Claim processor jobs in Raleigh, NC

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

Now Hiring: Claims Settlement Specialist - Inspire, Lead, and Create Meaningful Impact! Are you passionate about leading with purpose, empowering others, and making a lasting impact? We are looking for motivated individuals to join our team as Claims Settlement Specialist, where you'll mentor, inspire, and implement strategies that help individuals achieve financial and personal breakthroughs while building a career that aligns with your values. Who We're Looking For: ✅ Visionary leaders who are passionate about servant leadership and impact ✅ Entrepreneurs and professionals eager to empower others while scaling success ✅ Licensed & aspiring Life & Health Insurance Agents (We'll guide you through licensing!) ✅ Individuals ready to lead with integrity, purpose, and a strong mission for success As a Claims Settlement Specialist, you'll help individuals discover their potential, achieve financial independence, and create meaningful change in their lives and communities. Is This You? ✔ Passionate about mentorship, leadership, and creating impact-driven success? ✔ A strong communicator who thrives on guiding and inspiring others? ✔ Self-driven, disciplined, and committed to personal and professional growth? ✔ Open to mentorship, leadership development, and continuous learning? ✔ Looking for a recession-proof career with unlimited earning potential? If you answered YES, keep reading! Why Become a Claims Settlement Specialist? 🚀 Work from anywhere - Build a career aligned with your values and goals. 💰 Uncapped earning potential - Part-time: $40,000-$60,000+/year | Full-time: $70,000-$150,000+++/year. 📈 No cold calling - Work with individuals who have already requested guidance. ❌ No sales quotas, no pressure, no pushy tactics. 🏆 Leadership & Ownership Opportunities - Develop and expand your own team. 🎯 Daily pay & performance-based bonuses - Direct commissions from top carriers. 🎁 Incentives & rewards - Earn commissions starting at 80% (most carriers) + salary. 🏥 Health benefits available for qualified participants. This is more than just a career-it's an opportunity to lead with purpose, inspire positive change, and build a future that aligns with your mission and impact. 👉 Apply today and take your first step as a Claims Settlement Specialist! (Results may vary. Your success depends on effort, skill, and commitment to learning and execution.)

MBP is looking for Claims Analyst/Lead Claims Analyst/Senior Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Highly proficient in Oracle P6 and experienced with one or more of the following: Microsoft Project, Phoenix Project Manager, or similar. Responsibilities Main Duties: * Performs review and analysis of construction claims. * Assists with development of contractor claims. * Develops and/or review time extension requests. * Assist with development of expert reports and exhibits. Qualifications Education * B.S. in Civil Engineering, Construction Management, or relevant experience which equates to this degree. * P.E. license, Certified Construction Manager, Planning and Scheduling Profession, or similar, certification preferred. Skills and Abilities * Experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. * Experience drafting expert reports and deliverables. * Proficient in Oracle P6 required and experienced with Microsoft Project desired. * Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration. * Ability to relate technical knowledge to a non-technical audience. * Proficiency in reading/understanding construction plans and specifications. * Proficiency with Microsoft Office software programs including Word, Excel, and PowerPoint. * Experience providing training, supervision, proposal development, and business development desired. * Occasional overnight travel may be required. STATUS: Full-time BENEFITS: * Competitive compensation with opportunities for semi-annual bonuses * Generous Paid Time Off and holiday schedules * 100% Employer paid medical, dental, vision, life, AD&D, and disability benefits (for individual) * Health Savings Account with company contribution * 401(k)/Roth 401(k) plan with company match * Tuition Assistance and Student Loan Reimbursement * Numerous Training and Professional Development opportunities * Wellness Program & Fitness Program Reimbursement Applicants must be authorized to work in the U.S. without sponsorship. MBP is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Protected veterans and individuals with disabilities are encouraged to apply.

