Claim processor jobs in Wilmington, NC

Under general supervision assures accurate and timely insurance claim processing to include resolving claim edits and paper claims for submittal. Resolves denied/unpaid insurance claims in a timely manner. Entity University Medical Associates (UMA) Only Employees and Financials Worker Type Employee Worker Sub-Type Regular Cost Center CC002058 UMA CORP RC PPA Physician Patient Accounting CC Pay Rate Type Hourly Pay Grade Health-20 Scheduled Weekly Hours 40 Work Shift * Account maintenance: Updating registration, authorization issues, identifying charge correction, , processing adjustments as needed and denial follow up according to payer rules and departmental policies. * Use electronic billing system appropriately to follow up on outstanding denied claims and all no response claims. Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can't resolve * Follow up on denied or no response claims by calling third party payers or using payer websites. Gathering information from patients or other areas to resolve outstanding denied or no response claims. Researching accounts to take appropriate action necessary to resolve. * Keep management aware of issues and trends to enhance operations and escalates slow-pay issues to managerial level when necessary. * Uses payer websites to stay current on payer rules and changes to include reading newsletters and communicating payer/claim issues and trends. * Maintains 95% quality standards on account follow and activity. * Maintains productivity standard as set forth by management team. * Other duties as assigned. Additional Job Description Education: High School Degree or Equivalent Work Experience: 0-6months If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: ***************************************

Logistics: PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 200 N Dozier Blvd., Florence, SC 29501. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. What You'll Do: Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. To Qualify for This Position, You'll Need the Following: Required Education: High School Diploma or equivalent Required Skills and Abilities: Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills. Required Software and Tools: Basic office equipment. We Prefer That You Have the Following: Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment. Preferred Skills and Abilities: Ability to use complex mathematical calculations. Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). This position enjoys a flexible, hybrid work schedule and is available in any location near a CNA office. JOB DESCRIPTION: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically, Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically, a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-LG1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Job Details Onslow Memorial Hospital - Jacksonville, NC Full Time 1.0 Day FinanceDescription Claims Analyst Specialist is knowledgeable of all payers. Responsible for the tracking, review and follow-up of all outstanding patient accounts. This includes but is not limited to timely review of Patient Accounting Desktop, Clearinghouse billing list and Intermediary on line error list. Contact insurance companies and patients, filing primary, secondary and tertiary insurance, re-bills, and review payment remittance. Review line item denials and claim rejections for possible appeal and/or research for resubmission. Be proficient in the use of multiple payer software systems. The knowledge of billing codes including CPT, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits and claim formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payers to ensure maximum cash flow. Additional responsibilities include posting payments and denials to claims filed directly to a patient's account via electronic posting and manual batch posting. Also required to process requested adjustments, complete daily reconciliation of bank deposits and payment posting. The Claims Analyst Specialist is responsible for entering daily posting numbers to accounting shared spreadsheet, processing refunds from credit balance report and completing insurance requests to include follow up. Interact with insurance carriers in all aspects of claim resolution. Monitor and follow up Medicare and Medicaid accounts identified by recovery audit contractors (RAC). May be required to work overtime if needed. Qualifications Education/Certification: N/A Experience: Three years hospital billing in several financial classes preferred. Two years recent hospital cash posting. General accounting practices required

+ Responsible for the accurate and timely processing of claims. + Research and processes claims according to business regulation, internal standards and processing guidelines. **Responsibilities:** + Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. + Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. **Skills:** + **Required Skills and Abilities:** Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math. + **Required Software and Tools:** Proficient in word processing and spreadsheet applications. Proficient in database software. **Education:** + **Required Education Level and Degree Type** : High School Diploma or equivalent + Required Work Experience: Experience processing, researching and adjudicating claims **Experience:** + Experience processing, researching and adjudicating claims **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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

