Claim processor jobs in Orem, UT

Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Resolute PB Claims Analyst you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you'll do/Responsibilities As a Project Delivery Senior Analyst (PDSA) at Deloitte, you will work within an engagement team and be responsible for supporting the overall project goals and objectives. In this role, you will interact with stakeholders and cross-functional teams. It is expected that you will be able to perform independent tasks as well as provide technical guidance to team members, as needed. + Work with the implementation team to plan and complete build, implement end-to-end Epic. + Work command center shifts to investigate during go-live, document, and resolve break-fix tickets. + Conduct and document root cause analysis and complete any assigned system maintenance. + Assist in low level design, operational discussions, build, test, and migrate Epic build, provide go-live support following migration of new build. + Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management. The Team Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation. AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector. Qualifications Required + Current Epic Certification in Epic Professional Billing + 3+ years' experience in Epic Professional Billing + Experience in Epic implementation or enhancement processes + Experience in application design, workflows, build, troubleshooting, testing, and support. + Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience + Limited immigration sponsorship may be available. + Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve Preferred + Hospital or Clinic operations experience + Additional Epic Certifications + ITIL process knowledge + Analytical/ Decision Making Responsibilities + Analytical ability to manage multiple projects and prioritize tasks into manageable work products + Can operate independently or with minimum supervision + Excellent Written and Communication Skills + Ability to deliver technical demonstrations Additional Requirements Information for applicants with a need for accommodation: ************************************************************************************************************ All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

What to Expect Tesla is seeking a skilled and experienced Auto Damage Supervisor to join our growing team. In this role, you will be responsible for coaching and developing a team of 5-8 adjusters/appraisers who will be writing the estimate, obtaining accurate valuations, preparing the necessary correspondence for the insureds, claimants, and their legal representatives and finalizing settlement of claims. Emphasis on accuracy of estimates and settlements, efficiency while maintaining file compliance. What You'll Do * Lead and develop a team of adjusters/appraisers to ensure quality, accuracy, and timely resolution of auto estimate assignments * Continuously develop talent by creating opportunities for direct reports to grow and acquire new skills * Promotes claims customer service excellence by building empathy and passion for a customer experience that meets or exceeds expectations * Proactively assists in selecting top talent, delivering ongoing coaching, and recognizing employees to reinforce behaviors that ensure service excellence * Analyzes problematic trends, takes steps to prevent recurrence, and escalate issues when necessary * Promotes a culture focused on identifying process efficiencies to continuously improve work completion What You'll Bring * Strong supervisory, organizational, and interpersonal skills * Experience with major estimating software * 2+ years' experience as a Tesla claims appraiser or prior Auto Damage Appraiser supervisor experience required * Ability to complete work individually or in a team atmosphere * Onsite presence is required everyday * Tesla vehicle working knowledge preferred Compensation and Benefits Benefits Along with competitive pay, as a full-time Tesla employee, you are eligible for the following benefits at day 1 of hire: * Aetna PPO and HSA plans > 2 medical plan options with $0 payroll deduction * Family-building, fertility, adoption and surrogacy benefits * Dental (including orthodontic coverage) and vision plans, both have options with a $0 paycheck contribution * Company Paid (Health Savings Account) HSA Contribution when enrolled in the High Deductible Aetna medical plan with HSA * Healthcare and Dependent Care Flexible Spending Accounts (FSA) * 401(k) with employer match, Employee Stock Purchase Plans, and other financial benefits * Company paid Basic Life, AD&D, short-term and long-term disability insurance * Employee Assistance Program * Sick and Vacation time (Flex time for salary positions), and Paid Holidays * Back-up childcare and parenting support resources * Voluntary benefits to include: critical illness, hospital indemnity, accident insurance, theft & legal services, and pet insurance * Weight Loss and Tobacco Cessation Programs * Tesla Babies program * Commuter benefits * Employee discounts and perks program Tesla is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to any factor, including veteran status and disability status, protected by applicable federal, state or local laws. Tesla is also committed to working with and providing reasonable accommodations to individuals with disabilities. Please let your recruiter know if you need an accommodation at any point during the interview process. For quick access to screen reading technology compatible with this site click here to download a free compatible screen reader (free step by step tutorial can be found here). Please contact ************* for additional information or to request accommodations. Privacy is a top priority for Tesla. We build it into our products and view it as an essential part of our business. To understand more about the data we collect and process as part of your application, please view our Tesla Talent Privacy Notice . Claims Supervisor, Auto Damage Tesla participates in the E-Verify Program

