Become a part of our caring community and help us put health first The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks.
The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Accurately enters claims information into the company's database and maintain up-to-date records. Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status. Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements. Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed. Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously.
Use your skills to make an impact
Required Qualifications
Medical Claims experience and/or knowledge of medical claims processes
Knowledge of CPT, ICD-10, and HCPCS coding
Medical terminology
Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change
Aptitude for quickly learning and navigating new technology systems and applications
Ability to think analytically
Strong focus on accuracy and detail
Proficiency in all Microsoft Office Programs, including Word, PowerPoint, and Excel
Preferred Qualifications
Billing experience
Coding Certification
Previous inbound call center or related customer service experience
Knowledge of HIPAA 837 and 835 electronic claims transactions
Knowledge of Medicare Risk Adjustment and/or Medicaid processes
Additional Information
Onsite (Location: 3351 Executive Way Miramar, FL 33025)
Required shifts: 8:00a - 5:00p (ET)
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$39,000 - $49,400 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$39k-49.4k yearly Auto-Apply 12d ago
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Claims Mgmt Correspondence Tech
Southern Ohio Medical Center 4.7
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 Claims Management Manager and Assistant Manager. The Claims Management Correspondence Tech's primary responsibility is to sort and deliver all mail, records, and paper correspondence that are handled by the Claims Management department. Organizing all transfers of the mail by either scanning or placing it in designated mailboxes. Mailing all paper claims and letters printed within the department. Tracking and ordering all office supplies used by the department. Performing all other duties as assigned.
QUALIFICATIONS
Education:
* High School Diploma or successful completion of an equivalent High School Exam required
Licensure:
* None
Experience:
* Two years of office/clerical experience preferred
* Basic typing, computer and office equipment skills 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.
* Records arrival of mail for reference when needed.
* Distributes, retrieves and sorts all mail for Claims Management Department into offices/practices and financial classes to prepare for scanning.
* Scans mail into the system and distributes mail electronically to appropriate mailboxes.
* Pulls electronic mail from insurance websites and distributes to proper offices/practices and financial classes.
* Responsible for mailing all printed patient letters and printed claims to insurance.
* Responsible for printing records and EOBs to match w/claims that are to be mailed.
* Answers phones and retrieves electronic faxes, adhering to HIPPA regulations.
* Monitors Claims Management Department telephone extensions with the assistance of the assistant manager and manager.
* Covers PTO/schedule changes for other main Revenue Cycle Department Assistant.
* Manages and orders office supplies for the Claim Management department.
* 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.
$33k-41k yearly est. 38d ago
Crop Claims Seasonal Adjuster
Great American Insurance 4.7
Ohio
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.
The Crop Division of Great American has been helping generations of farmers take control of their risks since 1915. The D ivision is also one of a select few private companies authorized by the United States Department of Agriculture Risk Management Agency (USDA RMA) to write MPCI policies. With six regional offices throughout the U.S., the teams provide tremendous expertise in the specific needs of farmers and crops.
**********************************
Great American is currently seeking Seasonal Crop Adjusters. These positions are seasonal and may not be eligible for full-time or part-time benefits. Qualified candidates will cover territory in one of the following states:
Alabama
Arkansas
California
Colorado
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Washington
Wisconsin
Wyoming
Schedule: Seasonal part-time. Hours fluctuate based on seasonal needs.
As a Crop Adjuster, you will:
Understand and can work claims for all major crops, policy/plan types, in all stages of growth.
Complete field inspections, reviews, and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company Crop insurance policies.
Review and evaluates coverage and/or liability.
Secure and analyze necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims.
Ensure compliant and cost effective application of Crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements.
Accurately document, process and transmit loss information to determine potential.
Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions, or trials as necessary.
May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
Ensures that claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
Follow regulatory and company rules, policies, and procedures.
Performs other duties as assigned.
Physical Requirements for employees in the Crop Business Unit/Crop Claims General Adjuster
Requires continuous and prolonged walking and standing.
Requires frequent lifting, carrying, pushing and pulling of objects up to 50 lbs.
Requires frequent climbing grain bins, bending, twisting, stooping, kneeling and crawling.
Requires overhead reaching and grabbing.
Requires regular and predictable attendance.
Requires ability to conduct visual inspections.
Requires work outdoors, in inclement weather conditions.
Requires frequent travel.
May require ability to operate a motor vehicle.
Business Unit:
Crop
Salary Range:
$0.00 -$0.00
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
$43k-52k yearly est. Auto-Apply 57d ago
Water Restoration Claims Coordinator
Roto-Rooter Services Company 4.6
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 Auto-Apply 60d+ ago
Claims Representative I (Health & Dental)
Carebridge 3.8
Mason, OH
Title: Claims Representative I (Health & Dental) 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 Claims Representative I responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. Must pass the appropriate pre-employment test battery.
How you will make an impact:
* Learning the activities/tasks associated with his/her role.
* Works under direct supervision.
* Relies on others for instruction, guidance, and direction.
* Work is reviewed for technical accuracy and soundness.
* Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
* Researches and analyzes claims issues.
Minimum Requirements
* HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
* Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.
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.
$28k-36k yearly est. Auto-Apply 60d+ ago
Water Restoration Claims Coordinator
Roto-Rooter 4.6
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.
Not ready to apply? Connect with us for general consideration.
$19-21 hourly Auto-Apply 1d ago
Professional Billing Claims Follow Up Rep II
Cincinnati Children's Hospital Medical Center 4.5
Cincinnati, OH
JOB RESPONSIBILITIES * Billing - Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.
* Systems Support - Maintain and update departmental system, including templates, and payer and physician information.
* Collaboration - Act as a preceptor for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments.
* Financial Support - Obtain and evaluate family, third party payers and agency resources for payment of charges. Counsel patient on third party coverage and present financial aspects. Determine eligibility for State Medicaid, Social Security and other outside funding. Complete necessary paperwork for eligible patients, including medical and financial applications. Coordinate inpatient and outpatient admissions. Coordinate information with the inpatient and outpatient charge systems. Input charges and relative information. Manage accounts receivable data and collection information, ensure timeliness and accuracy. Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges. Check and update charge master. Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department. Process, post, and balance payments to accounts timely, accurately, and in the correct period.
* Quality - Provide Quality Assurance reports for the division.
JOB QUALIFICATIONS
* High school diploma or equivalent
* 2+ years of work experience in a related job discipline
Primary Location
South Campus
Schedule
Full time
Shift
Day (United States of America)
Department
Professional Billing Operation
Employee Status
Regular
FTE
1
Weekly Hours
40
* Expected Starting Pay Range
* Annualized pay may vary based on FTE status
$18.16 - $22.25
Market Leading Benefits Including*:
* Medical coverage starting day one of employment. View employee benefits here.
* Competitive retirement plans
* Tuition reimbursement for continuing education
* Expansive employee discount programs through our many community partners
* Shift Differential, Weekend Differential, and Weekend Option Pay Programs for qualified positions
* Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group
* Physical and mental health wellness programs
* Relocation assistance available for qualified positions
* Benefits may vary based on FTE Status and Position Type
About Us
At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's.
Cincinnati Children's is:
* Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years
* Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding
* Recognized as one of America's Best Large Employers (2025), America's Best Employers for New Grads (2025)
* One of the nation's America's Most Innovative Companies as noted by Fortune
* Consistently certified as great place to work
* A Leading Disability Employer as noted by the National Organization on Disability
* Magnet designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC)
We Embrace Innovation-Together. We believe in empowering our teams with the tools that help us work smarter and care better. That's why we support the responsible use of artificial intelligence. By encouraging innovation, we're creating space for new ideas, better outcomes, and a stronger future-for all of us.
Comprehensive job description provided upon request.
Cincinnati Children's is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability