Claim processor jobs in West Virginia

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

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. + Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. + Performs claim re-work calculations. + Follow through completion of claim overpayments, underpayments, and any other irregularities. + Process complex non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. + Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. + Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to lesser experience staff. + Utilize all resource materials to manage job responsibilities. **Required Qualifications** + 2+ years medical claim processing experience. + Experience in a production environment. + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. + Effective communications, organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Associate degree preferred. **Education** + High School Diploma or GED. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures. Required: High school diploma or equivalent. Ability to follow written directions and work independently. Familiarity with medical terminology, CPT and ICD-10 coding is required. Computer and typing experience is required. Desired: Previous claims processing. Experience in billing or physician office experience is preferred. Responsibilities: Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines. Reports patterns of incorrect billing and utilization to manager or claims coordinator. Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines. Maintain a quality rating of 98%. Processes 15-20 claims per hour. Consistently displays a positive attitude and acceptable attendance. Participate in external and/or internal trainings as requested. Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

To see the full job description, please click the link below: Processor Full-Time Careers at Gabe's Offer: * Flexible Schedules * Employee Discount and Assistance Program * Wide Range of Employee Benefit Programs * Fun, Casual Work Environment

$1,000 Signing Bonus Available! Highlights: * Looking for a new opportunity to apply your fingerprint (latent print or tenprint), facial, or iris examination experience in a fast-paced environment in support of the Department of Defense (DoD) Warfighter? Are you interested in expanding your examination skills to be trained on a new emerging biometric examination skillsets in facial and iris identification? If so, the Biometric Examiner position on the Ideal Innovations, Inc. Department of Army Criminal Investigative Division (DACID) Biometric Operations Department (BOD) Examination Services Support (ESS) contract is the perfect position for you. * Working within a unique 100% digital environment, the Biometric Examiners on the ESS contract work both independently and often as a team to work through individual biometric examination requests and/or routine casework. * The ESS Biometric Examiner position is unique because of the unique mission that it serves. Given that the operation is a 100% digital operation, the ESS Biometric Examiners play an important role in supporting DoD customers to build and search biometric files through DoD ABIS and often perform complex examinations on extremely fragmented friction ridge detail impressions and differing quality of facial and iris images. This requires experienced fingerprint examiners to transform and utilize previously learned non-digital comparison skills into a digital environment, while also being trained on facial and iris identifications. The ESS Biometric Examiners are also trained to perform case reception/administrative tasks to help serve on the ESS Biometric Technician operations as necessary. * The ESS Biometric Examiner will be working on the front lines, performing biometric examinations, comparisons and effecting identifications to help serve the DoD Warfighter and protect the United States of America. * The ESS Biometric Examiner candidate will have the opportunity to hone their skills in using the Microsoft Office Suite and Windows through day-to-day operational work. The ESS Biometric Examiner will have the opportunity to become proficient in using Adobe Photoshop to format fingerprint, palm print, facial and iris images for searching purposes, as well as utilizing Lakota Whorl to help complete necessary tasks to support the Warfighter. The ESS Biometric Examiner will receive unique training in performing facial and iris examinations. Typical Day: The DACID BOD Examination Services section is a 100% digital operation. Therefore, the typical day for a Biometric Examiner consists of working on a Windows 10 computer performing biometric examinations and comparisons as part of completing internal BOD and/or external customer request and casework Tasks: Responsibilities include, but are not limited to: * Preparation of biometric files (fingerprints, palm prints, facial images and/or iris images) for entry into DoD ABIS through digital imaging techniques to enhance and maintain integrity of the images. * Monitor queue applications to resolve DoD ABIS yellow resolve transactions. * Manual comparison (on screen) of available biometrics with candidate biometrics retrieved from the DoD ABIS to eliminate individuals or effect positive identifications. * Verification of fingerprints to validate the correct sequence and orientation. * Perform manual biometric comparisons for the purpose of identity deconfliction at the request of BOD customers. * Utilize a case management/database portal system to properly document case notes and metrics as well as prepare reports to communicate results to the submitting customer. * Maintain digital Standard Operating Procedures (SOPs) and Work Instructions (WIs). * Provide case reception/admin support, as necessary, to the ESS Biometric Technician operation. Requirements: * Education: * Doctorate, Masters, or Bachelor's degree and 6 years related work experience OR Associate degree and 8 years related work experience OR High School diploma and 10 years related work experience. * Be able to obtain/maintain DoD Secret Clearance and FBI CJIS campus access clearance. * Must be able to successfully pass proficiency testing prior to and periodically during employment with the company. * Must be willing to work shifts (10-12 hours) based on a 24/7, 365 days a year schedule to include nights, weekends and holidays. * Must be willing to relocate or commute to the Clarksburg, WV area. * Must be willing to complete pre-employment comparison assessment test. Desired Qualifications: * Current certification by the International Association for Identification (IAI) as a Certified Tenprint Examiner * Prior tenprint, facial or iris examination experience * Digital imaging processing tool experience (Adobe Photoshop preferred) * AFIS/ABIS system experience Physical Job Requirements: Meet physical demands of working in a general office environment to include long hours working at a computer, either sitting or standing. Work Shift Information: * Must be willing to work shifts (10-12 hours) based on a 24/7, 365 days a year schedule to include nights, weekends and holidays. * Candidates will have the option of working either 10 or 12-hour days for an indefinite period of time, depending on coverage requirements. Shift times are flexible and are up to the discretion of management based off the needs of the operation. * No shift differential available. * Shifts: * Day: 5a-5p, 5a-3p or 7a-5p * Afternoon: 3p-3a * Evening: 5p-5a, 5p-3a or 7p-5a * Rotating or set shifts? No Rotation, primarily set shifts. Citizenship: US citizenship required Clearance: * Must be willing to obtain/maintain US Secret clearance * Current Interim Secret or Secret clearance preferred Location: Clarksburg, WV Ideal Innovations, Inc. is an Equal Opportunity Employer: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or veteran status. Ideal Innovations, Inc. is a VEVRAA Federal Contractor.