This position will primarily be responsible for following a strict procedure for processing life insurance claims, and answering phone calls from our policy holders and funeral homes. This is an entry level position with a Monday - Friday business hours schedule. We offer a comprehensive benefits package that includes health insurance, PTO, Employee Discounts, and more. What You'll Do: * Data entry for new claims into our system * Processing life insurance claims * Analyzing contracts for monetary discrepancies * Inbound & outbound calls from Funeral Homes and Beneficiaries * Provide excellent customer service on phone and through email * Other special projects as assigned #LI-DNI Requirements What We'll Love About You: * Customer service oriented * Self-motivated * Dynamic, friendly and outgoing personality * Team oriented * Detail oriented * Multi-tasker Requirements: * Basic computer operation skills * Ability to type 35 wpm * Working knowledge of Microsoft Office (Outlook, Excel, Word) * Ability to pay close attention to detail * Ability to quickly learn new processes and procedures * Ability to work independently and with a team when needed * Ability to work Monday through Friday, 8:00 am to 5:00 pm * Prolonged periods sitting at a desk and working on a computer * Must be able to lift up to 10 pounds at times, and engage in repetitive movements Education and Experience: * High school diploma or equivalent * Work experience of 1-2 years preferred * Bilingual in English and Spanish required What You'll Love About Us * Great Company Culture. Top Workplaces 5 years in a row * Rest and Relaxation. 2 weeks paid time off, 10 paid holidays, and accrued sick leave * Health Benefits. Medical with HSA and FSA options, dental, and vision * Prepare for the Future. 401(k) with company match

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking an experienced and motivated Claims Investigator professional to join our Special Investigation unit. The position requires the following, but is not limited to: Become familiar with the specialized investigation of claims Meet with people involved with claims. This may be outside our office environment. Increased role as a trainer/resource for branch associates in the Claims Department. Develop and present educational materials to claim associates that focus on fraud awareness/investigation. Desired Skills & Experience Bachelor's degree or equivalent experience. Ability to handle conflict comfortably. Field Claim Rep with Auto and Field experience preferred. Ability to read, interpret and react to documents such as insurance policies, procedures manuals, and legal documents. Able to assemble information, develop opinions and clearly express decisions using sound reasoning and judgment. Ability to write reports and compose correspondence. Ability to communicate, both verbally and in writing, and possess good problem resolution skills and good interpersonal skills. Able to accurately deal with mathematics and financial areas and develop an understanding of personal and business finance documents. Can tactfully and effectively deal with all types of people. Able to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage. Ability to organize assigned work. Ability to maintain a professional image. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-AT1 #LI-Hybrid

About Specialty Program Group: Specialty Program Group (SPG) is the wholesale & MGA division of HUB International. SPG acts in a holding company capacity acquiring best-in-class underwriting businesses to operate independently under discrete brands (portfolio companies). About ANOVA Marine: ANOVA is a premier provider of first-class Cargo and Logistics Insurance, Liability Insurance, and Bonds for freight forwarders, NVOCC's, shipping lines, customs brokers, and international trading companies. Right from the outset in 2011, our aim was to create a smarter, more agile experience for our clients. That includes superior cargo insurance coverage designed by freight forwarders and transport-industry attorneys; technology that simplifies quotes and speeds up coverage; and experienced claims people who understand the challenges our clients face, with the authority to settle fast. About ANOVA Personal Effects: In addition to our core logistics offerings, ANOVA provides specialized Personal Effects and Household Goods insurance solutions, supporting storage partners, and individuals navigating domestic and international relocations. Our Personal Effects claims team plays a critical role in delivering compassionate, accurate, and efficient resolutions for customers during stressful transitions. Summary of the Role: The Personal Effects Claims Specialist is a key member of ANOVA's Claims Department, responsible for managing the full lifecycle of household-goods and personal-effects claims. This role requires a balance of technical coverage analysis, strong customer communication, and disciplined claim-handling practices. Responsibilities: Investigation & Evaluation: Conduct thorough investigations of claims arising from the transit or storage of household goods and personal effects, including domestic moves, international shipments, and storage. Coverage & Liability Analysis: Review and interpret applicable policy forms, apply provisions to factual scenarios, and determine coverage and liability. Valuation & Settlement: Assess the value of lost or damaged items and negotiate fair, accurate settlements consistent with ANOVA guidelines. Customer Advocacy & Communication: Communicate clearly, empathetically, and proactively with insureds. Documentation & Compliance: Maintain meticulous and timely claim documentation following internal controls and regulatory standards. Stakeholder Collaboration: Work closely with internal departments, surveyors, adjusters, and brokers. Qualifications: 5+ years of experience as a Claims Adjuster preferred. Experience in P&C, Inland Marine, or Household Goods/Moving claims preferred. Strong analytical and communication skills. Customer-focused mindset. Ability to manage high-volume claims. Proficiency with claims systems and Google Workspace. Adjuster license(s) or willingness to obtain. Salary Transparency: Disclosure required under applicable law in California, Colorado, Illinois, Maryland, Minnesota, New York, New Jersey, and Washington states: The expected salary range for this position is $70,000-$75,000 and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level. HUB International is proud to offer comprehensive benefit and total compensation packages: health/dental/vision/life/disability insurance, FSA, HSA and 401(k) accounts, paid-time-off benefits such as vacation, sick, and personal days, and eligible bonuses, equity and commissions for some positions. Compensation may vary based on experience, skillset, and location. Eligible employees may also receive benefits including health/dental/vision/life/disability insurance, FSA/HSA, 401(k), PTO, and incentives. #SPG Department Claims ManagementRequired Experience: 5-7 years of relevant experience Required Travel: NegligibleRequired Education: High school or equivalent HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations. E-Verify Program We endeavor to make this website 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 recruiting team **********************************. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us The Field Claims department is currently seeking Field Claims Representatives to service the territory surrounding: Salt Lake City, Utah. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be Ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: Salary: The pay range for this position is $57,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: Salary: The pay range for this position is $62,000- $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

