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Claims analyst full time jobs

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  • SCADA Analyst

    Percentchase Hirecruiters

    New Albany, OH

    Job Title: DMS/EMS/SCADA Analyst (Onsite) Duration: 12-month contract (W2 only) Schedule: Mon-Fri, 8am-5pm (OT as needed) Travel: ~5% to Gahanna, OH Possibility of conversion | No sponsorship About the Role We are seeking a DMS/EMS/SCADA Analyst to support real-time operational systems for Distribution and Transmission Operations. This role is 100% onsite and requires hands-on experience with SCADA, DMS, or EMS systems in an electric utility environment. Responsibilities Maintain and support DMS/EMS/SCADA systems and real-time data interfaces Build and maintain SCADA models, on-line displays, and tools Support RTU modeling, configuration, checkout, and commissioning Troubleshoot SCADA technical issues and provide after-hours support when needed Improve system reliability, data quality, and SCADA processes Assist Protection & Control Engineering with SCADA standards and configuration Participate in small/medium SCADA project scoping Train and support junior analysts Minimum Qualifications Associate Degree in Computer Science, Electrical Engineering, Telecommunications, or related field OR High school diploma + 5 years DMS/EMS/SCADA experience OR Bachelor's Degree + 1 year DMS/EMS/SCADA experience 3+ years experience with DMS/EMS/SCADA systems (utility preferred) Strong skills in: Application development OS support System administration Database technologies (any 2 required) Required Skills Hands-on experience with SCADA systems Understanding of real-time operations and field equipment Experience with RTUs, I/O settings, alarms, and communication protocols Strong troubleshooting, communication, and organizational skills Ability to work onsite full-time and support occasional after-hours issues Preferred Skills Experience with TOPS SCADA Knowledge of Protection & Control (P&C) applications Familiar with legacy communication technologies (async/sync)
    $57k-79k yearly est. 1d ago
  • Claims Supervisor

    Corvel Enterprise Claims, Inc. 4.7company rating

    Dublin, OH

    Job Description The Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a Hybrid role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides technical and jurisdictional guidance to claims staff regarding complex compensability, investigation, litigation issues and service account instructions Acts as a liaison by recommending and executing final resolutions for clients and employees concerning claim-specific, procedural, or special requests Participate in customer claim reviews and presentations Ability to travel overnight and attend meetings if required Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to assist team members to develop knowledge and understanding of claims practice Effective quantitative, analytical and interpretive skills Strong leadership, management and motivational skills Demonstrated, strong customer service skills Maintains composure under pressure and communicates diplomatically across various channels, including telephone, email, and written correspondence Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to work both independently and within a team environment Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Demonstrated public speaking skills Minimum of 5 years' claims handling experience Knowledge of WC required Current license or certification in Workers' Compensation must be maintained throughout employment with CorVel Self-Insured Certificate preferred State Certification as an experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $71, 696 - $110,701 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Hybrid
    $71.7k-110.7k yearly 2d ago
  • Entry Level Vibration Analyst

    I-Care USA 4.8company rating

    Columbus, OH

    Responsible for maintaining a full time on site Condition Monitoring services ensuring quality and customer satisfaction. Candidate is responsible for scheduling work as necessary as well as reporting metrics, KPIs that accurately reflect the performance, progress, reports and findings as required by the client and I-care. The Manager is also accountable for developing and updating SOP's, internal audits, overall safety, including ensuring compliance with all I-care, client, OSHA, and all other applicable standards to the facility that they are servicing, be a technical resource to the client and I-care employees in troubleshooting PdM and lubrication-related issues and perform and oversee specific projects as assigned. ESSENTIAL FUNCTIONS AND BASIC DUTIES 1. Leads condition monitoring program setup or for clients as required, including but not limited to: a. Building and maintaining CM technology databases to applicable I-care and client-required standards. 2. Responsible for communication and education between the company and clients, including but not limited to: a. Communicating the I-care deliverables to the client. b. Conduct technology awareness sessions for clients as requested. c. Submit documented case studies for customers to support machine life cycle improvement. d. Must be able to interact comfortably, gain trust, and communicate effectively. 3. Responsible for necessary auditing, metrics and reporting, including but not limited to: a. Ensuring all databases are in compliance with current applicable standards. b. Managing all database changes. c. Lead Management of Change (MOC) process adherence. e. The accuracy and timeliness of all internal and external communications and reporting. f. Nuisance alarm management. 4. Responsible for the overall safety awareness of the work environment. a. Ensuring compliance with I-care, client, OSHA, and other applicable standards. b. Actively participates in I-Care and client safety programs to foster continuous improvement. c. Issue a “Stop Work” action if any situation, environment, or condition is an immediate concern of injury to himself or others. If it is not safe then do not perform the work until a safe method or condition exists, period. 5. Mentoring - A few of the activities in the area of Mentoring will include, but are not limited to: a. Assist in training/mentoring of I-Care employees. b. Able to convey obtained knowledge from seminar/training sessions. 6. Performs Condition Monitoring and Reporting of equipment. Condition Monitoring responsibilities include but are not limited to: a. Collect technology data in accordance with I-Care and best practice industry standards. b. Maintains technology databases with current information. e. Reports results in a clear concise manner following all I-Care and/or client procedures for content. 7. Other Responsibility a. Performs special projects as assigned. Work on call and/or overtime as needed and required. b. Ensures that the work area and all I-Care and/or client-supplied equipment are clean, secure, and well maintained. _______________________________________________________________________________________ GENERAL PERFORMANCE MEASUREMENTS 1. Technical - verifies accurate analysis and reporting of technology data, reports are accurate, and neat, and assignments are completed as scheduled. 2. All inquiries are courteously attended to. Good business relations exist with I-Care employees and clients. A professional image is projected at all times. 3. Work is performed safely and the employee actively participates in continuous improvement of the safety programs. Work areas and equipment are kept neat, clean, and well organized. QUALIFICATIONS EDUCATION/CERTIFICATION: High school graduate or equivalent, College Graduate preferred in technology or engineering field. ASNT-TC1A or ASNT-CP189 Professional Certification Level 2, or ISO Category 3, or industry equivalent. REQUIRED KNOWLEDGE: Mechanical CM Analyst: machinery fundamentals including pumps, motors, gearboxes, blowers, compressors, switchgear, etc. Knowledge of mechanical fundamentals, such as fits and tolerances. Detailed knowledge of data acquisition techniques utilizing Vibration Analyzers, Ultrasound. Working knowledge of other condition-monitoring technologies. Electrical CM Analyst: knowledge of electrical fundamentals including: switchgear, fuses, disconnects, cable, torquing of fasteners, transformers, etc. Knowledge of data acquisition techniques utilizing Infrared Cameras, Ultrasound, Motor Testing Equipment. Working knowledge of other condition-monitoring technologies. EXPERIENCE REQUIRED:3 or more years of direct related experience. SKILLS/ABILITIES: Good communication skills, both oral and written. Proficient computer skills, including but not limited to Windows, Word, and Excel. Solid analytical and problem-solving abilities. Able to work well independently.
    $65k-83k yearly est. 60d+ ago
  • Bilingual (Spanish) Account Examiner 2 - 20067469

    Dasstateoh

    Columbus, OH

    Bilingual (Spanish) Account Examiner 2 - 20067469 (250009A1) Organization: Workers' CompensationAgency Contact Name and Information: ********************** Unposting Date: Dec 19, 2025, 11:59:00 PMWork Location: William Green Building 30 West Spring Street Columbus 43215-2256Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $22.96Schedule: Full-time Work Hours: 8:00 - 5:00Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Accounting and FinanceTechnical Skills: Customer ServiceProfessional Skills: Attention to Detail, Customer Focus, Responsiveness Agency OverviewA Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries. Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.Our Vision:To transform BWC into an agile organization driven by customer success.Our Mission:To deliver consistently excellent experiences for each BWC customer every day.Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.I have worked at several state agencies and BWC is the best place to work.Best place to work in the state and with a sense of family and support.I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!Job DescriptionBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. What You'll Be Doing: · Provides assistance to walk-in customers at the service office front counter. · Responds to written & telephone inquiries from public & private employers regarding coverage issues. · Monitors, reviews, & establishes coverage on business accounts for private & public employers. · Determines if employer is amenable to O.R.C. Section 4123.01 prior to effective date of coverages. · Examines & processes annual employer payroll reports & processes true-up reporting or amended true-up reporting. · Identifies & refers audits to the appropriate Auditing Supervisor · Answers inquiries (verbally &/or written) from government officials, Bureau personnel, & other customers regarding entities, dissolution of corporate entities, payroll processing &/or financial adjustments. · Attends training &/or meetings as needed. Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsTo Qualify, You Must Clearly Demonstrate: 24 mos. exp. in position involving review & processing of claims, collections, billings, payments or review of documents for accuracy, completeness &/or compliance with reporting guidelines, laws or rules with exp. commensurate to duties to be assigned. -Or 16 semester or 24 quarter hours in accounting; 12 mos. exp. in accounting or other fiscal/financial activity. -Or 12 mos. exp. as Accountant/ Examiner 1, 66111, with state government exp. commensurate with duties to be assigned. -Or equivalent of Minimum Class Qualifications for Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. MAJOR WORKER CHARACTERISTICS:Knowledge of accounting; applicable state &/or federal regulations governing documents processed, reviewed &/or prepared*; public relations*. Skill in use of calculator/adding machine, typewriter, video display terminal or personal computer & photocopier*. Ability to apply principles to solve practical, everyday problems; gather, collate & classify information about data, people or things; complete routine forms & prepare standard reports & business correspondence; handle routine & sensitive inquiries from & contacts with other government officials, general public, claimants &/or providers.(*) Developed after employment.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox *********************** OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.Background Check:Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.
    $23 hourly Auto-Apply 3h ago
  • CX Incident and Bug Analyst III

    Coinbase 4.2company rating

    Columbus, OH

    Ready to be pushed beyond what you think you're capable of? At Coinbase, our mission is to increase economic freedom in the world. It's a massive, ambitious opportunity that demands the best of us, every day, as we build the emerging onchain platform - and with it, the future global financial system. To achieve our mission, we're seeking a very specific candidate. We want someone who is passionate about our mission and who believes in the power of crypto and blockchain technology to update the financial system. We want someone who is eager to leave their mark on the world, who relishes the pressure and privilege of working with high caliber colleagues, and who actively seeks feedback to keep leveling up. We want someone who will run towards, not away from, solving the company's hardest problems. Our ******************************** is intense and isn't for everyone. But if you want to build the future alongside others who excel in their disciplines and expect the same from you, there's no better place to be. While many roles at Coinbase are remote-first, we are not remote-only. In-person participation is required throughout the year. Team and company-wide offsites are held multiple times annually to foster collaboration, connection, and alignment. Attendance is expected and fully supported. As an Analyst for CX Incident Response, you'll join a high functioning team of passionate support professionals who know their performance is critical to Coinbase achieving its mission. We're looking for an individual who has a passion for making the customer experience seamless and fantastic. You have a strong passion for the product, user empathy, and can maintain a calm demeanor in high stress situations. People describe you as accountable and organized. *What you'll be doing (ie. job duties):* * Responsible for the day to day operations of the CX Incident Response team through identification, mitigation, remediation and resolution of customer facing incidents across all Coinbase products. * Responsible to triage and escalate customer reported bugs across all Coinbase Products * Communicate with internal and external stakeholders in an effective, tactical, and empathetic manner. * Serve as an escalation point for the Customer Experience organization in high touch critical issues and platform defects (incidents and bugs). You should be able to gauge customer impact and guide decisions with Product Managers, Engineers, Legal, and other related partners with users in mind. * Represent the voice of our customer in proactively driving impactful changes across workflows, policies and tools by succinctly relaying customer feedback in escalations to internal support teams. * Maintain an investigative mentality to help address critical customer issues while keeping in mind next-issue avoidance and building operational processes to develop and maintain our program at scale. *What we look for in you (ie. job requirements):* * Motivated by Coinbase's mission and creating a seamless support experience for our global customer base. * Experience with CRM tooling, such as Salesforce. * Comfortable responding to high level internal stakeholders, such as executives and board members * Demonstrated experience with end-to-end platform incident management. * Must work in a defined shift, as required by the business. * Minimum of 2 years of relevant experience in incident management and/or customer support. * Exceptional communication skills in order to operate across multiple departments and stakeholders. * Flexible and adaptable to meet the evolving needs of a high-growth and fast-paced organization. * Must be able to read, write and speak in English * Curiosity to chase problems to root cause and rollup sleeves to investigate the unknown/unusual. *Nice to haves:* * Experience at crypto exchanges or in financial services * Advanced experience in project management, analytics or quality assurance. * Advanced degree in business, finance, customer experience and/or blockchain. * Advanced understanding of Google apps, JIRA, Salesforce Service Cloud. * ITIL V4 Foundation certification * SQL Position ID: P72824 *#LI-Remote* Pay Transparency Notice: Depending on your work location, the target annual salary for this position can range from $40.64 to $47.81 + target bonus + target equity + benefits (including medical, dental, vision and 401(k)). *Pay Transparency Notice:* Depending on your work location, the target annual salary for this position can range as detailed below. Full time offers from Coinbase also include bonus eligibility + equity eligibility**+ benefits (including medical, dental, vision and 401(k)). Pay Range: $40.64-$47.81 USD Please be advised that each candidate may submit a maximum of four applications within any 30-day period. We encourage you to carefully evaluate how your skills and interests align with Coinbase's roles before applying. Commitment to Equal Opportunity Coinbase is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, sex, gender expression or identity, sexual orientation or any other basis protected by applicable law. Coinbase will also consider for employment qualified applicants with criminal histories in a manner consistent with applicable federal, state and local law. For US applicants, you may view the *********************************************** in certain locations, as required by law. Coinbase is also committed to providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation because of a disability for any part of the employment process, please contact us at accommodations*********************************** *Global Data Privacy Notice for Job Candidates and Applicants* Depending on your location, the General Data Protection Regulation (GDPR) and California Consumer Privacy Act (CCPA) may regulate the way we manage the data of job applicants. Our full notice outlining how data will be processed as part of the application procedure for applicable locations is available ********************************************************** By submitting your application, you are agreeing to our use and processing of your data as required. *AI Disclosure* For select roles, Coinbase is piloting an AI tool based on machine learning technologies to conduct initial screening interviews to qualified applicants. The tool simulates realistic interview scenarios and engages in dynamic conversation. A human recruiter will review your interview responses, provided in the form of a voice recording and/or transcript, to assess them against the qualifications and characteristics outlined in the job description. For select roles, Coinbase is also piloting an AI interview intelligence platform to transcribe and summarize interview notes, allowing our interviewers to fully focus on you as the candidate. *The above pilots are for testing purposes and Coinbase will not use AI to make decisions impacting employment*. To request a reasonable accommodation due to disability, please contact accommodations[at]coinbase.com
    $40.6-47.8 hourly 60d+ ago
  • Claims Processor

    Summa Health 4.8company rating

    Akron, OH

    SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days * Hybrid after training As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Summary: Accurately and efficiently handles claims in accordance with regulatory and contractual guidelines. Reviews claims related to coordination of benefits, medical coding, and authorization allocation while ensuring compliance with established policies. Applies cost-containment strategies in collaboration with vendor partners to minimize claim expenses while adhering to plan-specific processing rules. are essential for success in this position. 1. Formal Education Required: a. High School Diploma or equivalent 2. Experience & Training Required: a. One (1) year experience to include any combination of the following: i. Health insurance claims processing ii. Health claims data entry including Document Management Services (DMS) iii. Customer service experience in a managed care environment iv. Physician or hospital billing v. Patient accounts Essential Functions: 1. Requires close attention to detail with independent judgment, decision making and problem solving skills necessary to complete the task being performed 2. Organizes reference materials for easy access; manages time to accurately complete tasks within time frames in a fast paced environment 3. Processes all types of claims, promptly and accurately, as assigned via the document management system, and ensures self-funded service standards, prompt pay standards, and regulatory requirements are met. 4. Maintains a working knowledge of the claims processing system, imaging system, key-stroke emulation system, code editing application, claims processing policies & procedures, and unique benefits/processing rules for self-funded, Medicare, MEWA, Marketplace and fully-insured plans. 5. Escalates questions or concerns to their mentor for evaluation and potential referral to the Claims Management staff for action plan and resolution 6. Meets or exceeds claims production and quality standards as established/communicated by Claims Management staff 7. Coordinates information and resolves service forms and other assignments promptly, in accordance with experience/capabilities. Handles special projects within timeframes established/assigned by supervisor 3. Other Skills, Competencies and Qualifications: a. Strong independent judgment and decision-making skills b. MS-windows based computer environment c. Medical terminology, CPT, HCPCs and ICD-10 knowledge d. Familiar with professional (CMS1500) and institutional (UB-04) claim types 4. Level of Physical Demands: a. Sit for prolonged periods of time b. Bend, stop and stretch c. Lift up to 20 pounds d. Manual dexterity to operate computer, phone and standard office machines Equal Opportunity Employer/Veterans/Disabled $19.23/hr - $23.08/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. * Basic Life and Accidental Death & Dismemberment (AD&D) * Supplemental Life and AD&D * Dependent Life Insurance * Short-Term and Long-Term Disability * Accident Insurance, Hospital Indemnity, and Critical Illness * Retirement Savings Plan * Flexible Spending Accounts - Healthcare and Dependent Care * Employee Assistance Program (EAP) * Identity Theft Protection * Pet Insurance * Education Assistance * Daily Pay
    $19.2-23.1 hourly 6d ago
  • Pre-Certification Specialist

