FEMA Claims Specialist
Claim processor job in Albuquerque, NM
CDM Smith has been supporting FEMA for two years in developing policy, procedures, and processing claims in support of the Hermit's Peak Calf/Canyon fire. We are looking for additional staff to process claims with a focus on high quality output. Staff must be quick learners with excellent computer skills. Successful final candidate will be assigned to Santa Fe, Las Vegas, NM or Mora, NM.
- Inspects damaged property to include all parts of the structure, taking into consideration condition, design, construction, and land value.
- Photographs interior and exterior components and all areas of the property to document findings. Verifies legal descriptions in public records and uses comparable methods to determine value.
- Prepares detailed appraisal reports. Communicates and coordinates with staff within FEMA as well as local, state, tribal and/or territorial governments.
- May coordinate and complete basic to moderately complex site inspections to validate and record damage to assist in the FEMA Public Assistance grant delivery process.
- Performs other duties as assigned.
\#LI-LP2
**Job Title:**
FEMA Claims Specialist
**Group:**
WAF Field Mod Fringe
**Employment Type:**
Temporary
**Minimum Qualifications:**
- HS Diploma or equivalent.
- 5 years of in-field experience or 2 years of in-field of expertise with a bachelor's degree.
Domestic travel is required.
**Preferred Qualifications:**
- Ability to learn new systems.
- Experience managing files.
- Highly Proficient with Microsoft Office and Adobe Programs.
**EEO Statement:**
We attract the best people in the industry, supporting their efforts to learn and grow. We strive to create a challenging and progressive work environment. We provide career opportunities that span a variety of disciplines and geographic locations, with projects that our employees plan, design, build and operate as diverse as the needs of our clients. CDM Smith is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, pregnancy related conditions, childbirth and related medical conditions, sexual orientation, gender identity or gender expression), national origin, age, marital status, disability, veteran status, citizenship status, genetic information or any other characteristic protected by applicable law.
**Why CDM Smith?:**
Check out this video and find out why our team loves to work here! (*************************************************
**Join Us! CDM Smith - where amazing career journeys unfold.**
Imagine a place committed to offering an unmatched employee experience. Where you work on projects that are meaningful to you. Where you play an active part in shaping your career journey. Where your co-workers are invested in you and your success. Where you are encouraged and supported to do your very best and given the tools and resources to do so. Where it's a priority that the company takes good care of you and your family.
Our employees are the heart of our company. As an employer of choice, our goal is to provide a challenging, progressive and inclusive work environment which fosters personal leadership, career growth and development for every employee. We value passionate individuals who challenge the norm, deliver world-class solutions and bring diverse perspectives. Join our team, and together we will make a difference and change the world.
**Job Site Location:**
New Mexico - Albuquerque
**Agency Disclaimer:**
All vendors must have a signed CDM Smith Placement Agreement from the CDM Smith Recruitment Center Manager to receive payment for your placement. Verbal or written commitments from any other member of the CDM Smith staff will not be considered binding terms. All unsolicited resumes sent to CDM Smith and any resume submitted to any employee outside of CDM Smith Recruiting Center Team (RCT) will be considered property of CDM Smith. CDM Smith will not be held liable to pay a placement fee.
**Amount of Travel Required:**
100%
**Assignment Category:**
Fulltime-Temporary
**Visa Sponsorship Available:**
No - We will not support sponsorship, i.e. H-1B or TN Visas for this position
**Skills and Abilities:**
- Must be a U.S. citizen and be able to obtain a FEMA Badge, which includes a background investigation for a Public Trust position.
- High competency with the use of computers and computing software (Word, Excel).
- Demonstrates good organizational skills to balance and prioritize work.
- Demonstrates strong attention to detail and ability to work independently.
- Good written and oral communication skills.
- Ability to work with multiple stakeholders and process a large volume of requests.
- Ability to adapt to change quickly and remain flexible.
**Background Check and Drug Testing Information:**
CDM Smith Inc. and its divisions and subsidiaries (hereafter collectively referred to as "CDM Smith") reserves the right to require background checks including criminal, employment, education, licensure, etc. as well as credit and motor vehicle when applicable for certain positions. In addition, CDM Smith may conduct drug testing for designated positions. Background checks are conducted after an offer of employment has been made in the United States. The timing of when background checks will be conducted on candidates for positions outside the United States will vary based on country statutory law but in no case, will the background check precede an interview. CDM Smith will conduct interviews of qualified individuals prior to requesting a criminal background check, and no job application submitted prior to such interview shall inquire into an applicant's criminal history. If this position is subject to a background check for any convictions related to its responsibilities and requirements, employment will be contingent upon successful completion of a background investigation including criminal history. Criminal history will not automatically disqualify a candidate. In addition, during employment individuals may be required by CDM Smith or a CDM Smith client to successfully complete additional background checks, including motor vehicle record as well as drug testing.