The National Solutions Sector is currently looking experienced Chinese Triage Examiners in various languages to perform media exploitation (MEDEX) and triage in support a customer in the National Capital Region (NCR). Triage Examiners should be experienced in general linguist operations and Document and Media Exploitation (DOMEX) operations, and are expected to leverage language and analytical skills, as well as advanced computer systems aptitude in addressing triage examination projects. Triage Examiners will perform eDiscovery examinations of electronic media for content of interest using a suite of forensic examination tools and will identify and prioritize items of importance for further processing, in accordance with customer standard operating procedures. Examiners will also be expected to communicate effectively and provide ad-hoc notification to superiors on task progress and significant findings, and to produce a report of their findings for further dissemination to customer(s). Required Language: Chinese The primary responsibilities of the Triage Examiners are: Perform data discovery on large datasets of foreign language material and identify essential elements of information. Convert, reformat, parse, and otherwise exploit media files using customer tools to ensure compatibility and readability for translation systems. Prepare files and metadata for transfer to translation systems, including review of foreign-language data. Produce report of findings and disseminate to customer, analysts, and liaison officers. Prepare accurate written gists, translations, and/or transcriptions of general and technical material. Candidate must have operational experience within the Chinese language. Basic Qualifications Must have the sufficient language skills, analytic skills, and technical aptitude to gain proficiency with job-required tools and processes (On-the-job training may be provided as needed to address customer-specific needs, with ongoing evaluations throughout train-up period). Native-level proficiency in English. Two years of overall experience in Chinese linguist operations (i.e. translation, language analysis), and two years of experience performing media examination for Document and Media Exploitation projects. Willingness to perform occasional shift work to meet mission demands. Achieve a minimum score of a 3/3 in Reading and Listening in Chinese and 3+/3+ for Reading and Listening in English. BA degree and/or 4 prior relevant experience in lieu of degree, or Masters with 2 years of prior relevant experience. Ability to compose summarizations of highly technical and complex subjects that are both succinct and accessible to a general reader. Outcomes-based problem solving of ill-defined and abstract problems. Ability to maintain project momentum while working independently with limited oversight over a long period of time. Ability to quickly scan and process a large amount of material in a foreign language for essential elements of information. Ability to comprehend customer prioritization requirements and apply them to files under review, as well as apply personal judgment when assessing the potential value of files and information. Demonstrated history of working on screening or translation projects and in maintaining the integrity and meaning of the translated material. Demonstrated ability to communicate in a professional manner (email, spoken, & reports). Ability to make sound decisions and handle stress, while meeting deadlines and performing in a high-paced environment. Familiarity with report writing styles for DOD and IC consumers. Possess a working proficiency in standard computer systems and office programs, with additional experience in media examination tools. Ability to use or train to proficiency on customer specific software programs and tools. Clearance Must currently possess at least an active TS/SCI clearance. Current or recent SCI-level access is a significant advantage and preferred. Must be able to pass a polygraph and Subject Interview. Preferred Qualifications Native-level proficiency in foreign language Graduate of the Defense Language Institute Chinese Course. An advanced degree in one of the following fields: Engineering, Computer Science, Chemistry, Physics, Legal, Medical, Banking and Financing, Foreign Military, Forensics Familiarity with Digital Forensics/eDiscovery/Document and Media Exploitation (DOMEX) processes and specialized tools (i.e. FTK, en Case, or similar). Past performance as a media examiner in support of DOD or IC customers. At Leidos, we don't want someone who "fits the mold"-we want someone who melts it down and builds something better. This is a role for the restless, the over-caffeinated, the ones who ask, “what's next?” before the dust settles on “what's now.” If you're already scheming step 20 while everyone else is still debating step 2… good. You'll fit right in. Original Posting:August 26, 2025 For U.S. Positions: While subject to change based on business needs, Leidos reasonably anticipates that this job requisition will remain open for at least 3 days with an anticipated close date of no earlier than 3 days after the original posting date as listed above. Pay Range:Pay Range $72,150.00 - $130,425.00 The Leidos pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.

Our client is seeking a Claims & Benefits Resolution Specialist for a contract opportunity. This role performs comprehensive audits and resolution activities across the claims lifecycle, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. The specialist will handle complex claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong revenue cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify root-cause errors in a high-volume environment. This is an operational “fix-it” position - the manager needs someone who doesn't just process claims but can find what's broken and correct it without hand-holding. Key Responsibilities: Claims Audit & Correction Perform comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors. Correct claim discrepancies within established turnaround times. Ensure claim data accuracy, compliant coding, and alignment with the member's plan benefit. Timely & Accurate Claims Processing Process claims quickly and accurately according to organizational benchmarks. Apply reimbursement rules based on the member's benefits and plan specifications. Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.). Complex Follow-Up & Dispute Resolution Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed. Investigate processing delays, missing information, or system errors and implement corrective action. Refer cases to clinical management teams when medical review is required to ensure appropriate reimbursement. Eligibility, Benefits & Authorization Coordination Verify and document member eligibility, benefits coverage, and authorization requirements. Identify discrepancies in coverage or authorizations that impact payment determinations. Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information. Cross-Functional Collaboration Work closely with leadership, clinical review staff, and the CBO team to ensure timely resolution of claim issues. Participate in problem-solving discussions related to claim trends or systemic issues. Support training and onboarding efforts as needed during onsite sessions. Required Skills & Experience: Minimum 2+ years of experience in healthcare revenue cycle, claims processing, eligibility/benefits, or authorizations. Strong understanding of payer rules, reimbursement methodologies, and claims adjudication. Familiarity with Epic, payer portals, and other claims/RCM systems. High accuracy in auditing and error resolution work. Experience resolving complex claim issues across multiple systems. Ability to work independently, troubleshoot problems, and drive claims to completion Strong communication skills for interacting with payers, internal teams, and leadership. Comfortable with onsite onboarding and required monthly onsite days. Experience working in a Central Business Office or Shared Services model. Prior experience supporting Utah-based payer populations or multi-state payer networks. Kavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Kavaliro is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Kavaliro will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please respond to this posting to connect with a company representative.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to: Investigate, evaluate, and settle entry-level insurance claims Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products Learn and comply with Company claim handling procedures Develop entry-level claim negotiation and settlement skills Build skills to effectively serve the needs of agents, insureds, and others Meet and communicate with claimants, legal counsel, and third-parties Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements Desired Skills & Experience Bachelor's degree or direct equivalent experience with property/casualty claims handling Ability to organize data, multi-task and make decisions independently Above average communication skills (written and verbal) Ability to write reports and compose correspondence Ability to resolve complex issues Ability to maintain confidentially and data security Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Continually develop product knowledge through participation in approved educational programs Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI

The Workers' Compensation Claims Examiner, Medical Only team, plays a vital role in swiftly and efficiently investigating workers' compensation claims for injuries that need medical care, but don't involve lost wages. This dynamic position involves engaging with employers, claimants, medical providers, and other stakeholders to guarantee top-notch medical treatment is delivered using company resources in a smart and cost-effective way. AmTrust is a leading entity in the commercial property and casualty sector, ranking as the third largest provider of workers' compensation in the United States. Our portfolio of small business insurance products is continually growing, and we are seeking motivated individuals to become part of our dynamic team. Note, this role works on a hybrid schedule out of our South Jordan, UT office location Responsibilities Thrive in a fast-paced setting by juggling multiple tasks and prioritizing effectively. Dive into investigating losses ranging from low to moderate severity, pinpointing the cause, scope, and extent of injury or liability for potential subrogation. Confirm coverage and ensure all policy conditions are met. Gather missing information and guarantee data integrity for seamless regulatory reporting. Communicate effectively with claimants, policyholders, underwriters, agents, and other vital internal and external partners. Approve medical treatment and seamlessly schedule appointments. Set medical reserves, review and approve medical bills, and diligently review/request medical records. Keep meticulous claim file notes documenting every correspondence, report, discussion, and decision. Knowledge of multi-state jurisdictions (if applicable) Ability to obtain appropriate examiner licensing (if applicable) Qualifications Proficiency with MS Word, Excel, and other business applications Demonstrated skills in critical thinking and independent decision making State licensing requirements (if applicable) Preferred: 2 years handling Medical Only or other Workers' Compensation claims experience preferred but not required. Prior customer service, client support, and/or user assistance experience is a plus Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness or ability to learn them Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a Lost Time adjuster in the future 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.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.