Claim processor jobs in San Antonio, TX - 29 jobs

SWBC is seeking a talented individual to review and evaluate incoming claims for payment or denial and acts as a liaison for the carrier and the financial institution. Why you'll love this role: This role allows you to help those who are dealing with difficult circumstances in their lives. Your help gives them a sense of relief in times of need. You will also have a team who is supportive and there to help at any time. Essential duties include the following: Adjudicates routine to moderately complicated Payment Protection claims and determines if benefits are payable or not; ensures claims are adjudicated within the customer service level standards established by the company with adherence to Prompt Payment of Claims Regulation respective to each state. Prepares letters and requests any information needed to make a determination on claims from insurance carrier, family, claimant, physicians, employers, and others. Submits all claims determined contestable to carriers for review and final determination. Calculates the benefit amount and ensures claims are not being overpaid or underpaid according to the provisions within the specific insurance certificate/policy form that describes the terms and conditions of the applicable coverage. Assists claimants or financial institutions via phone to answer questions, and documents such within the claim file. Maintains carrier guidance and administrative files, required logs to comply with carrier requirements, reviews and evaluates instructions provided by carriers and assists management with proper implementation. Completes request for refund form and submits to Premium Processing; verifies monthly outstanding loan balances for active and inactive financial institutions; and ensures that open accounts loan balances are verified every 6 months and closed accounts are verified each month; provides back-up assistance to the claims processor position for establishment and set-up of new claims. Serious candidates will possess the minimum qualifications: High School Diploma or equivalency. Some college course work in medical terminology or related field preferred. Minimum one (1) year of claims processing or related experience. Able to type at least 40 WPM accurately and know 10 key by touch. Working knowledge of word processing and spreadsheets preferably in Microsoft Word and Excel. Excellent organizational and interpersonal skills. Able to draft business letters. Able to read and understand medical records. Able to prioritize job duties and be detail oriented. Able to lift up to 10-20 lbs. of claim storage boxes. Able to move (push/pull) up to 50 lbs. of files and documents. Able to bend, stoop, and stand to perform filing duties. SWBC offers*: Competitive overall compensation package Work/Life balance Employee engagement activities and recognition awards Years of Service awards Career enhancement and growth opportunities Leadership Academy and Mentor Program Continuing education and career certifications Variety of healthcare coverage options Traditional and Roth 401(k) retirement plans Lucrative Wellness Program *Based upon employee eligibility Additional Information: SWBC is a Substance-Free Workplace and requires pre-employment drug testing. Please note, SWBC does not hire tobacco users as allowed by law. To learn more about SWBC, visit our website at ************* If interested, please click the appropriate apply button.

Claims Specialist (Call Center CSR Experience Required) Duration : 12 Months Total Hours/week : 40.00 1 st shift Client: Medical Device Company Job Category: Customer Service Level Of Experience: Entry Level Employment Type: Contract on W2 (Need US Citizens, GC Holders Only) Training Schedule will be 7:30am - 4:30pm. Work days/hours: Work hours are between 7am - 6pm. 8-hour work schedule. Job Description: A Claims Specialist is responsible for entering and processing customer Claims. Duties will include: Completing the end-to-end Claims process. Communicating with customers over the phone or via email. Providing detailed Claim information. Reviewing customer orders and/or account information while resolving issues. Qualifications: Basic computer navigation skills required. Working knowledge of MS Excel, Word, Outlook required. Customer Service experience desired. Call Center experience desired. HS Diploma/GED required.

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: $21.65 - $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.

