Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim processor job in New Hartford, NY
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$103.3k-140k yearly 37d ago
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Long Term Disability Claims Specialist I 3 30 26 NY NC CT PR
Metlife, Inc. 4.4
Claim processor job in Oriskany, NY
At MetLife, we seek to make a meaningful impact in the lives of our customers and our communities. The LTD Claims Specialist I evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the LTD Claims Specialist is required to exercise critical thinking skills, exemplary customer service skills as well as effective inventory management skills with oversight and expected progression to a LTD Claims Specialist II role.
Job Location: Virtual, but must be commutable to the following offices:
* Oriskany, NY
* Bloomfield, CT
* Cary, NC
* San Juan, PR
Employees are required to come into the office for 2 weeks after initial training. After training, employees are to report to the office 1x a month.
Key Responsibilities:
* Virtual roles predominately work from a home office with periodic visits to the assigned office as needed for team events, meetings, training, business continuity, etc.
* Effectively manages some level of oversight an assigned caseload which consists of pending, ongoing/active reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators
* Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.
* Develop actions plans and identify return to work potential
* Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills
* Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations
* Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
* Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.
* Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
* Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.
Essential Business Experience and Technical Skills:
Required:
* New hires should live a commutable distance from the site the role is posted in
* High School Diploma
* Minimum 2 years of experience in external customer service or related experience
* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning
* Creative problem-solving abilities and the ability to think outside the box
* Excellent interpersonal and communication skills in both verbal and written form
* Excellent customer service skills proven through internal and external customer interactions
* Organizational and time management skills
Preferred:
* Bachelor's degree
Business Category
Operations - Claims
At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers.
The expected salary range for this position is $41,600 - $60,500. 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 - $60,500
$41.6k-60.5k yearly 13d ago
Analyst, Claims Research
Molina Healthcare Inc. 4.4
Claim processor job in Syracuse, NY
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
* Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
* Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
* Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
* Assists with reducing rework by identifying and remediating claims processing issues.
* Locates and interprets claims-related regulatory and contractual requirements.
* Tailors existing reports and/or available data to meet the needs of claims projects.
* Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
* Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
* Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
* Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
* Works collaboratively with internal/external stakeholders to define claims requirements.
* Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
* Fields claims questions from the operations team.
* Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
* Appropriately conveys claims-related information and tailors communication based on targeted audiences.
* Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
* Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
* Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
* At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
* Medical claims processing experience across multiple states, markets, and claim types.
* Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
* Data research and analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Ability to work cross-collaboratively in a highly matrixed organization.
* Customer service skills.
* Effective verbal and written communication skills.
* Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
* Health care claims analysis experience.
* Project management experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $22.81 - $46.42 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$22.8-46.4 hourly 15d ago
Claims Analyst
Integrated Resources 4.5
Claim processor job in Syracuse, NY
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.
$43k-69k yearly est. 8h ago
Claims Supervisor - NY
Corvel Career Site 4.7
Claim processor job in Syracuse, NY
The Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Supervises claims staff in their day-to-day operations
Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions
Ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements
Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval)
Provides technical and jurisdictional guidance to claims staff regarding complex compensability, investigation, litigation issues and service account instructions
Acts as a liaison by recommending and executing final resolutions for clients and employees concerning claim-specific, procedural, or special requests
Participate in customer claim reviews and presentations
Ability to travel overnight and attend meetings if required
Additional duties as assigned
KNOWLEDGE & SKILLS:
Excellent written and verbal communication skills
Ability to assist team members to develop knowledge and understanding of claims practice
Effective quantitative, analytical and interpretive skills
Strong leadership, management and motivational skills
Demonstrated, strong customer service skills
Maintains composure under pressure and communicates diplomatically across various channels, including telephone, email, and written correspondence
Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
Strong interpersonal, time management and organizational skills
Ability to work both independently and within a team environment
Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation
EDUCATION & EXPERIENCE:
Minimum of 3-5 years of VA workers compensation claims handling experience
Bachelor's degree or a combination of education and related experience
Demonstrated public speaking skills
Knowledge of WC required
Current license or certification in Workers' Compensation must be maintained throughout employment with CorVel
Self-Insured Certificate 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: $71, 696 - $110,701
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
$71.7k-110.7k yearly 6d ago
Claims Investigator - Part Time
Coventbridge Group 3.8
Claim processor job in Syracuse, NY
Claims Investigator - Part Time
Rochester / Syracuse, NY
Uncover the Truth. Protect the Integrity. Advance Your Career.
At CoventBridge Group, every claim tells a story - and as a Claims Investigator, you'll be the one uncovering it. Using your investigative instincts, field experience, and attention to detail, you'll help clients get the answers they need and ensure claims are resolved with accuracy and fairness.
Join a global leader in full-service investigations, where integrity meets action, and every day brings a new case - and a new challenge.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
Responsibilities/ Requirements
What You'll Do:
As a Claims Investigator, you'll combine analytical skill with real-world investigation techniques to uncover facts, document findings, and deliver objective results. You will:
· Conduct complex field investigations involving multiple claim types.
· Submit daily updates summarizing your progress and observations.
· Manage your time effectively to maintain client billable hour expectations.
· Write detailed, professional statements and investigative summaries.
· Deliver clear, client-ready reports that meet CoventBridge's quality standards.
· Perform scene investigations, background checks, and courthouse research.
· Operate safely and remain alert while driving during field assignments.
Your curiosity and persistence will turn each case into a story built on truth and evidence.
What You'll Bring:
We're looking for investigators who are driven, professional, and dedicated to uncovering facts with accuracy and integrity.
· Hold a valid New York Investigator license (or eligibility for licensure in surrounding states).
· Demonstrate at least 1 year of field investigations experience, including face-to-face statements and report writing.
· Travel across multiple states as needed to complete case assignments.
· Investigate claims related to product, auto, general liability, Workers' Compensation, disability, life insurance, and contestable death cases.
· Adapt to variable schedules - including nights and weekends when required.
· Maintain a reliable, fuel-efficient vehicle and required insurance coverage.
· Equip yourself with a digital recorder, laptop (Windows OS), and necessary investigative tools.
What You'll Need:
To qualify for this position, applicants must possess the following:
· An Associate's or Bachelor's degree in Criminal Justice or a related field.
· Strong report writing skills.
· Bring prior experience as a Private Investigator, detective, or law enforcement professional.
· Understand investigative processes, insurance law, and claim procedures.
· Excel in report writing and typing (50+ WPM) with accuracy and attention to detail.
· Thrive under pressure and maintain professionalism in sensitive situations.
· Demonstrate self-motivation, accountability, and sound judgment.
Benefits
We believe great work deserves great rewards. Here's what you can expect when you join our team:
· Home-based work and flexible scheduling
· Competitive pay with monthly vehicle allowance
· Paid time off
· Company fuel card and company-issued cell phone
· Medical, Dental, Vision plans
· Employer-paid Life, LTD, STD insurance
· 401(k) with company match
· Travel and report writing compensation
· Licensing fees paid by company
· Paid ongoing career advancement training
· Expense reimbursement with minimal out-of-pocket expenses
The salary range for this role is $25 - $30 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
About Us:
CoventBridge Group is a global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 700+ employees and affiliates worldwide.
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************.
CoventBridge (USA) Inc. New York License # 11000158134
IND123
$25-30 hourly Auto-Apply 1d ago
Long Term Disability Claims Specialist I
Metlife 4.4
Claim processor job in Oriskany, NY
* Oriskany, NY * Bloomfield, CT * Cary, NC * San Juan, PR Employees are required to come into the office for 2 weeks after initial training. After training, employees are to report to the office 1x a month.
Key Responsibilities:
* Virtual roles predominately work from a home office with periodic visits to the assigned office as needed for team events, meetings, training, business continuity, etc.
* Effectively manages some level of oversight an assigned caseload which consists of pending, ongoing/active reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators
* Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.
* Develop actions plans and identify return to work potential
* Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills
* Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations
* Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
* Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.
* Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
* Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.
Essential Business Experience and Technical Skills:
Required:
* New hires should live a commutable distance from the site the role is posted in
* High School Diploma
* Minimum 2 years of experience in external customer service or related experience
* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning
* Creative problem-solving abilities and the ability to think outside the box
* Excellent interpersonal and communication skills in both verbal and written form
* Excellent customer service skills proven through internal and external customer interactions
* Organizational and time management skills
Preferred:
* Bachelor's degree
Business Category
Operations - Claims
At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers.
