Claims Analyst remote jobs - 330 jobs

Create Music Group is currently looking for self-described viral internet culture enthusiasts to join our Viral Department. Viral Content Claiming Specialist perform administrative tasks such as YouTube copyright claiming and asset onboarding, as well as scope out trending memes and social media videos on a daily basis. This position requires a regular workload of data entry/administration in order to carry out the most basic functions of our department but there are plenty of opportunities for more creative and ambitious pursuits if you are so inclined. This is a full time position which may be done remotely, however our office is located in Hollywood, California, and we are currently only looking for job candidates who are located in California. In the future, you may be encouraged to come into our office for meetings or company functions, so it is best if you are located in the Los Angeles/Southern California area. Through our Viral team, we collaborate with some of the most prominent viral talent from the TikTok and meme world including Supa Hot Fire (Deshawn Raw), Welven Da Great (Deez Nuts), Verbalase, KWEY B, Hoodnews, presidentofugly1, 10k Caash, dimetrees, Zackass, Supreme Patty, The Man with the Hardest Name in Africa, ViralSnare, Adin Ross, and more. YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for content creators, artists and labels. REQUIREMENTS: 1-3 years work experience Excellent communication skills, both written and verbal Internet culture and social media platforms, especially YouTube Conducting basic level research Organizing large amounts of data efficiently Proficiency with Mac OSX, Microsoft Office, and Google Apps PLUSES: Strong understanding of the online video market (YouTube, Instagram, TikTok) Bilingual - any language, although Spanish, Mandarin, and Russian is preferred RESPONSIBILITIES: We work directly with our clients and their team to help them break down the data and find potential opportunities to build their career. Daily responsibilities include but are not limited to the following. Watching YouTube videos for several hours daily Content claiming Uploading and defining intellectual assets Administrative metadata tasks Researching potential clients Staying on top of accounts for current client roster As this is a remote position, you are required to have your own computer and reliable internet connection. This position may require you to download a great deal of video files (files which may be deleted once onboarding tasks are completed) so please make sure that you have a computer that is up to the task. Laptops are preferable if you would like to come into our office to work (snacks, soft drinks, and Starbucks coffee are provided at our physical office). BENEFITS: Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included. TO APPLY: Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.

--------------------------------------------------------------- The Claims Examiner II is an intermediate level position responsible for the timely review, investigation and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed. Consistently meet or exceed the quality and production standards established by the department and CareOregon. Provide excellent customer service to internal and external customers. Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals. Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed. Investigate third party issues as directed. May review, process and post refunds and claim adjustments or re-adjudications as needed. Report any overpayments, underpayments or other possible irregularities to the Lead or Supervisor as appropriate. Generate letters and other documents as needed. Proactively identify ways to improve quality and productivity. Continuously learn and stay up to date with changing processes, procedures and policies. Experience and/or Education Required Minimum 2 years' experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.) Preferred Experience using QNXT, Facets, Epic systems Knowledge, Skills and Abilities Required Knowledge Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding Knowledge of medical, dental, mental health and health insurance terminology Skills and Abilities Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and Medicaid/Medicare industry Ability to perform fast and accurate data entry Strong spoken and written communication skills Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed Good customer service skills Ability to participate fully and constructively in meetings Strong analytical and sound problem-solving skills Detail orientation Strong organizational skills and time management skills Ability to work in a fast-paced environment with multiple priorities Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift, carry, reach, and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Monday - Friday, 8:00 AM to 5:00 PM We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

The Claims Processor will use independent judgement and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical and dental claims, as well as various types of invoices, based upon specific knowledge and application of each client's customized plan(s). ESSENTIAL FUNCTIONS: Process a minimum of 1,200 medical, dental, and vision claims per week while maintaining quality goals. Read, analyze, understand, and ensure compliance with clients' customized plans Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto. Independently review, analyze and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud. Review, analyze and add applicable notes using the QicLink system. Review billed procedure and diagnosis codes on claims for billing irregularities. Analyze claims for billing inconsistencies and medical necessity. Authorize payment, partial payment or denial of claim based upon individual investigation and analysis. Review Workflow Manager daily to document and release pended claims, if applicable. Review Pend and Suspend claim reports to finalize all claim determinations timely. Assist and support other Claims Specialists as needed and when requested. Attend continuing education classes as required, including but not limited to HIPAA training. EDUCATION: High School Graduate or equivalent required. EXPERIENCE & SKILLS: Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/Medicaid does not count towards the experience) required. Prior experience with a Third-party Administrator (TPA) is highly preferred. Applicants must have knowledge of CPT and ICD-10 coding. Applicants must have strong analytical skills and knowledge of computer systems. Prior experience with dental and vision processing is preferred, but not required. COMPETENCIES Communication Customer Focus Accountability Functional/Technical Job Skills PHYSICAL DEMANDS: Office setting and ability to sit for long periods of time. WORK ENVIRONMENT: Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Protect Yourself from Hiring Scams Important Notice About Our Hiring Process To keep your experience safe and transparent, please note: All interviews are conducted via video. No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager. If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process. For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems Your security matters to us-thank you for helping us maintain a fair and trustworthy process!

