahoma, that offers undergraduate and graduate degrees. Dedicated to excellence, the university provides a wide range of economic, cultural, and educational opportunities for the betterment of all citizens. Master's-level graduate degrees are offered in business, behavioral sciences, and education; baccalaureate programs are offered in more than forty disciplines, and associate degrees are offered in many other studies. The close proximity of Fort Sill contributes to an area rich in cultural diversity and provides the opportunity for frequent cooperative efforts. The combined community of Lawton/Fort Sill has a population of more than 100,000 and is located adjacent to the picturesque Wichita Mountains Wildlife Refuge. A copy of the University's Annual Security Report, listing crime statistics and university policies, is available by contacting the Office of Public Safety or by accessing the report online at ********************
APPLYING: Attachments must include a cover letter indicating experience applicable to position, resume, transcripts (unofficial are acceptable at this point), names, addresses, and telephone numbers of three professional references. Incomplete applications might not be reviewed.
DEADLINE: Applications will be accepted until the position is filled.
EEO/AA Employer/Vets/Disability
JOB #-A1302J
Claims Analyst/Adjuster (Little Rock AR or Enid, OK)
Claim processor job in Rocky, OK
Triangle Insurance is Now Hiring - Full-Time Claims Analyst/Adjuster - with an option to work out of the Little Rock AR or Enid, OK office. Join our team and immerse yourself in a highly respected organization cemented by a dynamic culture rich with ingenuity and integrity. Our generous compensation packet includes competitive pay, paid time off, exceptional benefits and dual retirement. Claims Analyst/Adjuster -
Job Summary:
Responsible for processing workers' compensation claims where the injury or illness is limited to medical treatment. This role provides administrative and technical support to claims adjusters and other team members, ensuring efficient processing of claims.
Duties/Responsibilities:
Administrative:
Claim Setup and Data Entry. Receiving new claim information, inputting data into the claims management system, and creating claim files. This may involve gathering initial information from the insured or agent.
Document Management. Organizing, scanning, and indexing claim-related documents (e.g., accident reports, photos, medical records, legal correspondence) and maintaining electronic and physical claim files.
Communication. Answer phone calls and emails from insureds, agents, witnesses, and other parties involved in the claim, providing updates on claim status and answering general inquiries.
Correspondence. Preparing and sending letters, emails, and other correspondence related to claims. This could include requests for information, reservation of rights letters, or settlement offers.
Reporting. Generating reports on claim activity, such as open claims, closed claims, and reserve changes. Tracking key metrics and identifying trends.
File Review. Reviewing claim files for completeness and accuracy. Ensuring all necessary documents are present and that information is correctly recorded.
Support to Adjusters. Assisting claims adjusters with various tasks.
System Updates. Maintaining accurate and up-to-date information in the claims management system.
Other Administrative Tasks. Performing general administrative duties, such as filing, copying, and ordering supplies. Any others as assigned.
Claims Handling (Workers Compensation Medical Only):
Claim Intake and Setup. Receiving and processing First Reports of Injury (FROI) or other claim notifications, setting up new claims in the system, and verifying employee information and employer coverage.
Medical Treatment Authorization. Reviewing medical treatment requests from healthcare providers to determine if they are reasonable, necessary, and related to the work injury. This often involves applying established medical guidelines and utilizing review protocols.
Medical Bill Review. Analyzing medical bills for accuracy, appropriate coding (CPT, HCPCS), and compliance with fee schedules or negotiated rates. Identifying and resolving discrepancies.
Communication. Communicating with healthcare providers to obtain medical records, clarify treatment plans, and discuss billing issues, also with employers and claimants.
Claim Investigation (Limited). While the focus is medical, some investigation may be needed to confirm the injury occurred at work and is compensable under workers' compensation laws. This might involve gathering information about accidents or incident.
Coordination of Care. Working with case managers or nurse case managers (if involved) to ensure appropriate medical care is provided and to facilitate a timely return to work (if applicable, though less common in medical-only claims).
Payment Processing. Authorize and process payments to medical providers for authorized treatment.
Claim Closure. Closing medical-only claims once treatment is complete and all bills have been processed.
Compliance. Adhering to workers' compensation regulations, state-specific guidelines, and company policies.