If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we're hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a Claims Analyst II to support our growing Claims department. You will join our Claims Insights team, and in this role, you will help develop operational reports and dashboards that will support the team's continued scaling and growth and gain valuable insights into the processes and tools necessary to build and sustain a complex claim function. What you'd be doing: Identify operational reporting opportunities with Claims department leadership. Develop data and visual dashboards that can be used to identify needed actions quickly. Work with leaders to incorporate operational data and dashboards into daily and weekly management processes. Analyze Claims data in Domo, AWS Redshift and Excel to provide actionable insights to stakeholders. Perform data cleaning, validation, and quality checks within visualization tools to ensure accuracy, reliability, and consistency of datasets. Translate business requirements into scalable business intelligence solutions to track KPIs for senior leadership and operational teams. Build complex dashboards and automated reporting systems that serve as operational controls. Establish a framework for understanding and efficiently using currently available operational claims data. Mentor other analysts. Develop, test, and optimize complex ETL workflows in Domo for performance and efficiency. Maintain and monitor data pipelines to support operational and strategic reporting needs. Work closely with business stakeholders to understand data needs and collaborate with cross functional teams to troubleshoot issues, and support data-driven decision-making. We're looking for someone who has: 3+ years of experience in data analytics role. 1+ years of Property Insurance or Claims experience. Bachelor's degree in Mathematics, Statistics, Computer Science, or a related field. Advanced proficiency using data and visualization tools (eg Tableau, Domo, PowerBI, etc). Advanced SQL programming skills . Demonstrated ability to work with large datasets and tell a story using data visualization techniques. Understanding of database structure and ETL process. Excellent organizational skills for handling multiple projects simultaneously. Proven ability to gather requirements and develop custom reporting solutions. Advanced proficiency in Excel, AWS Redshift, and Microsoft SQL Server. Collect, validate, and analyze data to identify trends, patterns, and insights. Excellent verbal and written communication skills Advanced problem -solving and data validation skills. Proven ability to work independently and as a team member. About the Claims team at SageSure: On SageSure's Claims team, you'll be doing more than investigating and resolving losses. From the ground up, you'll be pioneering a best-in-class claims handling approach that leverages transformative technology to support our customers, agents and employees. As a part of this customer-focused, process-oriented team you will be the face of SageSure, helping our policyholders through some of their most trying times. Whether you hold a formal leadership role or are a key team player, you'll coach, mentor and engage with those around you in ways that bring out the best in people and effect change. You can easily distill complex processes in ways those outside the industry can understand and know the importance of aligning communication tools to customer preferences. You thrive on setting and exceeding expectations, and know building relationships, not completing transactions, is the heart of the insurance business. About SageSure: Named among the Best Places to Work in Insurance by Business Insurance for four years in a row (2020-2023), SageSure is one of the largest managing general underwriters (MGU) focused on catastrophe-exposed markets in the US. Since its founding in 2009, SageSure has experienced exceptional growth while generating underwriting profits for carrier partners through hurricanes, wildfires, and hail. Available in 16 states, SageSure offers more than 50 competitively priced home, flood, earthquake, and commercial products on behalf of its highly rated carrier partners. Today, SageSure manages more than $1.9 billion of inforce premium and helps protect 640,000 policyholders. SageSure has more than 1000 employees working remotely or in-office across nine offices: Cheshire, Connecticut; Chicago, Illinois; Cincinnati, Ohio; Houston, Texas; Jersey City, New Jersey; Mountain View, California; Marlton, New Jersey; Tallahassee, Florida; and Seattle, Washington. SageSure offers generous health benefits and perks, including tuition reimbursement, wellness allowance, paid volunteer time off, a matching 401K plan, and more. SageSure is a proud Equal Opportunity Employer committed to building a workforce that reflects the spectrum of perspectives, experiences, and abilities of the world we live in. We recognize that our differences make us strong, and we actively seek out diverse candidates through partnerships with organizations, institutions and communities that represent various backgrounds. We champion belonging and inclusion for all identities, including, but not limited to, race, ethnicity, religion, sexual orientation, age, veteran status, ability status, gender, and country of origin, striving to create a culture where all individuals feel valued, respected, and empowered to bring their authentic selves to work. Our nimble, highly responsive culture nurtures critical thinkers who run toward problems and engineer solutions. We relentlessly pursue better outcomes by investing in the technology, talent, and tools that position us to succeed in demanding markets. Come join our team! Visit sagesure.com/careers to find a position for you.

Full Time 12238 Silicon Drive Clerical Day Shift $18.75 - $24.25 /RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required. Two or more years of experience claim processing and/or billing experience required. Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred. Knowledge of ICD-9, CPT 4 coding and medical terminology is required.

