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DETAILS Complex Claims Specialist - Property & Casualty Department: Property and Casualty Claims Reports To: Claims Supervisor FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Claims Supervisor ATHENS ADMINISTRATORS Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits-every single day! With offices throughout the United States, Athens Administrators offers Workers' Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Complex Claims Specialist to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA, and WV). This position does allow for work from home if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week. The Complex Claim Specialist is responsible for the review, investigation, analysis, and processing of complex claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure and often entail litigation and complex coverage. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Advanced knowledge in the following areas: 1) Complex Auto or General Liability claims handling concepts, practices and techniques, to include but not limited to complex coverage issues, and product line knowledge, 2) advanced, functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills. Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure Ensure appropriateness of all coverage memorandums and payments Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities Provide superior customer service to all layers of authorities within the county Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account. May assist management in hiring other account dedicated examiners Provide guidance and serve as a technical expert to less experienced examiners May conduct meetings or training sessions to help develop less experienced examiners Attend all required meetings and educational seminars for professional development Conduct on-sight or frequent claim reviews in Ventura County with the client representatives, as required. Maintain required licenses ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred Additional State Adjuster License(s), may be required within 180 days Maintain licenses and continuing education requirements in all states Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 8-10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims Experience with relevant insurance laws, codes, and procedures Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures Understanding Auto and General Liability exposure and unique coverage endorsements Understanding of medical, legal terminology and liability concepts Proficiency in investigation and resolution of severe to major level casualty claims Time Management and project management skills Strong negotiation and litigation management skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************** This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

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

National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! 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. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (****************** National Interstate is looking for a Claims Specialist to join their team. This individual will work fully remote from the USA. Essential Job Functions and Responsibilities Manages a large inventory of complex claims to evaluate compensability/liability. Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages. Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners. Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. Performs other duties as assigned. Job Requirements Education: Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.Experience: Generally, a minimum of 9 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).Scope of Job/Qualifications: Works within broad limits and authority on assignments of the highest technical complexity, requiring specialized knowledge. Demonstrates excellent analytical, negotiation, and problem-solving skills. Maintains strong knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Advanced ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. Viewed as a senior resource within the Claims department and/or organization. Company: NIIC National Interstate Insurance Company Salary Range: $90,000.00 -$100,000.00 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.

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Claims Examiner. The Claims Examiner will be managing insurance claims for our policyholders with low to moderate severity and complexity. The Claims Examiner must have the experience and technical knowledge needed to manage a case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party bodily injury and property damage claims involving low to moderate complexity from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 5+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with willingness to expand licenses as needed. #LI-BM #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

Illinois Casualty Company is seeking an experienced Property Claims Specialist to join our team! As a small but growing insurance carrier, ICC provides unlimited opportunity for employees who demonstrate the interest and ability to contribute to their team and grow professionally. Work Location: Field, about 25% travel required with ability to work from home the remainder of the time. Company vehicle provided. Salary Range: $83,850 to $95,000 annually Essential Functions * Handling large property claims from start to finish, typically ranging from $75,000 to upwards of $1,000,000 in loss * Building accurate, reliable claim files through prompt and thorough investigation and documentation * Inspecting damaged property, writing repair estimates, and obtaining repair price agreement with contractors and policyholders * Determining coverage, damages, and recovery potential based on facts developed in the investigation of assigned claims * Establishing appropriate and timely reserves, updating as needed until conclusion of each claim * Provide exemplary customer service and build positive relationships with independent agents Qualifications * Minimum of five years' field commercial property claims experience including complex and severe claims * Strong working knowledge of construction practices * Computer and data entry skills with intermediate level proficiency in word processing, spreadsheets, presentations, and automated claims systems; experience with Xactimate or Symbility desired * Sound knowledge of insurance policies, coverage, theories, and practices as well as court decisions or case law impacting property claims * Must be a licensed driver and maintain a valid driver's license in the state of residence with the ability to travel extensively when required Best In Class Benefits * Comprehensive health and pharmaceutical plan with company-funded HRA and telemedicine * A la carte Dental, Vision, Critical Illness, and Accident insurance coverages * Lifestyle Account * Traditional and Roth 401k plans with company match * Modified workweek and generous PTO policy * Paid parental leave