Documentation. Maintaining accurate and detailed records of all claim-related activities, including medical records, billing information, and communication logs.
Subrogation. Identify and respond to any recovery potential.
Additional Responsibilities:
Identify and escalate potential fraud.
Provide excellent customer service to all stakeholders.
Regular and sustained attendance.
Perform other duties as assigned.
Required Skills/Abilities:
Excellent interpersonal and customer service skills.
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence.
Effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage and to draw and interpret bar graphs.
Effective organizational skills and attention to detail.
Excellent time management skills with a proven ability to meet deadlines.
Proficient with Microsoft Office Suite, Teams, and other internal operating systems.
Education - Licensing - Certifications - Experience:
A bachelor's degree with business experience is preferred, or two (2) or more years of past insurance claims experience may be substituted.
High School Diploma required.
Adjusters' license in claims is required within the first year of employment.
Physical & Work Requirements:
The physical demands described here represent 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 essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand, walk, sit, use hands and fingers to grasp, handle, or feel, and reach with hands and arms. The employee must occasionally lift and move up to 10 pounds. Specific vision abilities required by this job include close vision and distance vision.
The work environment for this position is normally a climate-controlled environment with moderate noise levels.
Safety Sensitive Position (Yes/No): NO
Safety-sensitive positions are defined as jobs or positions where the employees holding these positions have the responsibility for their own safety or other people's safety. It would be particularly dangerous if:
Such an employee is using drugs or alcohol while on the job. This could include legal or illegal controlled substances.
Employees are unable to provide their complete time and attention in performing the sensitive or hazardous tasks of the position.
Physical limitations of the job could result in injury or harm to employees or others.
DISCLAIMER
This Job Description indicates the general nature and level of work expected and does not imply a contract of employment. Employment is at-will. It is not designed to cover every activity, duty, or responsibility required of the employee. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time.
Contestable Claims Analyst
Claim processor job in Oklahoma City, OK
The Contestable Analyst reviews all aspects of a contestable claim and determines how to process. High exposure to a multitude of life claims is a norm for this position; Analyst needs to be able to identify claim benefits in regards to the specific policy and operates on multiple claims systems. The Analyst has a checklist of items to review before the claim can progress for further processing. Some of these items include; performing a name search to see if the insured has additional coverage, reinstating a policy if it has already been removed from the system, requesting various types of letters, reviewing application date versus effective date of policy, reviewing Medical Information Bureau reports, requesting recordings of contact with insured, ordering medical records, and reviewing medical records. The Contestable Analyst also determines if certain policies should be investigated by external third parties (i.e., RSB). Once the Analyst makes a claim determination, they either proceed with paying the claim or rescind the claim. A Contestable Analyst is responsible for keeping a claim moving through the processing procedures. Contestable Analyst is in contact with agents, funeral homes, coroners, medical providers, and police departments to gather and confirm information in regards to the claim.
Investigates all contestable life claims and processes in accordance with policy provisions and Company procedures.
Processes claims on a multiple claims system.
Contacts outside 3rd parties and obtains additional claim information needed. Third parties consist of agents, beneficiaries, funeral homes, coroners, medical providers and police departments.
Updates system notes with claim progress.
Orders and reviews medical information.
Responsible for claim movement and progression.
Maintains production data and must meet the production quota set by the department.
Other duties; as assigned by the supervisor.
Required Skills:
Must be PC/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Strong communication skills.
Detail oriented.
Ability to work in a fast paced environment.
Problem solving skills.
Physical Requirements; While performing the duties of the job, the employee is regularly required to sit for extended lengths of time. The employee is frequently required to reach with hands and arms, occasionally required to stand and walk, occasionally lift and or move up to 25 lbs.
Qualifications
Must be PC/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Strong communication skills.
Detail oriented.
Ability to work in a fast paced environment.
