Claim specialist jobs in Louisiana - 160 jobs

Review and understand Insurance policies and standard Explanation of Benefits. Review and understand medical documentation effectively Review and resolve Back Collections related tasks, such as Denial appeals Payment review and balance billing Claims generation Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit. Performs other clerical tasks as needed, such as Answering patient/Insurance calls Faxing and Emails Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor Other responsibilities and projects as assigned. Requirements: High School Diploma or equivalent Knowledge of Explanation of Benefits from insurance companies General knowledge of government, regulatory billing and compliance regulations/policies for Medicare & Medicaid Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits. Enough knowledge of policies and procedures to accurately answer questions from internal and external customers. Utilizes initiative while maintaining set levels of productivity with consistent accuracy. Experience: 3-5 Years in DME or medical billing experience preferred. Minimum of 1 year of insurance verification or authorizations required. Skills: Superior organizational skills. Proficient in Microsoft Office, including Outlook, Word, and Excel. Attention to detail and accuracy. Effective/professional communication skills (written and oral)

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Specialist, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$117,000 - $125,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

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

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. **POSITION PURPOSE** Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Analyzing, investigating, and resolving problem cases; executing recovery processes; and completing special projects. Accountable for complying with all laws and regulations that are associated with duties and responsibilities. **NATURE AND SCOPE** + This role does not manage people + This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS + Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist II must be in contact with personnel in other Units:Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices.Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans. **QUALIFICATIONS** **Education** + High School Diploma or equivalent required **Work Experience** + 2 years in medical claims processing required + Coordination of Benefits (COB) processing experience preferred **Skills and Abilities** + Strong analytical ability, that includes strong logical, systemic, and investigates thinking. + Strong oral and written communication skills and human relations skills are necessary. + Working knowledge of relevant PC software. + Ability to prioritize multiple streams of work effectively. **Licenses and Certifications** + None Required **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Reviews, researches, and makes necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction. + Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) in order to process both coordinated and non-coordinated claims correctly. Requesting of medical records may be required. + Communicates, both orally and in writing, with internal and external contacts in order to provide necessary and accurate information for the establishment of sound claim records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc. + Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction. + Researches, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to $1,000.00. + Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability. + Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability. + Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation). + May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction. **Additional Accountabilities and Essential Functions** _The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions_ + Perform other job-related duties as assigned, within your scope of responsibilities. + Job duties are performed in a normal and clean office environment with normal noise levels. + Work is predominately done while standing or sitting. + The ability to comprehend, document, calculate, visualize, and analyze are required. **An Equal Opportunity Employer** **All BCBSLA EMPLOYEES please apply through Workday Careers.** PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) **Additional Information** Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact ********************* for assistance. In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. _Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner._ _Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results._ **JOB CATEGORY:** **Insurance**

Job Category: Accounting Job Type: Full-Time Facility Type: Corporate Shift Type (Clinical Positions): Day Shift At AMG we offer our employees much more than just a job in the healthcare industry. We offer unique career opportunities for people who are called to make a difference in the lives of others and desire to be part of a team that contributes to making a difference each day for our patients. We invite you to join our team and share your gifts and talents. In addition to market-competitive pay rates and benefits in the Lafayette market, you will have the opportunity to work for an Employee Stock Ownership Plan (ESOP), as AMG is an employee-owned company! AMG, Integrated Healthcare Management (AMG Corporate) is seeking a Hospital Billing & Claims Appeal Specialist in Lafayette, Louisiana. This position is crossed trained and is responsible for patient account billing, including monthly statement mail out, and electronic billing submissions. Also responsible for fiscal year end cost reporting. Also providing support for the Billing Specialists and the corporate office team in relation to managing incorrect contracted payments with managed care payors to seek resolution and file necessary appeals. The position will be responsible for assisting the billing specialist with obtaining necessary documentation, writing appeals and following up with appeals as requested by the billing team. The candidate must possess strong communication skills, excellent customer services skills, and be able to work collaboratively with a team. This position requires a strong Hospital Billing and Claim Appeals background with experience in the Post-Acute setting and interpretation of payor contracts for appropriate appeal rights. This is not a remote position. Join our dynamic team and enjoy a career where you can make a difference with AMG Integrated Healthcare Management! Apply Now Job Requirements * Position located in Lafayette, Louisiana. * Strong knowledge of MS Word and Excel. * Requires a strong Claim Appeals background with experience in the Post-Acute setting. * Requires interpretation of payor contracts for appropriate appeal rights. * Minimum of 2-3 years hospital billing/collections/accounting experience in health care related field. * A strong background in Long Term Acute Care (LTAC). * Must be able to diplomatically articulate communications, interpret and explain complex information, and comprehend written, verbal and electronic communication. * Strong problem-solving skills with effective time management. * Strong organizational skills to maintain awareness of appeal timelines. * Self-starter with strong analytical skills and attention to detai About Us AMG is a hospital system committed to our patients, our people, and to the pursuit of healing. As a Top-5 Post-Acute hospital system, we're known for excellence, integrity, community, and compassion. Our mission is to return patients to their optimal level of well-being in the least restrictive medical environment. We accomplish this through a multi-disciplined approach that includes aggressive clinical and therapeutic interventions, as well as family involvement. Our high staff to patient ratio ensures individualized attention. Our nurses, therapists, and physicians work with each patient to obtain the best possible outcomes. Acadiana Management Group, LLC is an equal opportunity employer.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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