SOLV Energy is an engineering, procurement, construction (EPC) and solar services provider for utility solar, high voltage substation and energy storage markets across North America. The Property & Casualty Claim Specialist is responsible for managing and processing insurance claims related to property and casualty losses. This role involves investigating claims, assessing damages, claim reporting, and ensuring timely and accurate claim resolution. The ideal candidate will have a strong understanding of insurance policies, excellent analytical skills, and a commitment to providing outstanding service. : *This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned Position Responsibilities and Duties: Investigate and evaluate property and casualty claims to determine coverage, liability, and damages. Communicate with carriers, adjusters, claimants, and other stakeholders to gather necessary information and documentation. Analyze policy terms and conditions to determine claim eligibility. Coordinate with adjusters, contractors, and other professionals to assess and estimate damages. Work with carrier(s) in settlement negotiations with claimants and ensure fair and equitable claim resolution. Maintain accurate and detailed claim files and documentation. Provide regular internal updates on the status of claims. Ensure compliance with company policies, procedures, and regulatory requirements. Identify and report potential fraud or suspicious activities. Participate in training and development programs to stay current with industry trends and best practices. Minimum Skills or Experience Requirements: Bachelor's degree in a related field or equivalent work experience. Recommended heavy knowledge in Commercial Auto and Builders Risk coverages. Minimum of 5-10 years of experience in property and casualty claims handling - whether at a carrier, broker or with a construction client. Strong knowledge of insurance policies, coverage, and claim processes. Excellent analytical and problem-solving skills. Effective communication and negotiation abilities. Ability to work independently and as part of a team. Strong attention to detail and organizational skills. Customer-focused with a commitment to delivering high-quality service. SOLV Energy Is an Equal Opportunity Employer At SOLV Energy we celebrate the power of our differences. We are committed to building diverse, equitable, and inclusive workplaces that improve our communities. SOLV Energy prohibits discrimination and harassment of any kind against an employee or applicant based on race, color, age, religion, sex, sexual orientation, gender identity or expression, marital status, national origin, or ethnicity, mental or physical disability, veteran status, parental status, or any other characteristic protected by law. Benefits: Employees (and their families) are eligible for medical, dental, vision, basic life and disability insurance. Employees can enroll in our company's 401(k) plan and are provided vacation, sick and holiday pay. Compensation Range: $65,133.00 - $81,416.00 Pay Rate Type: Salary SOLV Energy does not accept unsolicited candidate introductions, referrals or resumes from third-party recruiters or staffing agencies. We require all third-party recruiters to communicate exclusively with our internal talent acquisition team. SOLV Energy will not pay a placement fee to any third-party recruiter or agency that has not coordinated their recruiting activity with the appropriate member of our internal talent acquisition team. In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. Any unsolicited candidate introductions, referrals or resumes sent by third-party recruiters to SOLV Energy or directly to any of our employees, or received through our website or career portal, will be considered property of SOLV Energy and will not be eligible for a placement fee. In the event a third-party recruiter submits a resume or refers a candidate without a previously signed vendor agreement, SOLV Energy explicitly reserves the right to pursue and hire the candidate(s) without financial liability to such third-party recruiter. Job Number: J11771 If you're interested in a meaningful career with a brighter future, join the SOLV Energy Team.