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 Liability Claims Examiner - General Liability 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 general liability and auto liability 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 general liability and auto liability 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. + Assesses liability and resolves claims within evaluation. + 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. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of General Liability claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **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. _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 $75,000 - $95,000. 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 #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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**

Job Description Medical Billing Audit Support Specialist (Claims Processor) Type: Contract | Full-time Pay Rate: $20-$25/hr Acts as the primary liaison and support resource for Injury/Casualty Adjusters supporting Medical Bill Audit (MBA) operations in MedFlow. Provides hands-on claims and system support, helps reduce medical bill backlogs, improves adjuster efficiency, and ensures compliance with service level objectives and state regulations. This is not a traditional IT helpdesk role. Key Responsibilities Serve as primary point of contact for MBA operations between adjusters, vendors, and claims teams Support adjusters using MedFlow through onboarding, training, and daily issue resolution Assist with high volumes of pending medical bills; identify root causes and recommend improvements Review MBA reports, identify issues, and facilitate resolution per SLOs Maintain user access lists and coordinate access changes with vendors Assist with complaint responses related to medical bill payments Provide light systems support, ticketing, documentation, and issue escalation as needed Required Skills & Experience 1+ year of first-party injury medical claims adjusting or auto liability adjusting experience Experience with medical bill processing, medical terminology, or health insurance claims Working knowledge of claims investigation, evaluation, and adjudication Strong analytical, prioritization, and problem-solving skills Clear written and verbal communication skills Technology MedFlow - Required Guidewire - Preferred (training available) Ticketing systems and documentation experience preferred Ideal Background Claims adjuster with medical billing or MBA experience Health insurance claims processor with system SME experience Comfortable in fast-paced, high-communication environments Medical Industry knowledge

**Why USAA?** At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. **The Opportunity** As a dedicated **Injury Examiner** , you will be responsible to adjust complex bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy. This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week. **What you'll do:** + Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. + Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. + Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. + Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. + Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. + Serves as a resource for team members on complex claims. + Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. + Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. + Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. **What you have:** + High School Diploma or General Equivalency Diploma. + 4 years auto claims and injury adjusting experience. + Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations. + Advanced negotiation, investigation, communication, and conflict resolution skills. + Demonstrated strong time-management and decision-making skills. + Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. + Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims. + Ability to exercise sound financial judgment and discretion in handling insurance claims. + Advanced knowledge of coverage evaluation, loss assessment, and loss reserving. + Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. **What sets you apart:** + 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage + College Degree (Bachelor's or higher). + Insurance Designation. **Compensation range:** The salary range for this position is: $85,040 - $162,550 **.** **USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).** **Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. **Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com _Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._ _USAA is an Equal Opportunity Employer. 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._ **If you are an existing USAA employee, please use the internal career site in OneSource to apply.** **Please do not type your first and last name in all caps.** **_Find your purpose. Join our mission._** USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity. USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself - you just need to share our passion for serving our more than 13 million members. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law. California applicants, please review our HR CCPA - Notice at Collection (********************************************************************************************************** here. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. BCforward's headquarters are in Indianapolis, Indiana and also operates delivery centers in 20 locations in North America as well as India and Puerto Rico. We are currently the largest consulting firm and largest MBE certified firm headquartered in Indiana. Title : Transaction Processing Representative Location : SAN ANTONIO TX 78249 Duration : 12 Months Job Description: Basic Qualifications: 1-2 experience with automotive warranty, policy and procedure 1-2 years experience with management systems used in automotive warranty and administration Overtime will be required Qualifications Preferred Qualifications: Technical and mechanical background Experience with management systems used in automotive warranty Administration Skills: Experience with coding warranty claims and warranty administration. Good verbal and written communication skills. Computer and excel skills Education: High school or equivalent work/military experience Additional Information Thanks & Regards, BCforward Recruitment Team

Hi! I am a professional senior healthcare recruiting consultant placing healthcare professionals permanently in the United States. I am currently hiring for Claims & Denials Coordinators in the San Antonio area.This is for a Fortune 125 company. We have 5 Claims & Denials Coordinators positions available. I'm looking to hold my final batch of phone screenings tomorrow so apply now and please send your update resume directly. Position is Long Term Temp up to 6 months (after that position may end, get extended or go permanent based on business need), Schedule is Mon-Fri, 8:00am-5:00pm, some OT may be required. Will be working in office. Competitive pay and amazing benefits! Thanks, Ron Payos 321-332-6801 Job Description In charge of generating denial letters to explain to providers why services were not approved. Qualifications High school diploma or equivalent 2+ years of managed care experience (either working at a plan or interacting with a plan) Knowledge of medical terminology Knowledge of claims, appeals, & denials Computer skills Administrative experience Additional Information All your information will be kept confidential according to EEO guidelines.

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. **Job Summary** This position is responsible for provider recruitment and contracting, education of providers, and for ongoing provider service. Ability and willingness to travel within assigned areas of responsibility, including overnight stays. Job Requirements: + Bachelor's degree in business OR 4 years' experience in managed care environment. + 2 years' experience in a position that demonstrates leadership abilities and sound decision-making. + Knowledge of contracts, applications and products; claims processing systems. + Demonstrated proficiency in provider reimbursement methods. + Demonstrated ability to meet deadlines and work well under pressure. + Verbal and written communication skills; organizational and planning skills; ability to take initiative and work independently. + PC proficiency to include Microsoft Office + Ability and willingness to travel within assigned areas of responsibility, including overnight stays Preferred Qualifications: + Knowledge of contracting and Single Case Agreements + Negotiation skills + Strong documentation skills **This is a Flex (Hybrid) role: 3 days in office; 2 days remote.** \#LI-MW2 \#LI-Hybrid **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************* . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. **HCSC Employment Statement:** We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. **Base Pay Range** $55,900.00 - $123,500.00 Exact compensation may vary based on skills, experience, and location. **Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.** **Join our Talent Community. (******************************************** PA8v\_eHgqFiDb2AuRTqQ)** For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at ************** to request reasonable accommodations. Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.

Benefits: Paid Sick Time Paid Vacation Paid Holiday Cell phone stipend 401(k) matching Restoration 1 of Texas Hill Country is growing our team to increase our ability to serve the greater San Antonio and Texas Hill County areas. We are locally owned, operated and are committed to providing top-notch services with a focus on integrity, client satisfaction, and efficient operations. We specialize in remediation and mitigation services for residential and commercial properties that have been affected by water mitigation, mold remediation, fire/smoke/odors remediation, and contents cleaning and storage. Our team is dedicated to delivering high-quality results while providing exceptional customer service. We are currently seeking a highly skilled Project / Claims Coordinator to join our dynamic team. Job Title: Project Coordinator Responsibilities: Client Communication: Act as the primary point of contact for clients throughout the restoration process. Ensure clear and effective communication with clients, addressing concerns and providing updates on project progress. Conduct regular follow-ups to ensure client satisfaction. Project Coordination: Serve as the primary point of contact with external vendor representatives, insurance adjusters, and project managers. Assemble emergency services estimates. Complete and track contracts, invoices, submittals, and estimates. Provide timely project status updates to the Project Manager Maintain project work schedules and files. Job File Management: Collect and audit production daily site reports Organize and manage project documentation, including contracts, permits, and other relevant paperwork. Ensure that all project files are accurate, complete, and compliant with industry standards. Communicate effectively with adjusters and other stakeholders to streamline the claims process to ensure timely approvals and payments. Invoicing and collection calls Experience / Skills: Minimum of 2 years of experience in property restoration as a project/claims coordinator. Skilled planner and highly organized with the ability to manage multiple tasks and deadlines. Strong written and verbal communication skills. Problem-solving and conflict resolution. Xactimate experience - preferred but not mandatory. Familiarity with insurance claims processes and procedures. Qualifications: Bachelor's degree in a related field (preferred) or equivalent work experience. Proven track record in project coordination within the property restoration industry. Detail-oriented with a commitment to delivering high-quality results. Ability to work collaboratively with a diverse team and adapt to changing priorities. Proficiency in Microsoft Office applications Working Conditions: Daily reporting to the office is required - this is not a remote role. Predominantly carried out in an office environment. Typical hours: 8am - 5pm additional hours and work days may be required depending on work volume Compensation: $19.00 - $24.00 per hour Restoration Support to Help You Get Your Normal Back At Restoration 1, we help people get their property and life back to normal when they're dealing with water, mold, or fire damage. We understand that our customers are going through a taxing and emotionally trying time. This is why our restoration specialists strive to be attentive, offer upfront communication, and valuable services to our customers. Most people struggle to clean up the mess after a disaster such as a flood or fire. We've created a straightforward process to guide our customers through their property restoration. With one phone call, your life can get back to normal. What We Do Our reputation for fast response, exceptional quality, and commitment has contributed to our growth as a company throughout the United States. Our restoration specialists understand that a disaster and the need for property restoration services can come without warning, and that is why we are always at hand to assist you 24/7! Restoration 1 aims to go the extra mile for our customers and make sure their property is back the way they remember it. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to Restoration 1 Corporate.

Full Time 12238 Silicon Drive Clerical Day Shift $18.75 - $24.25 /RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required. Two or more years of experience in claim processing and/or billing experience required. Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred. Knowledge of ICD-9, CPT 4 coding and medical terminology is required.

SWBC is seeking a talented individual to supervise the staff and activities involved in the accurate processing of mortgage claims to include resolving complex claims, training employees, and overseeing the department in management's absence. Why you'll love this role: This role allows one to learn, develop, or use a wide-set of skills in a face-paced environment. The person will be able to act as a business owner that makes key strategic, business, personnel, and development decisions. It is ideal for someone looking to manage and lead in multi-functional and complex environment. Essential duties include the following: Supervises the staff and activities involved in all aspects of processing CPI claims to ensure the highest degree of. quality, customer satisfaction, and compliance with company policies and procedures to include maintaining work schedules; interviewing for open positions; coaching, counseling and disciplining; and resolves personnel related issues. Resolves and provides assistance with complex calls, status questions, problems or client complaints to ensure customers satisfaction to include negotiating the settlement of claims and settling loss claims. Trains new employees and keeps staff members informed of new procedures to include ensuring that the claims procedure manual is current and up-to-date. Monitors, submits, and coordinates scheduling change requests with Workforce Management to ensure attendance and adherence standards. Oversees all aspects and functions of Claim's processing in the absence of the department manager. Provides coaching and feedback as necessary in support of performance goals and objectives. Performs assignment coordination of all work queues and roles related to ensuring the timely working of the claims inventory. Serious candidates will possess the minimum requirements: Some college course work in business, marketing, related field, or equivalent experience. Possess a Texas P&C Adjuster's License. Minimum of three to four (3-4) years high-level call center, telemarketing, customer service, quality auditing, or related experience, which includes one (1) year in a team lead, instructional, or training capacity, preferably in an insurance or banking environment. Property insurance claims adjusting experience, catastrophe, and/or field experience preferred. Working knowledge of mortgage insurance coverage and procedures. Excellent negotiation, analytical, and organizational skills. Excellent communication (both written and oral), customer service, and telephone etiquette skills. Working knowledge of personal computers to include MS Word, Excel, Internet, and AS400. Self-starter, be able to work independently and exercise sound judgment. Able to sit for long periods of time while executing computer applications and responding to customer phone inquiries. May be required to lift 10-20 lbs. of training materials or other documents. May be required to stand for long periods of time while conducting training and/or observation sessions. SWBC offers*: Competitive overall compensation package Work/Life balance Employee engagement activities and recognition awards Years of Service awards Career enhancement and growth opportunities Emerging Professionals and Mentor Program Continuing education and career certifications Variety of healthcare coverage options Traditional and Roth 401(k) retirement plans Lucrative Wellness Program *Based upon employee eligibility Additional Information: SWBC is a Substance-Free Workplace and requires pre-employment drug testing. Please note, SWBC does not hire tobacco users as allowed by law. To learn more about SWBC, visit our website at ************* If interested, please click the appropriate apply button.

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 General Liability Claims Examiner 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 general liability and auto liability 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 general liability and auto liability 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. + Assesses liability and resolves claims within evaluation. + 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. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of General Liability claims management experience or equivalent combination of education and experience required. **TAKING CARE OF YOU** + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _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 $75,000 - $90,000. 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 #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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**

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. * QNXT, Salesforce and basic SQL 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: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Hi! I am a professional senior healthcare recruiting consultant placing healthcare professionals permanently in the United States. I am currently hiring for Claims & Denials Coordinators in the San Antonio area.This is for a Fortune 125 company. We have 5 Claims & Denials Coordinators positions available. I'm looking to hold my final batch of phone screenings tomorrow so apply now and please send your update resume directly. Position is Long Term Temp up to 6 months (after that position may end, get extended or go permanent based on business need), Schedule is Mon-Fri, 8:00am-5:00pm, some OT may be required. Will be working in office. Competitive pay and amazing benefits! Thanks, Ron Payos 321-332-6801 Job Description In charge of generating denial letters to explain to providers why services were not approved. Qualifications High school diploma or equivalent 2+ years of managed care experience (either working at a plan or interacting with a plan) Knowledge of medical terminology Knowledge of claims, appeals, & denials Computer skills Administrative experience Additional Information All your information will be kept confidential according to EEO guidelines.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Full Time 12238 Silicon Drive Professional Non-Nursing Day Shift $19.80 - $31.25 /RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.