**Additional Compensation:**
All bonuses at CDM Smith are discretionary and may or may not apply to this position.
**Work Location Options:**
Successful candidate will be required to work 100% in the field locations.
**Driver's License Requirements:**
An appropriate and valid driver's license is required.
**Seeking candidates for a potential future opportunity!:**
We are excited to announce that CDM Smith won the next 5-year contract for Public Assistance Technical Assistance Contractors - PA TAC V in the West Zone. The West Zone includes Alaska, Washington, Oregon, Idaho, Nevada, California, Arizona, Northern Mariana Islands, American Samoa, Guam, Hawaii, Nebraska, Iowa, Kansas and Missouri. We are looking for qualified candidates for this position in anticipation of future project opportunities. Please note this is an "Evergreen" position which will be used to build our candidate pool but is not a role that is open at this time. If you are interested in being considered for this position should this position become available, we encourage you to apply to be part of our talent community. By having your information on file, we can reach out to you when this or a similar role officially opens.
**Massachusetts Applicants:**
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Claims Examiner
Claim processor job in Albuquerque, NM
Every day, Kelly Services connects professionals with opportunities to advance their careers.
In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect: Competitive pay Paid holidays Year-end bonus program Portable 401(k) plans Recognition and incentive programs Access to continuing education via the Kelly Learning Center Kelly Services is a U.S.-based Fortune 500 company.With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
For 70 years, Kelly Services has provided outstanding employment opportunities to the most talented individuals in the marketplace. Today, we are proud to offer a Claims Examiner position for a top company located in Albuquerque, NM
Job Description
This position is responsible for processing complex insurance claims, requiring further investigation and coordination of benefits. Also responsible for resolving pending claims.
Qualifications
High school diploma or equivalent.
6 months data entry experience OR 6 months experience in a medical office environment.
Analytical and organizational skills and independent decision making skills.
Ability to use discretion in working with confidential information.
Clear and concise written and verbal communication skills
Experience processing medical claims
Additional Information
IMPORTANT INFORMATION: This position is being recruited by a remote office, not your local Kelly branch. To be considered for this position, please send your resumes to romt021 @kellyservices.com
Adjudicator, Provider Claims
Claim processor job in Albuquerque, NM
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.
Claims Specialist / Claims Representative (Albuquerque or Belen, NM)
Claim processor job in Belen, NM
Be part of a team that values safety, inclusion, and excellence We are one of the largest U.S. railroads transporting the nation's freight across 28 western states and 3 Canadian provinces. As a member of our team, you will play a role in supporting the movement of essential products and materials that help feed, clothe, supply, and power communities throughout America and the world.
We are committed to a culture where all employees are included, belong, and have equal opportunity to achieve their full potential. Come make a difference with us!
Learn more about BNSF and our Benefits
Job Location: Belen
Other Potential Locations: Albuquerque, NM; Belen, NM
Anticipated Start Date: 12/16/2025
Number of Positions: 1
Salary Range: $68,800 - $100,000
Apply early as this job may be removed or filled prior to the closing date, which is approximately seven (7) days after the posting date.
Salary Range:
1+ years of experience: $68,800 - $87,900
3+ years of experience: $77,600 - $100,000
These ranges reflect what BNSF Railway reasonably expects to pay for this position, based on the role's level, scope, and responsibilities. Final compensation and position level will be determined by factors such as job-related skills, experience, and relevant education or training. In addition to base pay and bonus eligibility, BNSF offers a comprehensive benefits package.
The BNSF Railway Law and Claims Department provides expert in-house counsel and collaborates with outside counsel to ensure the railroad operates safely and meets all legal and contractual obligations. Our licensed attorneys and legal professionals are dedicated to upholding the highest legal compliance standards. Additionally, our specialized Claims team promotes safety, investigates incidents, and resolves them ethically.
This is a full-time position located in either Albuquerque,NM or Belen, NM.
Travel is extensive, but irregular averaging over 30%.