Equal Employment Opportunity/Disability/Veterans
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.
$48k-59k yearly est. 12d ago
Analyst, Claims Research
Molina Healthcare 4.4
Claim processor job in Syracuse, NY
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
**Essential Job Duties**
- Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
- Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
- Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
- Assists with reducing rework by identifying and remediating claims processing issues.
- Locates and interprets claims-related regulatory and contractual requirements.
- Tailors existing reports and/or available data to meet the needs of claims projects.
- Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
- Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
- Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
- Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
- Works collaboratively with internal/external stakeholders to define claims requirements.
- Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
- Fields claims questions from the operations team.
- Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
- Appropriately conveys claims-related information and tailors communication based on targeted audiences.
- Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
- Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
- Supports claims department initiatives to improve overall claims function efficiency.
**Required Qualifications**
- At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
- Medical claims processing experience across multiple states, markets, and claim types.
- Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
- Data research and analysis skills.
- Organizational skills and attention to detail.
- Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Ability to work cross-collaboratively in a highly matrixed organization.
- Customer service skills.
- Effective verbal and written communication skills.
- Microsoft Office suite (including Excel), and applicable software programs proficiency.
**Preferred Qualifications**
- Health care claims analysis experience.
- Project management experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $22.81 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$22.8-46.4 hourly 14d ago
Claims Analyst I
Integrated Resources 4.5
Claim processor job in Syracuse, NY
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
$43k-69k yearly est. 8h ago
Claims Supervisor - NY
Corvel 4.7
Claim processor job in Syracuse, NY
The Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
* Supervises claims staff in their day-to-day operations
* Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions
* Ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements
* Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval)
* Provides technical and jurisdictional guidance to claims staff regarding complex compensability, investigation, litigation issues and service account instructions
* Acts as a liaison by recommending and executing final resolutions for clients and employees concerning claim-specific, procedural, or special requests
* Participate in customer claim reviews and presentations
* Ability to travel overnight and attend meetings if required
* Additional duties as assigned
KNOWLEDGE & SKILLS:
* Excellent written and verbal communication skills
* Ability to assist team members to develop knowledge and understanding of claims practice
* Effective quantitative, analytical and interpretive skills
* Strong leadership, management and motivational skills
* Demonstrated, strong customer service skills
* Maintains composure under pressure and communicates diplomatically across various channels, including telephone, email, and written correspondence
* Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
* Strong interpersonal, time management and organizational skills
* Ability to work both independently and within a team environment
* Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation
EDUCATION & EXPERIENCE:
* Minimum of 3-5 years of VA workers compensation claims handling experience
* Bachelor's degree or a combination of education and related experience
* Demonstrated public speaking skills
* Knowledge of WC required
* Current license or certification in Workers' Compensation must be maintained throughout employment with CorVel
* Self-Insured Certificate 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: $71, 696 - $110,701
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
$71.7k-110.7k yearly 7d ago
PFML Claim Specialist Oriskany Central NY 3 23 26
Metlife, Inc. 4.4
Claim processor job in Oriskany, NY
Role Value Proposition: Global Operations (Global Ops) focuses on creating positive experiences for MetLife customers and helping the company make the best use of its global resources. The Absence Leave Solutions Organization is a fast-paced ever-changing environment in which MetLife strives to create and maintain collaborative solutions for our customers' leave landscape.
We're looking for unique talent with fresh perspectives that can propel innovation. In this role, you would be responsible for managing Paid Family Medical Leave (PFML) along with a a combination of leaves. These leave types may include, but are not limited to, Americans with Disabilities Act (ADA), Family and Medical Leave Act (FMLA) and Benefit Calculated Employer Leave (BCEL) claims.
Job Title
Paid Family Medical Leave Claim Specialist
Job Location
Virtual within a commutable distance of Oriskany / Central NY. New Hires must live within a commutable distance of Oriskany / Central NY.
Training: IN-PERSON TRAINING for 4 weeks, Monday through Friday, 8:00AM - 4:30 PM.
Key Responsibilities
* Virtual roles work from a home office with periodic visits to the assigned GCSO office as needed for team events, meetings, training, business continuity, etc.
* Reviewing and adjudicating leave and/or accommodation requests in compliance with federal, state and company policies.
* Establishing eligibility and applicability of leave requests while ensuring timely communication with employees, employers and other key stakeholders necessary to appropriately determine liability.
* Maintain active oversight of leave claims from initiation to closure following appropriate policies and procedures around timely submission of information and absences in accordance with the plan(s).
* Providing exceptional customer service while maintaining confidentiality and regulatory compliance requirements.
* Support a continuous focus on quality and continuous improvement by ensuring efficiency, accuracy and a positive claimant experience.
* Meeting and exceeding Key Performance Indicators and productivity metrics while maintaining quality.
Essential Business Experience and Technical Skills:
Required
* New hires should live a commutable distance from the site the role is posted in.
* 1-2 years Customer Service background.
* Strong communication skills, both written and oral.
* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
* Strong Letter writing/Microsoft Word.
* High School Diploma or GED equivalent.
* This role has mandatory paid training starting on March 23rd. Candidates must be available and present for all training days.
Preferred
* 1+ years' experience in one or more leave State and Federal Leave Laws.
* 1-2 years of experience in Leave Claims (AMS, Disability, FMLA, ADA).
* College Degree.
At MetLife, we're leading the global transformation of an industry we've long defined. United in purpose, diverse in perspective, we're dedicated to making a difference in the lives of our customers.
The expected salary range for this position is 45,000 - 48,000. 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.
45,000 - 48,000
$48k-59k yearly est. 1d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare Inc. 4.4
Claim processor job in Syracuse, NY
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
* Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
* Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
* Assists in reviews of state and federal complaints related to claims.
* Collaborates with other internal departments to determine appropriate resolution of claims issues.
* Researches claims tracers, adjustments, and resubmissions of claims.
* Adjudicates or readjudicates high volumes of claims in a timely manner.
* Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
* Meets claims department quality and production standards.
* Supports claims department initiatives to improve overall claims function efficiency.
* Completes basic claims projects as assigned.
Required Qualifications
* At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
* Research and data analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Customer service experience.
* Effective verbal and written communication skills.
* Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.65 - $38.37 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 33d ago
Claims Analyst
Integrated Resources 4.5
Claim processor job in Syracuse, NY
Job Title: Claims Analyst
Duration: 1+ months contract
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.
$43k-69k yearly est. 60d+ ago
Claims Specialist - Massachusetts
Corvel Enterprise Claims, Inc. 4.7
Claim processor job in Liverpool, NY
Job Description
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
$51.8k-83.6k yearly 15d ago
Adjudicator, Provider Claims
Molina Healthcare 4.4
Claim processor job in Syracuse, NY
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment.
- Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.
- Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
- 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.
- 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 re-adjudicates high volumes of claims in a timely manner.
- Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
- Meets claims department quality and production standards.
- Supports claims department initiatives to improve overall claims function efficiency.
- Completes basic claims projects as assigned.
**Required Qualifications**
- At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
- Research and data analysis skills.
- Organizational skills and attention to detail.
-Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Customer service experience.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.65 - $38.37 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 7d ago
Claims Analyst
Integrated Resources 4.5
Claim processor job in Syracuse, NY
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
$43k-69k yearly est. 8h ago
Claims Specialist - NY
Corvel Enterprise Claims, Inc. 4.7
Claim processor job in Liverpool, NY
Job Description
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
$51.8k-83.6k yearly 29d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare 4.4
Claim processor job in Syracuse, NY
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
- Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
- Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
- Assists in reviews of state and federal complaints related to claims.
- Collaborates with other internal departments to determine appropriate resolution of claims issues.
- Researches claims tracers, adjustments, and resubmissions of claims.
- Adjudicates or readjudicates high volumes of claims in a timely manner.
- Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
- Meets claims department quality and production standards.
- Supports claims department initiatives to improve overall claims function efficiency.
- Completes basic claims projects as assigned.
**Required Qualifications**
- At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
- Research and data analysis skills.
- Organizational skills and attention to detail.
-Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Customer service experience.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.65 - $38.37 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 32d ago
Claims Analyst
Integrated Resources 4.5
Claim processor job in Syracuse, NY
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
$43k-69k yearly est. 60d+ ago
Claims Specialist - NY
Corvel Career Site 4.7
Claim processor job in Syracuse, NY
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
How much does a claim processor earn in Utica, NY?
The average claim processor in Utica, NY earns between $24,000 and $77,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.