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Claims Examiner is considered an expert in managing insurance claims for our policyholders. The Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. PRIMARY RESPONSIBILITIES: • Maintains compliance with all state-specific timelines and MSI best practices, including timely initial contact, acknowledgments, diary management, and thorough claim documentation. • Provides professional, proactive communication to insureds, agents, vendors, public adjusters, and attorneys. • Applies policy language accurately to make fair, well-supported coverage decisions. • Participates in team trainings, process improvement initiatives, and ongoing development. • Meets performance expectations related to responsiveness, claim cycle times, reserve accuracy, and timely claim closure. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company's reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster's license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 2-3 years' experience in claims Must have Property & Casualty Insurance License #LI-JW2 #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

Join a USA Today Top 100 Workplace & Best in KLAS Team! Claims Analyst- Hybrid Baldwin Park Pay Range: $20.00- $22.00 per hour | Schedule: Monday-Friday 8:00 AM- 4:30 PM | Location: Orlando, FL About RSi: RSi is a leading Revenue Cycle Management company serving healthcare organizations nationwide. We are committed to innovation, customer service excellence, and developing future leaders. Our culture values diversity, teamwork, and a tech-forward approach. Position Summary: Join our dynamic Medicaid Enrollment Department as a Claims Analyst. In this hybrid role, you'll work both remotely and in-office (three days per week), supporting Medicaid enrollment and retro authorization processes. You'll collaborate with internal teams and external partners to ensure timely and accurate authorization, with opportunities to expand into Enrollment Specialist duties as needed. Key Accountabilities: Process retro authorization requests for Medicaid, ensuring compliance with state and federal guidelines Collaborate with hospital personnel, clients, and payers to verify eligibility and secure authorizations Respond promptly to daily inquiries and resolve issues related to Medicaid enrollment and authorizations Maintain effective workflow and support organizational standards, policies, and procedures Foster a positive, customer-focused work culture Support enrollment activities, including application review, eligibility verification, and documentation Perform other duties as assigned, including Enrollment Specialist tasks when required Skills/Abilities/Experience & Qualifications: High School Diploma or equivalent Authorized to work in the United States; able to pass a background check Exceptional customer service and communication skills Strong problem-solving and case management abilities Proficiency with technology (Microsoft Word, Excel, Outlook, phone systems, etc.) Ability to work independently and collaboratively in a hybrid environment Preference will be given to candidates with additional skills such as: Experience with Medicaid, Medicare, TPL, and commercial insurance recovery Understanding of HIPAA and HITECH patient confidentiality laws Familiarity with hospital systems and healthcare environments Prior experience in enrollment or authorization roles Competitive Compensation Package: Competitive salary Medical, dental, and vision insurance Company-paid life insurance Paid volunteer time off Free wellness memberships 401K retirement plan Paid training and mentoring Opportunities for advancement Physical Demands/Working Conditions: Work will be primarily performed remotely. Candidates must have a stable dedicated workspace and secure internet connectivity. Computer equipment will be provided by the Company. Requires prolonged sitting, standing, or walking. Requires on-camera interactions with colleagues, leadership, and occasionally, clients. Consequently, appropriate work attire and professional setting is required. Requires eye-hand coordination and manual dexterity enough to operate a computer keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 15 pounds occasionally. Work may be stressful at times. Must be an effective communicator with strong problem resolution abilities. OSHA Category: The candidate selected for this position will not be required to conduct any medical care. Claims Analysts must abide by client-required policies such as wearing masks, providing COVID-19 vaccination status and testing, in the event that any on-site visits occur.