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 Claim Examiner - Workers Comp (Southeast Experience Required) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **PRIMARY PURPOSE** **:** To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. **Experience** : Five (5) years of claims management experience or equivalent combination of education and experience required **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. 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**

MBP is looking for Claims Analyst/Lead Claims Analyst/Senior Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Highly proficient in Oracle P6 and experienced with one or more of the following: Microsoft Project, Phoenix Project Manager, or similar. Responsibilities Main Duties: Performs review and analysis of construction claims. Assists with development of contractor claims. Develops and/or review time extension requests. Assist with development of expert reports and exhibits. Qualifications Education B.S. in Civil Engineering, Construction Management, or relevant experience which equates to this degree. P.E. license, Certified Construction Manager, Planning and Scheduling Profession, or similar, certification preferred. Skills and Abilities Experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Experience drafting expert reports and deliverables. Proficient in Oracle P6 required and experienced with Microsoft Project desired. Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration. Ability to relate technical knowledge to a non-technical audience. Proficiency in reading/understanding construction plans and specifications. Proficiency with Microsoft Office software programs including Word, Excel, and PowerPoint. Experience providing training, supervision, proposal development, and business development desired. Occasional overnight travel may be required. STATUS: Full-time BENEFITS: Competitive compensation with opportunities for semi-annual bonuses Generous Paid Time Off and holiday schedules 100% Employer paid medical, dental, vision, life, AD&D, and disability benefits (for individual) Health Savings Account with company contribution 401(k)/Roth 401(k) plan with company match Tuition Assistance and Student Loan Reimbursement Numerous Training and Professional Development opportunities Wellness Program & Fitness Program Reimbursement Applicants must be authorized to work in the U.S. without sponsorship. MBP is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Protected veterans and individuals with disabilities are encouraged to apply.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. + Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. + Performs claim re-work calculations. + Follow through completion of claim overpayments, underpayments, and any other irregularities. + Process complex non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. + Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. + Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to lesser experience staff. + Utilize all resource materials to manage job responsibilities. **Required Qualifications** + 2+ years medical claim processing experience. + Experience in a production environment. + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. + Effective communications, organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Associate degree preferred. **Education** + High School Diploma or GED. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Generous PTO and Excellent Medical Benefits General Description of the Job Class At the direction of the Assistant Vice President, Risk Management, the Insurance Manager will provide general support to the DUHS Clinical Risk Management Department. * Provide administrative direction and support to the professional liability insurance program for Duke University Health System and affiliated organizations. This support includes: * Identification of both insurable and non insurable risk * Advising department leadership and other internal clients of potential exposures * Proposing risk reduction strategies * Proposing risk financing mechanisms, including potential insurance coverage or financial transfer of risk * Maintain familiarity with insurance markets and stability Duties and Responsibilities of this Level * Research, evaluate, and make recommendations regarding current and state of the art trends in risk financing, loss control and claims management strategies. * Assist with professional liability insurance coverage program development, including working with brokers at all levels to obtain coverage, renew coverage, and revise coverage as needed. * Provide consultation and technical advice on professional liability insurance issues relating to new programs, contracts, and affiliation agreements. * Working with Corporate Finance, maintain and continually revise as needed the financial and operational records that support the insurance, risk management, and legal operations affecting professional liability exposures. * Responsible for data management including statistical trending of losses, analysis of patterns, and analysis of incurred costs. * Responsible for data collection, verification, and transmission of exposure data to actuary, auditors and brokers, and others as required. * Review and maintain insurance policies, analyzes existing policies for coverage, endorsements and exclusions, anticipates and deals with policy expirations and renewals. * Coordinate coverage with DU Corporate Risk Management in areas where exposures and responsibilities overlap. Develop and prepare insurance program presentations as needed. * Participate in setting, documentation and ongoing evaluation of reserves. * Develop ongoing analysis of current losses as they might or will impact breach of reinsurance. Assures appropriate notifications are transmitted. * Supervise insurance support staff and oversee the documentation of provider claims histories, insurance verifications, and maintaining records of off-site and expert witness activities. * All other duties incidental to the work described herein. Required Qualifications at this Level Education: Work normally requires a Bachelor's degree in Insurance, Risk Management, Business Administration, Hospital Administration, Law or a closely related field. Experience: Work requires a minimum of five years of progressively responsible experience in third-party insurance, risk financing or captive insurance management. Prior experience must include contract and insurance policy review and projection/management of financial reserves. Degrees, Licensure, and/or Certification: Associate in Risk Management (ARM), or Certified Property and Casualty Underwriter (CPCU) designation preferred. Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Nearest Major Market: Durham Nearest Secondary Market: Raleigh

