Claim processor jobs in Syracuse, NY

We have an immediate need for a Construction Claims Analyst based in Syracuse NY location. Come join our team! We are looking to build services and capabilities through the growth of our key asset- our staff. Ranked among the nation's top A/E firms by Engineering News-Record, LiRo-Hill provides construction management, engineering, environmental, architectural, and program management solutions. You can become part of an organization that has a strong track record and is looking to strengthen relationships and capabilities to continue being a trusted resource for our clients in the public and private sector. We are proud to be known as an “Integrated Construction, Design and Technology Solutions” firm and we have delivered on that label time and again. Recently, Global Infrastructure Solutions Inc. (GISI), the parent company of The LiRo Group and Hill International, Inc. consolidated a portion of the highly experienced staff of both LiRo and Hill in the Northeast to create a larger, more efficient, and cost-effective team to serve clients. LiRo-Hill is a 1100-person firm with offices in NYC, Long Island, Buffalo, Rochester, Boston and Metro Park, NJ. The client for this project is the NYS Office of General Services (OGS). Responsibilities Construction Claims Analyst The Construction Claims Analyst will focus on the careful review and analysis of construction delay claims filed against the NY State. This role is well-suited for someone who values independent, detail-oriented work and thrives in an environment where critical thinking and written analysis are essential. Key Responsibilities: Evaluate contractors' delay claim notices for validity in accordance with contract requirements. Review and interpret detailed schedule analyses using Primavera P6. Conduct forensic delay analysis by examining project records, such as meeting minutes, schedules, and correspondence. Track, document, and manage assigned delay claims with accuracy and consistency. Facilitate fact-finding meetings with design and construction staff to gather information and ensure thorough review. Audit claim costs-including certified payrolls and invoices-and prepare clear, well-documented recommendations; negotiate settlements when appropriate. Prepare clear, concise reports on high-priority and problem projects for executive staff on a regular basis. Qualifications Education/Experience: Bachelor's degree in Construction Management or a related field, or Associate degree with 2+ years of experience in a similar role, or 4+ years of experience in a comparable position. Strong knowledge of construction schedules, schedule analysis, and time impact analysis. Experience in contracts, project management, and scheduling in a construction environment. Ability to work independently, manage workload efficiently, and produce clear, well-documented analysis. Strong attention to detail, critical thinking, and problem-solving skills. Effective written communication skills for reports and documentation; comfortable participating in structured, focused meetings. Construction project management or scheduling experience preferred. OSHA 10 certification required. At Liro-Hill we are committed to your success, and we invest in your growth and development to unlock your full potential. Our benefits include: Competitive Total Compensation Package Employee- Only Stock Purchase Plan Mentoring programs Continuing Education Program Employee referral bonus Compensation range for this role: Minimum: $100,000 to - $125,000 annually The range provided is the salary that the Firm in good faith believes at the time of this posting is willing to pay for the advertised position. Exact compensation will be determined on the individual candidates' qualifications and location #ID22 #ZR22 #LI-CM1 Minimum USD $100,000.00/Yr. Maximum USD $125,000.00/Yr.

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description Title : Claims Analyst I Location : Syracuse, NY Duration : 3+ Months (Possible extension) Responsibilities : · Mon- Fri 9am to 5:30 with OT possibly · Processing claims about 60 a day · Manager would like to have at least one year claims knowledge. Looking for medical claims experience for these position · Top Three: Claims knowledge, efficient and work well with a group · This is a fast paced environment. These positions have been created to hit a deadline · Interviews: Phone screens first and then face to face Summary : · Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments. · Investigates problem claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future. Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments. · Testing categories include but are not limited to the following: Benefit, Contract, and Fee Schedule Configuration System Enhancements · Report Validation: Validation of electronic file loads. Essential Functions : · Performs claims systems testing and/or system analysis to ensure accuracy of the system ' s configuration and provider payments. · Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns. · Develops/creates test plans/scripts which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts. · Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing by identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations. · Complies with performance standards by completing assignments within the specified time. Knowledge/Skills/Abilities : · Excellent verbal and written communication skills · Ability to abide by company policies · Maintain regular attendance based on agreed-upon schedule · Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) · Ability to establish and maintain positive and effective work relationships with co-workers, clients, members, providers and customers. Required Education : · High School graduate (or GED) / AA preferred Required Experience : · 0-2 years of claims processing with advancement to auditing / claims analysis / claims research. Level of autonomy/decision making required. · Mid-level decision making. · Some project management skills. Good oral and written communication skills. Advanced Word and Excel skills. If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry. We do offer a referral bonus that I'd be happy to extend to you if they turn out to be a great fit for my client. Qualifications n/a Additional Information Kind Regards Sumit Agarwal 732-902-2125

