Medical claims examiner full time jobs - 37 jobs

Become a part of our caring community and help us put health first The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks. The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Accurately enters claims information into the company's database and maintain up-to-date records. Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status. Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements. Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed. Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously. Use your skills to make an impact Required Qualifications Medical Claims experience and/or knowledge of medical claims processes Knowledge of CPT, ICD-10, and HCPCS coding Medical terminology Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change Aptitude for quickly learning and navigating new technology systems and applications Ability to think analytically Strong focus on accuracy and detail Proficiency in all Microsoft Office Programs, including Word, PowerPoint, and Excel Preferred Qualifications Billing experience Coding Certification Previous inbound call center or related customer service experience Knowledge of HIPAA 837 and 835 electronic claims transactions Knowledge of Medicare Risk Adjustment and/or Medicaid processes Additional Information Onsite (Location: 3351 Executive Way Miramar, FL 33025) Required shifts: 8:00a - 5:00p (ET) Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $39,000 - $49,400 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**Claims Processor - Luxottica | Mason, OH** Finding a job that fits your lifestyle isn't always easy. Kelly is hiring a **Claims Processor** to join Luxottica, a global leader in eyewear (TEAM VISION). **Why apply:** + Pay: **$18.40/hr** + **Hybrid:** On-site 3 days/week (Tue-Thu); training 100% on-site + Full-time: 8:00 AM - 5:00 PM (1-hr lunch) or 8:00 AM - 4:30 PM (30-min lunch) + 2-month contract with potential for long-term conversion + Work with a world-class company and gain hands-on claims experience **What you'll do:** + Process standard claims and adjustments accurately and efficiently + Participate in non-complex claims projects and network initiatives + Provide strong customer service to EyeMed Account Managers and leadership + Meet productivity and accuracy standards while adapting to process changes **Requirements:** + High school diploma + 0-1 year of claims processing or data entry experience + Knowledge of PCs, Excel, and basic software (EyeMed, Metastorm, Exclaim, EyeNet) + Strong customer service, attention to detail, and ability to multi-task **Next Steps:** Apply today and our recruiters will review your profile. Even if this role isn't a fit, you'll stay in our network for future opportunities. ? **Apply to be a Claims Processor with Kelly now!** As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here (********************************************************************* for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community. Get a complete career fit with Kelly . You're looking to keep your career moving onward and upward, and we're here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career. About Kelly Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year. Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.

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

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

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

Come to work with us at Community Health Services! We offer full-time benefits, 10 paid holidays, no weekend hours and so much more! We are looking for a full-time Claims Specialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrific team. The Claims Specialist will be responsible for performing general finance functions, entering encounters, processing and recording claims and all other duties as assigned. Hours for this position are: Mondays 7am-7pm, Tuesdays through Thursdays 8am-5pm, Fridays 8am-1pm Qualified candidates must have the following to be considered for employment: * Associate's degree from an accredited college or university * Experience in accounting/bookkeeping * Demonstrates ability to organize and implement general accounting and bookkeeping procedures for a healthcare organization * Ability to work with clinic personnel and patients in a courteous, cooperative manner * Ability to function as part of a team * Must have excellent customer service skills * Must have excellent multi-tasking, problem solving, and decision-making skills * Ability to follow instructions with attention to detail * Demonstrates professional relationship skills, and a strong work ethic * Prioritizes responsibilities, takes initiative, and possesses excellent organizational skills * Demonstrates effective communication skills * Ability to work with a culturally diverse group of people At CHS, we value our team and the critical role they play in patient care. If you're dependable, detail-oriented, and passionate about making a difference in your community, we'd love to hear from you. CHS is a drug-free/nicotine free organization. Candidates must pass a drug and nicotine screening upon employment offer.

Come to work with us at Community Health Services! We offer full-time benefits, 10 paid holidays, no weekend hours and so much more! We are looking for a full-time Claims Specialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrific team. The Claims Specialist will be responsible for performing general finance functions, entering encounters, processing and recording claims and all other duties as assigned. Hours for this position are: Mondays 7am-7pm, Tuesdays through Thursdays 8am-5pm, Fridays 8am-1pm Qualified candidates must have the following to be considered for employment: Associate's degree from an accredited college or university Experience in accounting/bookkeeping Demonstrates ability to organize and implement general accounting and bookkeeping procedures for a healthcare organization Ability to work with clinic personnel and patients in a courteous, cooperative manner Ability to function as part of a team Must have excellent customer service skills Must have excellent multi-tasking, problem solving, and decision-making skills Ability to follow instructions with attention to detail Demonstrates professional relationship skills, and a strong work ethic Prioritizes responsibilities, takes initiative, and possesses excellent organizational skills Demonstrates effective communication skills Ability to work with a culturally diverse group of people At CHS, we value our team and the critical role they play in patient care. If you're dependable, detail-oriented, and passionate about making a difference in your community, we'd love to hear from you. CHS is a drug-free/nicotine free organization. Candidates must pass a drug and nicotine screening upon employment offer.

Canton - WC Claims Specialist - PN: 20068376 (260000BG) Organization: Workers' CompensationAgency Contact Name and Information: Mia Truss-Davis - HCM Sr. Analyst: ******************** Unposting Date: Jan 22, 2026, 4:59:00 AMWork Location: Canton Service Office 339 East Maple Street Suite 200 North Canton 44720-2593Primary Location: United States of America-OHIO-Stark County-North Canton Compensation: $25.77 - $33.52Schedule: Full-time Work Hours: 40Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Claims ExaminationTechnical Skills: Claims Examination, Customer ServiceProfessional Skills: Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication Agency OverviewA Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries. Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.Our Vision:To transform BWC into an agile organization driven by customer success.Our Mission:To deliver consistently excellent experiences for each BWC customer every day.Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.BWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.I have worked at several state agencies and BWC is the best place to work.Best place to work in the state and with a sense of family and support.I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!What You'll Be Doing:Manages a caseload of Workers' Compensation claims: Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.Performs initial/subsequent claims investigation & determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, & work history of claimant).Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of OhioResponds to customer inquiries Follows Ohio Revised Code and BWC policies and procedures Communicates with legal representatives, employers, claimants, etc.Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.Qualifications36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law). -Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits). -Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation). -Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers' Compensation Employer Service Representative, 63521. -Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination Major Worker Characteristics: Knowledge of: workers' compensation laws, policies & procedures*; eligibility criteria & procedures used for processing workers' compensation claims*; English grammar & spelling; oral & written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals & percentages; interviewing techniques; internet search engines & navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*; Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers' Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet; Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox ************************ OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.Background Check:Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Canton - WC Claims Specialist - PN: 20068376 (260000BG) Organization: Workers' CompensationAgency Contact Name and Information: Mia Truss-Davis - HCM Sr. Analyst: ******************** Unposting Date: Jan 22, 2026, 4:59:00 AMWork Location: Canton Service Office 339 East Maple Street Suite 200 North Canton 44720-2593Primary Location: United States of America-OHIO-Stark County Compensation: $25.77 - $33.52Schedule: Full-time Work Hours: 40Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Claims ExaminationTechnical Skills: Claims Examination, Customer ServiceProfessional Skills: Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication Agency OverviewA Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries. Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.Our Vision:To transform BWC into an agile organization driven by customer success.Our Mission:To deliver consistently excellent experiences for each BWC customer every day.Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.Job DutiesBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.I have worked at several state agencies and BWC is the best place to work.Best place to work in the state and with a sense of family and support.I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!What You'll Be Doing:Manages a caseload of Workers' Compensation claims: Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.Performs initial/subsequent claims investigation & determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, & work history of claimant).Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of OhioResponds to customer inquiries Follows Ohio Revised Code and BWC policies and procedures Communicates with legal representatives, employers, claimants, etc.Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.Qualifications36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law). -Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits). -Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation). -Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers' Compensation Employer Service Representative, 63521. -Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination Major Worker Characteristics: Knowledge of: workers' compensation laws, policies & procedures*; eligibility criteria & procedures used for processing workers' compensation claims*; English grammar & spelling; oral & written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals & percentages; interviewing techniques; internet search engines & navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*; Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers' Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet; Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox ************************ OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.Background Check:Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists. - Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- New York Independent Adjuster License- Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- 18+ months of medical claim processing experience- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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

Water Claims Coordinator/Accounts Receiveable We are currently searching for a full-time Water Claims Coordinator related to water mitigation insurance claims for our Southeast Region. The pay range for this position will be $19.00-$21.00, depending on experience. This on-site position will be located in downtown Cincinnati, OH. You will also receive company-paid parking at a nearby garage. The primary role of the Water Claims Coordinator is to bill, collect payments, and maintain accounts for the Water Restoration Department. The Water Claims Coordinator will keep precise records of all insurance/homeowner payments. Founded in 1935, Roto-Rooter is North America's largest plumbing, drain cleaning, and water cleanup services provider. Roto-Rooter operates businesses in over 100 company-owned branches, independent contractor territories, and approximately 400 independent franchise operations, serving approximately 90% of the U.S. population and parts of Canada. The ideal candidate will have 1-3 years of experience in the collection industry. In addition, the ideal candidate should possess strong communication skills, both with customers and within the insurance industry, and have a good working knowledge and/or experience in water restoration collections. Responsibilities Working knowledge of restoration billing and collections procedures 1-3 years of collections experience, preferably in the water restoration industry Administrative experience in the restoration (preferred) or service industry Highly motivated, detail-oriented, and able to work independently Outstanding organizational, time management, and follow-up skills Self-starter who thrives in a fast-paced environment Able to handle multiple projects at once Strong communication skills and ability to work professionally with customers and the insurance industry Bilingual a plus Requirements Highschool diploma or equivlant is required. 1-2 years of collections experience, preferably in the water restoration industry. Must be able to speak and write in English Basic computer skills, including Microsoft Office AS400 experience is preferred Benefits At Roto-Rooter we believe our greatest investment is in our employees. We prioritize the health and well-being of our team and their families. That's why we offer an extensive employee benefit package including: Medical insurance with a Prescription Drug Card Accident and Critical Illness Insurance Dental Insurance Vision Insurance Paid Vacation Paid Training Life Insurance Matching 401K Retirement Savings Plan Tuition Reimbursement Profit Sharing Roto-Rooter offers excellent career paths for military veterans and personnel transitioning to civilian professions. Throughout our 86 years in business, we've found that military training and structure are a great fit at our company. EEO Statement We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, religion, color, sex, gender, age, national origin, veteran status, military status, disability, gender identity, sexual orientation, genetic information, or any other characteristic protected by law. Not ready to apply? Connect with us for general consideration.

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

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

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

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

JOB RESPONSIBILITIES * Financial Support - May perform duties of FSR I & II. May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds, etc.). * Systems Support - Identify system and technology needs. Participate in advancing use of technology. Ensures systems meet all regulatory and compliance requirements. * Quality - May perform research and analysis. Participate in departmental/division performance improvement and quality assurance controls. May develop and execute corrective actions plans. * Billing - Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed. * Collaboration - Act as a preceptor and/or lead for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments. May have supervisory responsibilities. JOB QUALIFICATIONS * High school diploma or equivalent * 3+ years of work experience in a related job discipline Primary Location South Campus Schedule Full time Shift Day (United States of America) Department Professional Billing Operation Employee Status Regular FTE 1 Weekly Hours 40 * Expected Starting Pay Range * Annualized pay may vary based on FTE status $20.57 - $25.72 Market Leading Benefits Including*: * Medical coverage starting day one of employment. View employee benefits here. * Competitive retirement plans * Tuition reimbursement for continuing education * Expansive employee discount programs through our many community partners * Shift Differential, Weekend Differential, and Weekend Option Pay Programs for qualified positions * Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group * Physical and mental health wellness programs * Relocation assistance available for qualified positions * Benefits may vary based on FTE Status and Position Type About Us At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's. Cincinnati Children's is: * Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years * Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding * Recognized as one of America's Best Large Employers (2025), America's Best Employers for New Grads (2025) * One of the nation's America's Most Innovative Companies as noted by Fortune * Consistently certified as great place to work * A Leading Disability Employer as noted by the National Organization on Disability * Magnet designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC) We Embrace Innovation-Together. We believe in empowering our teams with the tools that help us work smarter and care better. That's why we support the responsible use of artificial intelligence. By encouraging innovation, we're creating space for new ideas, better outcomes, and a stronger future-for all of us. Comprehensive job description provided upon request. Cincinnati Children's is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

Crop Insurance Adjuster At Farmers Mutual Hail (FMH), our mission is simple: protect the livelihoods and legacies of America's farmers through the complete farm insurance solutions we offer. As America's Crop Insurance Company™, we are headquartered in the U.S. and have been owned by the farmers we insure for over 125 years. As a full-time Crop Insurance Adjuster at FMH, you'll complete field inspections, read maps and aerial photos, measure fields, climb storage bins, and discuss findings of crop losses with producers to enable America's farmers to clothe, feed, and fuel the world. Due to the required travel, the potential candidate will need to be located in Northwest Ohio to be successful in this role. BENEFITS: Our employees appreciate our family-oriented culture, and we make sure their benefits reflect that. In addition to a competitive salary and bonuses, medical/dental/vision plan, 401(k) plan with a generous company match, you will be eligible for benefits such as: Paid Parental leave and Caregiver leave This position will receive a vehicle, cell phone, and paid expenses for travel Employee appreciation events Employee Assistance Program (EAP) for support when you and your family need it REQUIREMENTS: To be considered for this role, you will need the following: Experience: A minimum of 1 to 5 years of crop insurance adjusting experience or an agriculture background is preferred. Education: High school diploma or general education degree (GED) required; Associates and/or Bachelor's degree in business or an ag-related field preferred. Skills: Must possess basic computer skills: Ability to use a computer, printer, scanner, Internet and Microsoft Office Products. Additional Requirements: Must be available to attend all Company-mandated training events and conferences and be able to travel for work-related reasons for periods of time exceeding twenty-four (24) hours. Must be able to physically climb heights in excess or ten (10) feet, walk distances over ¼ mile over uneven terrain, and stand without rest for periods of time greater than one hour. Must maintain a valid driver's license, clean MVR, and own a vehicle. RESPONSIBILITIES: Understands and is able to work claims for all major crops, policy/plan types, in all stages of growth. Effectively and clearly communicates regulations and interpretations to producers, agents, and Company staff regarding claims processes. Stays current with RMA-requirements and maintains CAPP certification if working multi-peril crop insurance (MPCI) claims. Maintains a State Adjuster License where required. Does this sound like a good fit for you? Apply today through our website! This position is not eligible for sponsorship for work authorization by Farmers Mutual Hail Insurance Company of Iowa. Therefore, if you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Farmers Mutual Hail Insurance Company does not discriminate in employment (EOE). All qualified applicants are encouraged to apply.

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