Problem solving skills.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Claims Examiner
Claim processor job in Tulsa, OK
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Title: Claims Examiner
Pay Rate: $11.77/hour
Job Description Overview:
•Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims
•Review and compare information in computer systems and apply proper codes/documentation
•May place outgoing calls to providers and/or pharmacies for further investigation before processing claims
Job Specific Qualifications:
•High school diploma or GED
•Data Entry and/or typing experience
•Clear and concise written and verbal communication skills
•Ability to multi task and prioritize is required
•Interpersonal, verbal and written communication skills
•Ability to sit for long periods of time
•Analytical and problem solving skills
•Must be dependable and flexible
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Certification Specialist - Charles Atkins
Claim processor job in Oklahoma City, OK
CRM Residential has been a trusted name in the property management industry for over 46 years specializing in affordable housing. Our success story is a testament to the dedicated and talented individuals who have chosen to build their careers with us. We take great pride in our values, and we live and breathe them every day.
Working at CRM Residential is so much more than a job, it is a career with purpose. No matter what department or level of the company you join, our mission is to provide a comfortable and reliable home environment for those who need it most and to provide excellent service to our customers. You will make a difference.
Why Join the CRM Residential Team:
Comprehensive Health Coverage
Retirement Savings with employer contribution
Bonus Potential
Paid Time Off (PTO)
Company Paid Holidays
Once eligible for enrollment, the company will contribute a Safe Harbor match of 3% of your compensation to your 401(k) account, regardless of whether you choose to make your own contributions.
Pay Rate: $16-$19 per hour
What You'll Get To Do:
The Compliance Specialist will be responsible for keeping abreast of all HUD, state agency, and tax credit rules and regulations concerning occupancy, recertifications, and tax credit related issues. The Compliance Specialist will deal directly with HUD and state agencies in reference to Section 8 contract renewals. This role will be responsible for but not limited to:
Prepare monthly, quarterly, and annually reports for Tax Credit Properties
Prepare Company Occupancy Reports weekly and for properties and owners
Review and critique recertification move in packages at tax credit properties
Prepare handouts for training classes and an assist in allocating the cost to each property that attended training
Site visits may be required from time to time to offer assistance to onsite staff pertaining to occupancy, file compliance or other tax credit specific areas
Attend educational seminars relating to tax credit compliance & other affordable housing
Monitor the timely completion of annual recertifications for all sites. Advise Regional Manager of any potential problems
Written correspondence with owners and agencies, relating to affordable housing
Requirements:
High School diploma or equivalent education required. 3-4 years of experience can offset minimum educational requirements for this position.
Valid driver's license and reliable transportation
Ability to work with a variety of people and make them feel comfortable quickly
Strong customer service skills required
Must have strong organizational and time management skills
Valid driver's license
Proficiency at multi-tasking
Organizational skills
Working knowledge of Microsoft Office software
Experience with verifications and renewals
Other administrative duties as assigned
Onsite Monday-Friday 8:30am-5:00pm
Bi-lingual Spanish required
About CRM Residential:
CRM Residential is an award-winning full-service property management company which professionally manages 11,000+ apartments valued in excess of one billion. We are exclusively third-party so there is no conflict of interest between the properties that we manage for our clients and our own properties, because we do not own any properties. Our focus is dedicated to our clients.
We are an equal opportunity employer and welcome applicants from all backgrounds to apply. If you have a passion for property management and a desire to work for a reputable company, we encourage you to apply for this exciting opportunity.
Auto-ApplyProvider Services - Provider Relations Representative 115-1034
Claim processor job in Tulsa, OK
The Provider Services Representative supports the internal infrastructure of the Provider Relations department by managing provider lifecycle processes and maintaining operational efficiency. This administrative role ensures timely and accurate updates to provider records, coordinates credentialing and termination workflows, and responds to routine inquiries from provider offices and internal teams. The Provider Services Representative plays a critical role in supporting smooth internal operations and ensuring data integrity across systems. Serves as the liaison between the provider community and the health plan.
KEY RESPONSIBILITIES:
Serves as the primary administrative role for internal ticketing processes for provider credentialing, demographic updates, and terminations
Coordinate internal process and procedures among departments to ensure network, contract, operational procedures are appropriately reflected in our systems and processes.
Participate in departmental processes established to ensure accurate and timely contracting, credentialing and loading of providers.
Researches and responds to provider office inquiries received via calls and emails concerning directory listings, participation status and general administrative concerns (e.g., benefits, claims, reimbursement and member issues) and recommends appropriate actions to the requesting party.
Coordinates with internal departments (e.g., claims, quality, pharmacy, compliance) to resolve provider-elevated operational issues.
Works in tandem with Provider Services Representative - External (Education & Engagement) to resolve complaints & grievance issues and documents appropriately
Assist contracting in all phases of the Contracting process established by CommunityCare Managed Healthcare Plans of Oklahoma. Processes may include communication with provider during negotiation through completion of executed document implementation of contract, and on-going contract deliverables. Participate in the development of networks and key geographical areas as needed.
Participates in special projects and assignments as directed, including the development of new/improved operating procedures.
Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.
Perform other duties as assigned.
QUALIFICATIONS:
Possess strong oral and written communication skills for interdepartmental and external communication.
Strong organizational and time management skills; attention to detail is essential.
Ability to monitor and assess rapidly changing information.
Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.
Ability to work independently while managing multiple tasks and meeting deadlines.
Proficient in Microsoft applications (especially Excel, Outlook)
Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
Associate's degree required; Bachelor's degree preferred OR each year of work experience in a healthcare or managed care setting can be substituted for each year of college not completed.
One to three years of industry related experience in managed care, insurance, physician environment or related area.
Customer Service or sales-related experience preferred.
Claims Representative (IAP) - Workers Compensation Training Program
Claim processor job in Bartlesville, OK
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**
Claims Examiner
Claim processor job in Tulsa, OK
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Title: Claims Examiner
Pay Rate: $11.77/hour
Job Description Overview:
•Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims
•Review and compare information in computer systems and apply proper codes/documentation
•May place outgoing calls to providers and/or pharmacies for further investigation before processing claims
Job Specific Qualifications:
•High school diploma or GED
•Data Entry and/or typing experience
•Clear and concise written and verbal communication skills
•Ability to multi task and prioritize is required
•Interpersonal, verbal and written communication skills
•Ability to sit for long periods of time
•Analytical and problem solving skills
•Must be dependable and flexible
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Provider Services - Provider Services Representative 115-1030
Claim processor job in Tulsa, OK
The Provider Services Representative supports the internal infrastructure of the Provider Relations department by managing provider lifecycle processes and maintaining operational efficiency. This administrative role ensures timely and accurate updates to provider records, coordinates credentialing and termination workflows, and responds to routine inquiries from provider offices and internal teams. The Provider Services Representative plays a critical role in supporting smooth internal operations and ensuring data integrity across systems. Serves as the liaison between the provider community and the health plan.
KEY RESPONSIBILITIES:
Serves as the primary administrative role for internal ticketing processes for provider credentialing, demographic updates, and terminations
Coordinate internal process and procedures among departments to ensure network, contract, operational procedures are appropriately reflected in our systems and processes.
Participate in departmental processes established to ensure accurate and timely contracting, credentialing and loading of providers.
Researches and responds to provider office inquiries received via calls and emails concerning directory listings, participation status and general administrative concerns (e.g., benefits, claims, reimbursement and member issues) and recommends appropriate actions to the requesting party.
Coordinates with internal departments (e.g., claims, quality, pharmacy, compliance) to resolve provider-elevated operational issues.
Works in tandem with Provider Services Representative - External (Education & Engagement) to resolve complaints & grievance issues and documents appropriately
Assist contracting in all phases of the Contracting process established by CommunityCare Managed Healthcare Plans of Oklahoma. Processes may include communication with provider during negotiation through completion of executed document implementation of contract, and on-going contract deliverables. Participate in the development of networks and key geographical areas as needed.
Participates in special projects and assignments as directed, including the development of new/improved operating procedures.
Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.
Perform other duties as assigned.
QUALIFICATIONS:
Possess strong oral and written communication skills for interdepartmental and external communication.
Strong organizational and time management skills; attention to detail is essential.
Ability to monitor and assess rapidly changing information.
Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.
Ability to work independently while managing multiple tasks and meeting deadlines.
Proficient in Microsoft applications (especially Excel, Outlook)
Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
Associate's degree required; Bachelor's degree preferred OR each year of work experience in a healthcare or managed care setting can be substituted for each year of college not completed.
One to three years of industry related experience in managed care, insurance, physician environment or related area.
Customer Service or sales-related experience preferred.
Claims Representative (IAP) - Workers Compensation Training Program
Claim processor job in Bartlesville, OK
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.
Auto-Apply