Claim specialist jobs in North Carolina - 150 jobs
Michigan Homeowners Claim Representative II
The Auto Club Group 4.2
Claim specialist job in Apex, NC
Michigan Homeowners Claim Representative II - AAA The Auto Club Group Reports to: Claim Manager IWhat you will do:
Work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units, resolve coverage questions, take statements, and establish clear evaluation and resolution plans for claims.
Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim, and initiate documentation in the claim handling system.
Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve payments for the appropriate parties accordingly.
Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.
Employees assigned to the Homeowner/CAT claim unit will handle claims generally valued between $5,000 and $25,000 (for the inside desk role) and up to $100,000 (for field role). Investigate claims requiring coverage analysis. When handling claims in the field, prepare damage estimates using claims software. Review estimates for accuracy. May monitor contractor repair status and update.
Supervisory Responsibilities:
None
How you will benefit:
A competitive annual salary between $64,000 - $72,000
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, and rewards and much more
We're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify) Education:
Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience in property adjusting
In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states
A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
Experience:
One year of experience or equivalent training in the following:
Negotiating claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:
Advance knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Knowledge of building construction and repair techniques
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guidelines
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Research, analyze, and interpret subrogation laws in various states
Strong negotiating skills
Ability to work outside normal business hours as needed
Preferred Qualifications:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Xactimate software experience/training or experience in an equivalent software
Claims adjuster experience specifically in home/property claims preferred
Experience working within a customer service setting
Call center experience or experience handling high volume calls preferred, but not required
Excellent communication skills both oral and written
Experience working within an insurance or claims-based role for one year or more
Full claims cycle experience preferred
Work Environment
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit ***********
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
$64k-72k yearly 1d ago
Looking for a job?
Let Zippia find it for you.
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in Charlotte, NC
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$28k-35k yearly est. 2d ago
Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim specialist job in North Carolina
The Company
At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an “A” rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
Manage all claims in accordance with Utica National's established claim procedures.
Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability ClaimsSpecialist's individual monetary authority level.
Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
Achieve the service standard of “excellent” during all phases of claims handling.
Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
Four year degree or equivalent experience preferred.
Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
Proven experience negotiating claims and active participation in alternative dispute resolution practices.
Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
Medical and Prescription Drug Benefit
Dental Benefit
Vision Benefit
Life Insurance and Disability Benefits
401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
Health Savings Account (HSA)
Flexible Spending Accounts
Tuition Assistance, Training, and Professional Designations
Company-Paid Family Leave
Adoption/Surrogacy Assistance Benefit
Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
Student Loan Refinancing Services
Care.com Membership with Back-up Care, Senior Solutions
Business Travel Accident Insurance
Matching Gifts program
Paid Volunteer Day
Employee Referral Award Program
Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$42k-64k yearly est. 41d ago
Claims Specialist
Libra Solutions 4.3
Claim specialist job in Huntersville, NC
Job Description
When life gets hard, we make it easier! Libra Solutions helps overcome the burdens created by slow-moving legal processes. Combining technical innovation and financial strength, we help speed cumbersome workflows and ease financial barriers for our customers. And our companies are leaders in their industries! Oasis Financial is the largest and most recognized national brand in consumer legal funding. Oasis helps consumers awaiting legal settlements to move forward with their lives. MoveDocs is a personal injury solutions platform that integrates and streamlines medical, financial, and professional services for personal injury cases. Our mission is to improve outcomes for plaintiffs, accelerate settlements for attorneys, and ensure timely payment for providers. We are proud of our mission and passionate about applying technology to the challenge of making healthcare more accessible. We also are the leading inheritance funding provider through Probate Advance, helping heirs access their inheritance immediately, without the lengthy process of probate.
Together, under the Libra Solutions banner, we have relationships with over 40,000 attorneys and over 7,000 healthcare providers nationwide, which gives us an amazing platform to service our customers.
MoveDocs is seeking a ClaimsSpecialist to join our growing Operations team. The successful candidate will be highly motivated to deliver exceptional customer service to various parties within the medical and legal community. This position will function as the primary point of communication with our clients to stay up to date on existing cases and answer client questions. MoveDocs takes pride in providing excellent and expedient service to our clients and the qualified candidate must be self-motivated, able to work autonomously and enjoy working in a fast-paced, high-volume environment.
This role is located in our Huntersville, NC office.