The salary range for this job posting is $55,132.00 - $110,642.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. While we may prefer candidates who can work a hybrid schedule in our Charleston, WV office, we will consider candidates who live in any of our listed payroll approved states. Lost Time Workers' Compensation claims handling experience in Virginia, West Virginia, Kentucky, or Pennsylvania is preferred. The position reports to the Director, Workers' Compensation Claims on the Energy team. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team. Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. JOB OBJECTIVE: The Lost Time Claims Specialist, Workers' Compensation primarily manages indemnity claims. The Lost Time Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. The position's objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. ESSENTIAL FUNCTIONS: 1. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion. 2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. 3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. 4. Take recorded statements when necessary. 5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. 6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. 7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate. 9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker's safe and timely return to work. 11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim. 12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. 13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed. 15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure. 16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 18. Develops presentations for special projects such as internal/external meetings and conferences as needed. 19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor's Degree from an accredited college or university is preferred. • Three years of experience in the field of workers' compensation insurance required. • Ability to manage claims through the litigation process. • Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. • One valid workers' compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as required. • Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Experience in workers' compensation claims practices and laws, court procedures, precedents and state statutes. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitasks and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons. Ready to join our team? At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities. Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential. What you can expect from us Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations. Encova Insurance is an EOE/E-Verify employer. #LI-Hybrid#LI-MF1