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

Claims Specialist Program Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance! Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes. The details When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault. You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case. You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual. Qualifications What you've got You have 0-2 years of professional experience. A strong academic record with a cumulative 3.0 GPA preferred You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism. You possess strong negotiation and analytical skills. You are detail-oriented and thrive in a fast-paced work environment. You must have permanent work authorization in the United States. What we offer Competitive compensation package Pension and 401(k) savings plans Comprehensive health and wellness plans Dental, Vision, and Disability insurance Flexible work arrangements Individualized career mobility and development plans Tuition reimbursement Employee Resource Groups Paid leave; maternity and paternity leaves Commuter benefits, employee discounts, and more Learn more about benefits at ************************** A little about us As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow. We were recognized as a ‘2018 Great Place to Work' by Great Place to Work US, and were named by Forbes as one of the best employers in the country for new graduates and women-as well as for diversity. Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information, or on any basis prohibited by federal, state, or local law. We can recommend jobs specifically for you! Click here to get started.

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives claims, confirms policy coverage and acknowledgment of the claim * Determines validity and compensability of the claim * Establishes reserves and authorizes payments within reserving authority limits * Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision * Communicates claim status with the customer, claimant and client * Adheres to client and carrier guidelines and participates in claims review as needed * Assists other claims professionals with more complex or problematic claims as necessary * Additional duties as assigned KNOWLEDGE & SKILLS: * Excellent written and verbal communication skills * Ability to learn rapidly to develop knowledge and understanding of claims practice * Ability to identify, analyze and solve problems * Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets * Strong interpersonal, time management and organizational skills * Ability to meet or exceed performance competencies * Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: * Bachelor's degree or a combination of education and related experience * Minimum of 1 year of industry experience and claims management preferred * State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

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 Examiner - Liability | Hybrid 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?** To analyze complex or technically difficult general 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. **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **OFFICE LOCATION:** If the selected candidate is located within 25 miles of any Sedgwick office, this position is hybrid and will be expected to commute with 2 days in office. If located outside of the radius this position will be remote. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Analyzes and processes complex or technically difficult general 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. + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** Education Bachelor's degree from an accredited college or university preferred. Licenses as required. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. **Jurisdiction Knowledge:** Multi State **Licensing:** TX/FL/NY preferred **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 ($61,857.00 - $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._ 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**

Our Workers Comp Claims team is currently seeking a Claims Representative to join our Level One team in our Worcester, MA, Syracuse, NY, or Itasca, IL offices. This is a full-time/non-exempt role. Responsible for the investigation and resolution of complex medical only and lost time claims of low complexity in accordance with policy provisions, best practices and jurisdictional requirements. Includes the input of claim data and guiding insured's and claimants through the claim process and options. IN THIS ROLE, YOU WILL: Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits. Work within specific limits and authority on assignments of moderate technical complexity. Use discretion and independent judgment in claim handling. Possess functional knowledge and skills reflective of fully competent practitioner. Identify possibly suspicious claims. Investigate, analyze, evaluate and negotiate personal and/or commercial lines claims of minimal to moderate complexity. Responsible for managing all aspects of each claim and maintaining a high level of productivity, confidentiality and customer service. Implement and coordinate the most effective management techniques to mitigate loss and expense payments. Reserving and expense authority levels are moderate. Work with the Special Investigations Unit, where appropriate. May be required to have and maintain sufficient home-based internet connection. WHAT YOU NEED TO APPLY: Typically has 1 - 3 years experience Technical knowledge in WC coverages Excellent written and verbal communication skills Knowledge of medical terminology Must possess organizational skills with regard to time management, task prioritization and integration of information from a variety of sources Excellent and proficient data entry skills High level of proficiency in Word, Excel and use of the Internet Ability to meet and/or exceed the goals and metrics of the role on a consistent basis Self-directed and self-motivated Possesses strong customer service skills and behaviors Makes decisions in an informed, confident and timely manner Maintains constructive working relationships despite differing perspectives Strong organizational and time management skills Ability to negotiate skillfully in difficult situations with both internal and external groups Demonstrates ability to win concessions without damaging relationships Demonstrates strong written and verbal communication skills. Promotes and facilitates free and open communication Understanding of applicable statutes, regulations and case law Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner Easily adapts to new or different changing situations, requirements or priorities Cultivates an environment of teamwork and collaboration Operates with latitude for un-reviewed action or decision Computer experience (MS Office, excel, word, etc) Proficient using Claims systems (i.e. CSS, PMS, etc.) Ability to use a personal computer and other standard office equipment Ability to travel as necessary Ability to sit and/or stand for extended periods Workload requirements may routinely call for work hours in excess of 40 hours per week This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform.