Liberty Cares With Compassion Liberty Advantage is currently seeking the following: CLAIMS SPECIALIST JOB SUMMARY: Accurately process department mail and handle as needed. Deposit premium payments and other checks as directed once reviewed and approved for deposit. Provide rosters to NP#s and others as directed each month. Review and audit TPA claim files sent for payment approval for accuracy including checking contracts are accurately applied, and various other items are accurately reflected in the payments or denials of claims to providers. Work fax que and address those items as needed Works with other departments and TPA as needed to keep a positive flow of information Must be deadline and project driven Evaluates tasks and prioritizes based off deadlines and other indicators of importance.# Continuously improves workflow#efficiencies# Other duties as assigned. JOB REQUIREMENTS: High School diploma or equivalent required; Bachelor#s degree in accounting or related field preferred but not required Knowledge of Medicare and Medicaid programs preferred but not required. Exceptional interpersonal skills Demonstrated ability to work independently as well as with a team Proficiency in MS Office Suite Exceptional organizational skills Deadline driven Background checks/drug-free workplace. EOE. Liberty Cares With Compassion Liberty Advantage is currently seeking the following: CLAIMS SPECIALIST JOB SUMMARY: * Accurately process department mail and handle as needed. * Deposit premium payments and other checks as directed once reviewed and approved for deposit. * Provide rosters to NP's and others as directed each month. * Review and audit TPA claim files sent for payment approval for accuracy including checking contracts are accurately applied, and various other items are accurately reflected in the payments or denials of claims to providers. * Work fax que and address those items as needed * Works with other departments and TPA as needed to keep a positive flow of information * Must be deadline and project driven * Evaluates tasks and prioritizes based off deadlines and other indicators of importance. Continuously improves workflow efficiencies * Other duties as assigned. JOB REQUIREMENTS: * High School diploma or equivalent required; Bachelor's degree in accounting or related field preferred but not required * Knowledge of Medicare and Medicaid programs preferred but not required. * Exceptional interpersonal skills * Demonstrated ability to work independently as well as with a team * Proficiency in MS Office Suite * Exceptional organizational skills * Deadline driven Background checks/drug-free workplace. EOE.

IAT Insurance Group has an immediate opening for a Management Liability Claims Specialist that can be located in any of our IAT locations. This role works a hybrid schedule from an IAT Office. The hybrid schedule reflects our values (thinking and acting like an owner, collaboration, and teamwork) as it requires working from the office with colleagues and other disciplines Monday through Wednesday, with the option of working Thursday and Friday remotely. Responsibilities: Responsible for handling Management Liability Claims (EPL, D&O, Fiduciary and Crime) for Private and Non-Profit businesses based on Claim Guidelines Within authority limit, thoroughly analyze, investigate, negotiate and resolve all levels of severity claims Selects, directs and manages defense counsel including approval of budgets Develops litigation/file disposition strategy. Attends mediations, settlement conferences and trials Verifies/analyzes applicable coverage for the reported claims Follow operational policies and procedures, including compliance, regulatory and performance and customer service standards Prepare reports, including Large Loss Reports, to management which accurately reflects loss development, potential/actual financial exposure, coverage issues, claim and recovery strategies Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file Identifies and addresses recovery/contribution/SIU opportunities Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines. Drafts correspondence, including but not limited to, coverage letters to stakeholders as required Support business partners on an as needed basis on various claim and underwriting related issues and marketing meetings Maintains resident/nonresident adjuster licenses as required Performs other duties as assigned Qualifications: Must Have: Bachelor's Degree with 5+ years of management liability claims experience (including handling employment liability practices, directors & officers' liability and fiduciary liability coverages) or equivalent Equivalent experience is defined as 9+ years of relevant claims experience, specifically claims involving litigation. Excellent coverage analysis skills with experience in drafting coverage position correspondence Experience handling litigated files and direction of defense counsel Excellent negotiation skills Must be willing to travel, average 1 day a month Claims Licensure as required by respective state(s) Excellent oral and written communication skills Ability to organize, multi-task and prioritize work Excellent customer service and interpersonal skills Ability to analyze data, utilize sound judgment to draw conclusion and make supported decisions To qualify, applicants must be authorized to work in the United States and must not require, now or in the future, VISA sponsorship for employment purposes Preferred to Have: CPCU and other insurance related studies Our Culture IAT is the largest private, family-owned property and casualty insurer in the U.S. I nsurance A nswers T ogether is how we define IAT, in letter and in spirit. We work together to provide solutions for people and businesses. We collaborate internally and with our partners to provide the best possible insurance and surety options for our customers. At IAT, we're committed to driving and building an open and supportive culture for all. Our employees propel IAT forward - driving innovation, stable partnerships and growth. That's why we continue to build an engaging workplace culture to attract and retain the best talent. We offer comprehensive benefits like: 26 PTO Days (Entry Level) + 12 Company Holidays = 38 Paid Days Off 7% 401(k) Company Match and additional Profit Sharing Hybrid work environment Numerous training and development opportunities to assist you in furthering your career Healthcare and Wellness Programs Opportunity to earn performance-based bonuses College Loan Assistance Support Plan Educational Assistance Program Mentorship Program Dress for Your Day Policy All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We maintain a drug-free workplace and participate in E-Verify. Compensation: Please note, that the annual gross salary range associated with this posting is $60,600 - $95,700. This range represents the anticipated low and high end of the base salary for this position. Actual salaries will vary based on factors such as a candidate's qualifications, skills, competencies, and geographical location related to this specific role. The total compensation will include a base salary, performance-based bonus opportunities, 401(K) match, profit-sharing opportunities, and more. To view details of our full benefits, please visit **************************************************

Now Hiring: Claims Settlement Specialist - Inspire, Lead, and Create Meaningful Impact! Are you passionate about leading with purpose, empowering others, and making a lasting impact? We are looking for motivated individuals to join our team as Claims Settlement Specialist, where you'll mentor, inspire, and implement strategies that help individuals achieve financial and personal breakthroughs while building a career that aligns with your values. Who We're Looking For: ✅ Visionary leaders who are passionate about servant leadership and impact ✅ Entrepreneurs and professionals eager to empower others while scaling success ✅ Licensed & aspiring Life & Health Insurance Agents (We'll guide you through licensing!) ✅ Individuals ready to lead with integrity, purpose, and a strong mission for success As a Claims Settlement Specialist, you'll help individuals discover their potential, achieve financial independence, and create meaningful change in their lives and communities. Is This You? ✔ Passionate about mentorship, leadership, and creating impact-driven success? ✔ A strong communicator who thrives on guiding and inspiring others? ✔ Self-driven, disciplined, and committed to personal and professional growth? ✔ Open to mentorship, leadership development, and continuous learning? ✔ Looking for a recession-proof career with unlimited earning potential? If you answered YES, keep reading! Why Become a Claims Settlement Specialist? 🚀 Work from anywhere - Build a career aligned with your values and goals. 💰 Uncapped earning potential - Part-time: $40,000-$60,000+/year | Full-time: $70,000-$150,000+++/year. 📈 No cold calling - Work with individuals who have already requested guidance. ❌ No sales quotas, no pressure, no pushy tactics. 🏆 Leadership & Ownership Opportunities - Develop and expand your own team. 🎯 Daily pay & performance-based bonuses - Direct commissions from top carriers. 🎁 Incentives & rewards - Earn commissions starting at 80% (most carriers) + salary. 🏥 Health benefits available for qualified participants. This is more than just a career-it's an opportunity to lead with purpose, inspire positive change, and build a future that aligns with your mission and impact. 👉 Apply today and take your first step as a Claims Settlement Specialist! (Results may vary. Your success depends on effort, skill, and commitment to learning and execution.)

Claims Auditor I, II and Senior Location : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Claims Auditor I is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The Claims Auditor II is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The Claims Auditor Senior is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. How you will make an impact : * Performs audits of high dollar claims. * Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. * Contacts others to obtain any necessary information. * Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. * Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. * Refers overpayment opportunities to Recovery Team. * Claims Auditor II - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. * Claims Auditor Senior - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. Minimum Requirements : * Claims Auditor I : Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. * Claims Auditor II : Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. * Claims Auditor Senior : Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: * Stop loss claims experience highly preferred. * Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. * Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. * Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CLM > Claims Support Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

General Medicine Claims Specialist Join a mission-driven team that supports those who've served. Veterans Guardian VA Claim Consulting is seeking a General Medicine Claims Specialist to help Veterans nationwide secure the VA disability benefits they have earned. This role is ideal for someone with a clinical or medical background who thrives in a fast-paced, high-volume environment and is passionate about making a difference. You'll work directly with Veterans, reviewing medical records, gathering symptom information over the phone, and identifying the key medical evidence needed to support disability claims. Strong communication skills, attention to detail, and comfort with phone-based work are essential for success. Key Responsibilities: Review and analyze medical records to identify relevant information Speak with Veterans daily about their medical history and symptoms Process and document case details in internal systems Manage a large caseload with a high call and client volume Collaborate with internal teams to ensure timely and accurate case work Qualifications: 1+ year experience in a clinical or medical support role (e.g., LPN, LVN, EMT, Medical Assistant, Military Medic) Familiarity with medical terminology and documentation Strong verbal and written communication skills High school diploma or GED required Proficient with computers and comfortable using Google Workspace Benefits 401(k) Dental insurance Health insurance Paid time off Vision insurance

Inventory Claims Coordinator Department: Warehouse Operations - 171032 Reports to: Inventory Supervisor Location: Wendell, NC Position Status: Full-time Status: Hourly, Non-Exempt Management Level: Non-Management JOB SUMMARY The Inventory Claims Coordinator serves as a support element and liaison for all distribution centers and the dealer network. This person will be cross trained and gain exposure to many functions including claims processing, inventory investigations, dealer network relationship building and recording claim data. KEY RESPONSIBILITIES OF JOB The Inventory Claims Coordinator key responsibilities are outlined below: Claims: Resolve and process claim disputes Technical drawing look-up Inventory background investigations Credit and Debit process on claim investigations Issuing and monitoring call tags Resolve and process freight claim disputes and tracking reimbursement if applicable Inventory Management Provide inventory control reporting and vendor reports Track claim data and communicate common themes for mitigation Directly or indirectly locate misplaced parts to help satisfy sale to customer/dealer Help maintain or relay proper product identification and location accuracy and ability to transfer product to correct location if needed Other Responsibilities Determine and record data for KPI's Promote dealer satisfaction utilizing customer service skills EDUCATIONAL AND PHYSICAL REQUIREMENTS High school diploma or GED equivalent required with minimum of 3 years' related experience Associate or Bachelor degree with a minimum of 1 year experience 1-5 Years of related customer service or inventory experience. Must be a team player with strong interpersonal communication skills Good time-management skills and attention to detail Outstanding written and oral communication skills with the ability to effectively present information Proficiency in Microsoft programs, including Excel, a plus SAP experience preferred SalesForce experience preferred

Company Details With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results. All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P. For further information about Key Risk please visit *************** The company is an equal opportunity employer. Responsibilities Key Risk is looking for a Claims Representative who enjoys analysis and management of workers compensation claims. Key functions include but are not limited to the following: Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Negotiate settlement of claims up to designated authority level and makes claims payments. Calculates and assigns timely an appropriate reserve to claims and continues to manage reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. Prepares necessary state filings within statutory limits. Actively manages the litigation process; ensures timely and cost-effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. Frequently communicates with all appropriate parties involved with the claim. Maintains professional client relationships. Actively executes appropriate claims activities to ensure consistent delivery of quality claims services. Qualifications BA/BS Degree 2-3 years of workers compensation claims experience Adjuster license strongly desired or ability to obtain license within six months Knowledge of appropriate insurance principles and laws of workers' compensation, preferably jurisdiction specific. Strong verbal and written communication Strong interpersonal, time management and organizational skills. Strong negotiation skills. Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail. Ability to perform with a sense of urgency. Ability to work both independently and within a team environment. Ability to travel for business purposes, approximately less than 10%. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.

Responsibilities: Processing fast paced inbound customer service calls. Taking inbound calls from clients Providers, Consumers and Insurance companies regarding medical billing. Resubmitting claims, and answering questions regarding benefits Demonstrates excellent customer service skills with the ability to take ownership in assisting, researching and resolving customer issues. Performs other duties as assigned. Requirements Previous Call Center or Customer Service experience preferred. Ability to develop rapport and demonstrate a caring attitude. Clear, distinct oral and written communication skills. Must be detail oriented.

Project Resources Group (PRG) is seeking a Claims Recovery Specialist for our Charlotte, NC office. Be part of our expanding team focused on recovering third-party property and utility damage claims, primarily in a B2B setting. We're looking for motivated, detail-oriented professionals with strong negotiation skills. Experience in collections or insurance adjusting is highly relevant and transferable. We offer a competitive base salary plus commission. Key Responsibilities Resolve and negotiate claims recovery of repair and replacement costs on third-party cable/fiber and utility damages across multiple state lines, via phone, email, and letters. Work directly with liable parties' insurance providers to defend and negotiate claims settlements. Collaborate with claims departments and management of liable parties, from small businesses to large corporations to municipalities. Learn, understand, and be able to utilize state dig laws and statutes, 811 excavator requirements, NESC standards, CGA guidelines, etc. Develop a professional working relationship with damaging parties, on-site field investigators, management, and other personnel. Conduct 40-50 inbound/outbound calls daily, approximately 2-2.5 hours of total talk time throughout the day. Enter notes and documentation throughout the recovery process into the company's proprietary Claims Database Tool. Use a calendar and diary system to coordinate handling claims to be worked twice weekly. Follow advanced claim handling procedures as detailed by the OPD Claims Manager. Use photographs, narratives, job costs, site sketches, locate tickets, and other components on-site field investigators provide to visualize and understand the damage scene to defend liability accurately. Participate in weekly department meetings to discuss individual and team recovery tactics, strategies, and goals. Maintain a working knowledge of the entire PRG claims recovery process. Preferred Qualifications Strong proficiency in Microsoft Word, Outlook, and Excel. Tech-savvy with the ability to quickly adapt to new software and systems. Excellent written and verbal communication skills, with an emphasis on professional phone and email correspondence. Familiarity with the construction, cable, or utility locate industries is advantageous. Understanding of B2B construction, claims management, recovery, or insurance claim negotiation and settlement processes is preferred. Ideally, 3-5 years of experience in claims, recovery, and/or the insurance industry. College education is preferred. Bilingual in Spanish is a plus. Compensation and BenefitsWe offer a competitive hourly pay ($19-$23/hour based on experience), plus the potential to earn substantial commissions up to $4,000-$10,000 monthly based on performance. Along with a comprehensive benefits package, including: Medical, dental, and vision coverage for employees and dependents 401(k) retirement plan, with company match after 1 year Short-term disability coverage after 1 year Paid time off and holidays Additional perks such as company-paid life insurance, and other supplemental insurances available About PRG Since 2001, PRG has been a leader in construction management and outside plant damage recovery for the telecommunications and utility industries. With 20+ offices and 800+ employees nationwide, we deliver industry-leading solutions with speed, accuracy, and expertise. Equal Opportunity EmployerPRG is proud to be an Equal Opportunity Employer. PRG does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state, or local law and ordinances.#INDCS

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

Job Title: Revenue Cycle Claim Specialist Company Overview: Eau Claire Cooperative Health Center, Inc. (dba Cooperative Health) is a leading community health center serving the Midlands of South Carolina since 1981. It is deeply rooted in its mission of providing accessible, high quality, compassion health care in the spirit of the Good Samaritan. The organization's values of: treating each other with respect, putting people first, being excellent at what we do, promoting a collaborative work environment, improving community/population health, fostering innovative thinkers, and getting results, are core attributes of every employee at Cooperative Health. Position Summary: The Revenue Cycle Claim Specialist will be assigned to specific Practice Locations and is responsible for increasing billing efficiency, accuracy and profitability through working Missing Slips and creating claims. Responsibilities will include, review of insurances, billing services, payer specific billing guidelines and other Billing duties and tasks as assigned by Revenue Cycle Supervisor, Sr. Lead Revenue Cycle Specialist and/or Revenue Cycle Director. This position may be considered for a future hybrid schedule. Principles Responsibilities: * Effectively communicates with Revenue Cycle Leadership staff to clarify coding and billing for accuracy. * Track and report insurance, billing and coding errors that impact claim creation. * Report identified coding and practice management system issues to Revenue Cycle Leadership. * Attend required Revenue Cycle meetings in person and/or via Zoom or Teams. * Perform daily Encounter review to assure general documentation supports coding on Superbills. * Perform Daily Day End review to identify the need for additional claim edits and validate charges. * Review and prepare claims for submission to various insurance carriers. * Responsible for responding to emails and Athena text pertaining to claim corrections. * Responsible for performing other billing task as directed by Revenue Cycle Leadership. Education & Experience: * Education - Min. High School Diploma with some college * Minimum 2 years working Registration in a Physician's office * Minimum 1 year experience performing Patient Check-in/Registration (Athena experience required) * Minimum 1 year experience performing Claim Creation (Athena experience required) * Minimum 2 years Medical Billing and Insurance experience. * Training or working knowledge of ICD-10 and CPT coding. * Current working knowledge of Medical software (Athena) * Knowledge of FQHC Billing Physical Demands * Prolonged periods sitting or standing * Must be able to lift up to 25 pounds. * Be able to sit, stand, stoop, squat for extended periods of time throughout the day. * Standing or walking for extended periods throughout the day. Company Conformance Statement In the performance of respective job assignments, all employees are required to conform with Cooperative Health's: * Board approved policies and procedures; * Confidentiality and professional provisions; * Compliance program; and * Standards of conduct. Cooperative Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Cooperative Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation and training.

The Nuclear Company is the fastest growing startup in the nuclear and energy space creating a never before seen fleet-scale approach to building nuclear reactors. Through its design-once, build-many approach and coalition building across communities, regulators, and financial stakeholders, The Nuclear Company is committed to delivering safe and reliable electricity at the lowest cost, while catalyzing the nuclear industry toward rapid development in America and globally. About the role The Nuclear Company is looking for an experienced Claims Mitigation & Management Specialist to support the deployment of major nuclear reactor projects. This role will focus on contract formation, administration, and proactive claims prevention. You will work closely with project teams, contract managers, and leadership to identify and address potential risks, respond to claims, and ensure contractual compliance across complex, utility-scale nuclear energy projects. Responsibilities Proactively identify potential claims and disputes on projects. Develop and implement strategies for early claims identification and mitigation. Provide guidance to project teams on contract administration and documentation. Conduct detailed forensic analysis of project documentation for claims assessment. Quantify cost and schedule impacts of potential claims, including delay and disruption. Prepare comprehensive claims position papers and reports. Support the negotiation process for claims and disputes. Assist in preparing for and participating in dispute resolution forums (e.g., mediation, arbitration). Develop and maintain a robust claims log, tracking all active and potential claims. Ensure all claims-related documentation is meticulously organized. Prepare regular reports on claims status, liabilities, and resolution progress. Work closely with Project Controls, Contracts, and Legal teams on claims management. Participate in project reviews to provide insights on claims trends. Experience Bachelor's degree in Engineering, Construction Management, Quantity Surveying, Law, or a related field. 8+ years of progressive experience in claims management, dispute resolution, or contract administration. 3+ years of focused claims management experience. Experience on energy mega-projects (utility-scale, high capital, high complexity). Experience on nuclear energy projects is highly valued. Demonstrated expertise in contract formation, negotiation, and administration. Exceptional analytical, critical thinking, and problem-solving skills. Excellent written and verbal communication and negotiation skills. Proficiency in project management software, scheduling tools, and advanced Excel. Ability to work effectively under pressure and manage multiple priorities. Knowledge of construction law and dispute resolution processes. Benefits Competitive compensation packages 401k with company match Medical, dental, vision plans Generous vacation policy, plus holidays Estimated Starting Salary Range The estimated starting salary range for this role is $121,000 - $143,000 annually less applicable withholdings and deductions, paid on a bi-weekly basis. The actual salary offered may vary based on relevant factors as determined in the Company's discretion, which may include experience, qualifications, tenure, skill set, availability of qualified candidates, geographic location, certifications held, and other criteria deemed pertinent to the particular role. EEO Statement The Nuclear Company is an equal opportunity employer committed to fostering an environment of inclusion in the workplace. We provide equal employment opportunities to all qualified applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic. We prohibit discrimination in all aspects of employment, including hiring, promotion, demotion, transfer, compensation, and termination. Export Control Certain positions at The Nuclear Company may involve access to information and technology subject to export controls under U.S. law. Compliance with these export controls may result in The Nuclear Company limiting its consideration of certain applicants.

Join Our Dynamic Insurance Team - Unlock Your Potential! Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for our next leaders-those who want to build a career or an impactful part-time income stream. Is This You? ✔ Willing to work hard and commit for long-term success? ✔ Ready to invest in yourself and your business? ✔ Self-motivated and disciplined, even when no one is watching? ✔ Coachable and eager to learn? ✔ Interested in a business that is both recession- and pandemic-proof? If you answered YES to any of these, keep reading! Why Choose Us? 💼 Work from anywhere - full-time or part-time, set your own schedule. 💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month. 📈 No cold calling - You'll only assist individuals who have already requested help. ❌ No sales quotas, no pressure, no pushy tactics. 🧑 🏫 World-class training & mentorship - Learn directly from top agents. 🎯 Daily pay from the insurance carriers you work with. 🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Ownership opportunities - Build your own agency (if desired). 🏥 Health insurance available for qualified agents. 🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom. 👉 Apply today and start your journey in financial services! ( Results may vary. Your success depends on effort, skill, and commitment to training and sales systems. )