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Hill Physicians Care Solutions (HPCS) is a wholly owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage claims for the full risk line of business. Under the leadership of the HPCS Supervisor, the Full Risk Claims Analyst is responsible for ensuring Full Risk claims and disputes are processed accurately and timely pursuant to health plan coverage and Hill Physicians' reimbursement policies as well as within CMS and AB1455 regulations. The analyst will be Responsible for resolving/responding to complex issues for members, health plans and physicians by conducting detailed research and by interfacing with appropriate departments and management to ensure that the standards for claims resolution processes are met. Analyst must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Essential Responsibilities Adjudicating and/or adjusting claims, specifically for the full risk line of business, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Ensure these full risk claims are handled accurately, timely and appropriately. Claim contains pertinent and correct information for processing. Services have the required authorization. Accurate final claims adjudication/adjustment by using pricing system and provider contracts. Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims. Adjudicate claims on Epic Tapestry according to HPCS and HPMG guidelines. Navigate and decipher pricing rules using Optum Prospective Pricing System. Review, interpret and process MS DRG rules, Home Health and ASC groupings, DME and ambulance claims. Ensure all claim lines post to the appropriate fund. Maintain departmental productivity goal. Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate in Claims Services Determine benefits using automated-system controls, policy guidelines, and HMO Fact Sheets. Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Review and process out of network claims according to the guideline/out of network claims research protocol in order to contain out-of-network cost Conduct second-level review of all Medicare denials for Not Authorized and/or Not A Covered Benefit. Research, resolve, and respond to claim resubmission disputes and inquires Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Provide claims contact resolution to the call center. Complete special projects as assigned to meet department and company goals. Document follow-up information on the system and generate appropriate letters to member and providers. Skills and Experience Required Minimum years of experience required - 3 Minimum level of education required - High School/GED Licenses and certifications required - None. Must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Working knowledge of CPT, Revenue codes, PDGM Home Health, ICD-10 codes, Red Book, MS DRGs, HCPC codes and ASC groupings. Three years' experience in claims-payment adjudication at a Health Maintenance Organization (HMO) Health Plan or IPA. (Internal applicants are expected to have one year of experience in claims-payment adjudication). Ability to process all claim types on UB-04 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology. Ability to understand member benefits and patient cost-shares. Ability to calculate and convert standard drug measurements. Knowledge of CMS and the DMHC rules and regulations. Excellent problem solving, organizational, research and analytical skills. Strong written- and verbal-communication skills. Strong Microsoft application skills. Strong interpersonal skills and the ability to interact with employees and others in a professional manner. Strong judgment, decision-making and detailed oriented skills. Ability to work independently or as a team. Ability to work in a fast- paced environment. Additional Information Remote - Multiple Positions Available Salary: $28 - $32 hourly Hill Physicians is an Equal Opportunity Employer

Under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts. This is a hybrid position requiring twice a month in-office with preference on candidates residing within 50 miles of Suwanee, GA office. Please note this is subject to change. Responsibilities Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly. Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources. Manages an inventory of property/casualty and disability claims (e.g. workers` compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits. Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols. Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action. Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources. Updates files and provides comprehensive reports as required. Qualifications Effective interpersonal, analytical and negotiation abilities required. Ability to provide information in a clear, concise manner with an appropriate level of detail. Demonstrated ability to build and maintain effective relationships. Demonstrated success in a professional environment; success in a customer service/retail environment preferred. Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent. Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory. Licensing may be required in some states. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Hill Physicians Care Solutions (HPCS) is a wholly owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage claims for the full risk line of business. Under the leadership of the HPCS Supervisor, the Full Risk Claims Analyst is responsible for ensuring Full Risk claims and disputes are processed accurately and timely pursuant to health plan coverage and Hill Physicians' reimbursement policies as well as within CMS and AB1455 regulations. The analyst will be Responsible for resolving/responding to complex issues for members, health plans and physicians by conducting detailed research and by interfacing with appropriate departments and management to ensure that the standards for claims resolution processes are met. Analyst must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. Essential Responsibilities * Adjudicating and/or adjusting claims, specifically for the full risk line of business, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. * Ensure these full risk claims are handled accurately, timely and appropriately. * Claim contains pertinent and correct information for processing. * Services have the required authorization. * Accurate final claims adjudication/adjustment by using pricing system and provider contracts. * Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims. * Adjudicate claims on Epic Tapestry according to HPCS and HPMG guidelines. * Navigate and decipher pricing rules using Optum Prospective Pricing System. * Review, interpret and process MS DRG rules, Home Health and ASC groupings, DME and ambulance claims. * Ensure all claim lines post to the appropriate fund. * Maintain departmental productivity goal. Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate in Claims Services * Determine benefits using automated-system controls, policy guidelines, and HMO Fact Sheets. * Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. * Review and process out of network claims according to the guideline/out of network claims research protocol in order to contain out-of-network cost * Conduct second-level review of all Medicare denials for Not Authorized and/or Not A Covered Benefit. * Research, resolve, and respond to claim resubmission disputes and inquires * Coordinate and resolve claims issues related to claims processing with the appropriate departments as required. Provide claims contact resolution to the call center. * Complete special projects as assigned to meet department and company goals. * Document follow-up information on the system and generate appropriate letters to member and providers. Skills and Experience Required * Minimum years of experience required - 3 * Minimum level of education required - High School/GED * Licenses and certifications required - None. * Must have experience processing full risk claims, including but not limited to MS DRG Inpatient Hospital, Ambulatory Surgery Centers, Home Health Care, Skilled Nursing Facility, DME, Emergency Room Facility, Ambulance, etc. * Working knowledge of CPT, Revenue codes, PDGM Home Health, ICD-10 codes, Red Book, MS DRGs, HCPC codes and ASC groupings. * Three years' experience in claims-payment adjudication at a Health Maintenance Organization (HMO) Health Plan or IPA. (Internal applicants are expected to have one year of experience in claims-payment adjudication). * Ability to process all claim types on UB-04 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology. * Ability to understand member benefits and patient cost-shares. * Ability to calculate and convert standard drug measurements. * Knowledge of CMS and the DMHC rules and regulations. * Excellent problem solving, organizational, research and analytical skills. * Strong written- and verbal-communication skills. * Strong Microsoft application skills. * Strong interpersonal skills and the ability to interact with employees and others in a professional manner. * Strong judgment, decision-making and detailed oriented skills. * Ability to work independently or as a team. * Ability to work in a fast- paced environment. Additional Information Remote - Multiple Positions Available Salary: $28 - $32 hourly Hill Physicians is an Equal Opportunity Employer

Looking for a career with purpose and reward? At LoanCare we help customers every day with what is for many their largest and most personal financial transaction: the purchase of their home. With the mission to simplify the complex with empathy and insight, we are constantly innovating and are a top provider in the mortgage services industry as a result. We are actively seeking to fill the role of Claims Specialist II. Our ideal candidate enjoys working with clients, both internal and external, eager to learn and maximize results, is detail oriented and driven to meet tight deadlines in a fast-paced environment. Background in the mortgage or real estate industry is a plus. If this sounds like you, and you are ready for a career and not just your next job, apply today! Responsibilities • Prepare mortgage insurance claims for two or more agencies- or investor-acquired properties. • Complete reconciliation of all advances to be included in the claim. • Assist in conducting internal department quality control audits of post claim activity. • Validate all the necessary supporting documents needed for the claim. • Maintain clear records and reports for management regarding daily production. • Assist with updating appropriate workstations for claim payments. • Follow up and track payment of filed claims. • Conduct miscellaneous research to complete daily tasks. • Conduct research for post-claim activities such as “missing documents and/or agency inquiries”. • Complete tasks queue and notate internal system accordingly. • All other duties as assigned. Qualifications 2-4 years of experience in default mortgage servicing and/or mortgage insurance claim and/or the legal field. Knowledge of accepted business practices in the mortgage industry and understanding of claims process. Proficient knowledge of foreclosure process and appropriate guidelines (FHD). LPS-MSP (Mortgage Servicing Platform) experience. Ability to manage time and priorities wisely. Ability to make sound decisions and resolve issues. Ability to work independently and effectively meet deadlines. Ability to communicate effectively in writing, in person, and by telephone. Ability to use Microsoft Office applications, specifically, Excel and Word. Ability to maintain strict confidentiality. Total Rewards LoanCare's Total Rewards Package offers a comprehensive blend of health and welfare, financial, lifestyle and learning benefits to support employee well-being and engagement. Highlights include: Health & Welfare Coverage: Optional medical, dental, vision, life, and disability insurance Time Off: Paid holidays, vacation, and sick leave Retirement & Investment: Matching 401(k) plan and employee stock purchase plan Wellness Programs: Access to mental health resources, including free Calm memberships, and initiatives that promote physical and emotional well-being Employee Recognition: Programs that celebrate achievements and milestones Lifestyle & Learning Perks: Enjoy discounts on gym memberships, pet insurance, and employee purchasing programs, plus access to a tuition reimbursement program that supports your continued education and professional growth. Compensation Range: $17.88 - $26.73 hourly. Actual compensation may vary within the range provided, depending on a number of factors, including qualifications, skills and experience. Build Your Future with LoanCare At LoanCare, we don't just service mortgage loans-we serve people. As a leading full-service mortgage loan subservicer, we deliver excellence to banks, credit unions, independent mortgage companies, investors, and the homeowners they support. Backed by the strength and stability of Fidelity National Financial (NYSE: FNF), a Fortune 500 company, we offer a career foundation built on integrity, innovation, and collaboration. Here, you'll find: A culture that helps you thrive, with resources and support to fuel your growth Flexibility to work remotely, while staying connected through virtual engagement Opportunities to make a real impact in an industry that touches millions of lives If you're ready to grow your career in a place that values your contributions and empowers your success, we invite you to join our team. About Remote Employment We provide the necessary equipment; all you need is a quiet, private place in your home and a high-speed internet connection with a minimum network download speed of 25 megabits per second (MBPS) and a minimum network upload speed of 10 MBPS. Work Conditions Able to attend work and be productive during normal business hours and to work early, late or weekend hours as needed for successful job performance. Overtime required as necessary. Physical Demands Sitting up to 90% of the time Walking and standing up to 10% of the time Occasional lifting, stooping, kneeling, crouching, and reaching Equal Employment Opportunity LoanCare, its affiliates and subsidiaries, is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, protected veteran status, national origin, sexual orientation, gender identity or expression (including transgender status), genetic information or any other characteristic protected by applicable law.

The Claims Specialist is responsible for managing the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims. This role is critical to maximizing reimbursement, reducing denials, and supporting the financial health of the laboratory. Job Responsibilities Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies. Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions. Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment. Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system. Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives. Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims. Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making. Education, Experience, and Skills Associate's or Bachelor's degree in healthcare administration, business, or related field (preferred). 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting. Strong knowledge of insurance billing, payer requirements, and denial management. Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice. Proficiency with billing software and Microsoft Office Suite. Excellent attention to detail, organizational, and communication skills. Ability to work independently and collaboratively in a fast-paced environment. Physical Demands This is a sedentary role requiring prolonged periods of sitting while working at a computer. Physical demands include: Sitting for extended periods (up to 8 hours per day) Repetitive use of hands and fingers for typing and mouse operation Visual acuity for reading computer screens and documents Ability to communicate effectively via phone and video calls Occasional lifting of up to 10 pounds (office supplies, equipment) Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. Work Environment This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs. Pay Transparency, Budgeted Range$34-$37 USD ~ Science - Minded, Patient - Focused. At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care. Experts in what matters most. With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry's genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust. SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES. From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way: TECHNICAL EXPERTISE High-quality testing : Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved. Advanced detection : By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed. CLINICAL EXPERTISE Thorough analysis : We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence. Customized care : Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations. Impactful discovery : Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals. Learn more About Us here. Our Culture At GeneDx, we are dedicated to cultivating an environment where creativity and innovation thrive. We believe in the power of community and collaboration, where diverse perspectives are embraced, and every voice contributes to our shared success. Our team is a vibrant mix of professionals who challenge and support each other in equal measure, fostering growth both personally and professionally. When you join us, you're not just taking on a job-you're joining a movement. A movement that champions curiosity, embraces change, and believes in making an impact, one patient at a time. Cultural principles we live by: Be bold in our vision & brave in our execution. Communicate directly, with empathy. Do what we say we're going to do. Be adaptable to change. Operate with a bias for action. Benefits include: Paid Time Off (PTO) Health, Dental, Vision and Life insurance 401k Retirement Savings Plan Employee Discounts Voluntary benefits GeneDx is an Equal Opportunity Employer. All privacy policy information can be found here.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. (AHIMA CCS, COC or AAPC CPC certification required) Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. QUALIFICATIONS · 5+ years of directly related experience · Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I) · Medical Terminology and anatomy knowledge is required · Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. · Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines. · Strong Microsoft Excel, PowerPoint, Word and OneNote skills · Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS) · Strong analytical capability, independent thinker and good decision-making skills · Excellent written and verbal communication and presentation skills · Strong computer and technology knowledge and skills · Highly professional demeanor, great client satisfaction skills ESSENTIAL DUTIES AND RESPONSIBILITIES · Become proficient in the use of the PARA Data Editor, our proprietary software; · Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. · Audit all aspects of claim including (but not limited to): o Omitted or incorrect charges, o Review OPPS and CAH charges and apply guidelines. o CMS/Payer specific guidelines o Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) o Departmental review for inaccuracies, omitted data/documentation and charges o NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, o Units of services o E/M Profee/Facility o Units of services o Documentation improvement. · Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries. · Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing. · Participate in presentations to clients and prospective clients, typically over web meetings. · Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant. · Maintain current certifications and accreditations (as applicable). · Research new guidelines, data elements, payer specifications, etc. · Other duties may be assigned as necessary. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB This Claims Specialist is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards. The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a complex claims inventory. Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: Consistently provides exceptional customer service. Effectively collaborates with team members from various departments for project and process discussions. Acts as a Subject Matter Expert for the department. Makes recommendations for streamlining processes and adopting the industry's best practices. Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. Provides knowledge transfer across the organization. Continuously seeks to improve technical skills by attending job related training and tracking current case law. Acts as a mentor and provides training for less experienced team members. Prepares and presents claims status reports for internal and external stakeholders. Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 8-10 years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Thorough understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information to management, public groups, and/or boards of directors. Must be adept at learning new technology and embrace change. Facilitates and leads meetings across a team of claims professionals for assigned projects. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $78,678.61 - $132,686.15 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? • Challenging work and the ability to make a difference • You will have a voice and feel a sense of belonging • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match • Bonus potential for all positions • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) • 11 paid holidays throughout the calendar year • Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