Answers high volume of inbound calls from insurance companies, attorneys, clients and/or medical providers daily
Statuses cases to get updates on pending and ongoing case litigation and/or medical treatment.
Drafts correspondence to defense insurance companies and/or attorneys including demand letters, emails, and faxes
Delivers customer satisfaction through timely, accurate communications
Develops rapport with the attorneys, firms, insurance companies and medical providers
Requirements
High School or GED required
Experience in a high-volume call environment preferred
Knowledge or experience with personal injury, medical billing, or claims a plus
Previous claims and/or personal injury case manager experience preferred
Self-motivated with desire to build great relationships, and to meet and exceed goals
Ability to multitask while on the phone and the computer is a must
Able to adapt to change and pivot easily between tasks
Ability to work quickly and accurately to meet tight deadlines
Possess excellent verbal and written communication skills for communicating with insurance companies, attorneys, and medical providers
Basic computer proficiency and Outlook experience
Benefits
MoveDocs offers competitive compensation, benefits that include medical, dental, vision and life insurance plans, plus 401(k) with company match and paid time off.
$38k-67k yearly est. 8d ago
Claims Specialist
Primeritus Financial Services 4.4
Claim specialist job in Raleigh, NC
Primeritus Financial Services is a national leader in repossession management, remarketing, skip tracing, and title services for the automotive finance industry across the United States and Puerto Rico. We provide our clients with comprehensive, outsourced solutions that combine a nationwide network of certified recovery agents, advanced investigative techniques, and a commitment to compliance and customer service. Our approach ensures that collateral is located, recovered, and remarketed quickly, efficiently, and professionally.
As a ClaimsSpecialist, you will be responsible for gathering, investigating, and analyzing information related to automotive damage claims arising from the repossession, transportation, or storage process. You will work directly with clients, vendors, and consumers to facilitate timely resolutions, ensure compliance with applicable laws and company standards, and maintain the integrity of the claims process, the company and its clients. This position requires excellent communication and organizational skills, sound judgment, and the ability to work effectively in a fast-paced, detail-oriented environment. The ClaimsSpecialist will serve as a key point of contact throughout the life cycle of a claim and contribute to the overall quality and accountability of our service delivery. This is a full-time, in-office HYBRID position based in our Raleigh, NC office. Key Responsibilities
Collaborate with internal teams, clients, vendors (recovery agents), and consumers to collect necessary information for claim investigations.
Analyze documentation and supporting evidence to determine claim validity and assist in recommending resolution strategies.
Draft clear and professional communications, including denial letters and settlement agreements, for review by the Claims Manager.
Guide consumers through the formal claims process via inbound calls, providing excellent customer service and maintaining professionalism under pressure.
Maintain accurate records in claims tracking systems, ensuring up-to-date case statuses and documentation.
Support compliance efforts by coordinating with the Vendor Relations team on agent-related concerns.
Conduct audits to ensure vendor and internal adherence to claims policies, industry regulations, and company procedures.
Stay informed on business operations and privacy/security protocols to ensure accurate and compliant claims handling.
Perform other duties as assigned to support the Claims team and company objectives.
Required Qualifications
High School Diploma or equivalent required; Associate's or Bachelor's degree preferred.
3-5 years of administrative experience required; prior experience in claims handling, insurance, repossession, or related industries preferred.
Strong interpersonal and written communication skills with the ability to manage sensitive conversations professionally.
High level of confidentiality, discretion, and sound judgment.
Proficient in Microsoft Office Suite and general office software.
Ability to multitask, prioritize work, and manage time effectively in a deadline-driven environment.
Why Primeritus?
Join a collaborative and growing organization at the forefront of the automotive finance recovery industry. At Primeritus, you'll have the opportunity to make a meaningful impact while working with a team that values accountability, respect, and continuous improvement. Equal Opportunity Employer
Primeritus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, pregnancy, national origin, age, veteran status, or disability status.
$40k-70k yearly est. 1d ago
Claims Settlement Specialist
The Strickland Group 3.7
Claim specialist job in Raleigh, NC
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.)
$39k-70k yearly est. Auto-Apply 60d+ ago
Billing Procedure Claims Specialist
Summit Spine and Joint Centers
Claim specialist job in North Carolina
Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty-three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard-working Claims Processor who can join our growing team of professionals. Job Duties:
Audits and ensure claim information is complete and accurate.
claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
Ensures accurate and timely billing of HCFA 1500 claims.
Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.).
Creates logs for providers of pending medical encounters and or encounters with errors.
Work directly with other billing staff and management to meet end of month closing deadlines.
Able to work with clearinghouse rejections, print, and mail secondaries.
Address inquiries from insurance companies, patients, and providers.
Understands CPT, ICD10, HCPCS coding and modifiers.
Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc.
Knowledge of ERAs, EOBs
Knowledge of payer specific/LCD guidelines
Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification
Must be proficient with spreadsheets and word processing applications.
Qualifications:
Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting
Experience with Medicare, Medicaid, Commercial insurance plans, Workers' comp, and Personal Injury cases.
Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management
Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials.
Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required.
Excellent computer skills and familiarity with Microsoft Office
Comfortable working in a growing, dynamic organization and able to navigate change.
Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment.
Bachelor's degree preferred.
Experience using eClinicalWorks preferred.
Experience with high level procedure billing and coding for Pain Management preferred
The position is full time with competitive salary, PTO, health benefits and 401k match. The ideal candidate will be located in Georgia and able to be present at our administrative office, or near Austin, Texas where other members of the billing team are located.
$31k-54k yearly est. 31d ago
Inventory Claim Specialist
Kioti Tractor
Claim specialist job in Wendell, NC
Job Description
Inventory Claims Coordinator
Department:
Warehouse Operations - 171032
Reports to:
Inventory Supervisor
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
$31k-55k yearly est. 6d ago
Insurance Claims Specialist
National Ondemand
Claim specialist job in Burlington, NC
National OnDemand, Inc. is a communications and utilities infrastructure provider delivering service solutions to the Fiber, Wireless, Energy and Technology sectors in the United States. Headquartered in Burlington, North Carolina, the Company provides full turnkey infrastructure solutions - on demand, anywhere across its service footprint and has secured and sustained its current standing in the market through the successful completion of mergers and acquisitions, along with demonstrable, steady organic growth.
Under the supervision Insurance Claims Manager, coordinate and administer workers' compensation program, automotive, property and casualty claims.
Primary Position Duties:
* Process and document all worker's compensation claims and property & casualty claims, ensuring compliance with relevant policies, procedures, and legislation.
* Serve as liaison with external agencies and regulatory bodies in the claims administration and the care and disposition of claimants.
* In coordination with the Insurance Claims Manager, evaluate property and casualty claims to determine liability, damage and exposure.
* Elevate to the Insurance Claims Manager larger, more complex claims.
* Assist the Insurance Claims Manager, the Senior Director of EHS & Compliance, Human Resources, and Legal, in third-party claims, including negotiations and settlement when required.
* Reviews and evaluates all work-related accident reports for completeness and clarity of data; analyzes data, as needed, to ensure compliance with policy and regulatory requirements.
* Determines appropriateness and amount of worker's compensation claims; investigates individual claims for eligibility for workers' compensation benefits; ensures that all legal and procedural requirements are met for the processing of claims to ensure proper and timely payment to employees and medical facilities.
* Provide authoritative advice and counsel to organizational leadership on interpreting and applying for worker's compensation and property & casualty policies, legislation, regulations, and processes.
* Liaison with the organization's insurance broker and providers.
* Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries.
* Assembles appropriate medical information and facts regarding claims for cases pending litigation; participates in the Workers' Compensation Administration mediation and formal hearings.
* Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts and to facilitate either return to work, job restrictions or, depending upon the medical status of the claimant, placement into appropriate alternative positions, ensuring compliance with all appropriate regulations and guidelines.
* Updates organizational leadership on employees' return to full duty status.
* Prepares all necessary forms, records and documentation, including statistical analyses and reports, for all claims, as required by various regulatory agencies.
* Makes recommendations for reducing the frequency and severity of losses using a workers' compensation database and/or other claims data reports; designs and develops databases; performs integrated data analyses and prepares reports.
* Process assigned property and casualty claims and performed other job-related duties as assigned.
* Claims support during Emergency Events.
* Assist EHS & Compliance Administrator as needed.
* Assists the Director of EHS & Risk in developing policies and procedures to reduce risk.
* Performs miscellaneous job-related duties as assigned.