Job Type: Permanent Build a brilliant future with Hiscox Please note that this position is hybrid and requires work in office a minimum of two (2) days per week. Position can be based at our following hub office locations: Atlanta, GA Chicago, IL Manhattan, NY Scottsdale, AZ West Hartford, CT The US Claims Compliance and Quality Assurance team at Hiscox is a growing group of professionals with operational and technical experience. The team serves as a claims technical resource, as well as provides assistance and expertise across Hiscox by identifying and promoting claims best practices and facilitating required improvements. We foster consistency, calibration, and continuous improvement in the handling of Hiscox claims. Our team is quite diverse, and you will be able to demonstrate that you can flex your work and delivery style to accommodate different stakeholders. You'll play a critical role in safeguarding our organization from regulatory risk. This is a high-impact role suited for an experienced insurance claims compliance professional or attorney, with deep knowledge of insurance claims regulations, processes, and technology. This role is ideal for someone who can translate risk into actionable strategy and build sustainable compliance practices as Hiscox USA grows. Key Responsibilities Manage and maintain 50-state claims database Monitor legislation, DOI bulletins, court reporters/decisions, and statutory changes; manage backlog and implement targeted compliance training Develop and own controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols Partner with Claims Technical, US Legal, and IT to design controls and workflows aligned with regulatory requirements Lead US Claims response to regulatory inquiries and complaints Deliver training and legal support to internal teams and vendors Develop audit programs and dashboards to monitor compliance effectiveness Oversee/support technology-related compliance integrations Provide executive reporting, trends analysis, and regulatory insights Qualifications 10+ years of experience in claims compliance, insurance regulation, or legal operations J.D. highly desired Degree in law, risk management, or a related field; required Advanced insurance compliance certifications a plus (CPCU, CIPP, CAMS, CRCM, or similar) Scrum/PMP a plus but not required Deep understanding of claims handling regulations, Medicare protocols, and market conduct standards Experience with multiple lines of business in a 50-state claims environment Knowledge of Medicare Secondary Payer requirements and Section 111 reporting Strong research and policy writing skills Excellent collaboration, project management, and problem-solving skills Experience with regulatory audit preparation and response Compensation: $90,000-$140,000 based on experience The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. About Hiscox USA Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Today, Hiscox USA has a talent force of about 420 employees mostly operating out of several major cities - New York, Atlanta, Chicago, West Hartford, and Scottsdale. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. What We Offer: 401(k) with competitive company matching Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) Company paid group term life, short- term disability and long-term disability coverage 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days Paid parental leave 4-week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing 2024 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance). #LI-AJ1 Work with amazing people and be part of a unique culture

Full-time Description Christopher Community, Inc. (CCI) seeks a Part Time Property Certification Specialist to join its growing organization! The physical work location for this position will be to support the FNR Property Portfolio located in Syracuse, NY! CCINC is a not-for-profit Housing Development and Property Management company that assist low- and moderate-income families and seniors to secure suitable housing across Upstate New York. Christopher Community currently manages over 3,300 units of housing in more than 100 buildings, and administers the Rental Assistance Program in Onondaga County, which provides assistance to over 1,200 households. Since 1971, Christopher Community has maintained a proven track record in developing and operating affordable housing. We regularly receive very high ratings both from government and private entities for the way we manage our properties. We offer competitive wages and generous benefits. Please see below for additional information: Benefit Summary: Part Time Position 25-hour work week (Monday - Friday) with flexible schedule Paid Time Off (PTO) Paid Holidays 403(b) Retirement Plan Hiring Hourly Rate is: $22.00 to $25.00 per hour Additional opportunities for performance related incentives available throughout each fiscal year. Requirements The Property Certification Specialist is responsible for ensuring full compliance with Low-Income Housing Tax Credit (LIHTC) program requirements across a scattered-site portfolio. Reporting directly to the Assistant Regional Property Manager, this position focuses on initial certifications, annual recertifications, income and asset verifications, rent calculations, and ongoing file maintenance to ensure adherence to all state and federal regulations. The ideal candidate possesses strong organizational skills, a deep understanding of LIHTC compliance, and a high level of accuracy in documentation and reporting. Conduct and manage initial, annual, and interim certifications in accordance with LIHTC and other applicable affordable housing program guidelines. Verify household income, assets, and student status for all applicants and residents to determine program eligibility. Calculate tenant rent levels and utility allowances based on program rules and property-specific requirements. Maintain complete and organized resident files-both electronic and physical-to ensure readiness for audits and investor or agency reviews. Collaborate with the Property Manager and Assistant Regional Property Manager to monitor compliance tracking systems and ensure deadlines are met without lapse. Review and prepare Tenant Income Certifications (TICs), income verifications, and supporting documentation for accuracy and completeness. Assist with file audits, state agency reviews, and compliance reporting required by syndicators, investors, or housing authorities. Stay current with LIHTC regulations, including income limits, rent limits, student rules, and recertification standards. Support leasing and occupancy activities, ensuring all move-ins and renewals meet program eligibility requirements. Respond to resident and agency inquiries regarding eligibility, documentation, or certification-related matters. Assist in preparing for state monitoring visits, management reviews, and compliance audits. Provide excellent customer service to residents, staff, and external partners. Support the Property Manager as needed and fill in during their absence. Comply with fair housing and anti-discrimination laws in all aspects of housing, renting, and advertising. Perform other duties as assigned. EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED); associate or bachelor's degree preferred. Three-five years of experience in property management and affordable housing programs (HUD, PRAC, Section 8, etc.). Certified Occupancy Specialist (COS) certification is a plus Proficiency in relevant Property Management software including experience with RealPage/OneSite and Microsoft Office. Excellent written and verbal communication skills to interact effectively with residents, staff, and regulatory bodies. Strong attention to detail and organizational abilities essential for accurate record-keeping and managing complex processes. Excellent time management and communication skills are necessary. Travel up to 20% of the time to properties to provide on-site certification and HUD compliance support. Must have a valid Class D driver's license ADDITIONAL SKILLS: Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence, understand work orders and fill out completed spreadsheets. Ability to effectively present information in one-on-one and small group situations to customers, vendors, and other employees of the organization. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Compute areas and volumes necessary for project budgeting. Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in flexible situations that may call for various solutions. Ability to delegate tasks to specialized vendors if required and deliver quality workmanship in an efficient timeframe. This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. Additionally, there may be circumstances that would require the employee(s) to work additional hours over and above the normal 35-hour work week. Christopher Community is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Christopher Community is a drug free workplace and complies with ADA regulations as applicable. Salary Description $22.00 to $25.00 per hour

