Claims representative jobs in Rochester, NY

CENCO is a trusted name in property claims solutions, working with leading insurance carriers to provide accurate, timely, and efficient adjusting services. We are currently seeking experienced Daily Property Claims Adjusters to handle residential and commercial claims throughout Rochester and the surrounding Western New York region. This position is ideal for independent adjusters looking for steady work and the flexibility of field-based assignments. Key Responsibilities: Conduct thorough inspections of property damage from wind, water, fire, hail, and other covered events. Document damages with detailed reports and high-quality photos. Create accurate estimates using Xactimate or Symbility. Maintain professional communication with policyholders, contractors, and insurance carriers. Manage claims efficiently and meet all required reporting deadlines. Requirements: Licensing: Active New York adjuster license is required. Software: Familiarity with Xactimate or Symbility preferred. Equipment: Reliable transportation, ladder, laptop, and standard field tools. Work Style: Self-motivated, detail-oriented, and able to work independently. Availability: Must be responsive to assignments and able to complete claims promptly. Why Join CENCO? Steady claim volume in Rochester and surrounding areas Competitive, on-time compensation Supportive internal team and efficient claims handling systems If you're an experienced adjuster looking for consistent work and the opportunity to grow with a respected industry leader, we want to hear from you!

Division or Field Office: New York Branch Office Claims Department Work from: Home in ERIE operating footprint Salary Range: $55,261.00 - $88,274.00 * salary range is for this level and may vary based on actual level of role hired for * This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you're not just part of a Fortune 500 company; you're also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including: * Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. * Low contributions to medical and prescription premiums. We currently pay up to 97% of employees' monthly premium costs. * Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. * 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. * Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. * Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year. Position Summary Exercises independent discretion and judgement in claims handling involving complex liability issues, to include coverage issues and minor injury claims. * The selected candidate will work from home within the ERIE operating footprint, but will handle New York claims. Duties and Responsibilities * Conducts investigations, evaluate and make recommendations regarding coverage and liability. * Sets and maintains reserves. Obtains documents to establish the value of claims and negotiates settlement or declines claim. * Documents files and submits final report. * Identifies subrogation opportunities and initiates appropriate action. * Negotiates with all parties, or their representatives, within designated authority. * Completes required training. * Trains and mentors. * Travel for training may be required. The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident. Capabilities * Values Diversity * Nimble Learning * Self-Development * Collaborates * Customer Focus * Cultivates Innovation * Information Management Skills * Instills Trust * Optimizes Work Processes (IC) * Job-Specific Knowledge * Ensures Accountability * Decision Quality Qualifications Minimum Educational and Experience Requirements * High school diploma or equivalent and two years of claims or customer service experience, preferably with casualty claims, required. * Equivalent educational experience will be considered. * Associate's or Bachelor's degree, preferred. Designations and/or Licenses * Appropriate license as required by state. Physical Requirements * Lifting/Moving 0-20 lbs; Occasional ( * Lifting/Moving 20-50 lbs; Occasional ( * Ability to move over 50 lbs using lifting aide equipment; Occasional ( * Pushing/Pulling/moving objects, equipment with wheels; Occasional ( * Climbing/accessing heights; Rarely * Driving; Occasional ( * Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Workers' Compensation Claims Representative | NY Lost-Time Experience | NY Licensing **Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?** + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. **ARE YOU AN IDEAL CANDIDATE?** To analyze **New York Lost-Time** claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **OFFICE LOCATION:** **Syracuse, NY - candidates within reasonable commuting distance to office will be required to work a hybrid schedule** **Remote for candidates with the right experience outside of commutable distance to Syracuse, NY** **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. + Negotiating settlement of claims within designated authority. + Communicating claim activity and processing with the claimant and the client. + Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. **QUALIFICATIONS** + Education & Licensing: 1 - 2 years of claims management experience or equivalent combination of education and experience required. + High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. + Professional certification as applicable to line of business preferred. **Jurisdiction Knowledge: NY** **Licensing: NY** **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Opportunity to work in an agile environment. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (60K - 70K). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ \#LI-BP1 \#claims \#claimsexaminer \#remote \#LI-remote \#hybrid \#LI-hybrid Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. **Job Location (Full Address):** 905 Elmgrove Rd, Rochester, New York, United States of America, 14624 **Opening:** Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500011 Patient Financial Services Work Shift: UR - Day (United States of America) Range: UR URC 206 H Compensation Range: $20.99 - $28.34 _The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE: Performs follow-up activities designed to bring all open account receivables to successful closure and obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. Mentors and trains new or lower-level staff. **LOCATION** + Rochester Tech Park (RTP), Gates, NY + Remote options available after in-person training. + Occasional onsite meetings / work at RTP are required. + Remote location must be within 2 hours of RTP and within New York State. **ESSENTIAL FUNCTIONS** + Independently determines the most effective method to follow up on disputed, unpaid, underpaid, or overpaid insurance or contracted service accounts in order to bring about prompt account resolution and revenue collection from complex claims, high dollar claims, and specialized services. Identifies and resolves problems related to primary and secondary accounts which are disputed, unpaid, underpaid or overpaid. + Determines cause of problem and initiatives corrective action through reviews of electronic medical records. + Works to confer with external agencies. + Analyzes accounts and determines if correct proration of revenue has been collected, using detailed understanding and application of all payer contracts. + Contacts applicable agency, payer or department for resolution. + Decides when resubmitting efforts are complete, including writing an appeal using applicable content and supporting documentation to appropriately influence the highest level of revenue. + Acts as a resource for questions from assigned collection and billing staff on payer policies, procedures and methods of revenue collection. + Trains new staff on the use of the billing application, payer systems, and clearinghouse systems. + Demonstrates how to apply the knowledge of payer contracts and resources to resolve disputed, unpaid, underpaid, or overpaid accounts. + Provides feedback to leadership on results of training of new and existing staff. + Provides input for performance assessments based on observation, questions, and quality reviews of work performed. + Acts as area leader, when needed, including responding to payers, patients, and issues referred to the area from hospital departments or department representatives. + Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts and status of collection activities affecting departmental revenue. + Assesses if/when patients are contacted. + Resolves complex, high dollar, and specialized claim resolution issues due to coordination of benefits, eligibility issues, and authorizations. + Resolves accounts identified in third party audits involving retroactive approvals, resulting in adjustments, refunds, and subsequent secondary billing. + Researches, verifies, and/or obtains authorizations post-claim submittal. + Determines allocation of reimbursement applicable to multiple providers for global transplant payments and initiates transfer of money to each payer. + Identifies need for in-person meetings and phone conferences with third party insurance representatives due to claim and system issues requiring prompt attention for complex high dollar accounts. + Prepares information for and attends meeting with third-party insurance representatives on claims and systems issues for scheduled in-person meetings and phone conferences regarding complex high dollar claims. + Identifies and clarifies issues that require management and intervention to avoid loss of revenue. + Recommends filing of a formal complaint with the State's regulation commission or agency. + Determines when to change the account to a self-pay financial class after a review of previous efforts has not resulted in revenue collection and further attempts would not be successful without patient intervention. + Research and initiates suggestions to leadership to streamline processes and training materials. + Performs coverage for other positions as needed. Performs administrative office tasks and maintains records. Other duties as assigned. **MINIMUM EDUCATION & EXPERIENCE** + Associate's degree and 3 years of relevant experience required + Or equivalent combination of education and experience The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law. Notice: If you are a **Current Employee,** please **log into my URHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward. **Learn. Discover. Heal. Create.** Located in western New York, Rochester is our namesake and our home. One of the world's leading research universities, Rochester has a long tradition of breaking boundaries-always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better. If you're looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals. At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better-Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.

Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As an auto damage claims adjuster, you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end. Managing your own inventory while working independently, you'll work closely with body shops and others to negotiate repair pricing and assess liability. Ideal candidates will possess leadership and conflict management skills, along with strong attention to detail and a passion for providing excellent customer service. This is a field position with access to a company car and frequent driving within your assigned geographical area. We assess our workload collectively, which means you may cover assignments outside your geographical area. You may also be required to report into an office occasionally. Duties and responsibilities * Complete vehicle inspections, write estimates, determine total loss evaluations, and set clear expectations and timelines * Negotiate repair process with body shops * Document information related to the claim and make decisions consistent with claims standards and local laws * Evaluate and handle claim payments and resolution of claims without payments * Review and determine validity of any supplement requests Must-have qualifications * A minimum of four years of relevant work experience with one year appraisal/estimatics or insurance experience * {OR} Associate's degree and a minimum of three years relevant work experience with one year appraisal/estimatics or insurance experience * {OR} Bachelor's degree and a minimum of one year appraisal/estimatics or insurance experience * Valid driver's license, auto insurance, and compliance with Progressive's driving standards and/or policies Compensation * $67,000 - $81,200/year, depending on experience * Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Location * Rochester, NY * We assess our workload collectively, which means you may cover assignments outside your geographical area as well. Benefits * 401(k) with dollar-for-dollar company match up to 6% * Medical, dental & vision, including free preventative care * Wellness & mental health programs * Health care flexible spending accounts, health savings accounts, & life insurance * Paid time off, including volunteer time off * Paid & unpaid sick leave where applicable, as well as short & long-term disability * Parental & family leave; military leave & pay * Diverse, inclusive & welcoming culture with Employee Resource Groups * Career development & tuition assistance Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership. Equal Opportunity Employer For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************** Share: Apply Now

At MVP Health Care, we're on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll** **bring:** + High School Diploma required. Associate degree in health, Business or related field preferred + The availability to work Full-Time, Virtual within New York State + Previous related health care experience required + Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. + Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. + Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. + Knowledge of Facets and Macess systems strongly preferred, but not required. + Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. + Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. + Meets or exceeds department quality and work management standards for claims adjudication. + Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. + Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. + Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. + Keeps abreast of all benefit changes. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual, Rochester or Schenectady, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Claims/Operations** **Pay Type** **Hourly** **Hiring Min Rate** **20 USD** **Hiring Max Rate** **24 USD**

Kaeppel Consulting is seeking a qualified Claims Support Specialist II to join our client's team in New York. This is a 6-month onsite contingent position providing administrative and claims/zone support services at the New York Branch. The role involves a variety of administrative and customer service responsibilities performed under moderate supervision, with a strong focus on accuracy, confidentiality, and delivering excellent customer service. Key Responsibilities Perform administrative support tasks such as answering phones, filing, imaging, faxing, processing/distributing mail, and assisting with vendor processes. Order office supplies and coordinate/schedule meetings. Greet and direct visitors to the appropriate personnel. Provide inbound and outbound phone support to policyholders, claimants, agents, and other customers-ensuring all inquiries are handled with a strong focus on customer service. Support claims operations during weather-related events, including CAT loss reports and other CAT response activities. Assist across multiple claim types, including material damage, property, liability, subrogation, workers compensation, medical, and litigation. Prepare, process, and maintain confidential claim file documentation on a routine basis. Conduct follow-up calls and provide additional claim support as needed. Verify policyholder information and assist in setting follow-ups for claim activity completion. Enter new loss report details and update claim documentation in systems. Qualifications Previous experience in administrative support, claims processing, or a related clerical role preferred. Strong organizational and multitasking skills. Excellent communication and customer service abilities. Ability to maintain confidentiality with sensitive information. Proficiency with office equipment and standard software applications (Microsoft Office Suite). Ability to work independently with moderate supervision. Schedule: Shift: 8:00 AM - 4:30 PM, Saturday start of week

Collection Adjuster 1 - Consumer Reports To: Consumer Collection Manager Department: Retail Lending - Collections FLSA Status: Non-Exempt Purpose: The Consumer Collection Adjuster 1 is responsible for managing delinquency to acceptable levels in accordance with established Department goals and objectives. Must strictly adhere to all Bank policies and procedures, in addition to all State and Federal mandates and requirements. This position will work with borrowers in providing financial counseling and to implement structured repayment plans to bring the borrower's loan status to current and to encourage a future banking relationship. Supervisory Responsibilities: Degree of Supervision Received: Extensive * Supervision Received (title): Consumer Collection Manager Degree of Supervision Given: None * Supervision Given to (Titles): N/A Essential Functions: * Contact delinquent borrowers to arrange for timely repayment. The majority of the contact is initiated though telephone contact. Letters and approved e-mails are other permissible contact options. A measurable goal is the expectation for borrower contact via telephone: Example - An average of 135 calls per day. * Obtain updated borrower information. Verify information with each interaction. Utilize standard collection practices when attempting to located borrowers such as: skip tracing tools and techniques; approved social media outlets; and approved and authorized references and third parties. Fully, clearly and concisely document all borrower interactions and conversations. Fully disclose all collection activity. * Solid knowledge of regulations governing collection activity such as, but not limited to: FDCPA, SCRA, Privacy, Fair Lending, and Identity Theft. Must ensure strict adherence is critical to avoid sanctions, fines and penalties both from a Bank and personal liability standpoint. * Resolution of delinquency; NSF items; returned electronic payments; all for the purpose of reducing delinquency and avoiding losses. Creation of repayment/workout plans that are both good for and reasonable for the borrower and the Bank. Daily review of delinquent queues and borrowers to identify potential/y serious problems; to receive immediate repayment and to schedule future payments. A measurable goal is the expectation for acquiring electronic payments: Example - 200-250 per month. * Define problems, collect data, establish facts. Promptly respond to all inquiries. Research borrower inquiries and resolve payment posting issues. Provide loan history information and explanations. Work closely with peers across the Bank to provide the best possible borrower experience. Develop solid working relationships with: Branches, Loan Servicing, Banking Center and Systems Analysts. * Educate borrowers on the resolution process - provide assistance and alternatives, fully describe and detail eligibility for relief options: Extensions/deferments, government established relief programs, charitable organizations, and debt counseling agencies. * Provide assistance to ensure the most accurate borrower information and records: Change of Address Forms, Extension/Deferment Forms, Due Date Change Requests, Authorization for Preauthorized Payments, and Repossession Request Forms. * Identify potential loss situations by securing pertinent borrower information, and by analyzing financial data. Determine the probability of timely repayment - income vs debt. Proactively alert management to possible fraud situations. Formulate plans and seek approval by working closely with management. * Must perform all tasks and responsibilities by working in a partnership with peers, management, Loan Servicing and Call Center teams. Values must align with working in a true team environment to consistently deliver a superior quality of service. * Demonstrate the standards and principles of the Five Star Bank experience in every interaction with internal and external customers, associates, and stakeholders. Incorporate the high-performance behaviors of teamwork, leading by example, and service in every facet of work. * This job description is not exhaustive. The Collection Adjuster 1 - Consumer may be required to perform other duties as assigned. Job Related Qualifications - Education and Prior Experience: Required: * Education: High School Diploma or equivalent * Prior Experience: 2+ years of Collection, Banking, Customer Service, Call Center, Sales, Auto Financing, Collection Agency, Law Firm, Credit Union Preferred: * Education: Associate Degree in business or related field * Prior Experience: 2+ years of Collection, Banking, Customer Service, Call Center, Sales, Auto Financing, Collection Agency, Law Firm, Credit Union Competencies: * Strong verbal and written communication skills. Demonstrated customer service skills. * Basic knowledge of the collection function. * Working knowledge of Microsoft Office, Windows operating system, and Excel applications with the ability to learn new and existing Banking software. * Analytical ability to interpret data and to make sound decisions and logical recommendations. Excellent negotiation skills with the ability to overcome objections. * Strong organizational skills. * Ability to work in a fast- paced, high volume environment with specific measurement performance goals. Follow through, accountability, integrity, empathy, accuracy, attention to detail and problem solving are required skills. Physical Requirements: * Able to regularly sit for prolonged periods of time. * Extensive computer usage is required. * Ability to work: * Evenings * Occasionally * Weekends * Occasionally

