Claim processor jobs in West Valley City, UT - 61 jobs

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **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:** $22.71 **Pay Range Maximum:** $35.18 _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: J273755

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.

Full-time Description This position will primarily be responsible for following a strict procedure for processing life insurance claims, and answering phone calls from our policy holders and funeral homes. This is an entry level position with a Monday - Friday business hours schedule. We offer a comprehensive benefits package that includes health insurance, PTO, Employee Discounts, and more. What You'll Do: Data entry for new claims into our system Processing life insurance claims Analyzing contracts for monetary discrepancies Inbound & outbound calls from Funeral Homes and Beneficiaries Provide excellent customer service on phone and through email Other special projects as assigned #LI-DNI Requirements What We'll Love About You: Customer service oriented Self-motivated Dynamic, friendly and outgoing personality Team oriented Detail oriented Multi-tasker Requirements: Basic computer operation skills Ability to type 35 wpm Working knowledge of Microsoft Office (Outlook, Excel, Word) Ability to pay close attention to detail Ability to quickly learn new processes and procedures Ability to work independently and with a team when needed Ability to work Monday through Friday, 8:00 am to 5:00 pm Prolonged periods sitting at a desk and working on a computer Must be able to lift up to 10 pounds at times, and engage in repetitive movements Education and Experience: High school diploma or equivalent Work experience of 1-2 years preferred Bilingual in English and Spanish required What You'll Love About Us Great Company Culture. Top Workplaces 5 years in a row Rest and Relaxation. 2 weeks paid time off, 10 paid holidays, and accrued sick leave Health Benefits. Medical with HSA and FSA options, dental, and vision Prepare for the Future. 401(k) with company match

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage 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-DNI #IN-DNI

TruHearing is a rewarding, fun and friendly, mission-based organization that makes a real difference towards improving people s lives. Our employees enjoy a positive working environment in a company that has experienced rapid growth. We offer a comprehensive benefits package, educational assistance, and opportunities for advancement. TruHearing is the market leader and a force for positive change in the hearing healthcare industry. We reconnect people to the richness of life through industry-leading hearing healthcare solutions. We work with insurance companies, hearing aid manufacturers, and healthcare providers to reduce prices and expand access to better hearing care and whole-body health. TruHearing is part of the WS Audiology Group (WSA), a global leader in the hearing aid industry. Together with our 12,000 colleagues in 130 countries, we invite you to help unlock human potential by bringing back hearing for millions of people around the world. The WSA portfolio of technologies spans the full spectrum of hearing care, from distinct hearing brands and digital platforms to managed care, hearing centers and diagnostics locations. About the Opportunity: This role exists to work with patient health plans to coordinate the patients claims and insurance benefits when purchasing hearing aids through a provider in TruHearing s provider network. What will you be doing? Confirm patient s insurance coverage, demographic information and other details with health plans via outbound phone calls, web chats, or online portals. Accurately document patient hearing aid benefit details, and patient information in TruHearing s proprietary data system according to compliance requirements and TruHearing standards. Demonstrate an understanding of applicable patient claims and insurance benefits by providing specific insurance information to claimants, health plans, and members of the TruHearing insurance department. Validate patient demographic information with health plan payers (e.g., Medicare, Medicaid, private, and commercial) via outbound phone calls, web chats, or online portals. Confirm insurance claim payments are paid correctly. Apply insurance payments to patient accounts through TruHearing s proprietary data system. Prepare basic insurance claims by transferring data from TruHearing s proprietary data system to the clearinghouse so payers receive timely and accurate claims. Confirm that payments received from TruHearing s Accounting Department are processed and accounts are reconciled. Complete a log of submitted claims and track to ensure timely payment from health plan partners. What skills do you need to bring? In addition to exhibiting the TruHearing Values of Going Beyond Together, Pioneering for Better Solutions, and Passion for Impact, this role requires the following: Accountability Operates autonomously in most situations, communicates limits and needs. Quality Consistently meets quality standards of the organization with limited assistance. Productivity Consistently meets productivity standards of the organization with limited assistance. Initiative Acts proactively and independently in common situations, asks appropriate questions, offers appropriate suggestions. Customer Focus Develops customer relationships over time, provides services and offerings in the right moment. Teamwork Collaborates with others to accomplish standard, documented processes. Using Technology Uses basic IT tools or software. Resilience Maintains energy in the face of occasional strenuous work demands. What education or experience is required? Required: High School Diploma or equivalent. One (1+) years experience working in the healthcare industry, preferably directly with insurance companies. Medical Claim submission experience Medical Prior authorization experience Medical benefit verification experience Preferred: Two (2+) years experience working in the healthcare industry, preferably directly with insurance companies OR one (1+) years experience working as a Level I Insurance Specialist at TruHearing. Managed Care experience Fee for Service Claims experience Knowledge in Availity, TriZetto, Waystar, other clearinghouses What benefits are offered? TruHearing offers a generous compensation and benefits package including health coverage, a fully vested 401k match, education assistance, fully paid long and short-term disability, paid time off and paid holidays. We are conveniently located across the street from the Draper FrontRunner station and subsidize the cost of a UTA pass with access to FrontRunner, TRAX and regular bus service employee cost is less than $2 per day. You ll work in an exciting and fun environment and have the opportunity to grow with us. Equal Opportunity TruHearing is an Equal Opportunity Employer who encourages diversity in the workplace. All qualified applicants will receive consideration for employment without regards to race, color, national origin, religion, sex, age, disability, citizenship, marital status, sexual orientation, gender identity, military or protected veteran status, or any other characteristic protected by applicable law.

About Specialty Program Group: Specialty Program Group (SPG) is the wholesale & MGA division of HUB International. SPG acts in a holding company capacity acquiring best-in-class underwriting businesses to operate independently under discrete brands (portfolio companies). About ANOVA Marine: ANOVA is a premier provider of first-class Cargo and Logistics Insurance, Liability Insurance, and Bonds for freight forwarders, NVOCC's, shipping lines, customs brokers, and international trading companies. Right from the outset in 2011, our aim was to create a smarter, more agile experience for our clients. That includes superior cargo insurance coverage designed by freight forwarders and transport-industry attorneys; technology that simplifies quotes and speeds up coverage; and experienced claims people who understand the challenges our clients face, with the authority to settle fast. About ANOVA Personal Effects: In addition to our core logistics offerings, ANOVA provides specialized Personal Effects and Household Goods insurance solutions, supporting storage partners, and individuals navigating domestic and international relocations. Our Personal Effects claims team plays a critical role in delivering compassionate, accurate, and efficient resolutions for customers during stressful transitions. Summary of the Role: The Personal Effects Claims Specialist is a key member of ANOVA's Claims Department, responsible for managing the full lifecycle of household-goods and personal-effects claims. This role requires a balance of technical coverage analysis, strong customer communication, and disciplined claim-handling practices. Responsibilities: Investigation & Evaluation: Conduct thorough investigations of claims arising from the transit or storage of household goods and personal effects, including domestic moves, international shipments, and storage. Coverage & Liability Analysis: Review and interpret applicable policy forms, apply provisions to factual scenarios, and determine coverage and liability. Valuation & Settlement: Assess the value of lost or damaged items and negotiate fair, accurate settlements consistent with ANOVA guidelines. Customer Advocacy & Communication: Communicate clearly, empathetically, and proactively with insureds. Documentation & Compliance: Maintain meticulous and timely claim documentation following internal controls and regulatory standards. Stakeholder Collaboration: Work closely with internal departments, surveyors, adjusters, and brokers. Qualifications: 5+ years of experience as a Claims Adjuster preferred. Experience in P&C, Inland Marine, or Household Goods/Moving claims preferred. Strong analytical and communication skills. Customer-focused mindset. Ability to manage high-volume claims. Proficiency with claims systems and Google Workspace. Adjuster license(s) or willingness to obtain. Salary Transparency: Disclosure required under applicable law in California, Colorado, Illinois, Maryland, Minnesota, New York, New Jersey, and Washington states: The expected salary range for this position is $70,000-$75,000 and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level. HUB International is proud to offer comprehensive benefit and total compensation packages: health/dental/vision/life/disability insurance, FSA, HSA and 401(k) accounts, paid-time-off benefits such as vacation, sick, and personal days, and eligible bonuses, equity and commissions for some positions. Compensation may vary based on experience, skillset, and location. Eligible employees may also receive benefits including health/dental/vision/life/disability insurance, FSA/HSA, 401(k), PTO, and incentives. #SPG Department Claims ManagementRequired Experience: 5-7 years of relevant experience Required Travel: NegligibleRequired Education: High school or equivalent HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations. E-Verify Program We endeavor to make this website 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 recruiting team **********************************. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.