Position Requirements:
* Access-only office environment with reasonable heating and cooling.
* The position will be at a computer workstation much of the time.
* Ability to work extended or irregular hours/days (nights and weekends)
* Prolonged sitting at a computer workstation performing repetitive tasks.
* Ability to occasionally lift, push, or pull up to 25 lbs.
* Must have reliable transportation and a valid driver's license.
* Ability to travel 10% of the time.
Education or Skills:
* Bachelor's Degree in Business Administration; at least four years of directly related experience in claims adjusting, investigations, litigation and/or risk management.
* Completed degree(s) from an accredited institution.
* One or more certifications - Certified Medical Insurance Specialist (CMIS), Certified Risk Insurance Specialist (CRIS), Transportation Risk Insurance Professional (TRIP), Associate in Claims (AIC), or Associate in General Insurance (AINS).
* 4 years of experience in risk management handling various claims processes.
* Ability to liaison with insurance carriers professionally.
* Ability to work independently or with a team at all levels of the organization.
* Ability to maintain confidentiality.
* Ability to professionally represent the organization.
Benefits:
This is a full time position with access to our comprehensive benefits which include paid time off (PTO), medical, dental, vision, short- and long-term disability, and life insurance, an Employee Assistance Program (EAP), and 401(k).
EQUAL OPPORTUNITY EMPLOYER:
NATIONAL OnDemand, Inc. is an equal opportunity employer. The company's policy does not discriminate against any applicant or employee based on race, gender, sex, sexual orientation, gender identity, color, religion, national origin, disability, genetic information, age, veteran status or any other consideration made unlawful by applicable federal, state or local laws. NATIONAL OnDemand, Inc. prohibits harassment of applicants and employees based on any of these protected categories.
$31k-54k yearly est. 13d ago
Claims Examiner
Harriscomputer
Claim specialist job in North Carolina
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.
$28k-46k yearly est. Auto-Apply 34d ago
Claims Specialist
Capsigna
Claim specialist job in Charlotte, NC
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.
$30k-54k yearly est. 60d+ ago
Claims Examiner II - Absence Management Specialist
Matrix Absence Management 3.5
Claim specialist job in Ruth, NC
Job Responsibilities and Requirements The Claims Examiner will act as a liaison between client, employee and healthcare provider. In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients.
Description of responsibilities:
* Investigates claim issues providing resolution within departmental and regulatory guidelines.
* Interprets and administers contract provisions: eligibility and duration
* Accurately codes all system fields with correct financial, diagnosis and duration information.
* Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work.
* Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
* Makes determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management.
* Determines the duration associated with the leave and or disability based on the information given by the healthcare provider.
* Process medium to high complexity or technically difficult claims.
* Develops and manages claims thought well developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
* Actively contributes to customer service, quality and performance objectives.
* Proactively engages in departmental training to remain current with all claim management practices.
* Responsible for managing Performance Guarantee clients and meet targeted metrics.
* Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
Qualifications:
* High School Diploma or GED (Bachelor's preferred)
* Ability to develop proficiency regarding required RSL products, systems and processes related to the effective delivery of new business proposals
* Microsoft Office experience
* Attention to detail, analytical skills, and the ability to collaborate with others and work independently
* Strong organizational skills, including the ability to prioritize work and multi-task
* Customer service experience and orientation
* Written and verbal communication skills.
The expected hiring range for this position is $23.24 - $29.04 hourly for work performed in the primary location (South Portland, ME). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future.
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you.
That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.
Our Benefits:
* An annual performance bonus for all team members
* Generous 401(k) company match that is immediately vested
* A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
* Multiple options for dental and vision coverage
* Company provided Life & Disability Insurance to ensure financial protection when you need it most
* Family friendly benefits including Paid Parental Leave & Adoption Assistance
* Hybrid work arrangements for eligible roles
* Tuition Reimbursement and Continuing Professional Education
* Paid Time Off - new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service.
* Volunteer days, community partnerships, and Employee Assistance Program
* Ability to connect with colleagues around the country through our Employee Resource Group program
Our Values:
* Integrity
* Empowerment
* Compassion
* Collaboration
* Fun
EEO Statement
Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.
#LI-Hybrid #LI-MR1
$23.2-29 hourly Auto-Apply 19d ago
Claims Specialist
PRG 4.4
Claim specialist job in Charlotte, NC
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.
