Claim processor jobs in Tennessee

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

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 - Workers Comp (REMOTE - Southeast, VA, WV Exp Needed) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. 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. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Licensing / Jurisdiction Knowledge: Southeast and VA, WV Claims Exp 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. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Claims Division is seeking a team member to join the Shared Services Team as a Claims Examiner. Responsibilities include investigating, evaluating and resolving various types of commercial first and third party low complexity claims. This requires accurate and thorough documentation, as well as completion of resolution action plans based upon the applicable law, coverage and supporting evidence. Responsibilities: * Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level * Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution * Review and analyze supporting damage documentation * Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions * Establish appropriate loss and expense reserves with documented rationale * Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines Experience & Qualifications * Hands-on experience and strong aptitude with Outlook, Microsoft Excel, PowerPoint, and Word * Knowledge of ImageRight preferred * Exceptional communication (written and verbal), influencing, evaluation, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines * Ability to take part in active strategic discussions and leverage technical knowledge to make cost-effective decisions * Strong time management and organizational skills; ability to adhere to both internal and external regulatory timelines * Ability to work well independently and in a team environment * Texas Claim Adjuster license preferred, but not required for posting. Upon employment candidate would be required to obtain Texas Claim Adjuster license within six months of hire date. Education * Bachelor's degree preferred * 3-5 years' experience handling the process of commercial insurance claims #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $71,900 - $97,110/year * Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. * Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.

Job DescriptionJob Title: Claims ExaminerLocation: Memphis, TNHire Type: ContingentPay Range: $31.00 - $41.00/hour Work Type: Full-time Work Model: RemoteWork Schedule: Monday - Friday, 8:30am - 4:30pm Recruiter Contact: Sean Craft, sean@marykraft.com Nature & Scope:Positional OverviewWe are seeking an experienced Claims Examiner - General Liability / Professional Liability to manage complex and high-exposure liability claims. This role is responsible for analyzing technically difficult claims, assessing liability, managing litigation, and negotiating settlements while ensuring compliance with service expectations, industry best practices, and client-specific requirements. The Claims Examiner will also identify subrogation opportunities and support cost-effective claim resolution strategies.Role & Responsibility:Tasks That Will Lead to Your Success Analyze and process complex or technically difficult general liability and professional liability claims by conducting investigations and gathering relevant information to assess exposure. Evaluate liability and resolve claims within established authority and evaluation guidelines. Develop and execute well-defined action plans to ensure timely and appropriate claim resolution. Negotiate settlements within designated authority levels. Calculate, establish, and manage appropriate claim reserves throughout the life of the claim. Authorize and issue timely claim payments, adjustments, and settlements in accordance with authority levels. Prepare and submit required state filings within statutory deadlines. Manage the litigation process to ensure timely, effective, and cost-conscious outcomes. Coordinate vendor referrals for investigations, expert services, and litigation support. Apply cost containment strategies, including strategic vendor partnerships, to reduce overall claim costs. Manage claim recoveries, including subrogation and applicable excess or offset recoveries. Report claims to excess carriers and respond to direct requests in a professional and timely manner. Communicate claim status and activity clearly with claimants, insureds, attorneys, and clients. Maintain accurate, complete claim documentation and ensure proper claims coding. Escalate complex or high-risk cases to supervisors or management as appropriate. Skills & ExperienceQualifications That Will Help You Thrive High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Active adjuster license required. Florida (or reciprocal state) and/or New York adjuster license preferred. Professional certifications related to liability claims preferred. Three (3) to five (5) years of relevant General Liability and/or Professional Liability experience required. Product liability experience is a plus but not required. Strong knowledge of general liability and professional liability insurance principles, laws, and regulations. Expertise in claim evaluation, liability assessment, recovery, offsets, and settlement negotiation. Knowledge of litigation management and cost containment best practices. Excellent verbal and written communication, including presentation skills. Strong analytical, interpretive, and organizational skills. Excellent negotiation and interpersonal abilities. Proficient in Microsoft Office and standard claims systems. Ability to work independently and collaboratively in a remote team environment. Proven ability to meet or exceed service level expectations.