This position is responsible for investigating and settling all claims and lawsuits involving the company, arising out of personal injuries or property damage, excluding bill of lading claims.
Key responsibilities may include:
Investigating and settling, under direction of Manager Claims, all claims and lawsuits involving the company, arising out of personal injuries or property damage, excluding bill of lading claims.
Implementing processes and procedures under direction of Manager Claims and Sr. Manager - Claims.
Cooperating and coordinating duties with claims personnel on adjacent territories.
Performing thorough and ethical investigations and resolves exposures in a fair, honest and responsible manner.
Evaluating and effects settlements of claims and lawsuits within proper authority.
Accountable for recovery of BNSF's incurred damages due to the negligence of third parties within assigned territory.
Working closely with all BNSF departments to perform incident investigations/analyses and promote the General Claims Department's Vision Statement with such other internal departments.
Observing and reviewing potential liabilities on company property with respective non-claims field personnel.
Conducting investigations in various weather conditions.
Working irregular hours and available 24/7 for on-call duties, with frequent evening, night, and weekend shifts (including holidays).
External Contacts: Local counsel, state, county, city, and law enforcement officials, physicians, medical specialists, and expert consulting witnesses in specialized fields.
The duties and responsibilities in this posting are representative categories to be used in deciding whether to apply for this position. This is not an exhaustive list of the position's duties.
At BNSF Railway, we encourage individuals from all backgrounds to apply, showcasing their skills, experiences and development. We provide resources and tools to help you reach your full potential, fostering a supportive and inclusive environment.
Basic Qualifications:
* Able to work now and in the future without BNSF's assistance (whether monetary, through sponsorship, or otherwise) in obtaining, maintaining, or extending employment authorization (including H-1B, STEM OPT/CPT, or TN nonimmigrant status).
* Bachelor's degree.
* Minimum 1 year experience at BNSF or in a related field (railroad claims, railroad, insurance, legal, investigative) or a combination thereof.
Preferred Qualifications:
* General knowledge of railroad operations and principles and/or insurance claims or related medical/legal field
* Knowledge and understanding of Federal Employers Liability Act (FELA)
At BNSF, you will have access to a comprehensive and competitive benefits package including:
* An industry-leading 401(k) and renowned Railroad Retirement program.
* A range of robust health care options for you and your dependents (including domestic partners), including medical, dental, vision, telemedicine, mental health, cancer support, and high-quality care network options.
* Health care spending accounts (HSA) with employer contributions, as well as life and disability insurance, provided at no cost.
* Family benefits including parental, pediatric and family building support, adoption and surrogacy reimbursement, and dependent care spending account (with employer match).
* Access to discounts on travel, gym memberships, counseling services and wellness support.
* Annual bonus (Incentive Compensation Program)
* Generous leave / time off policies.
* For more information, visit Benefits.
Please be aware of potential fraud that can occur when searching for new career opportunities. Please review our FAQ for more information and awareness.
All positions require pre-employment background verification, medical review and pre-employment drug screen. You can find more information by reviewing the Hiring Process. Federal authority requires BNSF employees, whose work requires unescorted access to secure areas of port facilities, to obtain a TWIC. More information is available at *************************************
BNSF Railway is an Equal Opportunity Employer, all qualified applicants receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
SF: MO | [[mfield5]] | Law | Belen, NM | 87002
Medical Coding Analyst I or II - Must have a NM Residence
Claim processor job in Albuquerque, NM
Job Description
UNM Medical Group, Inc. is hiring for a Medical Coding Analyst I or II to join our Coding Department. This opportunity is a REMOTE, full-time and day shift opening located in New Mexico.
*This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico*
*This position is remote, however the selected candidate would need to be available to come into the office in Albuquerque, New Mexico if they experience network or laptop issues*
*Sign-On Bonus: $2,000*
Medical Coding Analyst 1:
Minimum $44,604 - Midpoint $55,766*
*Salary is determined based on years of total relevant experience.
*Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.
Medical Coding Analyst 2:
Minimum $52,038 - Midpoint $65,043*
*Salary is determined based on years of total relevant experience.
*Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.