$19-23 hourly Auto-Apply 13d ago
Public Adjuster
The Misch Group
Claim specialist job in Charlotte, NC
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
$75k-100k yearly 16d ago
Warranty Claims Representative
Cornerstone Building Brands
Claim specialist job in Cary, NC
ABOUT THE ROLE The Claims Representative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The Claims Representative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards.
This position will work West Coast hours 8-5 Monday- Friday.
Two days in office three days work from home at any Cornerstone Building Brand Window facility.
WHAT YOU'LL DO
Claim Intake & Validation
Receive, review, and validate incoming warranty claims to determine accuracy and required information.
Initiate clarification calls to customers as needed to complete claim details.
Maintain accurate claim documentation and communication updates within Dynamics 365 CRM.
Claim Management & Resolution
Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality.
Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction.
Administer service reimbursements and prepare settlement letters when applicable.
Quality Review & Root Cause Analysis
Conduct research to identify root causes of product or service issues.
Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements.
Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality.
Communication & Reporting
Prepare clear communications and updates for management regarding claim trends, issues, and opportunities.
Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete.
Perform additional duties as assigned to support departmental needs.
SKILLS PREFFERED:
Strong ability to interpret customer claims and apply relevant warranty coverage.
Ability to read and interpret product specifications, drawings, and order confirmations.
Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions.
Strong verbal and written communication skills with a customer-centric approach.
Ability to manage difficult discussions and mitigate customer dissatisfaction effectively.
Strong attention to detail and accuracy in a fast-paced environment.
Ability to work independently while supporting team and departmental goals.
High curiosity, initiative, and willingness to grow in an evolving environment.
Qualifications
Education:
High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education.
Experience/Technical Skills:
Experience with CRM systems is desired.
Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Why work for Cornerstone Building Brands?
Our teams are at the heart of our purpose to positively contribute to the communities where we
live, work and play
. Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development.
*Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement.
Cornerstone Building Brands 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, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster
here
. You can also view Your Right to Work Poster
here
along with This Organizations Participation in E-Verify Poster
here
. If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or
[email protected]
. If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or
[email protected]
. This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.
All your information will be kept confidential according to EEO guidelines.
California Consumer Privacy Act (CCPA) of 2018
Must be at least 18 years of age to apply.
Notice of Recruitment Fraud
We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.
$31k-45k yearly est. 1d ago
Plant/Manufacturing - Adjuster
Schwarz Partners 3.9
Claim specialist job in Pineville, NC
STS Packaging, a Schwarz Partners, L.P. Joint Venture company, is currently seeking an Adjuster in Charlotte, NC. The primary responsibility of the Adjuster is to serve as the technical and operational leader for a designated group of bag machines. Duties focus on safety, operational efficiencies, machine uptime, instruction and guidance to the group operators, reporting and the overall performance of the machine group/shift. This position is located at 1201 Westinghouse Blvd in Charlotte, NC. 28273
ESSENTIAL JOB FUNCTIONS FOR THIS POSITION
Proven experience in operating a bag machine per production standards and output
Actively check bag quality (both for defects and predictive changes to bag attributes)
Maintain machine - Make comprehensive machine adjustments and lead major machine adjustments effort as needed to ensure quality and efficiency - See position tier levels for specific tasks
Keep machine running at optimal speeds
Interact, train and mentor all employees within the machine group
Maintain cleanliness of machine group and work area
Convey to the Production Superintendent any pending or current conditions that may impede the output of the machine group.
Oversee the accurate, complete documentation of daily shift paperwork
Perform any and all job assignments/functions as necessary to daily business demands as instructed by Management.
Lead PM activities (via dedicated or rotating schedule)
Maintain a positive, instructive attitude every day to foster employee job satisfaction
Technical Duties Include:
Effectively manage the machine group's performance (all operators)
Maximize uptime through optimal adjustments and time-efficient repair of machine during breakdowns
Mentor group Operators and Adjuster Trainees
Act as the area leader for meeting/exceeding production standards
OTHER SIGNIFICANTJOB FUNCTIONS INCLUDE
Maintains a clean and safe work area and reports unsafe conditions to management for resolution
Adheres to all safety policies, including always wearing required PPE, and sets an example to others for model safety behavior
Detailed understanding of quality defects, including how to detect as well as what to do if observed
Conform to Good Manufacturing Practices (GMP's), and Safe Quality Food (SQF) procedures and policies to assure products are suitable for food contact
Responsible for reporting any product quality or food safety issues to the Quality Manager (SQF Practitioner) or Management Team member
Additional duties as assigned by Production Superintendent
REQUIRED EDUCATION / EXPERIENCE
High School Diploma minimum required
Leadership skills and ability to work as an independent thinker
Proven team-oriented mindset
REQUIRED SKILLS (TECHNICAL, CLERICAL, LANGUAGE, ETC.)