Inventory Claims Coordinator Department: Warehouse Operations - 171032 Reports to: Inventory Supervisor Location: Wendell, NC Position Status: Full-time Status: Hourly, Non-Exempt Management Level: Non-Management JOB SUMMARY The Inventory Claims Coordinator serves as a support element and liaison for all distribution centers and the dealer network. This person will be cross trained and gain exposure to many functions including claims processing, inventory investigations, dealer network relationship building and recording claim data. KEY RESPONSIBILITIES OF JOB The Inventory Claims Coordinator key responsibilities are outlined below: Claims: Resolve and process claim disputes Technical drawing look-up Inventory background investigations Credit and Debit process on claim investigations Issuing and monitoring call tags Resolve and process freight claim disputes and tracking reimbursement if applicable Inventory Management Provide inventory control reporting and vendor reports Track claim data and communicate common themes for mitigation Directly or indirectly locate misplaced parts to help satisfy sale to customer/dealer Help maintain or relay proper product identification and location accuracy and ability to transfer product to correct location if needed Other Responsibilities Determine and record data for KPI's Promote dealer satisfaction utilizing customer service skills EDUCATIONAL AND PHYSICAL REQUIREMENTS High school diploma or GED equivalent required with minimum of 3 years' related experience Associate or Bachelor degree with a minimum of 1 year experience 1-5 Years of related customer service or inventory experience. Must be a team player with strong interpersonal communication skills Good time-management skills and attention to detail Outstanding written and oral communication skills with the ability to effectively present information Proficiency in Microsoft programs, including Excel, a plus SAP experience preferred SalesForce experience preferred

**Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law_ **Hours:** Monday - Friday, 8:30 am - 5:00 pm EST The **Claim Representative I** is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. **How you will make an impact:** + Learning the activities/tasks associated with his/her role. + Works under direct supervision. + Relies on others for instruction, guidance, and direction. + Work is reviewed for technical accuracy and soundness. + Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. + Researches and analyzes claims issues. **Minimum Requirements:** + Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities, and Experiences:** + Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred. + Previous experience working in health claims (CAS or ConnectsNX) is strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $16.67 to $25.00 **Locations** : Massachusetts In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Job title: Technical Specialist- Expert (HB, PB, Claims Analyst) Duration: 12 Months from projected Interview : Either Webcam Interview or In Person Competency Model: Business Acumen Understands the organization's strategic goals and how department goals support the organization. Seeks opportunities to extend and deepen learning of organization and area. Shares new information and knowledge with others. Be curious; question your assumptions when presented with an issue or question. Self-motivated to research and learn new information and explore new options. Seeks to maximize potential abilities and helps others. Follow instructions, written or oral. Adhere to all scheduling and attendance requirements. Honesty, truthfulness, reliability, accountability Read, understand and apply regulations and policies. Knowledge of relevant privacy regulations such as The Privacy Act, Freedom of Information Act and HIPPA law Knowledge of revenue cycle billing, hospital billing, professional billing, and claims processing operations and workflows Knowledge and understanding of third-party applications. Establishes professional working relationships. Communicates verbally with team, departments, guests, and management. Communication Expresses oneself clearly in conversations, business writing and interactions with others. Delivers oral and written communications that are impactful and persuasive to their intended audiences. Demonstrates a high level of emotional intelligence in the face of conflict. Responds to tickets and emails in a timely manner. Planning and Organizing Manages and monitors time and resources effectively to complete assignments. Utilizes resources and gets involvement from others where appropriate. Shares information, materials, and time readily with others who need them Teamwork Encourages participation from all team members, regardless of role within organization; supports team members and customers. Identifies and works through conflict that may derail the collaborative process. Holds self and others accountable to create unifying goals and measure with peers. Support NCDHHS analyst team through knowledge sharing and concise documentation. Applies the knowledge of fundamental IT concepts. Asks questions, diligently seeks and is receptive of guidance. Drive Change Anticipates potential concerns/resistance to change and takes constructive steps to address them. Encourages others to adopt new methods or technologies that add value or improve performance. Keeps others focused on critical goals and deadlines through periods of change or ambiguity. Be flexible and adopt new processes and methods. Stay positive in attitude and actions. Working Conditions: Essential: * May be required to work after hours or on weekends as needed * Infrequent travel * Pass pre-employment drug test Experience: Must have strong leadership and communication skills with the ability to effectively present information to clinical and business leaders within the organization. Must have experience with Epic PB, HB, and Claims. 8 years required. Ability to work in small groups under tight project deadlines. Working closely with business and revenue cycle leaders around Epic workflow and to translate business needs Epic billing functionality. Must possess Epic certification, Resolute PB, HB, and Claims. Minimum of five years' progressive revenue cycle/healthcare experience with demonstrated experience in Epic build. Self-starter with demonstrated teamwork & communication skills. Excellent communication and collaboration skills. Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required. Experience working with Third Party Vendors such as Experian, Relay Health, and Hyland OnBase. Knowledge of revenue cycle billing, hospital billing, professional billing, and claims processing operations and workflows Rapid Retest Payer/plan creation and maintenance PLBs Charge Router Contracts Behavioral Health Long term care psychiatric billing CMS IPF PPS billing regulations Substance abuse billing - IOP, methadone dosing Medicare exhaust billing No-pay claims. Claim splits/interim claims. Cash Management Self-pay remittance Developing testing scripts Responsibilities: Analyzes, documents, and communicates business requirements for new system functionality and enhancements to existing functionality. Test system changes to ensure that they meet business requirements and do not adversely impact other areas of the Epic system. Acts as the primary support contact for the application's end-users. Identifies issues that arise in their application areas and issues that impact other application teams and works to resolve them Guides workflow design, builds, tests the system, and analyzes other technical issues associated with Epic software Identifies, implements, completes integrated testing, and communicates requested changes to the Epic system Works with Epic representatives and end users to ensure the system meets the organization's business needs regarding the project deliverables and timeline Performs in-depth analysis of current and future workflows, data collection, report details, and other technical issues associated with the Epic EHR and designated third-party applications Partners with quality, operational, and business leaders on system design and optimization to meet quality, safety, financial, and efficiency needs Collects requirements regarding potential system enhancements or new system implementation and prepares details of specifications needed; prioritizes and implements requested changes to the system. Investigates standardization and process improvement opportunities by rounding within revenue cycle areas while making build decisions. Validates that data is accurate and meets business requirements. Completes integrated testing to test system changes in all Epic environments to ensure that they meet business requirements and do not adversely impact other areas of the system. Troubleshoots and identifies root causes and documents problems of simple to medium complexity for assigned applications and systems. Maintains data integrity and security for assigned applications and systems. Develops system documentation as assigned per standards. Develops communication-related education efforts for deployments, upgrades, optimizations, and other system changes as assigned. Stays current on Epic application releases and participates in upgrade planning and testing. Participates in performance improvement activities to measure, assess and improve the quality of assigned work area Education: Essential: Bachelor's degree or 8 years' experience in directly related field Credentials: Essential: * Pass general background check * Epic module certification as assigned * Epic HB/PB Claims Certification

Leverage your strong analytical, decision-making, and problem-solving skills to manage complexity and severity, ensuring a fair resolution of all claims, including those in litigation. This position will be located in our Stevens Point - Division Street office, Davenport, IA office, Goldsboro, NC office, Nashville, TN office, Madison, WI office, El Paso, TX office, or Richmond, VA office location. What You'll Do: As a Claims Representative Specialist on our PL - Litigation team, you'll provide prompt claim investigation, evaluation, and settlement or denial of claims of high complexity. In addition, you'll: * Handle complex claims involving litigation, and possibly high severity non-litigated exposures. * Verify coverages through investigation and reviewing policy terms, conditions, and language. This may require working with coverage counsel in filing declaratory/summary judgements. * Evaluate liability by taking recorded statements from involved parties and witnesses and reviewing police reports accident scene photos and other pertinent evidence. * Negotiate claims settlements with claimants and their legal representation within assigned authority limits * Comply with industry regulations, legal requirements, and internal policies through thorough documentation of all decisions correspondence and discussions that occur throughout the life cycle of the claim. * Work with and mentor other associates to share your knowledge, expertise, insights and perspectives to assist others in achieving their goals and enhancing their skills. What it Takes: * Bachelor's degree or equivalent work experience * 5+ years of related work experience * Extensive claims knowledge with the ability to understand and manage litigated claims * Ability to review and analyze complex documents, insurance policies, coverages, medical reports, and insurance regulations. * Ability to make appropriate claims decisions, prioritize, and manage workload * Advanced writing, communication, and presentation skills * Advanced conflict resolution and negotiation skills * Technology aptitude What You'll Receive: At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive. * Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you'll work in office. * As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office. * Meal Subsidy available for associates who report to an office. * 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future. * Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program * Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off * Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle. * Well-being and Employee Assistance programs * Sentry Foundation gift matching program to encourage charitable giving. About Sentry: We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction. Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States. We're rated A+ by A.M. Best, the industry's leading rating authority. Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth. Get ready to own your future at Sentry. Opportunities await! Joe Larsen Talent Acquisition Specialist ********************* Equal Employment Opportunity Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