Summary:
Responsible for coding Inpatient/Outpatient charges and specialty services using appropriate ICD and CPT classification systems for the purpose of reimbursement, research and compliance in accordance with federal regulation. Charges include all Inpatient/Outpatient visits, Day Surgeries, consultations and observation accounts. Specialty services include Interventional Radiology, GI Lab, Pathology, Cardiac Cath Lab, Vascular Lab, Orthopedics, Surgical and Anesthesia procedures. Responsible for review of documentation in medical records to assure that documentation by providers conforms to compliance and legal requirements. Provide feedback for practitioners on coding practices. Coder must meet department productivity and quality standards. Ensure adherence to policies and procedures and guidelines.
Minimum Job Requirements or a Medical Coding Analyst I:
High School diploma or GED and 6 months directly related experience or successful completion of UNMMG Medical Coding Internship Program. Certification in at least one of the following: RHIT, RHIA, RCC, CIRCC, CSS, CCA, CCS-P, COC, CIC, CPC, CPC-P or CPC-A. Verification of education and licensure (if applicable) will be required if selected for hire.
Minimum Job Requirements or a Medical Coding Analyst II:
High School diploma or GED and 2 years directly related experience. Certification in at least one of the following: RCC, CPC, CIRCC, CPC-P, CCS, CCS-P, COC, CIC, RHIA, or RHIT. Verification of education and licensure (if applicable) will be required if selected for hire.
Duties and Responsibilities:
Reviews and analyzes medical records in order to assign appropriate CPT and ICD-10 codes for inpatient and outpatient consultations, procedures, anesthesia, inpatient visits, and office visits for new or established patients.
Analyzes as well as resolution of coding edits that occur.
Identifies and reviews documentation in an EMR environment to ensure that all required signatures and addendums are present in the medical record(s).
Interaction and feedback to providers, when necessary, regarding medical documentation deficiencies or to request clarification of documentation components.
Ensures strict confidentiality of medical records and documentation.
Follows established departmental policies, procedures and objectives.
Why Join UNM Medical Group, Inc.?
Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence. We are dedicated to embracing and promoting diversity while fostering well-being across New Mexico through cultural humility and respect for everyone.
Benefits:
Competitive Salary & Benefits: UNMMG provides a competitive salary along with a comprehensive benefits package.
Insurance Coverage: Includes medical, dental, vision, and life insurance.
Additional Perks: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.
Claims - Field Claims Representative
Claim processor job in Santa Fe, NM
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: Santa Fe, NM. 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 $55,000 - $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.
Claims Representative (IAP) - Workers Compensation Training Program
Claim processor job in Santa Fe, NM
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative (IAP) - Workers Compensation Training Program
Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
+ A stable and consistent work environment in an office setting.
+ A training program to learn how to help employees and customers from some of the world's most reputable brands.
+ An assigned mentor and manager who will guide you on your career journey.
+ Career development and promotional growth opportunities through increasing responsibilities.
+ A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs.
**PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due.
**ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field.
**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**
+ Attendance and completion of designated classroom claims professional training program.
+ Performs on-the-job training activities including:
+ Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims.
+ Adjusting low and mid-level liability and/or physical damage claims under close supervision.
+ Processing disability claims of minimal disability duration under close supervision.
+ Documenting claims files and properly coding claim activity.
+ Communicating claim action/processing with claimant and client.
+ Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
+ Participates in rotational assignments to provide temporary support for office needs.
**QUALIFICATIONS**
Bachelor's or Associate's degree from an accredited college or university preferred.
**EXPERIENCE**
Prior education, experience, or knowledge of:
- Customer Service
- Data Entry
- Medical Terminology (preferred)
- Computer Recordkeeping programs (preferred)
- Prior claims experience (preferred)
Additional helpful experience:
- State license if required (SIP, Property and Liability, Disability, etc.)
- WCCA/WCCP or similar designations
- For internal colleagues, completion of the Sedgwick Claims Progression Program
**TAKING CARE OF YOU**
+ Entry-level colleagues are offered a world class training program with a comprehensive curriculum
+ An assigned mentor and manager that will support and guide you on your career journey
+ Career development and promotional growth opportunities
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Claims Specialist-Journal Center
Claim processor job in Albuquerque, NM
Schedule: MONDAY-FRIDAY 8:00AM-5:00PM and other shifts as needed.
Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.
ESSENTIAL FUNCTIONS:
1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
MINIMUM EDUCATION:
High school diploma or equivalent
MINIMUM EXPERIENCE:
Must have one of the following:
Six (6) months as an Apprentice in the Business Office at TriCore
Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
Minimum of three (3) years of medical billing or claims processing experience
OTHER REQUIREMENTS:
Must be able to type 30 words per minute (typing test required)
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications
PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology
IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted.