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

This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department's performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting staff as required for continually improved file handling. · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel. · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures. · Complete research pertaining to complex coverage issues, industry trends, and related topics. · May assist with targeted audits of a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management re-audits to verify calibration and accuracy of the first level reviews completed. · Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling Job Qualifications Formal Education & Certification Bachelor's degree or equivalent work experience Knowledge & Experience · A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty claims with high complexity. · Prior claims management experience and/or auditing preferred. Skills & Competencies · Communication and analytical ability at a level to interact with associates, managers, agents and vendors. · Demonstrated team building and coordination skills. · Must possess strong interpersonal skills and the ability to present critical information to Senior Management. · Ability to manage multiple priorities and work independently. · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts. · Must be able to work in a fast-paced automated production environment and possess solid planning and organizational skills including time management, prioritization, and attention to detail. · Must meet company guidelines for attendance and punctuality and professional appearance/decorum. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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 We are seeking a skilled Rideshare Bodily Injury Litigation Resolution Specialist to manage litigated files. The successful candidate will: Investigate all aspects related to assigned claims Evaluate coverage, liability and damages Negotiate and resolve claims Manage litigation related to auto accident claim disputes The Bodily Injury Litigation Resolution Specialist will also be responsible for maintaining electronic files, working with defense counsel's to drive performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. 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 can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) 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: Managing all aspects of litigated cases, including evaluation of the resolution process Analyzing auto claims to identify areas of dispute, investigating and gathering all necessary information and documentation, evaluating liability and damages and negotiating and resolving claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, communicating regularly with clients, attorneys, vendors and other stakeholders Reviewing legal documents and ensuring compliance with initial suit-handling plan of action. Analyzing policy language and reaching appropriate coverage decisions. Directing and controlling the activities and costs of outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Ride Share/TNC/Livery litigation is required. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical causation knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 60 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs 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 Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster 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!

Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for this position. Job Overview: In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies. Job Type: Full-time This is a fully remote position Pay: up to $19.00 per hour DOE Responsibilities: Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. Participate in ongoing training and professional development activities. Maintain accurate and detailed records of claims processing activities. Review claim forms and supporting documents Determine eligibility, verify data accuracy Request additional information when needed Process claims end-to-end Identify and escalate complex or unusual claims for further review or investigation. Participate in ongoing training and professional development activities. Handle more complex claims with multiple services, providers Experience: At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment. Understanding of health claims processing/adjudication Ability to perform basic to intermediate mathematical computation routines Medical terminology strongly preferred Understanding of ICD-9 & ICD-10 Basic MS office computer skills Ability to work independently or within a team Time management skills Written and verbal communication skills Attention to detail Must be able to demonstrate sound decision-making skills What We Offer Remote work offered Equipment provided Paid training to set you up for success Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) Paid Time Off (PTO) 7 paid holidays A supportive team and a company that values internal growth Ready to Grow Your Career? We'd love to meet you! Click “Apply Now” and tell us why you'd be a great addition to the Imagenet team. About Imagenet, LLC Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Summary: This position is responsible for investigating, evaluating and negotiating settlement of assigned large loss Commercial Auto Body Injury Claims in accordance with best practices and to promote retention or purchase of insurance from Grange Enterprise. If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. What You'll Be Doing: Pursuant to line of business strategies and good faith claim settlement practices, investigates, evaluates, negotiates, and resolves (within authorized limits) assigned claims. Demonstrates technical proficiency, routinely handling the most complex claims with minimal manager oversight. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business relationships with agents, insureds and Commercial Lines partners through regular, effective and insightful communications. May include face-to-face as needed. Will be the “point person” (when required) for certain identified large customer accounts where specialized communication and handling are required. Regularly develops and mentors other associates. Assists leadership in advancing the technical acumen of the department through the development of formal and informal training and resources. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assists other departments (when required) with investigations. May be assigned general liability claims during high volume workload periods. Demonstrates effectiveness and efficiencies in managing diary system and handling workload with limited supervision or direction. What You'll Bring To The Company: High school diploma or equivalent education plus five (5) years claims experience with at least three (3) years of Commercial Casualty experience. Experience in General Liability preferred. Bachelor's degree preferred. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Requires excellent decision-making ability, a broad depth of experience and technical competence and capacity to manage work to meet time sensitive deadlines. Demonstrated ability to interact with internal and external customers in a professional manner. State specific adjusters' license may be required. About Us: Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent). Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave. Who We Are: We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength. We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow. Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals. Our Inclusive Culture Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth. Together, we use our individual experiences to learn from one another and grow as professionals and as people.  We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.