Risk employees reduce accident, illness, and injury occurring on Church property or during Church-sponsored activities to protect people and to minimize the loss of sacred funds (donated confidentially in obedience to God's commandments) used for the Church's religious mission under the direction of senior ecclesiastical leaders. To manage and resolve general liability, property loss, and bodily injury claims and litigation of Church departments, ecclesiastical leaders and Church affiliate organizations in an honest, effective, fair and appropriate manner. 4 yr degree from accredited university required (business, law, insurance, accounting or related field preferred) Professional claims designations and certifications preferred (e.g., AIC, SCLA) 8 yrs multi-line claims or equivalent experience (advanced degree/certification or JD constitutes 2 years experience) Proficiency in Litigation Risk Analysis (decision tree software) Proficiency in computer systems Strong verbal and written communication proficiency Strong analytical and problem-solving capabilities and skills Capable of effective interface w/ claimants and attorneys Institutional knowledge of the Church At least one year in Claims Specialist II position Direct handling assigned property/liability claims of increasing size and complexity asserted against the Church and affiliate entities Retain, supervise and coordinate services of 3rd party vendors, insurance carriers, attorneys and other service providers Conduct on-site investigations and interviews Prepare loss evaluations, case plans, and strategic reports; Proficiency with and capable of directing Litigation Risk Analysis, which is the analytical process whereby the claims manager (with the assistance of Kirton & McConkie, experts, third party administrators, and local counsel) obtains relevant facts through investigation, identifies outcome-determinative legal and factual issues, determines the complex probabilities associated with those legal and factual issues, and establishes case values by predicting what a judge or jury in the relevant jurisdiction will award as damages. The process requires organizing these issues using decision tree software modeling as needed, directing and educating Kirton & McConkie and local counsel regarding the logic of the analytical process. This is the process whereby we identify the financial risk to the Church. Participate as the Church's representative in alternative dispute resolution

Risk employees reduce accident, illness, and injury occurring on Church property or during Church-sponsored activities to protect people and to minimize the loss of sacred funds (donated confidentially in obedience to God's commandments) used for the Church's religious mission under the direction of senior ecclesiastical leaders. To manage and resolve general liability, property loss, and bodily injury claims and litigation of Church departments, ecclesiastical leaders and Church affiliate organizations in an honest, effective, fair and appropriate manner. 4 yr degree from accredited university required (business, law, insurance, accounting or related field preferred) Professional claims designations and certifications preferred (e.g., AIC, SCLA) 8 yrs multi-line claims or equivalent experience (advanced degree/certification or JD constitutes 2 years experience) Proficiency in Litigation Risk Analysis (decision tree software) Proficiency in computer systems Strong verbal and written communication proficiency Strong analytical and problem-solving capabilities and skills Capable of effective interface w/ claimants and attorneys Institutional knowledge of the Church At least one year in Claims Specialist II position Direct handling assigned property/liability claims of increasing size and complexity asserted against the Church and affiliate entities Retain, supervise and coordinate services of 3rd party vendors, insurance carriers, attorneys and other service providers Conduct on-site investigations and interviews Prepare loss evaluations, case plans, and strategic reports; Proficiency with and capable of directing Litigation Risk Analysis, which is the analytical process whereby the claims manager (with the assistance of Kirton & McConkie, experts, third party administrators, and local counsel) obtains relevant facts through investigation, identifies outcome-determinative legal and factual issues, determines the complex probabilities associated with those legal and factual issues, and establishes case values by predicting what a judge or jury in the relevant jurisdiction will award as damages. The process requires organizing these issues using decision tree software modeling as needed, directing and educating Kirton & McConkie and local counsel regarding the logic of the analytical process. This is the process whereby we identify the financial risk to the Church. Participate as the Church's representative in alternative dispute resolution

Risk employees reduce accident, illness, and injury occurring on Church property or during Church-sponsored activities to protect people and to minimize the loss of sacred funds (donated confidentially in obedience to God's commandments) used for the Church's religious mission under the direction of senior ecclesiastical leaders. To manage and resolve general liability, property loss, and bodily injury claims and litigation of Church departments, ecclesiastical leaders and Church affiliate organizations in an honest, effective, fair and appropriate manner. 4 yr degree from accredited university required (business, law, insurance, accounting or related field preferred) Professional claims designations and certifications preferred (e.g., AIC, SCLA) 8 yrs multi-line claims or equivalent experience (advanced degree/certification or JD constitutes 2 years experience) Proficiency in Litigation Risk Analysis (decision tree software) Proficiency in computer systems Strong verbal and written communication proficiency Strong analytical and problem-solving capabilities and skills Capable of effective interface w/ claimants and attorneys Institutional knowledge of the Church At least one year in Claims Specialist II position Direct handling assigned property/liability claims of increasing size and complexity asserted against the Church and affiliate entities Retain, supervise and coordinate services of 3rd party vendors, insurance carriers, attorneys and other service providers Conduct on-site investigations and interviews Prepare loss evaluations, case plans, and strategic reports; Proficiency with and capable of directing Litigation Risk Analysis, which is the analytical process whereby the claims manager (with the assistance of Kirton & McConkie, experts, third party administrators, and local counsel) obtains relevant facts through investigation, identifies outcome-determinative legal and factual issues, determines the complex probabilities associated with those legal and factual issues, and establishes case values by predicting what a judge or jury in the relevant jurisdiction will award as damages. The process requires organizing these issues using decision tree software modeling as needed, directing and educating Kirton & McConkie and local counsel regarding the logic of the analytical process. This is the process whereby we identify the financial risk to the Church. Participate as the Church's representative in alternative dispute resolution

Claims Investigator - Full Time Ogden, UT 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 (state) 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 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. Utah License # P111501

Full-time Description We are seeking a detail-oriented and highly organized Pre-Claim Coordination Specialist to join our team. Pre-Claim Coordination Specialist play a crucial role in the Home Health and Hospice claims process and are essential to ensuring claims are ready for billing submission. The Pre-Claim Coordination Specialist will conduct daily reviews of holds in various areas, collaborating closely with agencies and the billing team to resolve issues efficiently, prevent billing delays, and support timely and compliant claim submission. Responsibilities and Duties: Monitor and resolve pre-claim holds to prevent billing delays Manage assigned tasks through the ticketing/workflow system and ensure timely completion Communicate with agency staff and the billing team to obtain needed follow-up and resolve issues Maintain accurate documentation and updates within the ticketing system Establish and maintain positive working relationships with agency staff and coworkers Support organizational culture by promoting a Friendly, Positive, and Excellence-Focused environment Perform other duties as assigned Requirements Competencies: To perform the essential functions of this position successfully, an individual must demonstrate the following competencies: Proficiency in verbal, written, and computer skills Excellent communication, organization, and follow-up abilities Ability to manage multiple assignments simultaneously Strong attention to detail and the ability to work independently Job Qualifications: Minimum of one (1) year of medical office experience required Knowledge of home health and/or hospice operations preferred Physical Requirements: Regularly required to walk, sit, stand, bend, reach, lift, and move about Ability to communicate effectively, both orally and in writing Schedule: • Full-Time • 8 Hour Shifts • Monday - Friday Salary Description $18 per hour

Our client is seeking a Claims & Benefits Resolution Specialist for a contract opportunity. This role performs comprehensive audits and resolution activities across the claims lifecycle, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. The specialist will handle complex claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong revenue cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify root-cause errors in a high-volume environment. This is an operational “fix-it” position - the manager needs someone who doesn't just process claims but can find what's broken and correct it without hand-holding. Key Responsibilities: Claims Audit & Correction Perform comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors. Correct claim discrepancies within established turnaround times. Ensure claim data accuracy, compliant coding, and alignment with the member's plan benefit. Timely & Accurate Claims Processing Process claims quickly and accurately according to organizational benchmarks. Apply reimbursement rules based on the member's benefits and plan specifications. Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.). Complex Follow-Up & Dispute Resolution Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed. Investigate processing delays, missing information, or system errors and implement corrective action. Refer cases to clinical management teams when medical review is required to ensure appropriate reimbursement. Eligibility, Benefits & Authorization Coordination Verify and document member eligibility, benefits coverage, and authorization requirements. Identify discrepancies in coverage or authorizations that impact payment determinations. Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information. Cross-Functional Collaboration Work closely with leadership, clinical review staff, and the CBO team to ensure timely resolution of claim issues. Participate in problem-solving discussions related to claim trends or systemic issues. Support training and onboarding efforts as needed during onsite sessions. Required Skills & Experience: Minimum 2+ years of experience in healthcare revenue cycle, claims processing, eligibility/benefits, or authorizations. Strong understanding of payer rules, reimbursement methodologies, and claims adjudication. Familiarity with Epic, payer portals, and other claims/RCM systems. High accuracy in auditing and error resolution work. Experience resolving complex claim issues across multiple systems. Ability to work independently, troubleshoot problems, and drive claims to completion Strong communication skills for interacting with payers, internal teams, and leadership. Comfortable with onsite onboarding and required monthly onsite days. Experience working in a Central Business Office or Shared Services model. Prior experience supporting Utah-based payer populations or multi-state payer networks. Kavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Kavaliro is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Kavaliro will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please respond to this posting to connect with a company representative.

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 Specialist, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice 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. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with 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. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$117,000 - $125,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ 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.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Job DescriptionDescription: We are seeking a detail-oriented and highly organized Pre-Claim Coordination Specialist to join our team. Pre-Claim Coordination Specialist play a crucial role in the Home Health and Hospice claims process and are essential to ensuring claims are ready for billing submission. The Pre-Claim Coordination Specialist will conduct daily reviews of holds in various areas, collaborating closely with agencies and the billing team to resolve issues efficiently, prevent billing delays, and support timely and compliant claim submission. Responsibilities and Duties: Monitor and resolve pre-claim holds to prevent billing delays Manage assigned tasks through the ticketing/workflow system and ensure timely completion Communicate with agency staff and the billing team to obtain needed follow-up and resolve issues Maintain accurate documentation and updates within the ticketing system Establish and maintain positive working relationships with agency staff and coworkers Support organizational culture by promoting a Friendly, Positive, and Excellence-Focused environment Perform other duties as assigned Requirements: Competencies: To perform the essential functions of this position successfully, an individual must demonstrate the following competencies: Proficiency in verbal, written, and computer skills Excellent communication, organization, and follow-up abilities Ability to manage multiple assignments simultaneously Strong attention to detail and the ability to work independently Job Qualifications: Minimum of one (1) year of medical office experience required Knowledge of home health and/or hospice operations preferred Physical Requirements: Regularly required to walk, sit, stand, bend, reach, lift, and move about Ability to communicate effectively, both orally and in writing Schedule: • Full-Time • 8 Hour Shifts • Monday - Friday

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.

The Worker's Compensation Medical Only Claims Adjuster is responsible for the prompt and effective investigation of worker's compensation claims involving injuries that require medical treatment but no wage loss. Claim adjudication requires interaction with Insureds, claimants, medical providers and other parties to ensure adequate medical treatment is provided while utilizing Company resources in a cost-effective manner. Responsibilities * Ability to multitask and prioritize work in a fast-paced environment and manage time effectively * Investigates losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogation * Verifies coverage and confirms policy conditions have been met * Obtains missing information and ensures data integrity for Regulatory reporting * Communicates effectively with claimants, policyholders, Underwriters, agents, and other internal and external stakeholders * Authorizes medical treatment and schedules medical appointments. * Establishes medical reserves, approves medical bills and reviews/requests medical records * Documents all correspondence, reports, discussions and decisions in Claim file notes * Knowledge of multiple state jurisdictions (if applicable) * Obtain appropriate Adjuster licensing (If applicable) * Performs other related duties as assigned The expected salary range for this role is $22.00-$26.50/HR. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. This is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time. Qualifications Required * Proficiency with MS Word, Excel and other business applications * Demonstrated skills in critical thinking and independent decision making * State licensing requirements (if applicable) Preferred: * Minimum of 2 years handling Medical Only or other Workers Compensation Claims experience * Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Claims Investigator - Full Time Ogden, UT 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 (state) 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 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. Utah License # P111501

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. 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.

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.