GENERAL REQUIREMENTS:
1. Proficient in PC/data entry skills
2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills
3. Ability to resolve problems and follow up as needed or appropriate
4. Effective communication skills and telephone skills
5. Ability to deal with difficult clients and patients
6. Strong working knowledge of insurance and reimbursement
Claims Investigator - Experienced
Claim processor job in Albuquerque, NM
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.
Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
AOE/COE, Auto, or Homeowners Investigations.
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
Full-Time benefits Include:
Medical, dental and vision insurance
401K
Extensive performance bonus program
Dynamic and fast paced work environment
We are an equal opportunity employer.
Auto-ApplyFEMA Claims Specialist
Claim processor job in Albuquerque, NM
CDM Smith has been supporting FEMA for two years in developing policy, procedures, and processing claims in support of the Hermit's Peak Calf/Canyon fire. We are looking for additional staff to process claims with a focus on high quality output. Staff must be quick learners with excellent computer skills. Successful final candidate will be assigned to Santa Fe, Las Vegas, NM or Mora, NM.
* Inspects damaged property to include all parts of the structure, taking into consideration condition, design, construction, and land value.
* Photographs interior and exterior components and all areas of the property to document findings. Verifies legal descriptions in public records and uses comparable methods to determine value.
* Prepares detailed appraisal reports. Communicates and coordinates with staff within FEMA as well as local, state, tribal and/or territorial governments.
* May coordinate and complete basic to moderately complex site inspections to validate and record damage to assist in the FEMA Public Assistance grant delivery process.
* Performs other duties as assigned.
#LI-LP2
Employment Type
Temporary
Minimum Qualifications
* HS Diploma or equivalent.
* 5 years of in-field experience or 2 years of in-field of expertise with a bachelor's degree.
Domestic travel is required.
Preferred Qualifications
* Ability to learn new systems.
* Experience managing files.
* Highly Proficient with Microsoft Office and Adobe Programs.
Claims Examiner
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description Overview
· Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims
· Review and compare information in computer systems and apply proper codes/documentation
· May place outgoing calls to providers and/or pharmacies for further investigation before processing claims
Qualifications
Job Specific Qualifications
· High school diploma or GED
· Data Entry and/or typing experience
· Clear and concise written and verbal communication skills
· Ability to multi task and prioritize is required
· Interpersonal, verbal and written communication skills
· Ability to sit for long periods of time
· Analytical and problem solving skills
· Must be dependable and flexible
Additional Information
All your information is kept confidential as per EEO standards.
Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!
Adjudicator, Provider Claims-Ohio-On the Phone
Claim processor job in Albuquerque, NM
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.
Claims Specialist / Claims Representative (Albuquerque or Belen, NM)
Claim processor job in Albuquerque, NM
Be part of a team that values safety, inclusion, and excellence We are one of the largest U.S. railroads transporting the nation's freight across 28 western states and 3 Canadian provinces. As a member of our team, you will play a role in supporting the movement of essential products and materials that help feed, clothe, supply, and power communities throughout America and the world.
We are committed to a culture where all employees are included, belong, and have equal opportunity to achieve their full potential. Come make a difference with us!
Learn more about BNSF and our Benefits
Job Location: Belen
Other Potential Locations: Albuquerque, NM; Belen, NM
Anticipated Start Date: 12/16/2025
Number of Positions: 1
Salary Range: $68,800 - $100,000
Apply early as this job may be removed or filled prior to the closing date, which is approximately seven (7) days after the posting date.
Salary Range:
1+ years of experience: $68,800 - $87,900
3+ years of experience: $77,600 - $100,000
These ranges reflect what BNSF Railway reasonably expects to pay for this position, based on the role's level, scope, and responsibilities. Final compensation and position level will be determined by factors such as job-related skills, experience, and relevant education or training. In addition to base pay and bonus eligibility, BNSF offers a comprehensive benefits package.
The BNSF Railway Law and Claims Department provides expert in-house counsel and collaborates with outside counsel to ensure the railroad operates safely and meets all legal and contractual obligations. Our licensed attorneys and legal professionals are dedicated to upholding the highest legal compliance standards. Additionally, our specialized Claims team promotes safety, investigates incidents, and resolves them ethically.
This is a full-time position located in either Albuquerque,NM or Belen, NM.