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: As a Claims Specialist, you'll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you'll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members. Your role goes beyond handling claims, you'll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful. What YOU will do: Research and process ITS claim adjustments, returned checks, refunds and stop payment in an accurate and timely manner Communicate with local Blue plans utilizing real time chat Process priority claims and general inquiries Respond to appeals and correspondence regarding claims functions Support team members and be open to providing assistance when and where neede Become a SME regarding BCBS network Requirements High school diploma required 3-5+ years of claims processing experience 2+ years of BCBS claims processing experience required Strong interpersonal and communication skills Strong attention to detail, with high degree of accuracy and urgency Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving Previous success in a fast-paced environment Benefits Compensation: The base salary range for this position in the greater Seattle area is $28/hr - $32/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates. 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: *****************

Claims Manager (Professional Liability) 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 a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider 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. YOU WILL Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes. 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 our Agentic Claim Experience (ACE) 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 10 years of professional experience, with at least 5 years of experience litigating or managing 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. Familiarity with Google Workplace is preferred, but not required. Willingness to quickly adapt to change and 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. Jaclyn Vogt, Senior Claims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College. 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. 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 $150,000 to $180,000. 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.

Join Our Team as a Claims Representative! Are you passionate about helping others, building relationships, and making a meaningful impact? We're looking for driven individuals to join our dynamic team as Claims Representative, where you'll receive top-tier training, mentorship, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for motivated individuals who want to grow into leadership roles or create a rewarding part-time income stream. Is This You? ✔ Passionate about helping clients find financial security? ✔ Willing to invest in yourself and your professional growth? ✔ Self-motivated, disciplined, and eager to succeed? ✔ Coachable and ready to learn from top industry professionals? ✔ Interested in a business that is recession- and pandemic-proof? If you answered YES, keep reading! What We Offer: 💼 Flexible Work Environment - Work remotely, full-time or part-time, on your own schedule. 💰 Unlimited Earning Potential - Part-time: $40,000-$60,000+/month | Full-time: $70,000-$150,000+++/month. 📞 Warm Leads Provided - No cold calling; you'll assist clients who have already requested help. ❌ No Sales Quotas, No High-Pressure Tactics. 🧑 🏫 Comprehensive Training & Mentorship - Learn from top-performing professionals. 🎯 Daily Pay - Get paid directly by the insurance carriers you work with. 🎁 Bonuses & Incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Leadership & Growth Opportunities - Build your own agency (if desired). 🏥 Health Insurance Available for qualified agents. 🚀 Start a meaningful career where you help clients secure their futures while securing your own. 👉 Apply today and take the first step toward success! ( Your success depends on effort, skill, and commitment to training and sales systems. )

Our client is seeking to add a Commercial Auto Claims Examiner to their team. This individual will be responsible for handling commercial auto liability and physical damage claims from initial intake through resolution. The position involves evaluating coverage, investigating losses, and negotiating settlements across various jurisdictions. This person will have the ability to work fully remote. Key Responsibilities: Investigate, evaluate, and resolve Commercial Auto and Trucking claims from first notice of loss through closure. Review liability, assess damages, and determine appropriate claim strategies. Establish timely and accurate reserves based on claim investigation and exposure. Collaborate with insureds, claimants, attorneys, and vendors to move claims toward resolution. Handle coverage analysis and issue coverage position letters as required. Maintain consistent communication with policyholders and stakeholders throughout the claim lifecycle. Ensure proper file documentation and compliance with company and regulatory standards. Negotiate settlements within authority and in accordance with company/client expectations. Stay current on state-specific laws and regulations related to commercial auto claims. Requirements: 3 - 5+ years of Commercial Auto/Trucking claims handling experience. Active Adjuster's License required. Strong analytical, negotiation, and communication skills. Ability to draft detailed claim reports and correspond professionally with stakeholders. Highly organized, proactive, and able to manage workload independently. Proficient in Microsoft Office and relevant claims management systems. Salary & Benefits: $65,000 - $75,000 annually (depending on experience) Comprehensive Medical, Dental, and Vision coverage 401(k) with company match Paid Time Off and holiday benefits Professional development and career growth opportunities

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.

We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates Input and update patient account information and document calls into the Practice Management system Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: High School Diploma or GED required Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST Minimum of 1-2 years of previous healthcare administration or related experience required Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) Manage/ field 60+ inbound calls per day Bilingual is a requirement (Spanish & English) Proficient knowledge of business software applications such as Excel, Word, and PowerPoint Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone Ability and openness to learn new things Ability to work effectively within a team in order to create a positive environment Ability to remain calm in a demanding call center environment Professional demeanor required Ability to effectively manage time and competing priorities #LI-SM2 ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.

The Company: At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier. Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago. What you will do: This position is responsible for managing and settling a high volume of insurance claims within assigned authority, operating independently with minimal supervision. The role requires extensive interaction with insured individuals, their legal representatives, and customer agents, as well as occasional contact with law enforcement officials. Key responsibilities include preparing and submitting reports within specified time frames in accordance with the Claims Technical Manual and supervisory requirements. The position also involves performing additional duties as assigned and ensuring compliance with all corporate policies and procedures. * Position requires extensive personal contact with insureds, their legal representatives and customer agents. Occasional contact with law enforcement officials may be required. * Operate on an independent basis with limited supervision in handling/settling a high volume of claims within assigned authority. * Submit reports within specified time frames as required by the Claims Technical Manual or as required by supervisor or manager. * Performs other duties as assigned. * Conforms with all corporate policies and procedures. Education: Bachelor's Degree preferred or Equivalent experience. Experience: 3-4 years adjusting experience in first party property line of business (personal and commercial) preferred. Salary Range: $68,321-$89,000 The final salary to be paid and position within the internal salary range will take into consideration the individual's work experience, geographic location, education, certification(s) or additional qualifications, and scope and responsibilities within the role. Benefits: We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following: * Medical and Prescription Drug Benefit * Dental Benefit * Vision Benefit * Life Insurance and Disability Benefits * 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results) * Health Savings Account (HSA) * Flexible Spending Accounts * Tuition Assistance, Training, and Professional Designations * Company-Paid Family Leave * Adoption/Surrogacy Assistance Benefit * Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance * Student Loan Refinancing Services * Care.com Membership with Back-up Care, Senior Solutions * Business Travel Accident Insurance * Matching Gifts program * Paid Volunteer Day * Employee Referral Award Program * Wellness programs Additional Information: This position is a full time salaried, exempt (non overtime eligible) position. As part of our hiring process, candidates who have accepted a formal offer must be willing to undergo a comprehensive background check and drug screen; additional screening for credit or MVR may be required for some positions. Utica National is an Equal Opportunity Employer. Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy. #LI-LH1

Ready to lead and shape Hospital Professional Liability claims strategy? Apply to this senior-level claims leader position, Claims Manager II. Join a high-performing team leading the Hospital Professional Liability claims unit for IronHealth/NAS Claims. We're looking for a seasoned Claims Manager with deep Hospital Professional Liability experience who wants to lead a technical team, shape claims strategy, and drive measurable improvements across a portfolio of complex and high-severity matters consistent with the standards of Liberty International Underwriters. *This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. This policy is subject to change. The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, and the overall cost of labor for that region, and based on you location you may not qualify for the top salary listed in the range. Responsibilities Responsible for performance, development and coaching of staff (including hiring, terminating, performance and salary management). Serve as technical resource not only for claims staff, but also cross-functional partners, including Underwriting (UW), Actuarial, Finance and Operations. Work with claims team and external attorneys to review coverages, investigate claims, analyze liability and damages, establish adequate indemnity and expense reserves, develop strategies and resolve claims, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions. Perform quality assurance reviews/observations and provide feedback to team as well as action plan for development of team, where necessary. Actively pursue all avenues of recovery including, but not limited to timely recovery of deductibles from insureds and manage subrogation activities. Provide regular reports to claims management regarding losses either exceeding or likely to exceed the authority level in accordance with best practices. Must be able to present effectively, produce appropriate reports and develop team and train team in these skills Partner with underwriting managers/team to provide excellent customer service and to market and meet with brokers, risk managers and reinsurers. Serve as external face claims leader for product line and demonstrate ability to forge and maintain relationships with external customers, effectively resolving concerns where necessary. Ability to effectively articulate the claims value proposition in claims advocacy meetings, account renewals and new business prospecting. Present at industry conferences or publishes external industry content. Lead short to medium-term strategic claims activities/priorities for the product line, with alignment with the strategic priorities of IronHealth and NAS Claims. Oversee projects assigned by the department head. Direct and manage the Claims participation and content for multidisciplinary reviews, monthly UW connectivity meetings, and quarterly actuarial meetings. Ensure timely feedback to senior management, underwriting and actuaries regarding relevant losses, account issues, and trends. Assist and coordinate with underwriting team regarding new policy forms, product development and/or product rollouts and provide timely feedback to senior management and underwriting regarding recommendations. Ability to achieve fluency in Loss Triangle interpretation and Product Level Profitability Understanding/Awareness. Other duties as assigned, including delivery on established operational goals and objectives. Qualifications Qualifications - what will make you successful! Bachelors' degree or equivalent training; advanced degrees or certifications preferred. A minimum of 8+ years of relevant and progressively more responsible work experience required, including at least 2 years of supervisory experience. At least 5 years claims handling within a technical specialty. Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace. Requires advanced knowledge of a technical specialty. Knowledge of law and insurance regulations in various jurisdictions. The ability to effectively interact with brokers and internal departments is also required. Strong verbal and written communications and organizational skills. Strong negotiation, analytical and decision-making skills also required. 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.

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 Specialist in our Life Health Global Claims unit to work remotely based out of our Stamford, CT office. Role Description The Claim Specialist is responsible for the delivery of the reinsurance claim risk management on multiple lines of business to both internal and external Gen Re clients. This includes, but is not limited to, the risk assessment of reinsurance liability and may include client training development and delivery, audit activities as well as representing the company and/or speaking at various industry conferences, as requested. Responsibilities: Responsible timely decision making and accuracy of reinsurance determinations on multiple lines of claim submissions. Incumbent contributes to the accurate and efficient adjudication of claims by supporting the department and client's investigation or coaching/mentoring on claims in all ranges of complexity to ensure compliance with policy provisions, state/federal regulations and reinsurance treaties in effect. Maintains a working knowledge of state and federal regulatory issues and keeps on the cutting edge of changes within the incumbent's area of expertise. Deliver high levels of customer service to internal and external customers in a professional, reliable and responsive manner. The incumbent works with claims management to develop, prioritize and execute a claim management strategy for each assigned client. Responsible for influencing a variety of constituents at various levels and not within one's direct employ. Thus, being accountable for the effective development, ongoing maintenance and consistent application of client communications and relationships. As an expert claim resource within a specific line of business, the Claim Specialist monitors national verdict/settlement trends and legal developments pertaining to their particular line of business. The incumbent researches, drafts and publishes articles and training oriented to educating clients on best practices gleaned. Responds to ad hoc reporting /projects from manager. Timely and accurate reporting of statistical information to management. Provides a broad range of regular (monthly/quarterly) management information in support of the Claims Department. Responsible for synthesizing a large amount of information from a variety of sources. May participate in client / TPA due diligence activities such as supporting audit activity, identifying emerging trends and themes not only in the client's inventory but within the industry; supporting manager with industry gleaned best practices via building and delivering customer specific training programs and seminars; emphasizing and implementing technical solutions to business needs to achieve desired improvements when asked. May participate in client meetings or with prospective accounts. Role Qualifications and Experience Prior claims experience in insurance and/or reinsurance operations. Prior experience managing claims (preferably LTC or Income Protection) thereby equipping the incumbent with the ability to assess reinsurer responsibility in its broadest sense (e.g. reviewing and offering risk management insights and recommendations on facultative and consultative claim submissions). Experience auditing claim files. Audit work of reinsured claims remotely or 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. Holds insurance adjuster's license or a willingness to secure same within 1 year of hire Strong working knowledge of key coverage lines especially health (Long Term Care, Individual Disability) type claims Strong written and verbal communication skills Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously or as an effective member of a team Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to detail Flexibility to travel for business purposes, approximately less than 10 trips per year Strong client relationship, influencing and interpersonal skills Proven initiative, prioritization, presentation, and training abilities. Experience with and proficiency in Microsoft Suite of Products (WORD, EXCEL, PowerPoint), Visio, Power BI, developing and running queries etc. Salary Range 91,000.00 - 152,000.00 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.