Be the change you wish to see in the world! Come join our team to empower children and families in our communities to transform their lives and develop to their full potential. Pressley Ridge Benefits Free single medical coverage available with a Health Savings Account (HSA) with 50% employer match Prescription coverage Dental and vision plans Patient advocate and Medicare specialists available at no cost Dependent Care Flexible Savings Account Wellness incentive (up to $250) 403b with up to 9% employer give/match Free life insurance and AD&D Paid Time Off (PTO) 9 paid holidays Tuition reimbursement Employee Assistance Program (EAP) Position Summary The Recruiting and Certification Specialist is responsible for all aspects of the recruitment and certification of Treatment Foster Care (TFC) Parents, including responsibility to train/teach TFC Parents. The Recruiting and Certification Specialist also understands community relations as well as the Re-Education Philosophies and Community Based service components. The Recruiting and Certification Specialist travels extensively. Essential Roles and Responsibilities Recruitment and Retention Community Relationship Building Documentation and Compliance Completes quarterly home safety inspections of treatment foster homes Completes CPR/First Aid Certification for Pressley Ridge staff and Treatment Foster Parents Completes monthly foster parent skills building/training Develops training curriculum and schedule for in-service trainings Completes Treatment Foster Parents re-certifications Qualifications Clearances. State Police; FBI clearance; child abuse clearance; CPSL Mandated Reporter-Recognizing and Reporting Child Abuse training; any additional background checks/clearances required by state governing bodies. Valid driver's license and current vehicle insurance. Working Conditions Physical Demands: Requires vision, speech, and hearing. Environmental Factors: Community, home, school. Working Hours: A non-traditional work schedule as defined by service needs.

Job DescriptionService Wire Company, a premier supplier of industrial and utility wire and cable, is currently seeking a Customer Quality and Claims Specialist in Culloden, WV. If you are looking to join a great organization and a chance to become a part of our growing team, this may be the opportunity for you! Position Summary:The Customer Quality and Claims Specialist supports internal and external customers by managing product claims, returns, and quality related inquiries. The role investigates issues, coordinates resolutions across departments, and ensures timely, accurate, and professional communication while recommending process improvements to prevent future claims.Tasks/Duties/Responsibilities: Monitor and manage customer cases, proactively addressing delays Investigate and resolve product claims, pricing adjustments, and deductions in coordination with Sales, Shipping and Quality Control Analyze customer complaints to determine root cause, corrective actions, and preventive measures Communicate findings, resolutions, and recommendations to customers and internal stakeholders Manage freight claim by providing raw material scrap values and re-claimed materials while tracking the funds received Check records, such as bills, computer printouts, and related documents and correspondence, and converse or correspond with customer and other company personnel, such as sales, shipping, engineering, and credit, to obtain facts regarding customer complaint Notify customer and designated personnel of findings, adjustments, and recommendations, such as exchange of merchandise Recommend improvements in product, packaging, shipping methods, service, or billing processes to minimize future claims. Perform additional duties as assigned Knowledge/Skills/Requirements: High school diploma or equivalent; 2-year degree preferred Strong research, documentation, and analytical skills Proficient with Microsoft Office Solid basic math skills Ability to multi-task, prioritize, and manage time effectively Strong written and oral communication skills Ability to effectively interact with internal and external customers Ability to travel from time to time (less than 10%) Familiarity with office equipment including printers, copiers, scanners etc. Reports To: Quality Assurance Manager

Goodwill of North Central West Virginia is a human services agency and network of not-for-profit businesses whose mission is to help people with special needs overcome barriers to employment and enjoy the dignity and benefits of work and improved quality of life. Goodwill retail stores are the principal business operation of Goodwill of Southwestern Pennsylvania. Members of our retail management team play a vital role in our organization. Our thrift stores are considered the "backbone' of the company by contributing nearly 60% of our annual revenues as well as offering training and employment opportunities for clients and consumers. Job Description As a production processor, you will have an opportunity to see all the amazing treasures that go up for sale in a Goodwill Retail Store. As a Production Processor your primary responsible will be to process donated material for sale in a Goodwill retail location while following established quality standards and pricing guidelines. The Production Processor will also support store operations by completing tasks in expected timeframes while maintaining accuracy and thoroughness. Responsibilities also include stocking and rotating product on the sales floor, and processing unsalable donations according to salvage guidelines. Understanding the benefits of working together as a team while maintaining a clean and safe work environment is also required. External starting wage, $8.75/Hour To apply for this position, follow the link; ********************** Qualifications Education: High school diploma or equivalent preferred Experience: 0-1 Years Additional Information To apply for this position, follow the link: ********************** All your information will be kept confidential according to EEO guidelines.

NATURE OF WORK: To provide an examination and preliminary diagnosis of individuals who are the subject of a mental hygiene proceeding (respondent), with the goal of determining if they suffer from mental illness and/or addiction, and whether they present an immediate danger to themselves or others. This evaluation will be presented at a mental hygiene hearing and will function as a recommendation to the court as to the disposition of the respondent. MINIMUM QUALIFICATIONS: LPC, LICSW or Licensed Psychologist Ability to obtain and maintain CPR, First Aid, and MANDT Certifications. Ability to comply with Client's Rights. Ability to comply with all agency and departmental safety procedures. Ability to read, write, understand and speak the English language.

To ensure procurement of accurate pre-certification authorization/referral for applicable returning and new patients as well as review and completion of accurate, complete patient charts. Scheduling of multiple physician ordered tests, exams and surgeries where applicable. Responsibilities * Daily review of charts to determine if pre-certification/pre-authorization or referrals are needed. * Review specific patient insurance info to determine medical necessity requirements for specific treatments. * Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements. * Perform clerical duties as necessary, including composing letters to patients, insurance carriers and referring physicians regarding any issues. * Per physician order, schedule patient surgery and communicate all necessary information to the appropriate parties. * Make subsequent referrals to other physicians per physician review of test/scan results. * Establish new patient account in billing software upon receiving referral from physician. Forward all applicable info to appropriate personnel for inclusion in the medical chart. * Maintain continuing education treatment trends, current medical terminology used in pre-certification, and ICD-10, CPT and HCPCS codes. * Cross train for front desk and medical assistant roles. Provide back up as needed. * Schedule all procedures, collect, apply and deposit all funds. Knowledge, Skills & Abilities Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned. Education * High School Diploma or GED Credentials * No Certification, Competency or License Required Work Schedule: Days Status: Full Time Regular 1.0 Location: Cancer Center Building Location of Job: US:WV:Charleston Talent Acquisition Specialist: Tamara B. Young ******************************

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Representative (IAP) - Workers Compensation Training Program Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? + A stable and consistent work environment in an office setting. + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities. + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. **ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Attendance and completion of designated classroom claims professional training program. + Performs on-the-job training activities including: + Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. + Adjusting low and mid-level liability and/or physical damage claims under close supervision. + Processing disability claims of minimal disability duration under close supervision. + Documenting claims files and properly coding claim activity. + Communicating claim action/processing with claimant and client. + Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. + Participates in rotational assignments to provide temporary support for office needs. **QUALIFICATIONS** Bachelor's or Associate's degree from an accredited college or university preferred. **EXPERIENCE** Prior education, experience, or knowledge of: - Customer Service - Data Entry - Medical Terminology (preferred) - Computer Recordkeeping programs (preferred) - Prior claims experience (preferred) Additional helpful experience: - State license if required (SIP, Property and Liability, Disability, etc.) - WCCA/WCCP or similar designations - For internal colleagues, completion of the Sedgwick Claims Progression Program **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum + An assigned mentor and manager that will support and guide you on your career journey + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Agent Pipeline St Albans, WV About Agent Pipeline Founded in 1988, West Virginia-based Agent Pipeline is one of the most successful insurance marketing organizations (IMOs) in the United States, with vast network of proud employees and satisfied customers. Agent Pipeline distributes a comprehensive mix of life and health insurance products. Agent Pipeline is a recognized market leader in the Medicare Advantage, Medicare Supplement, individual health plans, Prescription Drug Plans, and Final Expense markets. Agent Pipeline, an Integrity Company, is based in St. Albans, West Virginia. Job Summary The Commissions Processor role is responsible for processing commission statements, completing analysis of statement and payouts, completed audits, and working commission related service tickets. This position is part of the Commissions Department which is responsible for the payment to external agents and agencies. Primary Responsibilities: * Assist in pulling all statements that correspond with listed deposits within 24 hours of notification of deposit. * Follow company processes in ensuring no statement is processed prior to being Matched/Reconciled. * Process statements fully and accurately within two (2) business days of Matched/Reconciled date. Exceptions permitted. * Submit all batch exceptions in a timely manner. * Recalculate batches daily until all exceptions are cleared. * Update all systems as applicable. * Follow all departmental and company policies and procedures. * Respond to all commission tickets within eight (8) business hours of receipt. * Resolve all commission tickets within four (4) business days of receipt. Resolution means all internal steps have been taken to resolve the issue. If the issue must be submitted to the carrier for additional research, resolution means communicating clearly with the applicable internal parties. * Ensure the commission ticket board is updated. * Maintain an audit rate of * Promptly notify management of issues with company pay rates, statement issues, and other items that may impact the payout timing of statements. Primary Skills & Requirements: * Excellent verbal communication skills * Analytical skills * Excellent customer service aptitude * Attention to detail * Professionalism * Multi-tasking skills * Dependability * Willingness to learn and adapt * Organizational skills * High school diploma or equivalent; college degree preferred. * 1+ years of customer service, sales, and/or call center experience preferred. * Must have exceptional interpersonal, customer service, sales, problem solving, verbal and written communication, de-escalation, and conflict resolution skills. * Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. * Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form and apply those to daily tasks. * Proficiency with necessary technology, including computers, software applications, phone systems, etc. * Must be able to pass pre-hire and annual background check. * Must be able to pass pre-hire drug test. * Must be able to pass monthly OIG/SAM Exclusion List checks and annual compliance trainings About Integrity Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead. Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind. Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com. Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

Are you humble, hungry and smart? Are you also people smart? At PracticeLink.com, regardless of role or position, these are the personal traits we look for in a potential new colleague and teammate. Our culture is built on collaboration, commitment and care; our values are based upon trust, respect and mutual accountability; and our mission is to create, enhance and deliver value to those we serve. PracticeLink has been acknowledged three times as an Inc. 5000 company and recognized two times as one of the 100-Best Place to Work in Healthcare by Modern Healthcare Magazine. PracticeLink Magazine has been recognized by the American Society of Healthcare Publishing Executives and received multiple awards for both content and design each year for the last 5 continuous years. We are seeking a Physician/Provider Relations Representative to be a part of our growing team responsible for serving physicians and healthcare providers during the job search process. This position reports directly to the Director of Provider & Data Services, and interacts regularly with sales and support team members. This candidate would be accountable for completing and providing a high volume of quality phone interviews with candidates using effective communication to drive candidates to the PracticeLink website. In addition, will involve creating profiles for residents, physicians, and other healthcare professionals by developing contact information and contacting the candidates by phone or email; and other duties as needed, such as representing PracticeLink at regional and national conferences. Desired Skills & Experience Two or four-year degree in a related field Proficiency with MS Office, especially with Excel, and how to use various functions, Salesforce.com, GoToMeeting Recruitment, medical, and/or call center experience preferred but not required Knowledge of medical terminology is preferred but not required Highly organized and able to work in a fast-paced environment Relationship development skills at multiple levels within a client organization Excellent oral, written, presentation, and interpersonal skills, a teamwork-centric style, strong interpersonal skills, and superior organizational skills. Professional demeanor, poise, and appearance Must be able to travel Results-driven Ability to thrive in a team environment, and support department and cross-department team members Professional communication skills both verbal and written Friendly & outgoing attitude Quick study and pick up on new concepts quickly PracticeLink offers team members excellent growth and development opportunities, 401(k) with employer match, and FREE health benefits including dental and vision coverage, disability and life insurance. Education reimbursement programs available up to $1,500 per person per year. Please respond to Megan Harvey, VP of Human Resources & Staff Development, practicelink.bamboohr.com/jobs, 415 2nd Avenue, Hinton, WV 25951. PracticeLink is an Equal Opportunity Employer. Minorities and Women are encouraged to apply.