HAAWK is looking for a Claiming Specialist to join our team. In this role you will be responsible for accuracy and integrity of music assets within YouTube's Content Management System (CMS), and play a critical part in ensuring proper monetization, rights enforcement, and conflict resolution across digital content platforms. The ideal candidate is highly detail-oriented, technically proficient, and possesses a strong understanding of YouTube's platforms and policies. What You Will Be Doing: * Monitoring and troubleshooting issues related to claims, monetization, and policy enforcement within YouTube CMS. * Investigating and resolving disputed claims, reference overlaps, and ownership conflicts to ensure proper asset management. * Maintaining accurate metadata, confirming correct ownership, and applying appropriate policies across music assets. * Serving as a point of contact for clients and partners, providing timely assistance with content-related issues and conflict resolution. * Stay up-to-date and informed on YouTube platform developments, Content ID tools, and industry best practices. What Makes You Qualified: * Proficiency in organizing and analyzing data using tools such as Microsoft Excel or Google Sheets. * Strong attention to detail, with excellent organizational and analytical problem-solving abilities. * Comfortable working with and learning new technologies. * Proven ability to work collaboratively in a team environment with a positive, solutions-oriented attitude and a willingness to support others to achieve shared goals. * Hands-on experience with YouTube CMS or similar content management systems. * Background in music, digital rights management, or copyright is a plus. * Solid understanding of popular music and awareness of current and emerging trends in the music industry. * Exceptional communication skills with the ability to interact professionally in client-facing situations.

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year medical billing/medical office experience. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. Communicates problems hindering workflow to management in a timely manner. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 SYSTEM Patient Financial Services

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities The Claims Specialist is responsible for reviewing, analyzing, and processing healthcare claims to ensure accuracy, completeness, and compliance with policies and regulatory standards. They will have a strong understanding of health insurance guidelines and demonstrated experience working across multiple claims processing systems. What You'll Actually Do Maintain quality and procedure standards including compete review and examination of claim to ensure proper handling in accordance with company policies and procedures. Complete claims task in timely manner and maintain production requirement: Review and understand plans, documents and vendors. Ensure proper system setup while processing claims. Identify and report to management any potential errors, problems or issues regarding plan documents, claims processing or system setup. Work stop loss renewal process, as directed by management. Complete all training requirements in a timely manner, as directed by management. Understand and enforce company procedures, polices and standards. Practice good follow up procedures to ensure completion of task and/or inquiries. Direct client contact, internal staff and vendor support to ensure customer and member satisfaction. Support management team with projects and special request Qualifications What You Bring to Our Mission High school diploma or equivalent required; associate or bachelor's degree in healthcare administration or related field preferred. Minimum of 2 years' experience in healthcare claims examination or adjudication. Strong knowledge of medical terminology, CPT/ICD-10 coding, and healthcare billing procedures. Expertise in multiple claims processing platforms a plus. Prior experience with both manual and automated claims processing. Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world while building the career you want? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $20 to $24 per hour. Note that compensation may vary based on location, skills, and experience. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.

The Claims Specialist III is responsible for capturing, resolving/facilitating resolution, and reporting on claim adjustment requests. Essential Functions: Resolve complex COB issues through member information updates and adjustment of claims Maintain accountability for daily tasks and goals to ensure completion of requests within requested SLA and department standards Identify potential process improvements Work with peers to ensure implementation of identified process improvements through the Plan, Do, Study, Act (PDSA) cycle with proper documentation updates and sharing of improvement with team and department Process/adjust a wide variety of claims accurately and timely following established guidelines for accuracy, quality and productivity Act as a technical resource for training, providing job shadowing, departmental communication, and coaching Ensure all assigned provider issues are resolved and communicated to the provider within appropriate timeframes and claims resolutions are coordinated with all appropriate departments in order to resolve Assist providers with inquiries including but not limited to; verifying proper medical coding, explanation of benefits, negative balance requests, claims, and appeal procedures Identify, track and trend claims payment errors in order to determine root causes and actions needed to correct problems. Work directly with Configuration, Network Operations, and Service Center through resolution of payment errors. Ensure reporting on provider inquires and complaints is compliant with current and future regulatory and accreditation bodies such as; ODJFS, MDCH, CMS, OFIR, NCQA and URAC Adhere to all HIPAA, State, and Federal requirements and regulations at all times in existing and future lines of business Perform any other job related instructions, as requested Education and Experience: High School Diploma or equivalent is required Minimum of one (1) year of experience in claims environment or related healthcare operations experience required Previous experience in an HMO or related industry preferred Previous Medicare/Medicaid dual eligible claims experience is preferred Managed Care Organization or related healthcare industry experience preferred Competencies, Knowledge and Skills: Proficient in Microsoft Office Suite, to include Word, Excel and PowerPoint Medical terminology; CPT and ICD coding knowledge strongly preferred Knowledge of medical billing practices Intermediate level data entry skills Excellent written and verbal communication skills Ability to develop, prioritize and accomplish goals Effective listening and critical thinking skills Strong interpersonal skills and a high level of professionalism Ability to coach and provide feedback effectively Effective problem solving skills with attention to detail Ability to work independently and within a team environment Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $40,400.00 - $64,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

HAAWK is looking for a Claiming Specialist to join our team. In this role you will be responsible for accuracy and integrity of music assets within YouTube's Content Management System (CMS), and play a critical part in ensuring proper monetization, rights enforcement, and conflict resolution across digital content platforms. The ideal candidate is highly detail-oriented, technically proficient, and possesses a strong understanding of YouTube's platforms and policies. What You Will Be Doing: Monitoring and troubleshooting issues related to claims, monetization, and policy enforcement within YouTube CMS. Investigating and resolving disputed claims, reference overlaps, and ownership conflicts to ensure proper asset management. Maintaining accurate metadata, confirming correct ownership, and applying appropriate policies across music assets. Serving as a point of contact for clients and partners, providing timely assistance with content-related issues and conflict resolution. Stay up-to-date and informed on YouTube platform developments, Content ID tools, and industry best practices. What Makes You Qualified: Proficiency in organizing and analyzing data using tools such as Microsoft Excel or Google Sheets. Strong attention to detail, with excellent organizational and analytical problem-solving abilities. Comfortable working with and learning new technologies. Proven ability to work collaboratively in a team environment with a positive, solutions-oriented attitude and a willingness to support others to achieve shared goals. Hands-on experience with YouTube CMS or similar content management systems. Background in music, digital rights management, or copyright is a plus. Solid understanding of popular music and awareness of current and emerging trends in the music industry. Exceptional communication skills with the ability to interact professionally in client-facing situations.

The Claims Coverage Specialist is a technical resource on the Hagerty Claims Legal team who conducts legal research and assists the Hagerty Claims team with providing accurate and consistent application of policy coverages among all jurisdictions. As a Claims Coverage Specialist, you will play a critical role in providing advice to assist the Claims team with the resolution of insurance claims by analyzing coverage, identifying risks, and supporting the Claims team in making informed decisions. This role requires strong analytical skills, attention to detail, and the ability to collaborate effectively across teams. Ready to get in the driver's seat? Join us! What you'll do Coverage Analysis: Review and interpret insurance policies to provide advice to the Claims team regarding coverage and liability issues. Provide clear, well-reasoned coverage recommendations to claim adjusters and leadership. Support the Claims team by preparing written communications that explain coverage issues. Provide claim adjusters with assistance drafting clear, professional correspondence to communicate coverage positions and decisions to policyholders and other stakeholders. Contribute to the review and updating of policy language to ensure accuracy, compliance, and clarity. Stay current on emerging coverage issues, regulatory changes, and industry trends. Share knowledge and resources with the team. Provide guidance and training to claims staff on coverage matters and best practices. Risk Awareness: Identify potential risks and recommend strategies to mitigate exposure. Support cross-functional initiatives, respond to legal or regulatory inquiries, and assist with projects requiring coverage expertise. This might describe you Education: Juris Doctor and admission to at least one state bar Experience: Minimum of 3+ years in insurance claims, coverage analysis, or related legal/industry work. Auto or casualty insurance experience is a plus. Skills: Strong analytical and problem-solving abilities. Excellent written and verbal communication skills. Comfortable working on multiple priorities in a collaborative environment. Knowledge: Familiarity with insurance coverage principles, claims processes, and regulatory requirements. Litigation or dispute resolution experience is a plus. Excellent written, verbal and interpersonal communication skills Able to prioritize multiple tasks with good time management skills Able to work accurately and effectively in a highly confidential, detail- and results-oriented environment. Able to work independently with minimal direction while functioning well in a team environment Excellent judgment (common sense) and business instincts. Ability to collaborate with employees at all levels across the enterprise and in team settings. Self-managed, self-motivated, and ability to work both independently and as part of a team on assigned tasks. Highest levels of personal and professional integrity. Ability to effectively prioritize and execute tasks in a fast-paced environment. Proven experience in interfacing with executive teams, business management and external law firms. Other things to note This position may require occasional travel to attend industry conferences or training sessions This position is open to U.S. remote work. Say hello to Hagerty Hagerty is an automotive enthusiast brand and the world's largest membership organization. Along with being a best-in-class provider of specialty insurance for enthusiasts, Hagerty is also home to the Hagerty Drivers Foundation, Garage + Social, Hagerty Drivers Club, Marketplace and so much more. Committed to saving driving for future generations, each and every thing Hagerty does is dedicated to the love of the automobile. Hagerty is a rapidly growing company that values a winning culture. We provide meaningful work for and invest in every single team member. At Hagerty, we share the road. We are an inclusive automotive community where all are welcomed, valued and belong regardless of race, gender, age, or car preference. We are united by our shared passion for driving, our commitment to preserve car culture for future generations and our desire to make a positive impact in the world. If you reside in the following jurisdictions: Illinois, Colorado, California, District of Columbia, Hawaii, Maryland, Minnesota, Nevada, New York, or Jersey City, New Jersey, Cincinnati or Toledo, Ohio, Rhode Island, Vermont, Washington, British Columbia, Canada please email ********************** for compensation, comprehensive benefits and the perks that set us apart. #LI-Remote EEO/AA US Benefits Overview Canada Benefits Overview UK Benefits Overview If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!