Must follow Safety/GMP/PPE guidelines
Ability to work beyond 8-hour shifts as needed and participate in weekend PM and maintenance efforts as needed; Days of work may be shifted to accommodate a 5 day work week
Production-focused
Take direction from Production Superintendent/General Manager
High level of machine and mechanical knowledge
Read and understand instructions and job information
Excellent math and writing abilities
Desire to accept additional responsibility and learn new tasks
LANGUAGE SKILLS
Fluent in English required
Fluency in Spanish a plus
PHYSICAL DEMANDS
Continuous standing and walking with minimal sitting.
Able to bend, twist, kneel, crawl, and lay down on floor during cleanup/startup of machine - involves frequent, constant, continuous, and repetitious motions
Frequent lifting overhead & carrying of cases that can weigh in excess of 35-lbs
Frequent, regular pushing and pulling of paper rolls in excess of 1,500-lbs
Frequent ladder and stair climbing
WORK ENVIRONMENT
Standard production/manufacturing environment; Plants can be hot noisy, exhibit vibrations have, uneven surfaces mechanical hazards, dust/dirt, odor/fumes; work performed inside.
OTHER INFORMATION
Personal Protective Equipment required for the job: Steel toe shoes, hearing protection, safety glasses, hair nets
Steel toe shoes are provided by employee, all other tools provided by employer
If you would like to be part of a forward-thinking team with a family feel, culture of excellence, and customer-focused reliability, we want you to be a part of our team!
Our organization is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
$35k-45k yearly est. 10d ago
Casualty Adjuster - Medical Division
North Carolina Farm Bureau Mutual Insurance Company, Inc. 4.0
Claim specialist job in Raleigh, NC
About Us At North Carolina Farm Bureau Insurance, we take pride in our strong, community-oriented roots that began right here in North Carolina. In 1953, our company was born out of the need to provide insurance coverage to our farmers and rural communities. Now, with local offices in each of the 100 counties, we provide services to all North Carolinians across the state. Here at NCFB we are a familiar face in the community with a service oriented mindset that truly sets us apart. Guided by our mission, we are deeply committed to both our neighbors and employees. Helping you is what we do best! If you are passionate about making a meaningful impact and value a people-centered culture, we invite you to join us!
About the Role
Our Claims Department provides outstanding individuals with the opportunity for an exciting and rewarding career. Resolving claims combines the excitement of investigations with the reward of helping people through difficult times.
We are seeking motivated and proactive individuals to join our team. As a Casualty Adjuster, you will work directly with policyholders, claimants, and other involved parties to investigate, evaluate, and negotiate settlements of casualty insurance claims.
Education and Experience
Associate's degree or above preferred.
Preference given to applicants with extended education and/or training.
Preference given to applicants with experience handling bodily injury claims of any level.
Required Skills and Abilities
Present a professional and personable attitude and communicate effectively in stressful situations.
Demonstrate exceptional mental resilience and possess strong conflict management skills.
Possess strong written, verbal, and interpersonal communication skills.
Ability to organize and prioritize your workload to demonstrate effective time management towards meeting deadlines.
Demonstrate the strong ability to make decisions and problem solve using logical and analytical skills.
Must be reliable and capable of working independently as well with others.
Location & Commitments
Full-time office role
Reports to our Medical Claims District Claims Office: 5301 Glenwood Avenue, Raleigh.
Must obtain and maintain licensing CE in compliance with N.C. Department of Insurance and N.C. Farm Bureau Mutual Insurance Company requirements.
All offers are contingent on a Background Check.
Responsibilities of the Role
Provide prompt, timely, and professional communication for insureds and claimants.
Appraise and determine covered damages using provided resources.
Investigate losses, verify coverage, and apply policy coverage.
Determine legal liability for losses and damages.
Authorize or deny claim payments based on policy guidelines.
Evaluate and establish reserves for the possible payout amounts.
Adhere to company policies, procedures, and regulatory guidelines.
Maintain current, accurate, and detailed documentation throughout the claims process.
Ensure the protection and proper maintenance of all company equipment assigned to you.
Participate in industry-related conferences and training programs. *Certain training programs are located at the Corporate Office in Raleigh, NC.
This document is intended to outline the essential responsibilities of the position, and does not limit the tasks that may be assigned or amended by the supervisor.
$45k-58k yearly est. 4d ago
Verification Specialist
Surgery Partners Careers 4.6
Claim specialist job in Durham, NC
North Carolina Specialty Hospital (NCSH) is a private, physician-owned medical center that opened its doors in 1926. Its commitment to growth and continuous improvement has helped the hospital maintain a high ranking in both quality measures and patient satisfaction. North Carolina Specialty Hospital offers surgical specialties in orthopedics, ophthalmology, ear, nose, and throat, as well as sports medicine, oral, plastic, podiatry, general surgery, interventional radiology, pain management, reconstructive surgery, and more.
Why join North Carolina Specialty Hospital?
Award Winning Hospital for Special Surgery
5 Star CMS rated facility for patient experience
Positive Work culture
Career growth opportunities
Comprehensive Medical, Dental, Vision Insurance, Life and Disability Insurance
Paid Time Off
401k Employer Match
Tuition Assistance
JOB TITLE: Authorization & Health Information Specialist
GENERAL SUMMARY OF DUTIES:
Under the direction of the Admitting and Health Information manager, this position is responsible for verifying surgical authorizations, assisting with Performance Improvement projects, compiling statistical data, and insurance audits. In addition, the position will assist with other admission and reception duties as needed. Anticipate the needs of customers and work proactively to improve services. Work with others to improve customer satisfaction and participates in special projects as needed.
ESSENTIAL FUNCTIONS:
Verifies surgical authorizations according to established policies and procedures
Compiling statistical Data and assisting with insurance audits
Assists with reception and admission needs as necessary.
Follows all applicable laws and regulations regarding the release of information and the maintenance of medical records, including those that relate to the age and legal status of the patient.
Prioritizes work assignments and accomplishes tasks accurately and in a timely manner.
Utilizes automated processes and clinical information systems appropriately and efficiently.
Utilizes concepts of age/developmental stages in interactions with patients and families.
Adheres to all Hospital Policies and Procedures, specifically Guidelines for Appropriate Conduct, Corporate Compliance, Diversity, and Confidentiality.
Identifies potential risks to patients: identifies risks to patients in order to reduce incidence of injury; identifies actions to eliminate, minimize or report risks; identifies procedures to follow in the event of an incident; reports processes for common problems, failures and user errors.
Demonstrates the spirit of the philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment.
Applies the principles and values of customer service and continuous quality improvement while performing day-to-day activities of the position.
Maintains and protects confidentiality regarding all aspects of patient care, personnel and strategic issues.
Adheres to Confidentiality Policy.
Maintains positive working relationships and fosters cooperative work environment.
Adheres to the hospital's "Guidelines for Appropriate Conduct" in the HR Manual.
Displays honesty and mutual respect when communicating with peers and other departments.
Follows through on problems that may compromise effective job performance by using appropriate chain of command.
Complies with National Patient Safety Goals.
Universal precautions and infection control guidelines, including hand washing guidelines followed at all times.
Performs other duties as required or assigned, which are reasonably within the scope of duties in this job classification
Ability to work independently to meet established deadlines
Ability to make sound reasonable decisions
Demonstrates respect for diverse backgrounds of all patients, families and co-workers.
Seeks guidance, direction and assistance when needed.
EDUCATION:
High School or equivalent
EXPERIENCE:
Surgical authorization experience is required
SKILLS, KNOWLEDGE AND ABILITIES:
Effective communication skills; both orally and written.
Highly organized.
Computer skills needed.
Ability to work with others within a team to ensure quality patient care.
Strong problem-solving skills.
$22k-28k yearly est. 13d ago
Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim specialist job in North Carolina
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability ClaimsSpecialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$42k-64k yearly est. 30d ago
Claims Processing Expert
The Strickland Group 3.7
Claim specialist job in Raleigh, NC
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.
)