    Southwoods Health

    Boardman, OH

    Pre-Certification Specialist - Southwoods Executive Centre Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians. Essential Duties: Respond promptly to referral source requests for information, supporting documentation, or other report needs Obtain accurate and detailed information to begin investigating sources for payment and gather patient information Obtain authorization from payer sources to begin services. Assist in resolving insurance issues, re-authorization, and eligibility issues Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed Facilitate follow-up regarding ongoing services, eligibility, and authorization Communicate payer verification or benefit issues Record insurance information to maintain data and communicate insurance information to pertinent staff Maintain confidentiality of patient information Independently maintain and work from the electronic medical record and additional databases Obtain pre-certification number from physician's office if applicable Assist in the development, organization, and maintenance of role specific documents, policies, and tools Follow all federal, state, and regulatory guidelines to maintain compliance Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies Perform other duties as assigned Qualifications: Training or courses in business office activities, computer skills, and medical terminology Effective communication skills, ability to problem solve, and great attention to detail Insurance Verification experience Minimum of 2 years' experience pre-authorizing medical procedure and imaging exams across modality and specialty (FP or IM office experience a plus) Full-time. Monday-Friday 8:30am-5:00pm. At Southwoods, it's not just about the treatment, but how you're treated. #SWH ************************
    $48k-95k yearly est. 26d ago
  • Claim Benefit Specialist- Federal FFS Team

    CVS Health 4.6company rating

    Delaware, OH

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. A Brief OverviewPerforms claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies. Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development. Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Required Qualifications1-2 years' experience working in Customer Service. Possess strong teamwork and organizational skills. Strong and effective communication skills. Ability to handle multiple assignments competently through use of time management, accurately and efficiently. Strong proficiency using computers and experience with data entry. Preferred QualificationsExperience in a production environment. Healthcare experience. Knowledge of utilizing multiple systems at once to resolve complex issues. Claim processing experience preferred but not required. Understanding of medical terminology. EducationHigh School or GED equivalent. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$17. 00 - $25. 65This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/03/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $17 hourly 5d ago
  • Water Restoration Claims Coordinator

    Roto-Rooter Services Company 4.6company rating

    Cincinnati, OH

    Water Claims Coordinator/Accounts Receiveable We are currently searching for a full-time Water Claims Coordinator related to water mitigation insurance claims for our Southeast Region. The pay range for this position will be $19.00-$21.00, depending on experience. This on-site position will be located in downtown Cincinnati, OH. You will also receive company-paid parking at a nearby garage. The primary role of the Water Claims Coordinator is to bill, collect payments, and maintain accounts for the Water Restoration Department. The Water Claims Coordinator will keep precise records of all insurance/homeowner payments. Founded in 1935, Roto-Rooter is North America's largest plumbing, drain cleaning, and water cleanup services provider. Roto-Rooter operates businesses in over 100 company-owned branches, independent contractor territories, and approximately 400 independent franchise operations, serving approximately 90% of the U.S. population and parts of Canada. The ideal candidate will have 1-3 years of experience in the collection industry. In addition, the ideal candidate should possess strong communication skills, both with customers and within the insurance industry, and have a good working knowledge and/or experience in water restoration collections. Responsibilities * Working knowledge of restoration billing and collections procedures * 1-3 years of collections experience, preferably in the water restoration industry * Administrative experience in the restoration (preferred) or service industry * Highly motivated, detail-oriented, and able to work independently * Outstanding organizational, time management, and follow-up skills * Self-starter who thrives in a fast-paced environment * Able to handle multiple projects at once * Strong communication skills and ability to work professionally with customers and the insurance industry * Bilingual a plus Requirements * Highschool diploma or equivlant is required. * 1-2 years of collections experience, preferably in the water restoration industry. * Must be able to speak and write in English * Basic computer skills, including Microsoft Office * AS400 experience is preferred Benefits At Roto-Rooter we believe our greatest investment is in our employees. We prioritize the health and well-being of our team and their families. That's why we offer an extensive employee benefit package including: * Medical insurance with a Prescription Drug Card * Accident and Critical Illness Insurance * Dental Insurance * Vision Insurance * Paid Vacation * Paid Training * Life Insurance * Matching 401K Retirement Savings Plan * Tuition Reimbursement * Profit Sharing Roto-Rooter offers excellent career paths for military veterans and personnel transitioning to civilian professions. Throughout our 86 years in business, we've found that military training and structure are a great fit at our company. EEO Statement We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, religion, color, sex, gender, age, national origin, veteran status, military status, disability, gender identity, sexual orientation, genetic information, or any other characteristic protected by law.
    $19-21 hourly 18d ago
  • Commercial Lines Claims Specialist

    AAA Mid-Atlantic

    Cincinnati, OH

    * Top 100 Agency for 2025 * Best Agencies to Work for in 2024 by the Insurance Journal * Big "I" Best Practices Agency in 2023 * Annual bonus eligibility * No weekends required - great work/life balance * 3+ weeks of Paid Time Off * 8 Paid Company Holidays We are looking for someone who will * Manage the claims reporting process for agency clients. * Report claims to the appropriate carrier and maintain records in the agency management system by documenting claim actions in accordance with established procedures. * Follow up on claim to obtain the specific adjuster and claim number relevant to the reported loss. Notify appropriate parties when a claim is processed with carrier, providing accurate and timely claim information. * Continuously monitor claims until claims are closed by the insurance carrier. Report any potential issues with a claim to the client's Account Manager and Producer, escalating to management as needed. * Prepare reports by collecting and summarizing information as requested by management. Why Join AAA Club Alliance and the Energy Insurance team? * A base rate of $20.00 to $25.00/hour, depending on experience and geographic location. * Annual bonus potential Do you have what it takes? * Minimum of 2 years experience handling claims for Commercial Insurance - general liability, workers compensation, commercial auto, etc. * Strong communication skills (both verbal and written) and attention to detail * Strong time management skills * Ability to obtain property and casualty license within 60 days of hire Full time Associates are offered a comprehensive benefits package that includes: * Medical, Dental, and Vision plan options * Up to 2 weeks Paid parental leave * 401k plan with company match up to 7% * 2+ weeks of PTO within your first year * Paid company holidays * Company provided volunteer opportunities + 1 volunteer day per year * Free AAA Membership * Continual learning reimbursement up to $5,250 per year * And MORE! Check out our Benefits Page for more information ACA is an equal opportunity employer and complies with all applicable federal, state, and local employment practices laws. At ACA, we are committed to cultivating a welcoming and inclusive workplace of team members with diverse backgrounds and experiences to enable us to meet our goals and support our values while serving our Members and customers. We strive to attract and retain candidates with a passion for their work and we encourage all qualified individuals to apply. It is ACA's policy to employ the best qualified individuals available for all positions. Hiring decisions are based upon ACA's operating needs, and applicant qualifications including, but not limited to, experience, skills, ability, availability, cooperation, and job performance. Job Category: Insurance
    $20-25 hourly Auto-Apply 40d ago
  • Commercial Lines Claims Specialist

    Aaamidatlantic

    Cincinnati, OH

    Top 100 Agency for 2025 Best Agencies to Work for in 2024 by the Insurance Journal Big “I” Best Practices Agency in 2023 Annual bonus eligibility No weekends required - great work/life balance 3+ weeks of Paid Time Off 8 Paid Company Holidays We are looking for someone who will Manage the claims reporting process for agency clients. Report claims to the appropriate carrier and maintain records in the agency management system by documenting claim actions in accordance with established procedures. Follow up on claim to obtain the specific adjuster and claim number relevant to the reported loss. Notify appropriate parties when a claim is processed with carrier, providing accurate and timely claim information. Continuously monitor claims until claims are closed by the insurance carrier. Report any potential issues with a claim to the client's Account Manager and Producer, escalating to management as needed. Prepare reports by collecting and summarizing information as requested by management. Why Join AAA Club Alliance and the Energy Insurance team? A base rate of $20.00 to $25.00/hour, depending on experience and geographic location. Annual bonus potential Do you have what it takes? Minimum of 2 years experience handling claims for Commercial Insurance - general liability, workers compensation, commercial auto, etc. Strong communication skills (both verbal and written) and attention to detail Strong time management skills Ability to obtain property and casualty license within 60 days of hire Full time Associates are offered a comprehensive benefits package that includes: Medical, Dental, and Vision plan options Up to 2 weeks Paid parental leave 401k plan with company match up to 7% 2+ weeks of PTO within your first year Paid company holidays Company provided volunteer opportunities + 1 volunteer day per year Free AAA Membership Continual learning reimbursement up to $5,250 per year And MORE! Check out our Benefits Page for more information ACA is an equal opportunity employer and complies with all applicable federal, state, and local employment practices laws. At ACA, we are committed to cultivating a welcoming and inclusive workplace of team members with diverse backgrounds and experiences to enable us to meet our goals and support our values while serving our Members and customers. We strive to attract and retain candidates with a passion for their work and we encourage all qualified individuals to apply. It is ACA's policy to employ the best qualified individuals available for all positions. Hiring decisions are based upon ACA's operating needs, and applicant qualifications including, but not limited to, experience, skills, ability, availability, cooperation, and job performance. Job Category: Insurance
    $20-25 hourly Auto-Apply 42d ago
  • Insurance Claim Specialist- Claims Management

    Southern Ohio Medical Center 4.7company rating

    Portsmouth, OH

    Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process. Department: Claims Management Shift/schedule: Full Time (40 hrs/wk) Works under the supervision of the Assistant Manager of Claims Management and Lead Insurance Claim Specialists. The Insurance Claim Specialist's primary job functions is to analyze, process, submit, and follow up on inpatient and outpatient medical claims. Is responsible for safeguarding the public relations and confidentiality of the organization and its records by consistent professional conduct. QUALIFICATIONS Education: * High School Diploma or successful completion of an equivalent High School Exam Required Licensure: * None Experience: * Three to six months of related work experience in medical billing preferred JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. * Reviews all claims for complete and accurate information. * Contacts other SOMC departments, physician offices, and insurance companies to obtain necessary information to file complete, accurate, and timely claims. * Processes, edits, and submits all claims for the organization. * Follows up on Commercial, Worker's Comp, VA, and Governmental claims by phone calls to the insurance companies, websites, or any online resources available. * Works with the patient/guarantor by phone to assist with any questions regarding unpaid claims. Obtains information from the patient/guarantor with which to submit the claim for payment (i.e., claim forms, Medicare Secondary Payer (MSP) Questionnaire, etc.) * Processes administrative appeals, reinstatements, and rejections of insurance claims. * Completes account follow up daily, maintaining established goals, and notifies the Lead Specialist, when necessary, of issues preventing achievement of such goals. * Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues. * Adheres to HIPPA regulations by verifying pertinent information to determine caller authorization level receiving information on account. * Identifies billing and coding issues with individual claims, notifying medical billers for correction. * Makes determinations through on-line systems of patient eligibility, coverage, and reviews status of claims. * Performs other duties as assigned. Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.
    $47k-75k yearly est. 30d ago
  • Manufacturing Analyst

    Aerocontrolex 3.6company rating

    South Euclid, OH

    We're looking for a detail-driven Manufacturing Analyst to join our fast-paced manufacturing team! In this role, you'll perform a variety of general accounting duties, track inventory, and provide key financial insights that help drive profitability and efficiency. This is a full-time, on-site position with competitive pay and benefits. Responsibilities: * Cost accounting for ACX's two product lines * Cost individual manufacturing jobs: Review and post labor hours, inventory usage, and outside services necessary for job order completion * Ensure inventory is properly valued * Analyze inventory trends vs. expectations * Analyze margin variances trends and report on cost implications * Interact with manufacturing floor employees necessary to resolve ad-hoc requests * Coordinate cycle count procedures with stock room and assist in investigating variances * Conduct month-end close procedures within tight 3 day close process; assist with post-close reporting * Prepare monthly closing journal entries * Compile month-end package * Financial reporting & distribution * Load financials & statistics into corporate financial system * Backlog reporting & analysis * Sales, Margin, and Bookings report * Assist with corporate financial requests (month, quarter, annual sets of requests) * Monthly departmental spending/expense analysis (vs. Plan & fluctuations) * Assist with Monthly Forecast/Book and Ship Compilation * Reconcile general ledger accounts * Answer accounting and financial inquiries through data research * Optimize accounting processes through continuous improvement, including report automation through Power BI * Support internal and external audits throughout the year * Assist with compilation of Quarterly Management Meeting Presentations * Assist with annual Fiscal Year Plan process * Perform other duties assigned Qualifications: * 4-year college degree preferably in Accounting or Finance * 2 years of related experience preferred * Costing experience preferred Benefits: * Competitive pay based on experience * Health insurance coverage * Retirement plan options * Paid time off This position requires either a US Person (as defined in applicable export regulations) or a non-US person who is eligible to obtain required export authorization. An equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law. Benefits: * 401(k) * 401(k) matching * Dental insurance * Health insurance * Life insurance * Paid time off * Vision insurance Work Location: In person
    $62k-83k yearly est. 11d ago
  • Medical Claims Specialist

    Centerprise

    Loveland, OH

    Job Description Centerprise Inc. is seeking to hire a Medical Claims Specialist to join our team. The Medical Claims Specialist performs a variety of billing and administrative tasks including claim submission, claim correction, insurance follow-up and appeals and insurance verification. They will also assist with all other billing and finance duties as needed. ABOUT THE COMPANY: Centerprise is a professional services organization providing consulting and Revenue Cycle Management services to Federally Qualified Health Centers (FQHCs). We are located outside Cincinnati, Ohio, and conduct business nationally. Centerprise is a company on the rise! We are very excited to say that we currently employ 25 staff members, and we are steadily growing! We take great pride in focusing on employee satisfaction. Happy employees; means happy customers! At Centerprise we offer our clients a wide variety of services, therefore, we require a large range of skill sets within our company. We would love to hear from dynamic individuals who are seeking an opportunity to grow their skills in an upbeat, fast paced, and team-based environment. Centerprise has a small company feel, with larger company resources. Please refer to our website for more information, *************** ESSENTIAL DUTIES AND RESPONSIBILITIES: Follow-up: Regularly monitor patient account insurance balances to ensure timely payment and resolve any outstanding issues. Payer Communication: Contact payers regarding payment status, resolve incorrect payment issues, and ensure proper reimbursement. Denial Management: Work closely with leadership to address and resolve any denied claims promptly. Understanding Guidelines: Stay informed about both government and non-government contractual billing and follow-up guidelines, ensuring compliance with individual payer requirements. Payment Resolution: Address issues related to lack of payment or improper payment by government, non-government, and self-payers, ensuring that all incorrect payment issues are resolved promptly. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty completely. The requirements listed below are representative of the knowledge skill and/or ability required. Minimum Qualifications: High School Diploma or Equivalent (GED), associate degree preferred. Medical billing experience required. FQHC billing experience is a plus. Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets. Knowledge of Medical Terminology, CPT and ICD-10 Coding, Electronic Billing, and HIPPA EHR Experience in required. Preferred experience with NextGen or eClinicalWorks Excellent written and oral communication skills Pay: $18-$20/hour based on experience Benefits: Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts 401 (k) Program with competitive company match Courtesy Plan, full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio office up to $500.00 per family PTO and Long-Term Sick Bank, full time employees earn up to 25 days per year in first calendar year: 15 days of Paid Time Off (PTO), and 10 days of Long-Term Sick Bank (LTSB) Credit Union Privileges, Sharefax Credit Union Quarterly Bonus Incentive Program Schedule: Monday to Friday; no evenings, or weekends After training may be eligible to work a hybrid-remote schedule which will include 2-3 in office days per week. Work Location: Loveland, OH 45140. Must be able to commute or planning to relocate before starting work. Centerprise Inc. is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran
    $18-20 hourly 21d ago
  • Transactions Analyst

    Jpmorgan Chase & Co 4.8company rating

    Ohio

    JobID: 210680799 JobSchedule: Full time JobShift: : Join a dynamic team at JPMorgan Chase, where your skills will drive innovation and operational excellence. As part of the IMCC and ATM Monitoring Group, you'll play a key role in enhancing customer and employee experiences through proactive oversight of operational issues. This is your opportunity to grow your career and make a significant impact within a global financial leader. As a Transactions Analyst within the Integrated Monitoring and Control Center (IMCC) and ATM Monitoring Group (AMG), you will support the ATM Fleet and over 50 applications by monitoring their health, production environments, and job and file transmissions. You will act as a liaison between support groups and the line of business, providing resolution assistance and ensuring operational excellence. Your role is crucial in maintaining the normal flow of business and maximizing both customer and employee experiences. You will be part of a collaborative team that values innovation, continuous improvement, and shared success. Job Responsibilities: * Manage incidents via ServiceNow for timely resolution and escalation. * Provide L1 Technology support to 2-3 technology products. * Research performance/health and resolve technical failures. * Analyze details using multiple systems to resolve problems. * Maintain strict adherence to risk procedures and complete risk training. * Assist in IMCC risk avoidance assessments. * Escalate concerns to production areas or vendor partners for resolution. * Communicate clearly with internal/external clients, including senior management. * Identify risk trends and patterns for management and technology partners. * Participate in service/process education to enhance customer experience. * Lead/support Continuous Improvement activities. Required Qualifications, Capabilities, and Skills: * 3 years of experience in Operations, including Risk & Control. * Strong oral & written communication skills, problem-solving skills, and organizational skills. * Advanced MS Office skills. * Attention to detail and ability to make decisions with minimal supervision. * SQL knowledge. * Flexibility and project management skills. Preferred Qualifications, Capabilities, and Skills: * Technical qualification/skills preferred. * B.Tech, MBA, BCom graduates considered. * Prior Level 1 incident management experience preferred. * Excellent written communication skills. * Ability to communicate across all levels of leadership. * Ability to work within a team and maintain confidentiality. * Familiarity with ATMs. Work Schedule Tuesday - Saturday - 1:30 pm - 10:00 pm Shift Diff 10%
    $59k-78k yearly est. Auto-Apply 10d ago
  • Medical Claims Specialist

    The Hiring Method, LLC

    Brecksville, OH

    Job Description Job Type: Full-Time Compensation: $22.00 - $27.00 per hour (based on experience) Schedule: 40 hours/week, standard business hours About the Role We are seeking a detail-oriented Medical Claims Specialist to join a growing healthcare organization with a mission-driven focus on quality patient care and service excellence. In this role, you'll manage the full lifecycle of medical claims-ensuring accuracy, compliance, and timely reimbursement from Medicare, Medicaid, and commercial insurance payers. This position requires strong technical billing expertise, a passion for problem-solving, and a commitment to delivering a positive experience for patients and healthcare partners alike. What You'll Do Prepare and submit medical claims to Medicare, Medicaid, and private payers Follow up on unpaid, underpaid, or denied claims; initiate appeals or resubmissions Research payer rejections, denials, and discrepancies to resolve issues and maximize reimbursement Verify and maintain patient insurance and demographic data Process CPT, ICD-10, and HCPCS coding specific to ambulance and medical transport services Handle incoming billing-related phone calls with professionalism and compassion Coordinate with internal dispatch and operations teams for billing documentation Review and process EOBs and ERAs to reconcile patient accounts Generate billing reports, assist with month-end closing, and support payment plans when needed What You Bring Required: 2+ years of experience in medical billing or revenue cycle (ambulance/EMS billing preferred) Strong knowledge of CPT, ICD-10, and HCPCS codes Proficiency in clearinghouse portals and electronic claims processing Excellent verbal and written communication skills High school diploma or GED Strong organizational and customer service skills Familiarity with HIPAA and payer-specific compliance requirements Preferred: Associate's degree in Healthcare Administration or related field Certified Professional Biller (CPB) or Certified Professional Coder (CPC) Medicare Part B billing experience Experience with ambulance-specific billing practices Bilingual (English/Spanish) a plus What You Get Competitive hourly pay ($22.00-$27.00/hour) Full health, dental, and vision insurance 401(k) with company match Paid time off, holidays, and life insurance HSA, EAP, and professional development support Opportunities to grow your healthcare administration career
    $22-27 hourly 31d ago
  • Grievance/Appeals Analyst I

    Elevance Health

    Ohio

    Title: Grievance/Appeals Analyst I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Grievance/Appeals Analyst I is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. How you will make an impact: Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language. Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review. The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements. As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation. Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination. Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments. Minimum Requirements HS diploma or GED. Minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is highly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $22.53/hr to $33.80/hr. Locations: California and 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 considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, 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. 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. Job Level: Non-Management Non-Exempt Workshift: Job Family: CLM > Claims Support Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $22.5-33.8 hourly Auto-Apply 13d ago
  • Forest Analyst

    TUV Sud 4.6company rating

    Brecksville, OH

    Apply now Forest Analyst At TÜV SÜD we are passionate about technology. Innovations impact our daily lives in countless ways, and we are dedicated to being a part of that progress. We test, we audit, we inspect, we advise. We never stop challenging ourselves for the safety of society and its people. We breathe technology, we strive for professional excellence, and we leave a mark. We take the future into our hands. We are TÜV SÜD. Your Tasks * Support forest carbon project verification, including site visits in North America and internationally, project modeling analysis, documentation audits, and verification report completion. * Conduct on-site inventory audits, including forest mensuration, harvest/silvicultural method analysis, and boundary verification. * Analyze and audit carbon quantification data, including growth and yield modeling, and evaluate modeling software (e.g., USFS FVS, CBM-CFS3, Remsoft Woodstock). * Perform GIS analysis and cartography, ensuring conformance to forest carbon protocols; utilize online/mobile GIS tools for field data collection. * Build and maintain professional relationships with clients, agencies, and stakeholders; represent the company effectively and professionally. * Stay current on technical and regulatory issues related to forest carbon programs through active participation in industry groups. * Ensure a safe work environment by following and promoting company safety policies and participating in safety programs. Your Qualifications * Bachelor's degree in Forestry or a closely related field (required). * Minimum 5 years of experience in forestry or a related field. * Experience in forest carbon project development, validation/verification, or registry/regulatory oversight (preferred). * High proficiency in forest inventory measurements, sampling protocols, and the use of ESRI GIS software. * Strong skills in Microsoft Excel, database management (e.g., Access, R), and spatial data analysis. * Valid driver's license and clear driving record. * Ability to work safely and effectively in remote, rugged terrain and adverse weather conditions. * Excellent written and oral communication skills. * Professional Forester credential or SAF Certified Forester, or ability to obtain within 1 year (preferred). * Ability to attain forestry verifier credentials with relevant registries within 1 year of hire (preferred). What We Offer * Flexible remote work model. * Opportunities for professional development and certification. * Collaborative and inclusive team environment. * Exposure to innovative forest carbon and sustainability projects. * Support for safety and well-being, including comprehensive safety programs. * Opportunities for travel to diverse project locations. * Commitment to diversity, equity, and inclusion in the workplace. Additional Information * The anticipated annual base pay range for this full-time position is $80,000 - $110,000. Actual base pay will be determined based on various factors, including years of relevant experience, training, qualifications, and internal equity. The compensation package may also include an annual bonus target, subject to eligibility and other requirements. Additionally, we offer a comprehensive benefits package to employees, including a 401(k) plan with employer match, up to 12 weeks of paid parental leave for birthing parents and 2 weeks for other parents, health plans (medical, dental, and vision), life insurance and disability, and generous paid time off. * This position may require travel to remote locations, including use of specialized vehicles (e.g., float planes, ATVs). * Physical activities may include walking, hiking, or standing for extended periods in challenging terrain and weather. * The role is exempt and may require occasional lifting/moving of up to 50 pounds. * We welcome applications from people of all backgrounds, experiences, and perspectives. You don't meet every single requirement? No problem - we encourage you to apply if this role excites you. Equal Opportunity Employer - Disability and Veteran TÜV SÜD America, Inc. is an equal opportunity, affirmative action employer and considers qualified applicants for employment without regard to race, color, creed, religion, ancestry, marital status, genetics, national origin, sex, sexual orientation, gender identity and expression, age, physical or mental disability, veteran status and those laws, directives, and regulations of Federal, State, and Local governing bodies or agencies. We participate in the E-Verify Employment Verification Program.
    $80k-110k yearly 40d ago
  • FP&A Analyst

    MKIS Professional Search

    Solon, OH

    Solon, Ohio | Full-Time (HYBRID) | M-F We are seeking a skilled FP&A Analyst to provide financial insights and support strategic decision-making. In this role, you'll develop financial models, prepare budgets and forecasts, analyze performance, and collaborate with departments to drive the company's financial health. Key Responsibilities: Financial Planning & Forecasting: Develop and maintain financial models for revenue, expenses, and cash flow. Prepare budgets, forecasts, and long-term plans. Financial Analysis & Reporting: Analyze monthly, quarterly, and annual reports, conduct variance and profitability analyses, and present findings to management. Business Partnering: Collaborate with departments (e.g., Sales, Marketing) to gather financial data and provide insights. Process Improvement & Data Management: Recommend improvements to financial processes, ensure data accuracy, and maintain financial systems and reports. Main Challenges: Ensuring data accuracy and forecasting precision Maintaining transparent and reasonable financial models Responding to ad-hoc analysis requests Qualifications & Skills: 3+ years in FP&A or related financial role Bachelors in Finance, Accounting, Economics, or similar (MBA preferred) Advanced Excel Experience with PowerBI and CRM systems (Salesforce) Strong analytical and communication skills We're an equal opportunity employer. All qualified applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status, or any other characteristic protected by law. We offer a comprehensive benefits package including: 401(k) & 401(k) matching Health Insurance Dental & Vision Insurance Disability & Life Insurance Paid Time Off Flexible Schedule HSA, FSA Annual Bonus Employee Assistance Program
    $57k-80k yearly est. 60d+ ago
  • Re-Certification Specialist / Compliance - Affordable Housing Community

    Independent Management Services 4.0company rating

    Elyria, OH

    Job Details MIDVIEW CROSSING - Elyria, OH Full Time DayDescription Independent Management Services is a full-service property management and marketing firm, specializing in the revitalization of under-managed multifamily housing developments. Since our founding in 1989, we have expanded our nationwide presence to include over 100 sustainable communities in 11 states focusing exclusively in the affordable and workforce housing sectors. However, our total breath of experience also includes market rate and commercial property management. We offer competitive salaries commensurate with experience and a comprehensive benefit package. We intend to build a team of individuals, who are self-motivated, willing to learn and grow with our firm. We progressively uphold a professional management team to serve our clients, enhancing our management skills and capabilities. Your progress, training, experience, motivation, attitude, and goals may create many possibilities for career opportunities with our company. If you have superior attention to detail with outstanding communications skills and enjoy a challenging fast pace environment, join our team now! Responsibilities: Occupancy, marketing, leasing, and resident verification procedures. Collect information from residents for eligibility screening, rent calculation, and income verification. Initial and annual recertification of income for residents. Complete unit inspections prior to move in/out and ensure units are ready for occupancy within deadlines. Receive and resolve resident requests and concerns. Foster positive working relationships with residents while always maintaining a professional demeanor. Administrative support tasks such as filing, typing, answering telephones, and data entry. Reports directly to the Site Manager. Job Qualifications: Sales-minded individual with attention to detail and strong verbal/written communication skills. Excellent follow-up skills via telephone or email correspondence. Experience with Tax Credit Compliance, EIV, and HUD Section 8 subsidy programs. Knowledge of REAC and MOR compliance. Proficiency with Paycom software and Microsoft Office suite preferred. Experience with RealPage OneSite preferred. Demonstrated track record regarding work attendance and reporting to work timely. Must adhere to Federal Fair Housing Laws. Qualifications We offer a competitive salary plus benefits including: Employer paid health and dental insurance (100% employee only) with affordable dependent and family coverage. Voluntary insurance options: Vision, Life, Accident Injury, Long-Term Disability, and Identity Theft. 401(k) with above-average employer matching contribution. Generous paid time off package. Training and employee development program. Among many other employee benefits.
    $44k-82k yearly est. 52d ago

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