Claim processor jobs in Salt Lake City, UT

Job Title: Claims & Benefits Resolution Specialist Pay Rate: $25.00-$26.00 (Training Onsite; Remote After Training with 1 Required Onsite Day/Month) Department: Revenue Cycle Management - Central Business Office Assignment Length: 3 Months (Potential Extension) Top Things Needed: Minimum 2-3 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. JOB DESCRIPTION: 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 2-3 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.

We are so glad you are interested in joining Sutter Health! Organization: S3-Sutter Shared Services-Utah Serves as the pre-service point of contact for patients to obtain all necessary information to pre-register and financially clear patients prior to day of service delivery. Handles non-clinical referrals and authorization coordination and unbilled account follow-up. Enhances the patient experience throughout all patient interactions by serving as the customer service point of contact by demonstrating knowledge of Sutter's Health system and service offerings. Job Description: EDUCATION * Equivalent experience will be accepted in lieu of the required degree or diploma. * HS Diploma: High School Diploma or General Education Diploma (GED) or equivalent education/experience SKILLS AND KNOWLEDGE * Basic bookkeeping principles, general business procedures, knowledge of consumer collection and billing rules and regulations. * Written and verbal communication skills. * Ability to process requests quickly, accurately, and consistently with general supervision. * Able to work with others in a flexible and cooperative manner. * Proficient in using Microsoft Word, Excel, Visio and PowerPoint, and internet research. Job Shift: Days Schedule: Full Time Shift Hours: 8 Days of the Week: Monday - Friday Weekend Requirements: Once a Month Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 40 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $21.08 to $28.45 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities * Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. * This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. * Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. * Assists in the reviews of state or federal complaints related to claims. * Supports the other team members with several internal departments to determine appropriate resolution of issues. * Researches tracers, adjustments, and re-submissions of claims. * Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. * Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. * Handles special projects as assigned. * Other duties as assigned. Knowledgeable in systems utilized: * QNXT * Pega * Verint * Kronos * Microsoft Teams * Video Conferencing * Others as required by line of business or state Job Function Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent combination of education and experience; REQUIRED EXPERIENCE: 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 4 years PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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.

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, 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 #IN-DNI

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.

At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. The Analytics team is a data-driven team focused on unlocking insights that improve member outcomes and drive business performance. Our team sits at the intersection of data, strategy, and execution. The Analytics team reports directly to the Vice President, Data Engineering, Analytics, and AI in Product Development. In this role, you will help with standardizing and scaling all of the analytics deliverables which include reporting and self-serve dashboards leveraging data from claims, eligibility, population health, customer engagement, and digital platforms. You will collaborate across departments, mentor junior analysts, and work directly with business stakeholders and present meaningful insights to clients. If you're passionate about using data to make a meaningful impact in healthcare, you'll find a home here. What you'll do: Design, build, and deliver sophisticated analyses focusing on core metrics from various domains such as claims, eligibility, customer experience, digital engagement, and the complete member journey. Translate business questions into analytic plans and communicate results in a clear, actionable manner to both technical and non-technical audiences. Design logical categorizations for dashboards and views, building scalable and automated reports in Looker and other BI tools to provide self-service insights to the business. Support internal stakeholders (e.g., Product, Customer Success, Marketing, etc.) by generating insights that inform strategy and operational improvements. Proactively identify and execute opportunities to build automated reports and analytical processes, reducing manual effort and increasing reliability. Provide technical mentorship and peer review, including refactoring and optimizing complex code for existing reports to improve performance and scalability. Work closely with the Data Architect and engineering teams to help build and refine the semantic layer, ensuring data models are optimized for analytical use. To be successful in this role, you'll need: A minimum of 5+ years in data analytics, ideally within a related healthcare or health tech field. Requires a track record of success in a high-velocity environment and a strong technical aptitude for simplifying and scaling complex data assets to support long-term standardization. Proven ability to work with complex, large-scale datasets from disparate silos, with a deep focus on healthcare data. Strong SQL skills with a track record of writing efficient, scalable queries for analysis and reporting. To be technically savvy with modern data tools. This includes advanced SQL, hands-on experience with cloud data platforms like Databricks, and expert-level proficiency in BI tools, especially Looker. Demonstrated project management skills, with the ability to prioritize tasks, manage timelines, and drive cross-functional collaboration. Strong communication skills, with the ability to translate technical findings into clear, actionable recommendations for non-technical stakeholders. To champion data governance and quality by conducting audits and validation. This includes the ability to pull and interpret data from EDI files to support claims audits and analysis. A strong functional understanding of the claims adjudication process, from submission to payment. To be self-sufficient, intellectually curious and take ownership for everything you do. Pay Transparency Statement This is a hybrid position based out of one of our offices: San Francisco, CA, Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office two days per week.#LI-hybrid The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at ******************************************** San Francisco, CA Pay Range$120,000-$150,500 USDLehi, UT Pay Range$96,300-$120,500 USDPlano, TX Pay Range$105,575-$132,550 USDWhy Join Us? Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare Impactful projects that shape the future of our organization Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests Flexible work arrangements and a supportive work-life balance We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com. Privacy Notice For more information about why we need your data and how we use it, please see our privacy policy: *********************************************

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.

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**

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.

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.

**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-focusedmindset. + 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 Management Required Experience: 5-7 years of relevant experience Required Travel: Negligible Required 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.

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.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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.

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.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities * Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. * This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. * Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. * Assists in the reviews of state or federal complaints related to claims. * Supports the other team members with several internal departments to determine appropriate resolution of issues. * Researches tracers, adjustments, and re-submissions of claims. * Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. * Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. * Handles special projects as assigned. * Other duties as assigned. Knowledgeable in systems utilized: * QNXT * Pega * Verint * Kronos * Microsoft Teams * Video Conferencing * Others as required by line of business or state Job Function Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent combination of education and experience; REQUIRED EXPERIENCE: 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 4 years PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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.

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.

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.