The Opportunity Review, research, and investigate pended Group Life claim submission with multiple coverages and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amount(s). If not payable, develop detailed letter of explanation based on policy provisions and claim documents. Provides customer service with empathy and patience on incoming and outgoing phone inquiries and provides guidance on life claim processes. How You'll Help Us Build a Confident Future (Key Responsibilities) * Work with our customer administrative staff to clarify plan provisions and resolve claim discrepancies. * Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees. Provide guidance on claim processes and resolve customer issues swiftly and thoroughly. * Actively pursue and follow up on open claims within specified time frame. * Manage and organize work to meet multiple deadlines and competing priorities to ensure department turnaround and customer satisfaction are met. * Evaluate life claims to identify claim situations requiring referral to Senior Examiner, law department and medical department. * Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service. * Maintain production and quality standards. * Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training. * Use Microsoft Word and Excel to obtain information required to evaluate the life claim. * Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions. * Handle outbound calls needed in regards to Group Life servicing. * Handle customer escalations from Examiner and solve customer problems via telephone using sound business judgment. * Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer. * Process complex claims within payment authority. * Utilize BIOS, GLIF Production, CDF, Calligo, EDCS, Group Facts, WorkDesk, NetView and Accurint to update and maintain accurate data. * Identify and obtain missing information required to evaluate complex Group life claims such as rival claims, denials, accidental death & dismemberment claims and input information into a Windows based computer system (BIOS). * Interpret policy provisions and manually adjudicate complex Group Life claims to make claim determinations. * Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.). * Handle more complex claims. * Provide UAT support for system enhancements. What You Need to Succeed (Required Qualifications) * Ability to adjust to multiple demands and shifting priorities. * Consistently demonstrates the MetLife values. * Ability to introduce new ideas to improve work processes. * Directs action towards achieving goals that are critical to MetLife's success. * Uses knowledge of the business and the industry to make the best decisions, weighing the risks of different courses of action. * Plans and organizes time and priorities to achieve business results. * Works collaboratively with others, shares best practices, and assists teammates with work. * Projects an attitude of service, empathy, and patience to all customers. * Shares information and engages in candid and open dialogue. Expresses self well in conversations and written documents. * Takes personal accountability for follow through on customer commitments. * Strong data entry skills required. * PC knowledge required. (Microsoft Word and Excel) * Ability to work periodic overtime required; can include weekends. * Confidentiality required. * Excellent oral and written communication skills. * Ability to deal with people in stressful situations. * Analytical ability and good judgment in evaluating life claim submissions. * Life insurance experience required. * Demonstrated outstanding customer service and communication skills both written and verbal. * Desire, willingness and ability to learn and perform in a fast-paced environment. * Ability to work independently under minimum supervision and meet deadlines. * Ability to make independent decisions with minimum senior referrals. What Can Give You an Edge (Additional Skills) * College degree or relevant job experience desirable. The expected salary range for this position is $41,600 to $59,000. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms. Benefits We Offer Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more! About MetLife Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces, as well as the Fortune 100 Best Companies to Work For, MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East. Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible. Join us! MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics"). If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug-free workplace. 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 liabilities. $41,600 to $59,000

Job Title: Claims Analyst Duration: 1+ months contract racuse , New York 13212 Hours: Mon- Fri 9 am to 5:30 Job Description : Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments. Investigates problem claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future. Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments. Testing categories include but are not limited to the following: Benefit, Contract, and Fee Schedule Configuration, System Enhancements, Report Validation, Validation of electronic file loads. EDUCATION: At least one year claims knowledge. Looking for medical claims experience for these position. Top Three: Claims knowledge, efficient and work well with a group Required Education: High School graduate (or GED). Required Experience: 0-2 years of claims processing with advancement to auditing / claims analysis / claims research. Some project management skills. Good oral and written communication skills. Advanced Word and Excel skills. 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: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This role can be performed as hybrid or remote. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Hybrid

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 Workers' Compensation Claims Representative | NY Lost-Time Experience | NY Licensing 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? To analyze New York Lost-Time claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATION: Syracuse, NY - candidates within reasonable commuting distance to office will be required to work a hybrid schedule Remote for candidates with the right experience outside of commutable distance to Syracuse, NY ESSENTIAL RESPONSIBILITIES MAY INCLUDE Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. Negotiating settlement of claims within designated authority. Communicating claim activity and processing with the claimant and the client. Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. QUALIFICATIONS Education & Licensing: 1 - 2 years of claims management experience or equivalent combination of education and experience required. High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Jurisdiction Knowledge: NY Licensing: NY TAKING CARE OF YOU Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. 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 (60K - 70K). 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. #LI-BP1 #claims #claimsexaminer #remote #LI-remote #hybrid #LI-hybrid 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.

Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments. Additional Information Please let me know if you are available/interested so we can further discuss this position you can reach me @732- 983-4337

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities * Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. * This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. * Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. * Assists in the reviews of state or federal complaints related to claims. * Supports the other team members with several internal departments to determine appropriate resolution of issues. * Researches tracers, adjustments, and re-submissions of claims. * Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. * Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. * Handles special projects as assigned. * Other duties as assigned. Knowledgeable in systems utilized: * QNXT * Pega * Verint * Kronos * Microsoft Teams * Video Conferencing * Others as required by line of business or state Job Function Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent combination of education and experience; REQUIRED EXPERIENCE: 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 4 years PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. About CorVel CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

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

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote