Claims administrator jobs near me - 69 jobs

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ************************** How YOU will make a Difference: The Claims Operations Manager will oversee the end-to-end processing of healthcare claims. The manager is responsible for leading the HMA Claims Operations staff and their daily work requirements. Leveraging metrics and forecasts; they prioritize workload and resourcing to maximize operational production in partnership with vendor resources and liaisons. The manager will lead a team responsible for claims intake, pricing, adjudication, coordination of benefits and issue resolution while driving operational excellence What YOU will do: Direct supervisory responsibilities: Manages and coaches individual contributor's performance and quality. Assess and manages claims inventory: Tracks and manages inventory trends and proactively adjusts resource levers as needed to maximize productivity Manage daily operations of claims processing, ensuring accuracy, timeliness, and compliance with healthcare policies and federal guidelines Create daily updates for management team flagging production rates, critical issues and areas of escalation in real time Monitor and resolve pricing discrepancies impacting claims adjudication and provider payments. Lead initiatives to improve pricing workflows, automation, and system performance. Vendor auditing &QA: Leads vendor audits and manages reporting to ensure vendor quality. Apply subject matter expertise to the business of claims processing and operations Manage to vendor agreements, proactively identify and flag issues, escalate appropriately Develop and maintain workflows and documentation specific to claims processing. Train and coach staff and vendors on claims processes as needed Motivate talent: Ability to motivate and lead team members and vendors in accordance with HMA values and objectives Talent planning: Proactively review and assess talent. Continually develop and/or recruit talent to meet objectives Requirements Knowledge, Experience and Attributes: Bachelor's Degree or equivalent work experience Minimum 5 years' of claims operations experience, self-funded health plan experience is a plus Minimum 2 years' of people leading experience Experience with claims platforms such as HealthEdge, Mphasis, or Facets Knowledge of CPT, HCPCS, ICD-10 coding, and reimbursement methodologies. Strong understanding of provider contract terms, fee schedules, and pricing models (e.g., DRG, APC, RBRVS). Proven ability to manage and develop a team of highly skilled staff Proven ability to manage and interact with vendors to support execution of work within the SLA's established Benefits Compensation: The base salary range for this position in the greater Seattle area is $100,000-$123,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.) HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit

Associate Claims Manager - Professional Liability (Dental/Medical) Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk . As member of the Claims team, you will be one of the initial users of, and key feedback providers for, our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share. This will necessitate close collaboration with Claims leadership, our internal Data and Engineering teams, and our carrier partners. YOU WILL Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you. Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution. Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters). Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards. Support our data collection efforts and models by effectively using the Counterpart claim system to fully and accurately capture critical details about each claim assigned to you. Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments. Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems. Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision. YOU HAVE At least 5 years of professional experience, with at least 2 years of experience litigating or managing dental professional liability or medical professional liability claims. Previous carrier experience is a plus. Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred. Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire. Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed. High level of personal initiative and leadership skills. Exceptional time management, problem solving and organizational skills. Comfort and skill operating in a paperless claims environment and using Microsoft Office products (Word, Excel, etc.). Additional familiarity with Google Docs Editors suite is a plus. Willingness to use creative thinking and data-driven insights to overcome obstacles to resolution. Strong communication skills, both verbal and written. Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%). WHO YOU WILL WORK WITH: Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group. Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims. Dan Dubick, Claims Manager: Dan has worked across the insurance claims industry, including medical professional liability with MAG Mutual and Fortress Insurance and automobile liability with State Farm. A licensed attorney and mediator, he has held roles spanning legal practice and claims management. Tobias Schuler, Head of Data Analytics: After becoming a Fellow of the Casualty Actuarial Society and working as a consultant actuary at EY for several years, Tobias went on to drive the actuarial data & systems teams at QBE. He further leveraged his deep insurance and technical expertise at Munich Re Digital Partners in North America, where he headed data and analytics and oversaw the data infrastructure behind some of their largest programs. Chris Shafer, Chief of Staff: Chris is a published scientific author, having studied the neural correlates of gratitude at the lauded Brain and Creativity Institute. He has since helped to launch numerous businesses in which he held a variety of critical roles from product management to business operations to strategic partnerships. Chris received his bachelor's degree in Biological Sciences from the University of Southern California. Tanner Hackett, CEO & Founder: Having founded two other major startups, including Button and Lazada, Tanner now spends his time focused on mental health through his philanthropy, Openminded.org, in addition to reading, surfing, yoga, and enjoying the outdoors. WHAT WE OFFER Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan. Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members. 401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement. Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay. Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it. Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year. Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories. Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.) Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests. Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise. No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones. Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart. COUNTERPART'S VALUES Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others. Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met. Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal. Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected. Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there. Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life. Our estimated pay range for this role is $120,000 to $160,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience. We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives. We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: A Complex Claims Manager - Construction Defect and Environmental is responsible for investigating, evaluating, and resolving insurance claims related to environmental damage, as well as claims involving General Liability (GL) and Excess Liability. This role involves analyzing coverage, assessing liability, negotiating settlements, and managing legal defense strategies, all while ensuring compliance with environmental regulations and minimizing the company's financial exposure. Additionally, the Claims Manager will collaborate with underwriting on marketing, portfolio management, and other strategic initiatives. Thoroughly investigate environmental claims, GL and Excess Liability by gathering information on the incident, site assessment, potential pollutants, and impacted parties to determine the scope of damage and liability. Review insurance policies to determine coverage applicability for environmental, general liability and excess liability claims, including policy limits and exclusions. Evaluate potential liability based on the investigation findings, legal precedents, and environmental regulations. Calculate and assign appropriate claim reserves based on the potential damages and liability assessment to accurately reflect the financial exposure. Negotiate settlements with claimants or their legal representatives to reach a fair and cost-effective resolution. Coordinate with legal counsel to manage legal defense strategies, including assigning attorneys, reviewing legal documents, and monitoring litigation progress. Manage consultants and contractors, including reviewing environmental work plans, remedial designs, and other technical aspects of environmental projects. Identify and implement cost-saving measures during the claims process, such as utilizing preferred vendors or negotiating favorable settlement terms. Investigate potential fraudulent claims related to environmental and non-environmental damages. Ensure adherence to all relevant environmental regulations and reporting requirements throughout the claims process. Maintain clear communication with policyholders, brokers, adjusters, legal counsel, and internal stakeholders regarding claim status and updates. Identify patterns and trends within environmental claims to inform risk management strategies and proactive measures. Oversee a portfolio of claims for the Environmental Division, prioritizing critical cases, and monitoring overall claim performance. Provide underwriting teams with insights on environmental risks and participate in risk assessment meetings. Collaborate on marketing strategies and contribute real-world examples for marketing materials. Analyze claims portfolio performance and recommend risk mitigation strategies. Share claims insights for new product development and refine policy language. Conduct training on claims handling and regulatory changes. Liaise between claims, underwriting, and other departments to ensure cohesive risk management. EDUCATION AND EXPERIENCE The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Bachelor's Degree required, Juris Doctorate preferred. Minimum of 5 years' experience required. CERTIFICATIONS, LICENSES, REGISTRATIONS n/a FUNCTIONAL SKILLS Extensive knowledge of environmental laws, regulations, and compliance standards. Knowledge of Construction Defect Proven experience in managing complex insurance claims, including investigation, evaluation, and resolution. Ability to analyze complex data, assess environmental impacts, and make informed decisions. Strong negotiation skills to reach favorable settlements with claimants and legal counsel. Understanding of legal principles related to environmental liability and insurance coverage. Strong interpersonal skills to build and maintain relationships with internal and external stakeholders. Ability to represent the company in market-facing activities, including client meetings, industry conferences, and networking events. General Description of Available Benefits for Eligible Employees of CRC Group: All regular teammates (not temporary or contingent workers) working 20 hours or more per week are eligible for benefits, though eligibility for specific benefits may be determined by the division of CRC Group offering the position. CRC Group offers medical, dental, vision, life insurance, disability, accidental death and dismemberment, tax-preferred savings accounts, and a 401k plan to teammates. Teammates also receive no less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during their first year of employment, along with 10 sick days (also prorated), and paid holidays. Depending on the position and division, this job may also be eligible for restricted stock units, and/or a deferred compensation plan. As you advance through the hiring process, you will also learn more about the specific benefits available for any non-temporary position for which you apply, based on full-time or part-time status, position, and division of work. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative. WE ARE THE KIND OF EMPLOYER YOU DESERVE. Illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases. Reviews internal databases, client guidelines, and policy contract language to evaluate routine home and facility-based claims, in accordance with department processes and standards. Communicate clearly and routinely with claimants, representatives, third parties, physicians, and other health care providers as needed. Demonstrated interviewing skills which include the professional judgment to probe as necessary to uncover underlying concerns from the claimant or representative. Queries service providers to obtain licensure information, proof of loss, and dates of service. Verifies that provider and/or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers. Keeps clear and concise documentation of all claim activity within the required databases. Creates plans of care and refers for review and Chronic Illness Certification as appropriate. Uses time effectively to achieve expected productivity and efficiency. Demonstrates ability to prioritize workload. Performs work accurately and efficiently under deadline pressures. Always provides prompt, courteous and excellent customer service to internal and external customers Demonstrates effective communication skills, level of attentiveness, and use of appropriate lines of authority. Promptly shares accurate and complete information to others who need it, based on HIPAA and legal documents regarding release. Attends or is responsible for information provided at meetings and through other organizational channels. Maintains appropriate organizational confidentiality. Communicates with other team members and management on cases as needed. Meets quality and production metrics as established and communicated by the department. Works independently and seeks assistance as appropriate.