Travel is extensive, but irregular averaging over 30%.
This position is responsible for investigating and settling all claims and lawsuits involving the company, arising out of personal injuries or property damage, excluding bill of lading claims.
Key responsibilities may include:
Investigating and settling, under direction of Manager Claims, all claims and lawsuits involving the company, arising out of personal injuries or property damage, excluding bill of lading claims.
Implementing processes and procedures under direction of Manager Claims and Sr. Manager - Claims.
Cooperating and coordinating duties with claims personnel on adjacent territories.
Performing thorough and ethical investigations and resolves exposures in a fair, honest and responsible manner.
Evaluating and effects settlements of claims and lawsuits within proper authority.
Accountable for recovery of BNSF's incurred damages due to the negligence of third parties within assigned territory.
Working closely with all BNSF departments to perform incident investigations/analyses and promote the General Claims Department's Vision Statement with such other internal departments.
Observing and reviewing potential liabilities on company property with respective non-claims field personnel.
Conducting investigations in various weather conditions.
Working irregular hours and available 24/7 for on-call duties, with frequent evening, night, and weekend shifts (including holidays).
External Contacts: Local counsel, state, county, city, and law enforcement officials, physicians, medical specialists, and expert consulting witnesses in specialized fields.
The duties and responsibilities in this posting are representative categories to be used in deciding whether to apply for this position. This is not an exhaustive list of the position's duties.
At BNSF Railway, we encourage individuals from all backgrounds to apply, showcasing their skills, experiences and development. We provide resources and tools to help you reach your full potential, fostering a supportive and inclusive environment.
Basic Qualifications:
* Able to work now and in the future without BNSF's assistance (whether monetary, through sponsorship, or otherwise) in obtaining, maintaining, or extending employment authorization (including H-1B, STEM OPT/CPT, or TN nonimmigrant status).
* Bachelor's degree.
* Minimum 1 year experience at BNSF or in a related field (railroad claims, railroad, insurance, legal, investigative) or a combination thereof.
Preferred Qualifications:
* General knowledge of railroad operations and principles and/or insurance claims or related medical/legal field
* Knowledge and understanding of Federal Employers Liability Act (FELA)
At BNSF, you will have access to a comprehensive and competitive benefits package including:
* An industry-leading 401(k) and renowned Railroad Retirement program.
* A range of robust health care options for you and your dependents (including domestic partners), including medical, dental, vision, telemedicine, mental health, cancer support, and high-quality care network options.
* Health care spending accounts (HSA) with employer contributions, as well as life and disability insurance, provided at no cost.
* Family benefits including parental, pediatric and family building support, adoption and surrogacy reimbursement, and dependent care spending account (with employer match).
* Access to discounts on travel, gym memberships, counseling services and wellness support.
* Annual bonus (Incentive Compensation Program)
* Generous leave / time off policies.
* For more information, visit Benefits.
Please be aware of potential fraud that can occur when searching for new career opportunities. Please review our FAQ for more information and awareness.
All positions require pre-employment background verification, medical review and pre-employment drug screen. You can find more information by reviewing the Hiring Process. Federal authority requires BNSF employees, whose work requires unescorted access to secure areas of port facilities, to obtain a TWIC. More information is available at *************************************
BNSF Railway is an Equal Opportunity Employer, all qualified applicants receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
SF: MO | [[mfield5]] | Law | Belen, NM | 87002
Claims Specialist Apprentice - Journal Center
Claim processor job in Albuquerque, NM
Scheduled Shift: Monday-Friday 8:00AM-5:00PM and other shifts as needed.
This position starts with an eight-week paid training program that is designed to grow your skills in customer service.
The training program provides a paid opportunity for you to learn customer service and revenue operations skills. You will learn best-practices used in the business office focused on resolving patient accounts. Upon completion of the training program, you will be transitioned into a full-time role of preforming customer service on patient accounts.
ESSENTIAL FUNCTIONS:
1. Follow-up on basic claim denials for assigned accounts or from account receivable reports focusing attention on accounts over 60 days from primary and secondary payors working to resolution of account while gradually progressing to higher complexity denials.
2. Perform research of denials and unpaid claims making appropriate corrections until worked to resolution to include phone call, claims resubmission, appeal or reconsideration.
3. Complete BBP report to account resolution.
4. Demonstrate a working knowledge of basic healthcare contractual obligations such as claim filing limits, medical necessity and dual coverage through accurate and timely claims filing while progressively increasing understanding of payer policies and procedures.
5. Accurately verify eligibility on patient accounts using online insurance resources.
6. Work payer correspondence received.
7. Researches adjustments and pulls all necessary backup to support adjustments.
8. Communicate effectively and professionally to all customers (internal and external) using key words as appropriate.
9. Maintain confidentiality of patient and client information. Responsible for following TriCore safety, personnel, and billing department policies. Must participate in training as requested by Supervisor/Manager.
10. Meet all Quality Assurance (QA) accuracy and data.
MINIMUM EDUCATION:
High School Diploma or equivalent
MINIMUM EXPERIENCE:
No experience required.
OTHER REQUIREMENTS:
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications.
Must be able to type 30 words per minute (typing test required)
PREFERRED:
One year in a healthcare setting.
Claims Investigator - Experienced
Claim processor job in Albuquerque, NM
Job Description
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.
Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
AOE/COE, Auto, or Homeowners Investigations.
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
Full-Time benefits Include:
Medical, dental and vision insurance
401K
Extensive performance bonus program
Dynamic and fast paced work environment
We are an equal opportunity employer.
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Claims Examiner
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Title:
Claims Examiner
Pay Rate:
$
12.50 - up to
$
13.50 per hour
Start Date:
Monday, December 19, 2016
Type:
Temporary-to-Hire
Shift:
8 hour shift between 6AM-6PM)
Job Description Overview:
Attention to Detail
Perfect Attendance First 6 weeks during Training period
6-12 months of office experience
· Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims
· Review and compare information in computer systems and apply proper codes/documentation
· May place outgoing calls to providers and/or pharmacies for further investigation before processing claims
Job Specific Qualifications:
· High school diploma or GED
· Data Entry and/or typing experience
· Clear and concise written and verbal communication skills
· Ability to multi task and prioritize is required
· Interpersonal, verbal and written communication skills
· Ability to sit for long periods of time
· Analytical and problem solving skills
· Must be dependable and flexible
Kelly Services Benefits and Perks:
In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect:
- Competitive pay
- Paid holidays
- Year-end bonus program
- Portable 401(k) plans
- Recognition and incentive programs
- Access to continuing education via the Kelly Learning Center
Additional Information
Instructions :
Please call
641-424-3614
for more information on how to apply!
Why Kelly?
As a Kelly Services candidate you will have access to numerous perks, including:
Exposure to a variety of career opportunities as a result of our expansive network of client companies
Career guides, information and tools to help you successfully position yourself throughout every stage of your career
Access to more than 3,000 online training courses through our Kelly Learning Center
Group-rate insurance options available immediately upon hire*
Weekly pay and service bonus plans
Adjudicator, Provider Claims-Ohio-On the Phone
Claim processor job in Santa Fe, NM
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.
Claims Specialist - Journal Center
Claim processor job in Albuquerque, NM
Scheduled Shift: Monday-Friday 8:00AM-5:00PM and other shifts as needed.
Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.
ESSENTIAL FUNCTIONS:
1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
MINIMUM EDUCATION:
High school diploma or equivalent
MINIMUM EXPERIENCE:
Must have one of the following:
Six (6) months as an Apprentice in the Business Office at TriCore
Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
Minimum of three (3) years of medical billing or claims processing experience
OTHER REQUIREMENTS:
Must be able to type 30 words per minute (typing test required)
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications
PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology
IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted.
GENERAL REQUIREMENTS:
1. Proficient in PC/data entry skills
2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills
3. Ability to resolve problems and follow up as needed or appropriate
4. Effective communication skills and telephone skills
5. Ability to deal with difficult clients and patients
6. Strong working knowledge of insurance and reimbursement
Claims Examiner
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description Overview
·
Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims
·
Review and compare information in computer systems and apply proper codes/documentation
·
May place outgoing calls to providers and/or pharmacies for further investigation before processing claims
Qualifications
Job Specific Qualifications
·
High school diploma or GED
·
Data Entry and/or typing experience
·
Clear and concise written and verbal communication skills
·
Ability to multi task and prioritize is required
·
Interpersonal, verbal and written communication skills
·
Ability to sit for long periods of time
·
Analytical and problem solving skills
·
Must be dependable and flexible
Additional Information
All your information is kept confidential as per EEO standards.
Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!
Adjudicator, Provider Claims
Claim processor job in Santa Fe, NM
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.