About Us: Struction Solutions is an innovative Independent Adjusting, Building Consultant, and Disaster Recovery Firm, known for our commitment to delivering innovative and tailored solutions to our clientele. Our team of professionals work tirelessly to ensure accuracy, efficiency, and customer satisfaction. As we continue to grow and expand, we're seeking talented individuals who share our dedication to excellence and are eager to make a meaningful impact in our industry. Position Details: Resolves insurance claims involving marine casualties. Their role includes investigating, evaluating, and negotiating claims to determine the extent of the insurance company's liability. This role requires a thorough understanding of maritime laws, insurance policies, and handling procedures. Investigation: They conduct thorough investigations of marine incidents, such as collisions, groundings, sinkings, fires, or cargo damage. This includes gathering evidence, interviewing witnesses, and inspecting vessels and cargo. Assessment: They assess the extent of the damage and determine the cause of the incident. This may involve working with marine surveyors, engineers, and other experts to evaluate the condition of the vessel and cargo. Documentation: They collect and review relevant documents, such as ship logs, maintenance records, cargo manifests, and insurance policies, to support the claim. Evaluation: They evaluate the claim to determine whether it is covered under the insurance policy and to what extent. This involves interpreting policy terms and conditions, as well as applicable laws and regulations. Negotiation: They negotiate settlements with claimants, which can include shipowners, charterers, cargo owners, and other affected parties. The goal is to reach a fair and equitable resolution while minimizing the financial impact on the insurance company. Reporting: They prepare detailed reports and recommendations for the insurance company, documenting their findings, the extent of the damage, and the proposed settlement. Liaison: They act as a liaison between the insurance company and other parties involved in the claim, such as legal representatives, regulatory authorities, and other stakeholders. Compliance: They ensure that all claims are handled in compliance with relevant laws, regulations, and industry standards. Risk Management: They may also be involved in risk management activities, helping to identify and mitigate potential risks to reduce the likelihood of future claims. Qualifications: Proven experience in insurance claims adjustment, preferably in marine insurance. Strong knowledge of maritime laws and regulations. Excellent analytical, negotiation, and communication skills. Ability to manage multiple claims efficiently under tight deadlines. Proficiency in claim management software and Microsoft Office Suite. Location: New Orleans, LA area Marine casualty claim adjustment specialists need a strong understanding of maritime law, insurance principles, and the technical aspects of marine operations. They also require excellent analytical, communication, and negotiation skills. Join us at Struction Solutions, and let's redefine the future of the Independent Adjusting industry together! View all jobs at this company