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager. Specific Duties include: Claims & Incident Management: * Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to: * Input and/or review all incidents reported in DPR's RMIS system. * Maintain incident records in Insurance Team's document management system. * Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements. * Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities. * Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable. * Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate. * Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date. * Provide in-network aluminum certified repair shop information to drivers following an incident. * Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement. * When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form. * Work with Insurance Controller on auto program claim reports * Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed. Fleet Vehicle Safety & Operations Policy Management: * Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs * Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training * Ensure authorized driver list is kept current * Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions * Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy Key Skills: * Strategic thinking * Ability to mentor and inspire others * Integrity * Team player * Strong writing and communication skills * Self-Starter * Highly organized and responsive - ability to meet deadlines * Detail Oriented * Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs. * Risk and dispute management - insured claims Qualifications: * A minimum of five years relevant insurance industry experience * Previous experience in auto claims management highly desired DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world. Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek. Explore our open opportunities at ********************

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

Remote-Centric Hybrid (Nashville, TN) Company Overview: AMSURG is an independent leader in ambulatory surgery center services, operating a network of more than 250 surgery centers nationwide. In partnership with physicians and health systems, the organization delivers high-quality care for patients across a diverse spectrum of medical specialties, including gastroenterology, ophthalmology and orthopedics. To learn more about AMSURG, visit *************** POSITION SUMMARY: This position provides support to the Director, Licensure & Certification and overall Licensure & Certification (L & C) department. Work Schedule: Remote-Centric Hybrid ESSENTIAL RESPONSIBILITIES: Responsible for renewal of State and Federal licenses of ambulatory surgery centers including state licenses, Drug Enforcement Administration registrations (DEA), Clinical Laboratory Improvement Amendment (CLIA) permits, state clinical lab permits, pharmacy licenses, radiation licenses, blood bank licenses and controlled substance licenses. Responsible for Medicare and Medicaid enrollment for ambulatory surgery centers as well as Railroad Medicare and Tricare Responsible for reporting surgery center changes to State and Federal licensing agencies, Medicare, Medicaid and accreditation agencies. Requires regular contact via telephone and correspondence with state licensing agencies, federal regulatory agencies and internal departments Provides timely turnaround of license renewals, reportable changes, and Medicare/Medicaid revalidations. Works within a strict time frame of setting priorities and using discretion to exercise confidentiality. Works independently with state, government agencies and legal representatives. Performs research and helps develop policies and procedures for the department for assigned states Other projects as assigned requiring coordination with L&C staff. Regular and reliable attendance is required. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required. Ability to manage multiple deadlines and competing priorities Demonstrate exceptional organizational and time management skills Experience in drafting and completing Medicare 855B and Medicaid applications is preferred. Excellent PC Skills including Microsoft Word and Adobe Acrobat experience. The ability to type proficiently in a concise professional manner to correspond with licensing, legal and company representatives and record license information in multiple Licensure & Certification databases. Must be able to read and understand legal ease and state statutes/regulations and be able to articulate both verbally and in writing so others can understand. Ability to effectively interface and communicate, both written and verbal, will all levels inside and outside of the company Other duties as assigned Education/Experience: Associates degree from an accredited college or university with a minimum of five (5) years' experience is required. Bachelor's degree and/or Paralegal preferred. Experience in healthcare required Experience in Legal preferred Other Qualifications: Good interpersonal skills, organizational skills, attention to detail and accuracy are needed to perform in this work environment. Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. Must be able to work well with others. Strong verbal and written communication skills required. Must be detail oriented and organized. High integrity, including maintenance of confidential information. Must be able to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency. Based on business need, the ability to work a flexible schedule, including some evenings and weekends as approved in advance. Must be able to work under pressure and strict time frames occasionally. Must have good research skills. Employment at AMSURG: Living Our Values Every Day At AMSURG, our values define who we are and how we serve our patients, partners, and each other. As a national leader in ambulatory surgery, we are committed to a culture of excellence, integrity, teamwork and caring deeply. Our values guide every decision, ensuring we continue to elevate healthcare and provide the highest quality care. These guiding principles are the foundation of our culture and a guide to how we collaborate, innovate, and make a difference every day. Care Deeply for those around us. Cultivate Integrity to build trust. Champion Excellence for continuous improvement Celebrate Teamwork every step to the way. Benefits: To ensure we retain and invest in great people, AMSURG provides its employees with the benefits, recognition, training, and opportunities needed for professional growth. Our wide range of health and welfare benefits allow you to choose the right coverage for you and your family. AMSURG offers a variety of health and welfare benefit options to help protect your health and promote your wellbeing. Benefits offered include but are not limited to: Paid Time Off, Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking & HSAs, and a matching 401(K) Plan. Paid Time Off: AMSURG offers paid time off, 9 observed holidays, and paid family leave. You accrue Paid Time Off (PTO) each pay period and depending on your position and can earn a minimum of 20 days and up to 25 days per calendar year. EOE Statement: AMSURG is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age (40 or older), race, color, religion, gender, sex, national origin, pregnancy, sexual orientation, disability, genetic information or any other status protected under applicable federal, state, or local laws. We strive to also provide a disability inclusive application and interview process. If you are a candidate with a disability and require reasonable accommodation in order to submit an application, please contact us at: ******************. Please include your full name, the role you're applying for and the accommodation necessary to assist you with the recruiting process. #LI-CH1 #LI-REMOTE

Are you a results-driven claims professional with a background in bodily injury and commercial auto? Do you thrive in a leadership role where you can mentor others, influence best practices, and drive operational success? If so, we invite you to bring your expertise to a company known for industry leadership, long-term stability, and a culture that invests in its people. We're seeking a Liability Claims Supervisor to lead and support a high-performing team of Liability Adjusters managing complex claims in the commercial trucking insurance sector. This role is key to ensuring quality, compliance, and innovation in claims handling-impacting both client satisfaction and operational excellence. Location: Knoxville, TN offering a strong community, affordable living, and natural beauty (robust relocation package available). In this position, you will: * Supervise a team of liability adjusters handling third party bodily injury claims * Conduct file reviews and audits to ensure accuracy, timeliness, and regulatory compliance * Provide mentorship, training, and performance feedback to team members * Manage workloads and support efficient case distribution * Troubleshoot escalated issues and develop strategic solutions alongside your team * Collaborate with internal leadership to uphold best practices and continuous improvement What we're looking for: * Bachelor's degree or equivalent work experience in insurance, claims, or a related field * Proven claims handling experience in Bodily Injury and Commercial Auto (required) * Experience with commercial trucking claims strongly preferred * Demonstrated success in a supervisory or team leadership role (required) * Strong interpersonal, organizational, and communication skills * Ability to manage multiple priorities while fostering team development Your Future Starts Here: Benefits That Support Your Lifestyle * Competitive Compensation * Generous paid time off and paid company holiday schedule * Medical, Dental, Vision, Life, Long-Term Disability, Company Match 401(k), HSA, FSA * Paternal Leave, Adoption Assistance, Fertility and Family Planning Assistance, Pet Insurance, Retail Discount Programs * Community volunteer opportunities * Wellness programs, gym subsidies, and support for maintaining a healthy lifestyle * Scholarships for dependents and tuition reimbursement to further your education * Company paid continuing education and monetary awards for professional development * Opportunities for a hybrid work schedule (three days in the office, two days remote) Who we are: For over 65 years, Great West Casualty Company has provided premier insurance products and services to thousands of truck drivers and trucking companies across America. We have offices located around the country, and over 1,200 professionals are proud to call us an employer of choice. We are dedicated to the success, happiness, and wellness of our employees. If you are looking for a company where your contributions are valued, your continued learning is financially supported, and customer service is a priority, we want to talk to you. Apply today and join one of America's largest insurers of trucking companies as we help keep the nation's economy moving forward one mile at a time. Great People. Great Careers. Great West Casualty Company. Great West Casualty Company is an Equal Opportunity Employer.

HomeServe USA, a Brookfield Infrastructure Group portfolio company, is a Great Place to Work, and while we're biased, we're not just saying that. We're proud to have been certified as a Great place to Work the last ten years. What does HomeServe do and what makes it so great? Well, we're glad you asked! We put people at the heart of everything we do. That's priority number one for all of us. For the nearly 5 million customers we serve, that means being there when they have an emergency home repair need, such as getting their a/c working, clearing their clogged pipes, or fixing broken electrical systems. With over 1,300 municipal and utility partners, that means providing their customers with access to affordable home repair plans, making it easier, faster and less expensive to have their home repair needs met. And for the more than 1,500 people working alongside us, it means fostering a rewarding, inclusive and challenging career experience that we think is second to none. At HomeServe, everyone is welcome. We know that having diverse teams has a positive impact on our work and ultimately helps us better serve our customers. No matter your role at HomeServe, you're part of a growing team that's working to make home repairs and improvements easy. Position Overview: The Contractor Operations Claims Analyst will be responsible for data analysis, reporting, and auditing to ensure that internal operations teams and HomeServe's third- party contractor network are administering claims in accordance with policy terms and conditions, processes, and pre-negotiated rate schedules. The Claims Analyst will utilize claims data and reporting to identify opportunities to improve financial underwriting performance, operational efficiencies, and the customer experience. As well, the incumbent will work independently and collaboratively across both the Operations and Finance teams to develop analytical reports to better understand opportunities for cost avoidance. The Claims Analyst will conduct ad hoc reviews and regular deep dives of identified trends and opportunities, and work with key business stakeholders to provide summaries of findings and recommended actions. This position is onsite and will report into our office in Chattanooga, TN. Responsibilities: utilize claims data to identify unfavorable trends or opportunities in claims performance to determine where additional analysis is necessary. Conduct audits based on findings to analyze the unfavorable trends impacting business claims performance as well as identify and audit any contractors, and/or internal operations team members, not adhering to pre-negotiated rate schedules, processes, and/or policy terms and conditions. Accurately identify, document, and share findings and opportunities for improvement. Create and document action plans for any business process changes identified during audits and assist in guiding the implementation of the changes. Develop clear framework for tracking and monitoring the implementation of business process changes and continually assess the impact of the changes on claims performance. Communicate insightful summaries to key business stakeholders on findings along with recommended actions for improvement tailored to the needs of the department. Responsible for completing various audits monthly, quarterly, or annually within Contractor Management to remain SOX compliant. Keep current on operational processes, contractor rate schedules, repair methods and practices, and policy terms and conditions. Build and maintain excellent relationships with key business stakeholders including but not limited to the Regional Operations Managers, Cost Authorization, Contractor Administration, Repair Management, and Finance. Meet KPI targets established by the company. Perform other duties as assigned. Essential Functions: Essential Job Function % of Time on Function Completing contractor or claims audits to provide actionable feedback to the business and ensure performance & quality goals are met or exceeded. 50% Generating monthly, weekly, & daily reports to support contractor management in meeting or exceeding department goals 40% Reviewing Fraud reporting to identify potentially fraudulent customers or contractors to investigation. 10% Total 100% Job Requirements: Bachelor's degree in business, finance, or related field At least 2 years of experience in data analysis, reporting, auditing, or related field and demonstrates a good working knowledge of Contractor Operations processes. Advanced knowledge of Microsoft Excel and proficient in other Microsoft applications (Word/PowerPoint). Experience with field service management applications such as ServiceBench, Service Titan or Dispatch Technologies preferred. Strong analytical mind, critical thinking, and logical reasoning with the ability to make solution-oriented decisions that will guide business action. Excellent and accurate data entry skills with strong attention to detail. Self-driven and exceptional organizational, time management, and independent problem-solving skills with the ability to work in a team environment and independently. Feel comfortable working in an autonomous environment where you are expected to be self-managed, while responsible for meeting or exceeding personal and departmental goals. Strong time management and organization skills and the ability to shift priorities based on the needs of the business. Adept at managing multiple priorities and tasks in a fast-paced environment. Excellent written and verbal communication skills. Broad knowledge of home repair methods including plumbing, HVAC, and electrical In return, we offer: Competitive compensation Career development and advancement opportunities Casual attire throughout the week Friendly, open and team oriented work atmosphere Excellent benefits including generous medical, vision, dental and life & disability insurance 401(k) plan with a company match Eligibility to enroll in up to two HomeServe coverage plans paid for by the company Minimum Physical Requirements: The physical demands described represent those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions of the position for which they work. While performing the duties of this position, the employee is regularly required to listen, talk and hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls while executing tasks like working on a computer or talking on the telephone. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually moderate to low. HomeServe USA is an equal opportunity employer.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Job Description **A Brief Overview** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. **What you will do** + Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers. + Follows area protocols, standards, and policies to provide effective and timely support. + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Handles phone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. + Identifies and reports claim overpayments, underpayments, and any other irregularities. + Takes direction to execute techniques, processes, and responsibilities. **For this role you will need Minimum Requirements** + 2+ years of experience with medical claim processing. + 2+ years of experience in a production environment. **Preferred Qualifications** + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. + Effective communication, organizational, and interpersonal skills. **Education** + High school diploma or equivalent required. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $35.29 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/06/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-Hybrid #IN-DNI

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $25/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

Job Title: Liability Claims Adjuster Department/Agency: US Admin About US: US Administrator Claims, LLC manages, adjusts, and controls insurance claims filed against the workers' compensation and commercial general liability policies of multiple carriers across the country. The difference between US Administrator Claims and other third-party administrators is our approach to claims handling. Everything we do on behalf of your business is customer-driven. Fr One size does not fit all. For those accounts identified as requiring a claims advocate, we will assign an account manage dedicated to your program. If your program requires a specific skillset or proper administration and management, rest assured, we have the claims professionals you need. US Administrator Claims, LLC stands apart from our competitors and looks forward to working with you to turn those inevitable losses into a profitable solution. Job Summary: Review, process and handle general liability claims as assigned by claims supervisor to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations and identify subrogation of claims and negotiate settlements. Communicate directly with clients, physicians, and attorneys to manage claims in a timely and economic manner. Essential Duties and Responsibilities include the following. Other duties may be assigned : Investigate newly assigned claims by making 3-point contact (client, claimant, physician) within a 24-hour period. Inquire and probe for information with clients and claimants to determine nature and cause of injury; verify all parties agree on incidents. Contact physicians to obtain medical diagnosis and projected treatment plan. Record claimant statements to verify information and claim status. Determine and assess if benefits due and liability of claims through evaluation of claim. Respond to all inquiries and requests from clients, physicians, and attorneys in a timely manner. Draft and send written communications for follow-up as needed with all involved parties. Document all information from contacts with clients, claimants, physicians, and attorneys into the claims system. Review and process daily paperwork, mail or communication relating to claims status. Maintain diaries and files for medical records and legal documents for claims. Calculate and pays benefits due; approve and makes timely claims; manages reserve adequacy throughout the life of the claim. Set reminders to follow-up on tasks through a diary on the system, check diaries daily. Review legal bills for accuracy and approve for payment. Consult with outside medical counsel to obtain pre-certification approval for specific treatments when needed. Coordinate and monitor litigation with attorneys. Prepare necessary state fillings within statutory limits. Evaluate settlement amounts with client; negotiate settlement with claimants and attorneys. Handle claims involving subrogation from investigation through recovery including talking to witnesses, obtaining police reports, and communicating with legal contacts and third-party insurance companies. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Uses appropriates cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Ensures claims files are properly documented and claims coding is correct. Refer cases as appropriate to supervisor and management. Qualifications High school Diploma or equivalent is required 3-5 years prior experience handling auto/general liability claims/ or an equivalent combination of training, education and experience. Strong organization skills, attention to detail and the ability to multi-task and prioritize work are required. Analytical thinking skills are needed to properly evaluate complex claims A strong attention to detail is necessary as claims adjusters must carefully review documents and policies Good verbal and written communication skills, as well as interpersonal skills are required, experience with negotiations, knowledge of litigation process is preferred. Ability to listen well and negotiate with constituents is needed. Ability to speak a second language is an asset Basic computer skills or the ability to quickly learn new software are required A strong work ethic and time management skills is needed, to efficiently handle a large caseload Ability to establish and maintain good rapport with clients and claimants is needed. Ability to calculate figures is required Physical Demand While performing the duties of this job, the employee is regularly required to sit; stand; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This description is not meant to be all-inclusive and may be modified from time to time at the discretion of management. Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at ************************************* To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisure's property, and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisure's Human Resources Talent Department.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com . If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: Affordable Medical/Dental/Vision insurance options Generous paid time-off program and paid holidays for full time staff TeleMedicine 24/7/365 access to doctors Optional short- and long-term disability plans Employee Assistance Plan (EAP) 401K retirement accounts Employee Referral Bonus Program ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment Work assigned claim projects to completion Provide a high level of customer service to internal and external customers; achieve quality and productivity goals Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures Maintain production and quality standards as established by management Participate in and support ad-hoc audits as needed Other duties as assigned JOB REQUIREMENTS: Proficient in processing/auditing claims for Medicare and Medicaid plans Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations Current experience with both Institutional and Professional claim payments Knowledge of automated claims processing systems Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office. REQUIRED QUALIFICATIONS: Experience: Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system Two (2) years' experience in managed healthcare environment related to claims processing/audit Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans License/Certification(s): Coding certification preferred EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

Analyze, plan, design, maintain, and provide ongoing optimization and support of medical imaging systems. Perform workflow assessments, capture business needs and analyze internal business systems to determine functional requirements for optimal utilization. Possess proficient clinical, technical, or application knowledge and experience. Perform system builds, upgrades, and system enhancements as needed. Support application through all phases of implementation, optimization, and maintenance. Work with cross-functional teams and end users to achieve application integration to meet clinical and/or business needs. Contributes to project teams and collaborates to ensure system functionality and user satisfaction. Exercise discretion and judgment in the performance of original, creative, intellectual work. Incumbent is subject to callback and on-call as required. Perform other duties as assigned. Job Responsibilities • Assist in implementation and serve as point person on assignments related to all phases of implementation of medical imaging systems and new projects used in corporate-wide Epic-related information system solutions to meet project milestones. • Analyzes problems, recommends improvement, and develops appropriate action plans utilizing Baptist Management System tools to promote transformation and ensure successful implementation. • Completes testing of software applications using established standards and protocols. • Provides ongoing support of medical imaging systems and other applications under area of responsibility. • Supports system configuration and maintenance tasks, ensuring alignment with clinical workflows and operational requirements. • Collaborates with end users and stakeholders to gather and document requirements, facilitating effective system integration. • Assists in troubleshooting and resolving technical issues in medical imaging systems, escalating complex problems as needed. • Completes assigned goals Experience Minimum Required 5 yrs. of relevant experience Education Minimum Required Bachelor Degree in either Radiology, Computer Engineering or Information Technology. Training Minimum Required None Special Skills Minimum Required Skill and proficiency in communicating and performing the techniques of information systems and/or telecommunications assessment. Licensure Minimum Required DRIVER'S LICENSE (CURRENT)

Business Claim Specialist Visa GC/Citizen Division Pharmaceutical Contract 6 Month Timings Mon - Fri between 8.00AM - 5.00PM Qualifications The primary function/purpose of this job. Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed. Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency. Moderate knowledge of drugs and drug terminology used daily. Process claims according to client specific guidelines while identifying claims requiring exception handling. Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues. Adhere to strict HIPAA regulations especially when communicating to others outside the client. Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met. Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing. Analyze claims for potential fraud by member or pharmacy. May be required to work on special projects for claims team. ESSENTIAL FUNCTIONS: The 6-10 major responsibility areas of the job. Weight: (%) (Total = 100%) 1. Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 % 2. Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 % 3. Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 % 4. Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 % 5. Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 % 6. Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 % 7. Variety of other miscellaneous duties as assigned 5 % SCOPE OF JOB Provide quantitative data reflecting the scope and impact of the job - such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc. Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph). MINIMUM QUALIFICATIONS TO ENTER THE JOB: Formal Education and/or Training: High school diploma or equivalent required, some college or technical training preferred Years of Experience: Two years' experience in P.B.M. environment is helpful but not required. Computer or Other Skills: Strong data entry, 10-key skills, general PC skills and MS Office experience Knowledge and Abilities: • Strong data entry and 10-key skills • Retail pharmacy, customer service experience helpful but not required • PC and MS Office literate • Strong attention to detail • Excellent retention and judgment ability • Proficient written and oral communication skills • Ability to work in fast-paced, production environment • Reliable, self-motivated with excellent attendance • Team player who has the ability to stay on task with little supervision If you are available and interested then please reply me with your “ Chronological Resume” and call me on ************** . Additional Information Thanks & Regards, Ranadheer Murari | Team Recruitment | Mindlance, Inc. | W : ************ *************************

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide: Award-winning culture Inclusion and diversity as a priority Performance Based Incentive Plans Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability Generous PTO (including paid time to volunteer!) Up to 9.5% 401(k) employer contribution Mental health support Career advancement opportunities Student loan repayment options Tuition reimbursement Flexible work environments *All the benefits listed above are subject to the terms of their individual Plans . And that's just the beginning… With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! General Summary: Summary Minimum starting hourly rate is $22.12- $24.04 Training start date: Jan 2026 We are looking for candidates to fill various roles related to managing leave requests and disability claims. When you apply, you'll be considered for positions such as Integrated Paid Leave Specialist, STD Benefits Specialist Trainee, Associate Leave Specialist, Eligibility Specialist and Associate Life Event Specialist. Your placement will depend on your qualifications and role availability. These positions help ensure that our company complies with leave laws and policies while providing top-notch service to our customers. Each of these roles comes with a comprehensive training program, ensuring you gain all the knowledge and expertise needed. These roles are perfect for those who have strong analytical skills, like to learn, and want to help the working world thrive. Join us to make a meaningful impact and grow your career. This is a main campus based position, applicants will work in the Chattanooga, TN or Portland, ME office 3-5 days a week in office required. Principal Duties and Responsibilities Handle leave, short-term disability (STD), or paid leave claims efficiently and accurately. Determine if employees are eligible for different types of leave, such as FMLA, PFML, and corporate-paid plans. Have an advanced understanding of compliance and regulations and use this to make fair decisions about eligibility and benefits. Create necessary communications to comply with federal, state, and company leave policies. Review medical certifications and other documents, consulting with internal teams as needed. Stay updated on changes in leave laws and industry practices. Maintain good relationships with employer contacts, HR administrators, and employees. Answer questions and resolve issues for employees and employers promptly. Work with other departments to ensure smooth operations. Meet standards for accuracy, quality, and service in managing claims and leaves. Provide excellent customer service by processing claims promptly and addressing inquiries quickly. Job Specifications A 4-year degree or relevant experience is preferred. Experience in medical, disability claims, or leave management is a plus. Strong decision-making, analytical, and problem-solving abilities. Ability to use independent judgment and think critically in making decisions. Excellent interpersonal and communication skills (phone, email, and written). Proficiency with Windows and basic computer skills (Word, Excel, Access). Detail-oriented with strong organizational skills. Ability to perform in a fast-paced environment while managing multiple tasks and priorities Ability to make fair decisions quickly and efficiently. Self-motivated and able to work independently and as part of a team. ~IN2 #LI-JH1 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $36,000.00-$62,400.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. 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. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $67,000.00 - $110,600.00 Target Openings 1 What Is the Opportunity? Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. What Will You Do? * Handles 1st party property claims of moderate severity and complexity as assigned. * Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. * Broad scale use of innovative technologies. * Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. * Establishes timely and accurate claim and expense reserves. * Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. * Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. * Writes denial letters, Reservation of Rights and other complex correspondence. * Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. * Meets all quality standards and expectations in accordance with the Knowledge Guides. * Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. * Manages file inventory to ensure timely resolution of cases. * Handles files in compliance with state regulations, where applicable. * Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. * Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. * Identifies and refers claims with Major Case Unit exposure to the manager. * Performs administrative functions such as expense accounts, time off reporting, etc. as required. * Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. * May provides mentoring and coaching to less experienced claim professionals. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. * Must secure and maintain company credit card required. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. * This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * General knowledge of estimating system Xactimate. * Two or more years of previous outside property claim handling experience. * Interpersonal and customer service skills - Advanced. * Organizational and time management skills- Advanced. * Ability to work independently - Intermediate. * Judgment, analytical and decision making skills - Intermediate. * Negotiation skills - Intermediate. * Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate. * Investigative skills - Intermediate. * Ability to analyze and determine coverage - Intermediate. * Analyze, and evaluate damages -Intermediate. * Resolve claims within settlement authority - Intermediate. * Valid passport. What is a Must Have? * High School Diploma or GED. * One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. * Valid driver's license. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************