Please note: This position is for the Marshall University Foundation, Inc. and is not a state job. Type: Full-time, non-exempt position The mission of the Foundation is to support and promote the activities and programs of Marshall University. This is accomplished by providing advice and counsel regarding fundraising and philanthropy, investing and managing gifts and pledges for the University and providing a strong base of private-sector support for the University. Duties: Under general supervision, performs accounting support duties, primarily in support of gift processing. The incumbent is responsible for performing moderately complex posting, coding of transactions, and examining records to assure adherence to relevant laws and regulations. Performs related work as required. Classifies/codes a variety of transactions in accordance with internal and regulatory policies and guidelines which may require considerable knowledge or research. Reviews accounts, ledgers, and supporting documentation for completeness, accuracy, and compliance with laws and regulations. Prepares bank deposits and/or checks. Makes correcting and/or adjusting entries on ledger. Examines accounting records to assure adherence to accounting laws and regulations; verifies calculations and ensures accuracy and validity of transactions. Performs moderately complex posting and balancing of transactions. Maintains accounting records; gathers data and prepares moderate to complex reconciliations and reports from records maintained. May assist supervisor in preparing analytical materials by compiling data and preparing summaries and requests. May train and review the work of clerical staff. Support of other accounting and organizational activities as deemed appropriate. Marshall University Foundation, Inc. is an equal opportunity employer. The salary and benefits are competitive and commensurate with experience,qualifications and verifiable salary history. As a condition of employment, the MarshallUniversity Foundation, Inc. reserves the right to conduct background verificationincluding academic degree(s), work experience, driving and credit record and criminalhistories

Be the change you wish to see in the world! Come join our team to empower children and families in our communities to transform their lives and develop to their full potential. Pressley Ridge Benefits * Free single medical coverage available with a Health Savings Account (HSA) with 50% employer match * Prescription coverage * Dental and vision plans * Patient advocate and Medicare specialists available at no cost * Dependent Care Flexible Savings Account * Wellness incentive (up to $250) * 403b with up to 9% employer give/match * Free life insurance and AD&D * Paid Time Off (PTO) * 9 paid holidays * Tuition reimbursement * Employee Assistance Program (EAP) Position Summary The Recruiting and Certification Specialist is responsible for all aspects of the recruitment and certification of Treatment Foster Care (TFC) Parents, including responsibility to train/teach TFC Parents. The Recruiting and Certification Specialist also understands community relations as well as the Re-Education Philosophies and Community Based service components. The Recruiting and Certification Specialist travels extensively. Essential Roles and Responsibilities * Recruitment and Retention * Community Relationship Building * Documentation and Compliance * Completes quarterly home safety inspections of treatment foster homes * Completes CPR/First Aid Certification for Pressley Ridge staff and Treatment Foster Parents * Completes monthly foster parent skills building/training * Develops training curriculum and schedule for in-service trainings * Completes Treatment Foster Parents re-certifications Qualifications * Clearances. State Police; FBI clearance; child abuse clearance; CPSL Mandated Reporter-Recognizing and Reporting Child Abuse training; any additional background checks/clearances required by state governing bodies. * Valid driver's license and current vehicle insurance. Working Conditions * Physical Demands: Requires vision, speech, and hearing. * Environmental Factors: Community, home, school. * Working Hours: A non-traditional work schedule as defined by service needs.