Summary: Works to resolve claims/issues that impact the customer as it relates to errors in Order Processing, Accounts Receivable, Shipping, and defective products. There is a strong troubleshooting/problem solving component to this position Essential Responsibilities: Customer Care - Help resolve customer complaints/issues when an order was not entered, shipped, or received correctly. Investigation of customer complaints and ensuring resolution to these issues. Create CFB, document and report policy and procedure errors, and see CFBs through to resolution. Carrier Claims - Investigate and gather documentation with evidence. Prepare paperwork and submit claims for pursuance of payment/reimbursement. Act as the liaison with carriers involved with shipping errors. UPS - Coordinate the filing of UPS clams DOT - Ensure Liberty Pumps is in compliance with all DOT requirements/regulations; stay abreast of new DOT requirements; provide training/education to drivers; maintain driver completed log books Risk Management - Assist & work closely with Senior Claims Analyst and Chief Financial Officer in the administration of product liability claims Accounts Receivable - work with A/R in the resolution of disputes such as billing errors & shipping errors to ensure timely payments. Safety - Members are held responsible and accountable to follow safety guidelines, maintain a clean and organized work area, and use good safety judgment. Able to work well in a team environment and diverse group settings You will be expected to operate according to ISO 9001 requirements. Held responsible and accountable to follow safety guidelines, maintain a clean and organized work area, and use good safety judgment. Expected to report all unsafe activities and conditions to the Supervisor and/or Safety Representative. This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the member for this job. Duties, responsibilities, and activities may change at any time with or without notice. Minimum Qualifications: Organizational skills and being able to remain flexible at all times is necessary. Computer literate in common word processing, spreadsheet, and other Windows-based PC programs. Education/Training: High school diploma or GED Experience/Skills/Abilities: Ability to read, write, edit, analyze, and comprehend instructions, short correspondence, and general business documents. Ability to speak effectively before groups of customers or employees of organization. Ability to define problems, collect data, establish facts, and draw valid conclusions. Proficient personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, graphics, etc. Handle multiple projects simultaneously. Willing to work in a team environment. Self-motivated, capable of taking direction as well as working with minimal supervision. Ability to remain calm under pressure such as working through an employment situation. Work Schedule/Hours: Monday - Friday with typical business hours. Occasional overtime may be necessary when working on special projects. Minimal overnight travel (up to 10%) by land and/or air. Working Conditions: Well-lighted, heated, and/or air-conditioned indoor office/shop environment with adequate ventilation. Light physical activity performing non-strenuous daily activities of an administrative nature. Moderate noise (examples: business office with computers and printers, light traffic).

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Contents Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies and other records to determine insurance coverage. + Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. + Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance. + Estimates cost of repair, replacement, or compensation. + Prepares report of findings and negotiates settlement with claimant. + Recommends litigation by legal department when settlement cannot be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Obtain IIA-AIC designation within 12 to 18 months. Appropriate state adjuster license is required. **Experience** None. **Skills & Knowledge** + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Demonstrated commitment to timely reporting + Strong customer service skills + Strong interpersonal skills + Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently or in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** : Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** : + Must be able to stand and/or walk for long periods of time. + Must be able to kneel, squat or bend. + Must be able to work outdoors in hot and/or cold weather conditions. + Have the ability to climb, crawl, stoop, kneel, reaching/working overhead + Be able to lift/carry up to 50 pounds + Be able to push/pull up to 100 pounds + Be able to drive up to 4 hours per day. + Must have continual use of manual dexterity. **Auditory/Visual** : Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($50,000 - $70,000). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Qualifications you'll bring: High School Diploma required. Associate degree in health, Business or related field preferred The availability to work Full-Time, Virtual within New York State Previous related health care experience required Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Knowledge of Facets and Macess systems strongly preferred, but not required. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. Meets or exceeds department quality and work management standards for claims adjudication. Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. Keeps abreast of all benefit changes. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual, Rochester or Schenectady, NY

Collection Adjuster 1 - Consumer Reports To: Consumer Collection Manager Department: Retail Lending - Collections FLSA Status: Non-Exempt Purpose : The Consumer Collection Adjuster 1 is responsible for managing delinquency to acceptable levels in accordance with established Department goals and objectives. Must strictly adhere to all Bank policies and procedures, in addition to all State and Federal mandates and requirements. This position will work with borrowers in providing financial counseling and to implement structured repayment plans to bring the borrower's loan status to current and to encourage a future banking relationship. Supervisory Responsibilities : Degree of Supervision Received: Extensive Supervision Received (title): Consumer Collection Manager Degree of Supervision Given: None Supervision Given to (Titles): N/A Essential Functions : Contact delinquent borrowers to arrange for timely repayment. The majority of the contact is initiated though telephone contact. Letters and approved e-mails are other permissible contact options. A measurable goal is the expectation for borrower contact via telephone: Example - An average of 135 calls per day. Obtain updated borrower information. Verify information with each interaction. Utilize standard collection practices when attempting to located borrowers such as: skip tracing tools and techniques; approved social media outlets; and approved and authorized references and third parties. Fully, clearly and concisely document all borrower interactions and conversations. Fully disclose all collection activity. Solid knowledge of regulations governing collection activity such as, but not limited to: FDCPA, SCRA, Privacy, Fair Lending, and Identity Theft. Must ensure strict adherence is critical to avoid sanctions, fines and penalties both from a Bank and personal liability standpoint. Resolution of delinquency; NSF items; returned electronic payments; all for the purpose of reducing delinquency and avoiding losses. Creation of repayment/workout plans that are both good for and reasonable for the borrower and the Bank. Daily review of delinquent queues and borrowers to identify potential/y serious problems; to receive immediate repayment and to schedule future payments. A measurable goal is the expectation for acquiring electronic payments: Example - 200-250 per month. Define problems, collect data, establish facts. Promptly respond to all inquiries. Research borrower inquiries and resolve payment posting issues. Provide loan history information and explanations. Work closely with peers across the Bank to provide the best possible borrower experience. Develop solid working relationships with: Branches, Loan Servicing, Banking Center and Systems Analysts. Educate borrowers on the resolution process - provide assistance and alternatives, fully describe and detail eligibility for relief options: Extensions/deferments, government established relief programs, charitable organizations, and debt counseling agencies. Provide assistance to ensure the most accurate borrower information and records: Change of Address Forms, Extension/Deferment Forms, Due Date Change Requests, Authorization for Preauthorized Payments, and Repossession Request Forms. Identify potential loss situations by securing pertinent borrower information, and by analyzing financial data. Determine the probability of timely repayment - income vs debt. Proactively alert management to possible fraud situations. Formulate plans and seek approval by working closely with management. Must perform all tasks and responsibilities by working in a partnership with peers, management, Loan Servicing and Call Center teams. Values must align with working in a true team environment to consistently deliver a superior quality of service. Demonstrate the standards and principles of the Five Star Bank experience in every interaction with internal and external customers, associates, and stakeholders. Incorporate the high-performance behaviors of teamwork, leading by example, and service in every facet of work. This job description is not exhaustive. The Collection Adjuster 1 - Consumer may be required to perform other duties as assigned. Job Related Qualifications - Education and Prior Experience : Required: Education: High School Diploma or equivalent Prior Experience: 2+ years of Collection, Banking, Customer Service, Call Center, Sales, Auto Financing, Collection Agency, Law Firm, Credit Union Preferred: Education: Associate Degree in business or related field Prior Experience: 2+ years of Collection, Banking, Customer Service, Call Center, Sales, Auto Financing, Collection Agency, Law Firm, Credit Union Competencies : Strong verbal and written communication skills. Demonstrated customer service skills. Basic knowledge of the collection function. Working knowledge of Microsoft Office, Windows operating system, and Excel applications with the ability to learn new and existing Banking software. Analytical ability to interpret data and to make sound decisions and logical recommendations. Excellent negotiation skills with the ability to overcome objections. Strong organizational skills. Ability to work in a fast- paced, high volume environment with specific measurement performance goals. Follow through, accountability, integrity, empathy, accuracy, attention to detail and problem solving are required skills. Physical Requirements : Able to regularly sit for prolonged periods of time. Extensive computer usage is required. Ability to work: Evenings Occasionally Weekends Occasionally

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. Job Duties * Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects * Assists with reducing re-work by identifying and remediating claims processing issues * Locate and interpret regulatory and contractual requirements * Expertly tailors existing reports or available data to meet the needs of the claims project * Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error * Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. * Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. * Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. * Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. * Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. * Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. * Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. * Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. * Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. * QNXT Job Qualifications REQUIRED QUALIFICATIONS: * 5+ years of experience in medical claims processing, research, or a related field. * Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. * Advanced knowledge of medical billing codes and claims adjudication processes. * Strong analytical, organizational, and problem-solving skills. * Proficiency in claims management systems and data analysis tools * Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. * Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. * Microsoft office suite/applicable software program(s) proficiency PREFERRED QUALIFICATIONS: * Bachelor's Degree or equivalent combination of education and experience * Project management * Expert in Excel and PowerPoint * Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $106,214 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. + QNXT **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.