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role As a Claims Manager at Reserv, you will be responsible for a team of claims professionals managing claims in multiple LOBs. We want your background and experience to deliver operational effectiveness, particularly in leveraging technology and analytics to drive better efficiencies and performance. You will serve a critical role with the team, the customers, and the client. The high-performing team you will manage will service several clients as part of our Core Team. You will maintain high quality standards, and compliance with regulatory, internal, and external contractual SLAs. This position requires exceptional leadership skills, and foundational understanding of claims ideally with experience handling and/or managing multi lines of business. Who you are Highly motivated and growth-oriented Subject matter expert. You have deep technical and subject matter experience in the world of commercial transportation claims, including coverage and litigation. Experienced in reviewing and analyzing contracts Tech-oriented. You are excited by the prospect of building a tech-driven claims organization while delivering an excellent service and have proven results leveraging technology and analytics Passionate claims professional who cares about their team, the customer, and their experience Empathetic leader. You exercise empathy and patience towards everyone you interact with Sense of urgency - at all times. That does not mean working at all hours Creative. You challenge existing assumptions and find ways of leveraging technology and the talents of your team to address problems Curious. You want to know the whole story so you can make the right decisions early and be decisive when it counts. Problem solver. You have the ability to take a ‘deep dive' into the details of the business while staying focused on the big picture Anti-status quo. You don't just wish things were done differently, you action on it Communicative. You are comfortable with and understand the importance of phone communications throughout the claims process And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Manage a team of team leads and adjusters managing a mix of accounts and lines of business Be consistently dependable in achieving or exceeding goals and overcoming obstacles Implement and maintain best practices for claims handling, including: claim intake, investigation, evaluation, settlement, and recovery Monitor and analyze claims data to identify trends, patterns, and areas for process improvement Align team with client and customer expectations of the claims process Serve as a resource for escalated claims Responsible for accuracy and adequacy of all aspects of claim reserving Develop and implement strategies to mitigate fraudulent claims and ensure compliance with legal and regulatory requirements Foster a positive work environment, promote teamwork, and encourage professional growth and development Execute on performance management; attract, hire, retain and provide high level of training Collaborate with internal teams, such as Account Management, Compliance, and Claim Operations, to resolve complex or escalated claims-related issues Establish and maintain strong relationships with external stakeholders, including policyholders, agents, brokers, and legal representatives Prepare and present comprehensive claims reports, metrics, and analysis to clients and customers; advise clients on claim trends and loss mitigation Requirements Bachelor's degree in insurance, business administration, or a related field; relevant certifications (e.g., CPCU, AIC) are a plus Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license 10+ years in insurance claims management experience in multiple lines of business, preference for property, general liability and/or auto with bodily injury experience 5+ years management experience with preference for experience managing in a remote environment Comfortable with technology and the ability to evolve the claims systems and processes to drive better efficiencies and outcomes Demonstrated commitment to quality, accuracy, and attention to detail Integrity, ethics, and a strong sense of accountability in handling confidential and sensitive information Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

The SouthState story is one of steady growth, deep community roots, and an unwavering commitment to helping our customers move forward. Since our beginnings in the 1930s to becoming a trusted financial partner across the South and beyond - we are known for combining personal relationships with forward-thinking solutions. We are committed to helping our team members find their success while maintaining the integrity of our values: building trust, fostering lasting relationships and pursuing excellence. At SouthState, individual contributions are recognized, potential is cultivated and team members are inspired to achieve their greater purpose. Your future begins here! SUMMARY/OBJECTIVES This position is primarily responsible for handling Government Lending Guaranty Claims. This position must possess a strong knowledge of loan credit review, loan documentation, and loan compliance. This individual must also be able to identify issues and provide workable solutions, in addition to answering questions, regarding loan file documentation, loan exceptions, loan status, and other related loan issues. This position may also include special projects and other duties that are essential in delivering excellent service and maintaining the data integrity of their function. ESSENTIAL FUNCTIONS Manager functions as coordinator for compiling comprehensive claims on government guaranteed loans that have failed and where the bank is seeking reimbursement on the guaranteed portion of the loan. Facilitates strict compliance with government requirements and performs a detailed analysis of each failed loan. This position requires extensive industry knowledge in a variety of disciplines including originating, underwriting, portfolio management and workout experience to strategically craft a compelling case for honoring the guaranty. Must be able to analyze and identify claim vulnerabilities and pre-emptively determining proper responses, (rationale) to mitigate the chances of a monetary repair on the claim or a full denial of the claim. Recognizes problem areas and carefully articulates steps that the bank took to either correct or mitigate the impact of these issues. The Manager submits the approved claim package to the government and serves as the primary point of contact for the agency on requests for additional information or clarification of documentation submitted. Completed claim packages are reviewed in a tiered approval format that adds additional reviewers based upon the size of the claim. Manager submits claims once the appropriate internal approval is obtained. Manager must respond to the government quickly and thoroughly requiring both efficiency and skill to accurately understand the nature of the request and quickly provide supplementary information in a timely manner. Manager will be responsible to attend and complete all Training as defined by Management. Manager will be responsible to follow and adhere to SouthState Banking and compliance policies. Manager will be responsible to Report to manager any compliance banking policies violations found in your daily workflow. Manager will be responsible to keep the SAM Governance and Practices Manager or Director of Special Assets apprised of any issues that may result in a claim repair or denial. Manager will be responsible to help with all document's exceptions from time to time. Manager will be responsible to research and respond to audit requests related to all loans as needed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. COMPETENCIES Ability to work in PCFS Loan Manager, Excel, Word, Adobe, ETRAN, Navigator Fiserv. Must have knowledge of the SBA's most recent SOP servicing release. Must be capable of working independently. Qualifications, Education, and Certification Requirements Education: High School and some College Experience: Minimum of 5 years' experience in SBA Certifications/Specific Knowledge: SBA Loan Servicing SOP processes & procedures TRAINING REQUIREMENTS/CLASSES Included, but not limited to required SouthState Bank, NA annual compliance training, New Employee Orientation and continued SBA SOP training. PHYSICAL DEMANDS Must be able to effectively access and interpret information on computer screens, documents, reports, and cash denominations, and identify customers. This position requires a large amount of time in front of a computer. This can be done sitting or standing with use of the right desk. WORK ENVIRONMENT This position is 100% remote. Candidate must have a secure home office environment that is free from background noise and distractions. They must also have a reliable private internet connection that is not supplied by use of cellular data (hot spot). Cable or fiber connections are preferred. Requirements are subject to change, as new systems and technology are delivered. Travel may be required to come to meetings as needed. Equal Opportunity Employer, including disabled/veterans.

Catastrophe (CAT) Claims Manager Remote At Frontline Insurance, we are on a mission to Make Things Better, and our Catastrophe (CAT) Claims Manager plays a pivotal role in achieving this vision. We strive to provide high quality service and proactive solutions to all our customers to ensure that we are making things better for each one. What makes us different? At Frontline Insurance, our core values - Integrity, Patriotism, Family, and Creativity - are at the heart of everything we do. We're committed to making a difference and achieving remarkable things together. If you're looking for a role, as a Catastrophe (CAT) Claims Manager, where you can make a meaningful impact and grow your career, your next adventure starts here! Our Catastrophe (CAT) Claims Managers enjoy robust benefits: Full Time Remote Position! Health & Wellness: Company-sponsored Medical, Dental, Vision, Life, and Disability Insurance (Short-Term and Long-Term). Financial Security: 401k Retirement Plan with a generous 9% match Work-Life Balance: Four weeks of PTO and Pet Insurance for your furry family members. What you can expect as a Catastrophe (CAT) Claims Manager: Responsible for management of claims adjusters to ensure that catastrophe claims are handled in a timely and effective manner. Ensure that claims are handled in accordance with the available coverage and that applicable procedures, laws and regulations are followed. Oversee a team of claim handlers and provide feedback to team members on a regular basis regarding the status of their goals and performance. Participate in the development and monitoring of Frontline's catastrophe claim operations Maintain effective communication with other departments including Underwriting, Sales and Information Technology. What we are looking for as a Catastrophe (CAT) Claims Manager: Bachelor's degree in a related field required Minimum of 5 years of claims experience Must possess and maintain Adjuster's Licenses in all states Frontline does business within 90 days of employment Must be able to travel via commercial or personal transportation to CAT sites, as need, to support and/or manage the catastrophe response, within their area of responsibility. Why work for Frontline Insurance? At Frontline Insurance, we're more than just a workplace - we're a community of innovators, problem solvers, and dedicated professionals committed to our core values: Integrity, Patriotism, Family, and Creativity. We provide a collaborative, inclusive, and growth-oriented work environment where every team member can thrive. Frontline Insurance is an equal-opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. LI-REMOTE LI-AK1

OverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing cutting-edge technologies such as artificial intelligence and machine learning, crossed with the knowledge and experience of our small team of EDPNA's and case managers. We are seeking a Claims Assistant to play a key role in ensuring smooth case management and operational support at Advocate. In this position, you will handle a variety of important administrative tasks, from managing incoming communication to scheduling appointments for case managers. You'll ensure that our administrative processes flow efficiently, contributing directly to the success of our mission. If you're organized, detail-oriented, and enjoy working in a fast-paced environment, this could be the perfect opportunity for you to make a meaningful impact.Job Responsibilities Ensure the Social Security Administration (SSA) has processed representative forms and provided access to Electronic Records Express (ERE). Manage a high volume of incoming mail as the company continues to grow. Handle calls and texts to the client care team's dedicated 888 line. Schedule appointments for case managers to keep operations on track. Request medical source statements and assist with other administrative tasks to ensure smooth process flow. Qualifications Strong administrative and clerical skills are essential. Prior experience with Social Security disability is preferred but not required. Highly organized and capable of managing multiple tasks efficiently. Strong attention to detail and task-oriented mindset. Ability to thrive in a fast-paced and growing work environment. This is a remote position and Advocate is currently a fully remote team. Advocate is an equal opportunity employer and values diversity in the workplace. We are assembling a well-rounded team of people passionate about helping others and building a great company for the long term.