To ensure procurement of accurate pre-certification authorization/referral for applicable returning and new patients as well as review and completion of accurate, complete patient charts. Scheduling of multiple physician ordered tests, exams and surgeries where applicable. Responsibilities * Daily review of charts to determine if pre-certification/pre-authorization or referrals are needed. * Review specific patient insurance info to determine medical necessity requirements for specific treatments. * Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements. * Perform clerical duties as necessary, including composing letters to patients, insurance carriers and referring physicians regarding any issues. * Per physician order, schedule patient surgery and communicate all necessary information to the appropriate parties. * Make subsequent referrals to other physicians per physician review of test/scan results. * Establish new patient account in billing software upon receiving referral from physician. Forward all applicable info to appropriate personnel for inclusion in the medical chart. * Maintain continuing education treatment trends, current medical terminology used in pre-certification, and ICD-10, CPT and HCPCS codes. * Cross train for front desk and medical assistant roles. Provide back up as needed. * Schedule all procedures, collect, apply and deposit all funds. Knowledge, Skills & Abilities Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned. Education * High School Diploma or GED Credentials * No Certification, Competency or License Required Work Schedule: Days Status: Full Time Regular 1.0 Location: Teays Valley-3948 Teays Valley Rd. Location of Job: US:WV:Hurricane Talent Acquisition Specialist: Tamara B. Young ******************************

Job DescriptionSalary: Are you humble, hungry and smart? Are you also people smart? At PracticeLink.com, regardless of role or position, these are the personal traits we look for in a potential new colleague and teammate. Our culture is built on collaboration, commitment and care; our values are based upon trust, respect and mutual accountability; and our mission is to create, enhance and deliver value to those we serve. PracticeLink has been acknowledged three times as an Inc. 5000 company and recognized two times as one of the 100-Best Place to Work in Healthcare by Modern Healthcare Magazine. PracticeLink Magazine has been recognized by the American Society of Healthcare Publishing Executives and received multiple awards for both content and design each year for the last 5 continuous years. We are seeking a Physician/Provider Relations Representative to be a part of our growing team responsible for serving physicians and healthcare providers during the job search process. This position reports directly to the Director of Provider & Data Services, and interacts regularly with sales and support team members. This candidate would be accountable for completing and providing a high volume of quality phone interviews with candidates using effective communication to drive candidates to the PracticeLink website. In addition, will involve creating profiles for residents, physicians, and other healthcare professionals by developing contact information and contacting the candidates by phone or email; and other duties as needed, such as representing PracticeLink at regional and national conferences. Desired Skills & Experience Two or four-year degree in a related field Proficiency with MS Office, especially with Excel, and how to use various functions, Salesforce.com, GoToMeeting Recruitment, medical, and/or call center experience preferred but not required Knowledge of medical terminology is preferred but not required Highly organized and able to work in a fast-paced environment Relationship development skills at multiple levels within a client organization Excellent oral, written, presentation, and interpersonal skills, a teamwork-centric style, strong interpersonal skills, and superior organizational skills. Professional demeanor, poise, and appearance Must be able to travel Results-driven Ability to thrive in a team environment, and support department and cross-department team members Professional communication skills both verbal and written Friendly & outgoing attitude Quick study and pick up on new concepts quickly PracticeLink offers team members excellent growth and development opportunities, 401(k) with employer match, and FREE health benefits including dental and vision coverage, disability and life insurance. Education reimbursement programs available up to $1,500 per person per year. Please respond to Megan Harvey, VP of Human Resources & Staff Development, practicelink.bamboohr.com/jobs, 415 2nd Avenue, Hinton, WV 25951. PracticeLink is an Equal Opportunity Employer. Minorities and Women are encouraged to apply.

To see the full job description, please click the link below: Processor Full-Time Careers at Gabe's Offer: * Flexible Schedules * Employee Discount and Assistance Program * Wide Range of Employee Benefit Programs * Fun, Casual Work Environment