Job Title: Claims Analyst-Federal Construction ***Work Location: Panama City, FL (Tyndall AFB) *** Salary: Based on experience and will be discussed with manager in interview REQUIREMENT- Must be a US Citizen and must pass a federal background review and drug screen Responsibilities/Duties: Analyze contract terms, project schedules, and scope to identify potential claims or disputes. Prepare, evaluate, and document construction claims including Requests for Equitable Adjustment (REAs), time extensions, and cost impacts. Review subcontractor claims and coordinate analysis with project and legal teams. Maintain organized documentation related to claims, including correspondence, daily reports, meeting minutes, schedules, and cost records. Work closely with project managers, estimators, and schedulers to gather and validate data. Support negotiations and settlement of claims with clients and subcontractors. Provide recommendations for claim avoidance and risk mitigation. Ensure all claims comply with applicable contract clauses and federal regulations (FAR, DFARS, etc.). Assist in drafting position papers, presentations, and reports to support claim resolution or litigation support. Education/Experience: Bachelor's degree in Construction Management, Engineering, Business, or related field. Minimum of 5 years of experience in construction claims analysis, preferably in federal or military construction projects. Experience on U.S. Army Corps of Engineers (USACE) or NAVFAC projects. Certification in construction claims or contract management (e.g., CCP, PMP, AACE certifications). Working knowledge of construction law and dispute resolution processes. Strong understanding of federal contracting regulations and procedures (FAR, DFARS). Familiarity with scheduling techniques and tools (e.g., Primavera P6, Microsoft Project). Experience analyzing cost impacts and time delays using industry-standard methodologies. Excellent written and verbal communication skills. Highly organized with strong attention to detail. Ability to work independently and collaboratively with project teams. Proficient in Microsoft Office Suite (Excel, Word, Outlook). Benefits: Competitive salary based on experience. Comprehensive health, dental, and vision insurance. Retirement savings plan with company match. Paid time off and holidays. Professional development and career advancement opportunities. A supportive and collaborative work environment. Equal Opportunity Employer (U.S.) all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Accura uses E-Verify in its hiring practices to achieve a lawful workplace. *******************

Benefits: Paid time off Competitive salary Dental insurance Employee discounts Health insurance Vision insurance Position Overview As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. The Coordinator will be responsible to follow up daily with the OPS team to ensure and that all required documentation, estimates and procedures are followed according to required program guidelines.A successful Coordinator will possess tenacity and thrives in a fast-paced environment. The coordinator who is detail oriented and able to focus with many projects in varying degrees of completion will be most successful in this position. Job Responsibilities Understanding of the claims flow process - Water Mitigation, Reconstruction, Contents, and other Environmental work Manages data entry for each claim from First Notice of Loss through to completion of job in the CRM system Daily review of compliance tasks and all job tasks are completed on time Monitor and update jobs in required operating system making sure the job flows efficiently through the claims process requirements and cycle times Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call Creates and or assists with job estimate, reviews final estimate to ensure estimate is complete per company standards Manages Customer Service issues and complaints, documenting actions and resolution Understanding of all company cycle times and SLAs required for each job and phase Client Care Calls - ensure constant, often daily, communication with the customer, may communicate with adjuster Ensure daily notes are entered in all jobs, contacting relevant participants and escalating to the department manager as required May be responsible for creating job estimate and or assisting the Estimator/Project Manager with final estimate Job Requirements High school diploma/GED required Bachelor's Degree or applicable experience preferred, work experience will be considered IICRC Certifications preferred but not required: WTR, ASD, OCT, STC Exceptional Customer Service skills 1-3 years of Xactimate experience required- proficient use Xactimate Experience with Microsoft© Office application (Word, Outlook, PowerPoint, and Excel) required Personal time management and organizational skills Strong verbal and written communication skills Dependable and adaptable to operate within a fast-paced work environment Ability to manage highly confidential information Strong problem-solving skills Proficient at using Microsoft Office, Outlook, CRM software Experience do you have with customer interaction and conflict resolution Physical Demands and Working Conditions The physical demands are representative of those that must be met by an employee to perform the essential function to this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Incumbent must be prepared to: Move up to 20 pounds occasionally, by lifting, carrying, pushing, pulling, or otherwise repositioning objects. Sitting for long periods of time while using office equipment such as computers, phones etc. Fingering and Repetitive motions; such as movement of wrists, hands and fingers while picking, pinching and typing during your normal working environment. Express or exchange ideas with others quickly, accurately, and receive and act on detailed information. Close visual acuity to perform detail-oriented activities at distances close to the eyes, such as preparing and analyzing data, viewing computer screen and expansive reading. Be exposed to various inside working conditions: The change of building environment such as with or without air conditioning and heating. May be required to travel for short periods of time. Disclaimer The above statements are intended to describe the general nature and level of work being performed by associates assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. The Company reserves the right to modify this description in the future, with or without notice to the employee. This Job Description does not create an employment contract, implied or otherwise, and employment with the Company remains at will. These responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. Compensation: $15.00 - $20.00 per hour We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Built on a foundation of great brands and employees with a passion for service, our vision is to be the leading provider of essential services through empowered people, world-class customer service and convenient access. By joining ServiceMaster, you'll be part of a talented network of employees with a shared vision. Our environment is a diverse community where successful people work together to achieve common goals. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to The ServiceMaster Company, LLC.

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

About the Role PuroClean of Shreveport is seeking a high-character individual to join our team as a Loss Claims Specialist. This is more than a job-it's a leadership role designed for someone who can take full ownership of a project from start to finish and align with our mission of providing empathetic, efficient, and professional restoration services to our community. As a Loss Claims Specialist, you will serve in a project manager capacity, overseeing the execution of all services related to water damage, mold, biohazard, contents handling, and reconstruction. This role demands strong organizational skills, technical knowledge, and a commitment to both customer care and team collaboration. Why Join Us * Profit Sharing Position - your success is our success * Annual Draw of $50,000 + laptop + software subscriptions * Be part of a purpose-driven company that values integrity, excellence, and service * Opportunities for growth and advancement in a fast-paced industry What You'll Need * A personal vehicle and reliable transportation * A working phone * A desire to learn and align with our SOPs and company goals * Willingness to take ownership and be accountable for job outcomes * Ability to manage multiple claims and ensure timely completion of each project What You'll Do * Manage restoration projects from intake through completion * Coordinate and execute all mitigation and reconstruction services: * Water Damage * Mold Remediation * Biohazard Cleanup * Contents Pack-Out and Cleaning * Reconstruction/Build-Back * Estimate, invoice, and track jobs using software including: * Xactimate * Estimate * Time and Materials platforms * Learn and apply our internal SOPs with consistency and accuracy * Meet or exceed quarterly performance goals Preferred (but not required): * Prior construction or restoration experience * Familiarity with insurance claims processes or property loss mitigation Who We're Looking For We're looking for someone with more than just technical skills. We value character, accountability, and alignment with our company vision. If you take pride in your work, can lead by example, and are looking to grow in an environment that rewards dedication and results-you may be exactly who we're looking for.

The Claims Examiner is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements. Responsibilities: * Adjudicate claims at a rate equal to 150 per normal workday. * Maintain statistical accuracy of 98%, and financial accuracy of 98%. * Correct DoD error report as needed, respond timely to all Customer Service, Provider Relations type questions. * Other duties as assigned by management. * Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals. * Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI). Requirements: * High School Diploma required. Work Schedule: 8AM - 5PM Monday-Friday Work Type: Full Time

If you're passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide's Property and Casualty team could be the place for you! At Nationwide, "on your side" goes beyond just words. Our customers and partners are at the center of everything we do and we're looking for associates who are passionate about delivering extraordinary care. A $5,000 SIGN-ON BONUS will be given to all external candidates hired into this role. Half of the bonus will be paid after 3 months of employment and the remainder will be paid after 9 months of employment. This is a work-from-home position with day travel to policy locations (on average 3-4 days a week) via company vehicle (personal use, gas and maintenance included). Claims inspections will include onsite and virtual inspection. Ideal Candidate Locations: The ideal candidate will live in the Des Moines, IA, Omaha, NE, or Lincoln, NE areas. * Relocation assistance may be available for qualified candidates who reside more than 50 miles outside of the ideal candidate locations listed. Territory: This role will cover Iowa, Nebraska, North & South Dakota, Kansas, Missouri, Minnesota (Up to 50% travel). Occasional travel outside of the territory may be required. Qualifications: * 5 years of insurance field/property claims handling or adjusting experience (Large Loss experience - preferred) * Solid experience/proficiency with Xactimate * Solid experience writing own estimates and handling claims start to finish * Construction background/experience- Residential, Roofing, Remodeling, water mitigation, etc. * Strong customer service competency * Strong written & verbal communication skills PLEASE NOTE that CAT duty is required for this position. Benefits Include: Medical, Dental, Vision, 401k with company match, Company-paid Pension plan, Paid time off and more. #LI-JJ1 #LI-Remote Summary No two property claims are ever the same and each customer has unique needs. Our team thrives on providing the very best service and building lasting, successful relationships with our customers. If you are confident, curious, driven to learn and grow, and have a desire to help people when they most need it, we want to know more about you! As a Claims Specialist, you'll work to evaluate and resolve serious exposure, large loss claims requiring investigation, liability evaluation and negotiation. We'll count on you to expedite settlements and control average loss cost and litigation expense according to the best claims practices. Job Description Key Responsibilities: * Handles all assigned claims promptly and effectively, with little direction and oversight, which may include complicated and catastrophic losses. Makes decisions within delegated authority, recommends settlement values in the disposition of claims as outlined in company policies and procedures. * Accurately pays claims based on policy provisions, state mandates and/or fee schedules. * Determines proper policy coverages and applies standard methodologies to conclude assigned cases according to company guidelines. Adheres to high standards of professional conduct while delivering outstanding service. * Opens, closes and adjusts reserves according to company practices to ensure reserve adequacy. * Maintains knowledge of court decisions that may affect the claim's function; current principles and practices; innovations; and policy changes and modifications. May be required to maintain knowledge of other functions within assigned subject area. This may require attending various seminars or training sessions. * Maintains current knowledge of local industry repair procedures and local market pricing. * Able to act for Claims Manager. Mentors and provides leadership to less experienced claims associates. Provides one-on-one training and assists with training/presentations as assigned by claims management. * Creates and analyzes severe incident reports, reinsurance reports and other information to corporate office, claims management and underwriting. * Partners with Special Investigation Unit and Subrogation to identify fraud and subrogation opportunities. Assist general counsel to prepares files for suit, trial or subrogation. * Consults claims staff and defense counsel for discovery processes and lawsuit file/trial strategy on case-specific issues. * Initiates and conducts follow-ups through proficient use of the claims and other related business systems. * Delivers an outstanding customer service experience to all internal, external, current and prospective Nationwide customers. May perform other responsibilities as assigned . Reporting Relationships: Reports to Claims Manager. Individual contributor role. Typical Skills and Experiences: Education: Undergraduate degree or equivalent experience preferred. Advanced degrees in law or related field desirable. License/Certification/Designation: Successful completion of required claims certification schools/courses. Professional development such as IIA or CPCU preferred. State licensing where required. Experience: Five years of experience handling property claims, insurance processing or field claims adjusting. Knowledge, Abilities and Skills: General knowledge of insurance theory and practices, and contracts and their application. Property estimating and automated claims systems. Demonstrated knowledge of the investigation, consultation and settlement activities used to resolve extensive property damage claims. Proven ability to meet customer needs and provide exemplary meaningful service by guiding customers through the claims process and ensuring a positive customer experience. Analytical and problem-solving skills necessary to make decisions and resolve issues related to application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, and application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for property losses. Ability to evaluate and successfully advise on property claims. Organizational skills to prioritize work. Command of written and verbal communication skills to effectively communicate with policyholders, claimants, repairpersons, attorneys, agents and the general public. Ability to efficiently operate a personal computer and related claims and business software. Able to provide leadership to less experienced claims associates. Must be able to safely access and inspect rooftops using a ladder. Must be prepared and capable of conducting physical inspections on rooftops, including first and second story roofs with pitches up to 8/12. Other criteria, including leadership skills, competencies and experiences may take precedence. Staffing exceptions to the above must be approved by the hiring manager's leader and HR Business Partner. Values: Regularly and consistently demonstrates the Nationwide Values. Job Conditions: Overtime Eligibility: Not Eligible (Exempt) Working Conditions: Normal office or field claims environment. May require ability to sit and operate phone and personal computer for extended periods of time. Able to make physical inspections of property loss sites; including climb ladders, balance at various heights and rooftops up to 8/12 pitch stoop, bend and/or crawl to inspect vehicles and structures; work outside in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. May be on-call. Must be available to work catastrophes (CAT). Extended and/or non-standard hours as required. Must have a valid driver's license with satisfactory driving record in accordance with Nationwide standards. ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process. Benefits We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here. Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law. #claims Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at ************. NOTE TO EMPLOYMENT AGENCIES: We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means. Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule. The national salary range for Claims Specialist III, Property Large Loss : $88,000.00-$164,000.00 The expected starting salary range for Claims Specialist III, Property Large Loss : $88,000.00 - $132,000.00