Insight Global's partner in the Healthcare Technology space is searching for a Remote Claims Settlement Coordinator to join their team for a 6-Month Contract. This individual will support the Claims Settlement Team to manage disputed claims filed through arbitration. This role focuses on preparing and presenting settlement offers, supporting pricing decisions, and compiling data and arguments. Additional responsibilities include: - Prepare and submit arbitration and mediation responses under the No Surprises Act (NSA). - Help choose certified arbitration entities. - Improve and automate the process for creating defense packages. - Make sure all required information is included for arbitration cases. - Provide monthly performance reports to leadership. - Ensure documentation meets privacy, compliance, legal, and HIPAA standards. - Track deadlines to keep cases on schedule and compliant. - Handle other tasks as needed We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements HS Diploma or Associates Degree 3+ years of experience in Healthcare, Health Insurance, or Healthcare Compliance 1+ years of experience processing claims Professional experience handling arbitration, mediation, or contract negotiation Professional experience with MS Office products Bachelors Degree Experience with OnBase Background in Healthcare Collections, Provider Billing, Negotiations, or Compliance

The SouthState story is one of steady growth, deep community roots, and an unwavering commitment to helping our customers move forward. Since our beginnings in the 1930s to becoming a trusted financial partner across the South and beyond - we are known for combining personal relationships with forward-thinking solutions. We are committed to helping our team members find their success while maintaining the integrity of our values: building trust, fostering lasting relationships and pursuing excellence. At SouthState, individual contributions are recognized, potential is cultivated and team members are inspired to achieve their greater purpose. Your future begins here! SUMMARY/OBJECTIVES This position is primarily responsible for handling Government Lending Guaranty Claims. This position must possess a strong knowledge of loan credit review, loan documentation, and loan compliance. This individual must also be able to identify issues and provide workable solutions, in addition to answering questions, regarding loan file documentation, loan exceptions, loan status, and other related loan issues. This position may also include special projects and other duties that are essential in delivering excellent service and maintaining the data integrity of their function. ESSENTIAL FUNCTIONS * Manager functions as coordinator for compiling comprehensive claims on government guaranteed loans that have failed and where the bank is seeking reimbursement on the guaranteed portion of the loan. * Facilitates strict compliance with government requirements and performs a detailed analysis of each failed loan. * This position requires extensive industry knowledge in a variety of disciplines including originating, underwriting, portfolio management and workout experience to strategically craft a compelling case for honoring the guaranty. * Must be able to analyze and identify claim vulnerabilities and pre-emptively determining proper responses, (rationale) to mitigate the chances of a monetary repair on the claim or a full denial of the claim. * Recognizes problem areas and carefully articulates steps that the bank took to either correct or mitigate the impact of these issues. * The Manager submits the approved claim package to the government and serves as the primary point of contact for the agency on requests for additional information or clarification of documentation submitted. * Completed claim packages are reviewed in a tiered approval format that adds additional reviewers based upon the size of the claim. Manager submits claims once the appropriate internal approval is obtained. * Manager must respond to the government quickly and thoroughly requiring both efficiency and skill to accurately understand the nature of the request and quickly provide supplementary information in a timely manner. * Manager will be responsible to attend and complete all Training as defined by Management. * Manager will be responsible to follow and adhere to SouthState Banking and compliance policies. * Manager will be responsible to Report to manager any compliance banking policies violations found in your daily workflow. * Manager will be responsible to keep the SAM Governance and Practices Manager or Director of Special Assets apprised of any issues that may result in a claim repair or denial. * Manager will be responsible to help with all document's exceptions from time to time. * Manager will be responsible to research and respond to audit requests related to all loans as needed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. COMPETENCIES * Ability to work in PCFS Loan Manager, Excel, Word, Adobe, ETRAN, Navigator Fiserv. Must have knowledge of the SBA's most recent SOP servicing release. Must be capable of working independently. Qualifications, Education, and Certification Requirements * Education: High School and some College * Experience: Minimum of 5 years' experience in SBA * Certifications/Specific Knowledge: SBA Loan Servicing SOP processes & procedures TRAINING REQUIREMENTS/CLASSES Included, but not limited to required SouthState Bank, NA annual compliance training, New Employee Orientation and continued SBA SOP training. PHYSICAL DEMANDS Must be able to effectively access and interpret information on computer screens, documents, reports, and cash denominations, and identify customers. This position requires a large amount of time in front of a computer. This can be done sitting or standing with use of the right desk. WORK ENVIRONMENT This position is 100% remote. Candidate must have a secure home office environment that is free from background noise and distractions. They must also have a reliable private internet connection that is not supplied by use of cellular data (hot spot). Cable or fiber connections are preferred. Requirements are subject to change, as new systems and technology are delivered. Travel may be required to come to meetings as needed. Equal Opportunity Employer, including disabled/veterans.

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job Purpose The Claims Clerk plays a vital role in supporting the claims team by handling daily administrative tasks, including reviewing and responding to claims portal messages, processing incoming faxes, and organizing documentation. This position ensures efficient communication and smooth workflow within the department, helping to maintain timely and accurate claims processing. Duties and responsibilities Monitor and respond to claims portal messages daily. Assist Customer Service department with portal registrations. Process and categorize incoming claims-related faxes. Assist with Claims related inquiries from other departments. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Serve as a primary point of contact for providers, members, and internal staff regarding claims status, documentation requirements, and resolution steps. Respond to inbound claims phone calls, emails, and portal inquiries in a professional and timely manner. Provide clear explanations of claim outcomes, payment decisions, and next steps while maintaining a high level of customer service. Research and resolve claim-related issues by gathering information, reviewing documentation, and escalating as needed. Document all interactions in the system to ensure accurate records of customer communications and resolutions. Must maintain an error accuracy of under 5%. Support claims examiners and workflow projects. Attend weekly or monthly departmental meetings and provide feedback when requested. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit activities. Support other departments as needed. All other duties as assigned. Qualifications Experience in administrative support, claims processing, or a related field preferred. Excellent communication skills including reports, correspondence, and verbal communications. Experience with EZ-Cap and Encoder preferred. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving. Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Must work well under pressure and deadlines.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates residential and commercial contents inventories obtained by or submitted to VeriClaim on both a Replacement Cost and Actual Cash Value (ACV) basis. Applies limitations and/or exclusions on claims based on coverage afforded by the policy. Tracks time and log file notes for daily field activity. Assists with answering telephones. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS: Education & Licensing High school diploma or GED required. Resident Insurance Adjuster License (Fire and Other Hazards) preferred. Experience One (1) year customer service experience or equivalent combination of education and experience preferred. Accounting and insurance background preferred. Skills & Knowledge Oral and written communication skills PC literate, including Microsoft Office products Good comprehensive decision making skills Ability to read and comprehend policy language Ability to work in a team environment Ability to meet or exceed Performance Competencies

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply. Work Schedule Remote Monday through Friday, 8:30 AM to 5:00 PM EST Must be able to work 8am - 5pm Eastern Standard Time Responsibilities Claims Review and Processing Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. Critical Analysis Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. Timely Processing Ensure prompt claims processing to meet client standards and regulatory requirements. Identify and resolve any barriers using effective problem-solving strategies. Issue Resolution Collaborate with internal departments to proactively resolve discrepancies and issues. Use analytical skills to identify root causes and implement solutions. Confidentiality Maintenance Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. Detailed Record Keeping Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. Trend Monitoring Analyze and report trends in claim issues or irregularities to management. Assist Team Leads with reporting to contribute to continuous process improvements. Audit Participation Engage in audits and compliance reviews to ensure adherence to internal and external regulations. Critically evaluate and recommend process improvements when necessary. Mentoring Mentor and train new claims processors as needed. Requirements High school diploma or equivalent. Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. Billing experience doesn't count towards years of experience qualification Familiarity with ICD-10, CPT, and HCPCS coding systems. Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker's compensation claims is a plus). Strong attention to detail and accuracy. Ability to interpret and apply insurance program policies and government regulations effectively. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Ability to work independently and collaboratively within a team environment. Commitment to ongoing education and staying current with industry standards and technology advancements. Experience with claim denial resolution and the appeals process. Ability to manage a high volume of claims efficiently. Strong problem-solving capabilities and a customer service-oriented mindset. Flexibility to adjust to the evolving needs of the client and program changes. Benefits 401(k) with employer matching Health insurance Dental insurance Vision insurance Life insurance Flexible Paid Time Off (PTO) Paid Holidays What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Shape Your Future With UsGeneral Re Corporation, a subsidiary of Berkshire Hathaway Inc., is a holding company for global reinsurance and related operations, with more than 2,000 employees worldwide. It owns General Reinsurance Corporation and General Reinsurance AG, which conducts business as Gen Re. Gen Re delivers reinsurance solutions to the Life/Health and Property/Casualty insurance industries. Represented in all major reinsurance markets through a network of 38 offices, we have earned superior financial strength ratings from each of the major rating agencies. Gen Re currently offers an excellent opportunity for a Claims Manager in our Life Health Global Claims unit to work remotely based out of our Stamford, CT office. Role Description The Claims Manager in Life Global Claims oversees the unit claims business, including the protection of Gen Re's fiduciary interest. The incumbent is an expert claims resource with comprehensive claim knowledge and experience. Managerial duties include hiring as well as overseeing performance and development of employees. As a senior claim resource, the incumbent also acts as a teacher, developer, mentor and leader in the Unit and the claims department. Responsibilities: Human Resources: The Claims Manager completes performance appraisals, provides salary planning recommendations and implements training/educational plans for the Unit. Additionally, the incumbent manages the interviewing, hiring and performance management. Claims Leadership & Expertise: The Claims Manager is expected to demonstrate superior analytical and claim handing skills and to have strong knowledge of changes in case law, jurisdictions, coverage, and recognition of exposures for timely financial reporting purposes. The Claims Manager acts as a senior resource, teacher and technical claim advisor to the team and others within the Global Claims LH Organization. Performance Standards & Goals: The Claims Manager is expected to set the tone for the unit's performance via team and individual goals and client centric activity. Existing and potential future client relationship management, trend analysis and proactive inventory management, along with the establishment of and adherence to proper claim controls is the responsibility of the Claims Manager. The incumbent also is responsible for the development and implementation of process improvements and workflow within the product lines assigned. Professional Development: The Claims Manager oversees the professional development of the staff. The incumbent ensures individuals have the necessary skills and developmental opportunities to continually meet the business needs of the Unit, Department and Division. Unit Management: The Claims Manager coordinates all administrative and procedural aspects of the Unit. The incumbent acts as the unit champion and fosters a supportive and results oriented environment. As the unit leader, incumbent manages the unit in accordance with all Gen Re policies, procedures, philosophies, and goals. Regulatory: The Claims Manager is responsible for ensuring overall compliance with various reporting and auditing of controls. Claim Management Reporting: The Claims Manager partners with his/her internal constituents to ensure claims data collected is analyzed and claim statistics reported to senior management in a timely, proactive, consolidated and solution-oriented fashion. Responsible for managing multiple work streams and influencing a variety of constituents at various levels, not solely within one's direct employ. Accountable for the effective development, ongoing maintenance and consistent application of client communications and relationships. The Claims Manager is a client facing position with accountability to ensure his/her staff is visible and present in the reinsurance work performed. Flexibility to travel frequently and on short notice. Incumbent ensures appropriate representation occurs in the industry conference work that may require committee representation, networking with client, hosting client events oriented at the claims discipline, effective delivery of presentation material and travel on short notices. Role Qualifications and Experience Prior experience managing claims and people. Broad understanding of insurance/reinsurance life cycle and intersection with claims. Ability to perform complex multitasking with short/medium/long term deadlines - with need for contingencies. Analytical, strategic, and organized thinker with demonstrated ability to deliver results. Proven ability to develop staff, resource allocation and planning. Exposure to managing people and claims in multiple products lines. Demonstrated leadership abilities. Highly refined analytical skills and business acumen. Demonstrated abilities to operate strategically or tactically depending on the situation at hand. Strong claim technical abilities. Prior experience with claim audit activity. Audit work of reinsured claims in client locations is an expectation. The audit process requires the ability to quickly adapt to the multitude of imaged systems in use by clients. The audit process may involve analyzing and verifying coverage and/or corresponding payments issued. The audit process may consist of managing internal and external communication with client executives in various areas such as claims, financial and legal resources, actuarial resources, etc. Thus, demonstrating an ability to emphasize and implement solutions to help clients manage risk and developing an in-depth knowledge of the management and organization of each assigned account. Exceptional communication and presentation skills. Ability to work as a member of a team or independently. Similarly, strong oral and written communication skills are required. Proven ability to analyze and problem solve client needs, system failures and strategy projections. College degree (preferred) or equivalent work experience Salary Range 155,000.00 - 259,000.00 USD The annual base salary range posted represents a broad range of salaries around the US and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Our Corporate Headquarters Address General Reinsurance Corporation 400 Atlantic Street, 9th Floor Stamford, CT 06901 (US) At General Re Corporation, we celebrate diversity and are committed to creating an inclusive environment for all employees. It is the General Re Corporation's continuing policy to afford equal employment opportunity to all employees and applicants for employment without regard to race, color, sex (including childbirth or related medical conditions), religion, national origin or ancestry, age, past or present disability , marital status, liability for service in the armed forces, veterans' status, citizenship, sexual orientation, gender identity, or any other characteristic protected by applicable law. In addition, Gen Re provides reasonable accommodation for qualified individuals with disabilities in accordance with the Americans with Disabilities Act.

Location: Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Process Expert II supports the claims issue research and resolution for Home & Community Based Services (HCBS) by participating in project and process work. How you will make an impact Primary duties may include, but are not limited to: * Researches operations workflow problems and system irregularities. * Develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements. * Develops and leads project plans and communicates project status. Minimum Qualifications: * Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: * Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred. * Claims issue research and resolution for Home & Community Based Services (HCBS) highly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $66,880.00 to $100,320.00. Location(s): Columbus, OH. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: BSP > Process Improvement Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Process Expert II supports the claims issue research and resolution for Home & Community Based Services (HCBS) by participating in project and process work. How you will make an impact Primary duties may include, but are not limited to: Researches operations workflow problems and system irregularities. Develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements. Develops and leads project plans and communicates project status. Minimum Qualifications: Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred. Claims issue research and resolution for Home & Community Based Services (HCBS) highly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $66,880.00 to $100,320.00. Location(s): Columbus, OH. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: BSP > Process Improvement Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Are you looking for an opportunity to join a claims team with a fast growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available for a Workers Compensation Claims Technician. Claims Technicians obtain essential information in order to process routine workers' compensation claims with on-going medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identify potential problems and make claim referral decisions. GRS North America Claims is excited to announce our go forward strategy to provide employees with the flexibility to include an option to work from home full-time. Candidates who are selected for this position will be trained remotely. You will be required to go into the office twice a month if you reside within 50 miles of one a specified office. Please note this policy is subject to change. Responsibilities: Conduct investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with claim specific on-going medical management. Provides on-going medical case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and medical treatment. Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Arranges Independent Medical Exam and Peer Review as necessary. Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers). Authorizes payment of medical payments and/or medical treatment. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units. Qualifications High school diploma plus 1-3 years' of related customer service experience or applicable insurance knowledge. Licensing required in some states. Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

The Claims Quality Review Technician is responsible for performing detailed quality reviews of processed claims to ensure accuracy and compliance with eligibility rules, benefits paid, client requirements and applicable legislative and regulatory guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Reviews processed claims, including hospital, medical, dental, vision, prescription and time loss to confirm accuracy and appropriate adjudication of benefits. Identify and document quality trends, provide feedback, and assist management in monitoring processing performance against established standards. Reviews and interprets new benefit plans and/or benefit plan changes, develops resource materials and acts as a resource for staff. Conducts training for new and current employees on claims adjudication, contract language, benefit interpretation, claims QR process and departmental procedures. Collaborate with internal partners to resolve complex claim issues and support continuous improvement. Performs other duties as assigned. Minimum Qualifications High school diploma or GED required 5+ years of related experience, including claims processing, training and/or claims quality review. Strong understanding of claims processing guidelines and benefit plan structures, and regulatory requirements. Demonstrated analytical, research, and problem-solving abilities with strong attention to detail. Working knowledge of CPT, HCPC and ICD-10 coding Proficiency in Microsoft Word, Excel and Outlook. Preferred Qualifications Experience working in a Taft-Hartley environment Prior quality assurance or audit -focused experience Familiarity with automated claims platforms. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring, the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. NTT DATA is seeking to hire a **Remote Claims Processing Associate** to work for our end client and their team. **NOTE** : This is a US based, W-2 project. All candidates will be paid through NTT DATA only. Pay Rate: $18/hr 100% Remote, we provide equipment **In this Role the candidate will be responsible for:** + Processing of Professional claim forms files by provider + Reviewing the policies and benefits + Comply with company regulations regarding HIPAA, confidentiality, and PHI + Abide with the timelines to complete compliance training of NTT Data/Client + Work independently to research, review and act on the claims + Prioritize work and adjudicate claims as per turnaround time/SLAs + Ensure claims are adjudicated as per clients defined workflows, guidelines + Sustaining and meeting the client productivity/quality targets to avoid penalties + Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as priority work + Correctly calculate claims payable amount using applicable methodology/ fee schedule **Requirements:** + 1-3 year(s) hands-on experience in **Healthcare Claims Processing** + 2+ year(s) using a computer with Windows applications using a keyboard, **navigating multiple screens and computer systems, and learning new software tools** + High school diploma or GED. + **Previously performing - in P&Q work environment; work from queue; remotely** + Key board skills and computer familiarity - + **Toggling back and forth between screens** /can you navigate multiple systems. + Working knowledge of MS office products - Outlook, MS Word and **MS-Excel** . + Must be able to work **7am - 4 pm CST** online/remote (training is **required on-camera** ). + Effective **troubleshooting where you can leverage your research, analysis and problem-solving abilities** + **Time management with the ability to cope in a complex, changing environment** + **Ability to communicate (oral/written) effectively** in a professional office setting **Preferred Skills & Experiences:** + Amisys &/or Xcelys Preferred **About NTT DATA** NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long-term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at us.nttdata.com (************************* Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $18.00/hour. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. NTT DATA endeavors to make ********************** (**********************/en) accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at **********************/en/contact-us . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here (**********************/en/compliance#eeos) . If you'd like more information on your EEO rights under the law, please click here (**********************/en/compliance#know-your-rights) . For Pay Transparency information, please click here (**********************/en/compliance#ppnp) .