IAT Insurance Group has an immediate opening for a Management Liability Claims Specialist that can be located in any of our IAT locations. This role works a hybrid schedule from an IAT Office. The hybrid schedule reflects our values (thinking and acting like an owner, collaboration, and teamwork) as it requires working from the office with colleagues and other disciplines Monday through Wednesday, with the option of working Thursday and Friday remotely. Responsibilities: Responsible for handling Management Liability Claims (EPL, D&O, Fiduciary and Crime) for Private and Non-Profit businesses based on Claim Guidelines Within authority limit, thoroughly analyze, investigate, negotiate and resolve all levels of severity claims Selects, directs and manages defense counsel including approval of budgets Develops litigation/file disposition strategy. Attends mediations, settlement conferences and trials Verifies/analyzes applicable coverage for the reported claims Follow operational policies and procedures, including compliance, regulatory and performance and customer service standards Prepare reports, including Large Loss Reports, to management which accurately reflects loss development, potential/actual financial exposure, coverage issues, claim and recovery strategies Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file Identifies and addresses recovery/contribution/SIU opportunities Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines. Drafts correspondence, including but not limited to, coverage letters to stakeholders as required Support business partners on an as needed basis on various claim and underwriting related issues and marketing meetings Maintains resident/nonresident adjuster licenses as required Performs other duties as assigned Qualifications: Must Have: Bachelor's Degree with 5+ years of management liability claims experience (including handling employment liability practices, directors & officers' liability and fiduciary liability coverages) or equivalent Equivalent experience is defined as 9+ years of relevant claims experience, specifically claims involving litigation. Excellent coverage analysis skills with experience in drafting coverage position correspondence Experience handling litigated files and direction of defense counsel Excellent negotiation skills Must be willing to travel, average 1 day a month Claims Licensure as required by respective state(s) Excellent oral and written communication skills Ability to organize, multi-task and prioritize work Excellent customer service and interpersonal skills Ability to analyze data, utilize sound judgment to draw conclusion and make supported decisions To qualify, applicants must be authorized to work in the United States and must not require, now or in the future, VISA sponsorship for employment purposes Preferred to Have: CPCU and other insurance related studies Our Culture IAT is the largest private, family-owned property and casualty insurer in the U.S. I nsurance A nswers T ogether is how we define IAT, in letter and in spirit. We work together to provide solutions for people and businesses. We collaborate internally and with our partners to provide the best possible insurance and surety options for our customers. At IAT, we're committed to driving and building an open and supportive culture for all. Our employees propel IAT forward - driving innovation, stable partnerships and growth. That's why we continue to build an engaging workplace culture to attract and retain the best talent. We offer comprehensive benefits like: 26 PTO Days (Entry Level) + 12 Company Holidays = 38 Paid Days Off 7% 401(k) Company Match and additional Profit Sharing Hybrid work environment Numerous training and development opportunities to assist you in furthering your career Healthcare and Wellness Programs Opportunity to earn performance-based bonuses College Loan Assistance Support Plan Educational Assistance Program Mentorship Program Dress for Your Day Policy All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We maintain a drug-free workplace and participate in E-Verify. Compensation: Please note, that the annual gross salary range associated with this posting is $60,600 - $95,700. This range represents the anticipated low and high end of the base salary for this position. Actual salaries will vary based on factors such as a candidate's qualifications, skills, competencies, and geographical location related to this specific role. The total compensation will include a base salary, performance-based bonus opportunities, 401(K) match, profit-sharing opportunities, and more. To view details of our full benefits, please visit **************************************************

Join Our Dynamic Insurance Team - Unlock Your Potential! Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for our next leaders-those who want to build a career or an impactful part-time income stream. Is This You? ✔ Willing to work hard and commit for long-term success? ✔ Ready to invest in yourself and your business? ✔ Self-motivated and disciplined, even when no one is watching? ✔ Coachable and eager to learn? ✔ Interested in a business that is both recession- and pandemic-proof? If you answered YES to any of these, keep reading! Why Choose Us? 💼 Work from anywhere - full-time or part-time, set your own schedule. 💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month. 📈 No cold calling - You'll only assist individuals who have already requested help. ❌ No sales quotas, no pressure, no pushy tactics. 🧑 🏫 World-class training & mentorship - Learn directly from top agents. 🎯 Daily pay from the insurance carriers you work with. 🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Ownership opportunities - Build your own agency (if desired). 🏥 Health insurance available for qualified agents. 🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom. 👉 Apply today and start your journey in financial services! ( Results may vary. Your success depends on effort, skill, and commitment to training and sales systems. )

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR zXwwJNzVpn

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **A Brief Overview** Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. **What you will do** + Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. + Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. + Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. + Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. + Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. + Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. + Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies. + Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development. + Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. **Required Qualifications** + 1-2 years' experience working in Customer Service. + Possess strong teamwork and organizational skills. + Strong and effective communication skills. + Ability to handle multiple assignments competently through use of time management, accurately and efficiently. + Strong proficiency using computers and experience with data entry. **Preferred Qualifications** + Experience in a production environment. + Healthcare experience. + Knowledge of utilizing multiple systems at once to resolve complex issues. + Claim processing experience preferred but not required. + Understanding of medical terminology. **Education** High School or GED equivalent. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $17.00 - $25.65 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Job Description Inventory Claims Coordinator Department: Warehouse Operations - 171032 Reports to: Inventory Supervisor Full-time Status: Hourly, Non-Exempt Management Level: Non-Management JOB SUMMARY The Inventory Claims Coordinator serves as a support element and liaison for all distribution centers and the dealer network. This person will be cross trained and gain exposure to many functions including claims processing, inventory investigations, dealer network relationship building and recording claim data. KEY RESPONSIBILITIES OF JOB The Inventory Claims Coordinator key responsibilities are outlined below: Claims: Resolve and process claim disputes Technical drawing look-up Inventory background investigations Credit and Debit process on claim investigations Issuing and monitoring call tags Resolve and process freight claim disputes and tracking reimbursement if applicable Inventory Management Provide inventory control reporting and vendor reports Track claim data and communicate common themes for mitigation Directly or indirectly locate misplaced parts to help satisfy sale to customer/dealer Help maintain or relay proper product identification and location accuracy and ability to transfer product to correct location if needed Other Responsibilities Determine and record data for KPI's Promote dealer satisfaction utilizing customer service skills EDUCATIONAL AND PHYSICAL REQUIREMENTS High school diploma or GED equivalent required with minimum of 3 years' related experience Associate or Bachelor degree with a minimum of 1 year experience 1-5 Years of related customer service or inventory experience. Must be a team player with strong interpersonal communication skills Good time-management skills and attention to detail Outstanding written and oral communication skills with the ability to effectively present information Proficiency in Microsoft programs, including Excel, a plus SAP experience preferred SalesForce experience preferred

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law Hours: Monday - Friday, 8:30 am - 5:00 pm EST The Claim Representative I is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. How you will make an impact: * Learning the activities/tasks associated with his/her role. * Works under direct supervision. * Relies on others for instruction, guidance, and direction. * Work is reviewed for technical accuracy and soundness. * Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. * Researches and analyzes claims issues. Minimum Requirements: * Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred. * Previous experience working in health claims (CAS or ConnectsNX) is strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $16.67 to $25.00 Locations: Massachusetts In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CLM > Claims Reps Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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**