CENCO is a trusted provider of residential property claims services, partnering with leading insurance carriers to deliver accurate, efficient, and timely claim handling. We're currently seeking Daily Property Claims Adjusters to support residential claims throughout Shreveport and the greater North Louisiana area. This role is ideal for independent adjusters looking for consistent daily assignments, dependable pay, and the flexibility of field-based work. What You'll Be Doing: Perform on-site inspections for residential property losses related to wind, hail, water, fire, and other covered events Document damages with detailed notes and clear, high-quality photos Prepare accurate estimates using Xactimate or Symbility Communicate professionally with policyholders, contractors, and carrier partners Manage claim files efficiently from inspection through submission while meeting deadlines What We're Looking For: Licensing: Active Louisiana adjuster license Software: Working knowledge of Xactimate or Symbility Equipment: Reliable vehicle, ladder, laptop, and standard field tools Work Style: Organized, self-motivated, and comfortable working independently Availability: Ability to accept assignments promptly and turn in reports on time Why Work with CENCO? Steady residential claim volume across North Louisiana Competitive compensation with reliable, on-time payments Responsive leadership and streamlined systems designed to support field adjusters If you're a residential adjuster looking for consistent work with a dependable partner, CENCO would love to connect.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Job Description Purpose/Job Function: The claims associate will support the filing, tracking, and management of claims for all modes supporting a MTS customer. This role will include working closely with the customer at both corporate offices as well as in the field. There will also be frequent communications with carriers to collect documentation as well as status updates. The data collection and analysis produced in this role will be critical in driving continuous improvements to the customer's service performance. Essential Functions: File and manage LTL and Parcel freight claims including freight, shortages, overages, and damages. Deliver reliable service throughout the entire life cycle of each claim, including but not limited to: prompt contact and timely communication throughout the process until the claim is closed, explaining the process, setting expectations, follow-ups and meeting commitments to achieve optimal outcome on every file. Assist with client and vendor damage claims. Develop and grow effective relationships with clients, vendors, and internal business partners. Update and maintain records Recognize and request appropriate inspection type based on the details of the loss and coordinate the appraisal process. Maintain oversight of the repair process and ensure appropriate expense handling, manage approvals per guidelines. Manage and report weekly review of LTL carrier complaints. Provide reports to support visibility to claims trends and opportunities to reduce issues. Run reports and data analysis as needed. Qualifications/Requirements: Excellent verbal and written communication in order to respond effectively to sensitive inquiries and complaints Strong data entry and record keeping skills (may include maintaining records in database/s) Ability to apply principles of logical thinking to a wide range of practical problems Strong organizational skills with accurate attention to detail Aptitude to spot trends in shipment data and detail Proficient in use of Microsoft Office Suite (use of Excel, Word, Outlook) Education/Experience: Highschool diploma or GED Prior data entry experience preferred Working Conditions/Physical Demands: The Claims Associate will sit in front of a computer for long hours at a time responding to emails, communicating with clients, teammates and carriers, and entering financial data. Staring at the computer may cause eye irritation or even muscle strain. The increased repetitive motions and awkward postures attributed to the use of computer keyboards may also result in cumulative trauma disorders (CTDs). The job as Claims Associate does not require any strenuous or physical activity. Customary Work Hours: 8:00 A.M. to 5:00 P.M., Monday through Friday

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Responsibilities * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. Qualifications * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma