Senior claims processor jobs near me - 183 jobs

is remote (within the U.S.A.) and does not require regular in-office presence. What you do: Evaluates and authorizes disposition of complex claims. Obtains and analyzes medical records and financial documents. Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews. Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer. Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments. Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates. Assists with recoveries from reinsurance carriers. Performs all claims processing support functions. What you bring: Bachelor's degree or equivalent experience is required. 1-3 years of related experience is required. What we offer: A meaningful mission. Great benefits. A vibrant culture Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life. At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't: Ameritas Benefits For your money: • 401(k) Retirement Plan with company match and quarterly contribution. • Tuition Reimbursement and Assistance. • Incentive Program Bonuses. • Competitive Pay. For your time: • Flexible Hybrid work. • Thrive Days - Personal time off. • Paid time off (PTO). For your health and well-being: • Health Benefits: Medical, Dental, Vision. • Health Savings Account (HSA) with employer contribution. • Well-being programs with financial rewards. • Employee assistance program (EAP). For your professional growth: • Professional development programs. • Leadership development programs. • Employee resource groups. • StrengthsFinder Program. For your community: • Matching donations program. • Paid volunteer time- 8 hours per month. For your family: • Generous paid maternity leave and paternity leave. • Fertility, surrogacy, and adoption assistance. • Backup child, elder and pet care support. An Equal Opportunity Employer Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law. Application Deadline This position will be open for a minimum of 3 business days or until filled. This position is not open to individuals who are temporarily authorized to work in the U.S.

Supervisor, Claims - California| 100% Remote (WFH) Opportunity The Workers' Compensation Claims Supervisor is responsible for leading a team to successfully and proactively analyze and manage work comp claims assigned to the unit. The supervisor monitors and directs team effectiveness, guiding compliance with work comp state statutes within best practices to ensure claims move efficiently to closure. Participates in establishing team goals and objectives, participates in strategic and budgetary planning; monitors team effectiveness and supervises personnel and provides direct oversight on issues exceeding their authority. Successfully supports, coordinates and delegates objectives that support the company's mission and financial success. Preference given to those candidates with experience in the California Essential Duties and Responsibilities * Leads, supervises and manages a Workers' Compensation claims team to achieve company objectives and department goals by promoting and ensuring compliance with Company procedures and guidelines. * Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and supports and respects all team and company staff members, internal and external customers, and vendors. * Responsible for managing, developing, coaching, and motivating your work comp claims team. Conducts regular performance reviews. * Communicates effectively and assists with the interpretation and practical implementation of processes, workflows and systems. Provides technical and jurisdictional guidance to the team. * Responsible for monitoring the quality and quantity of work produced and coaching towards improved performance. * Fosters inter-departmental collaboration to build relationships throughout the organization to help drive success through partnership. Works closely with Corporate Claims and Quality Assurance for compliance. * Participates in the recruitment, selection and hiring of team members and facilitates training of new hires. * Exemplifies excellent customer service and models this for the team. Conduct business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality. * Participates in conference calls, meetings with adjusters, insureds, and agents. * Provides superior customer service by addressing inquiries from agents and policyholders. * Reviews and approves reserves, settlements, payments and other assigned tasks within level of authority. * Performs regular claim reviews based upon best practices, procedures and guidelines. Collaborates with the team for proactive claims management. * Other duties as assigned. Requirements * Must have a minimum of 10 years of technical claims experience in Workers' Compensation to include claim, coverage and compensability investigation, claim reserving, settlement negotiation and litigation management, regulatory compliance, and mentoring, training and developing adjusters. * At least two years of which must have been in a supervisory capacity. * Demonstrated business knowledge including effective communication, customer focus, the ability to collect and analyze information, problem solving and decision making in accordance with policies and regulations. * Demonstrated computer proficiency and comfortable using an internet-based claims system, reports, spreadsheets and databases. * Strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, customers, and other departments within the company. * Previous formal presentation experience. * Demonstrated technical PC skills to include MS Word, Excel, PowerPoint, and Windows, strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, clients, and other departments within the company. Certification * Active, current California Adjuster license * Insurance designation preferred (WCCP, ARM, AIC, CPCU, etc.) preferred. Education * Bachelor's Degree preferred or equivalent industry experience Work Environment: * Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship. * It requires a suitable space that provides a private and quiet workplace. * Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. * Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details! ********************************************************* About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As "America's small business insurance specialist", we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

Supervisor, Claims - California| 100% Remote (WFH) Opportunity The Workers' Compensation Claims Supervisor is responsible for leading a team to successfully and proactively analyze and manage work comp claims assigned to the unit. The supervisor monitors and directs team effectiveness, guiding compliance with work comp state statutes within best practices to ensure claims move efficiently to closure. Participates in establishing team goals and objectives, participates in strategic and budgetary planning; monitors team effectiveness and supervises personnel and provides direct oversight on issues exceeding their authority. Successfully supports, coordinates and delegates objectives that support the company's mission and financial success. Preference given to those candidates with experience in the California Essential Duties and Responsibilities Leads, supervises and manages a Workers' Compensation claims team to achieve company objectives and department goals by promoting and ensuring compliance with Company procedures and guidelines. Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and supports and respects all team and company staff members, internal and external customers, and vendors. Responsible for managing, developing, coaching, and motivating your work comp claims team. Conducts regular performance reviews. Communicates effectively and assists with the interpretation and practical implementation of processes, workflows and systems. Provides technical and jurisdictional guidance to the team. Responsible for monitoring the quality and quantity of work produced and coaching towards improved performance. Fosters inter-departmental collaboration to build relationships throughout the organization to help drive success through partnership. Works closely with Corporate Claims and Quality Assurance for compliance. Participates in the recruitment, selection and hiring of team members and facilitates training of new hires. Exemplifies excellent customer service and models this for the team. Conduct business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality. Participates in conference calls, meetings with adjusters, insureds, and agents. Provides superior customer service by addressing inquiries from agents and policyholders. Reviews and approves reserves, settlements, payments and other assigned tasks within level of authority. Performs regular claim reviews based upon best practices, procedures and guidelines. Collaborates with the team for proactive claims management. Other duties as assigned. Requirements Must have a minimum of 10 years of technical claims experience in Workers' Compensation to include claim, coverage and compensability investigation, claim reserving, settlement negotiation and litigation management, regulatory compliance, and mentoring, training and developing adjusters. At least two years of which must have been in a supervisory capacity. Demonstrated business knowledge including effective communication, customer focus, the ability to collect and analyze information, problem solving and decision making in accordance with policies and regulations. Demonstrated computer proficiency and comfortable using an internet-based claims system, reports, spreadsheets and databases. Strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, customers, and other departments within the company. Previous formal presentation experience. Demonstrated technical PC skills to include MS Word, Excel, PowerPoint, and Windows, strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, clients, and other departments within the company. Certification Active, current California Adjuster license Insurance designation preferred (WCCP, ARM, AIC, CPCU, etc.) preferred. Education Bachelor's Degree preferred or equivalent industry experience Work Environment: Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace. Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details! ********************************************************* About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Remote Claims Manager. In this role, you will have a significant impact on the operation of the claims department, supervising multiple teams to ensure the successful execution of client and corporate commitments. You will manage daily operations, providing support to team members and addressing complex issues. Your leadership will guide the team towards achieving high-quality service and production goals while fostering professional development. This role offers the opportunity to implement processes that enhance efficiency and client satisfaction.Accountabilities Supervise and manage the day-to-day operations of the claims team and outsourced vendor staff. Ensure successful achievement of quality, production, and service expectations. Facilitate staff development and the successful integration of new clients. Address complex claims or customer service inquiries. Provide guidance to team members on claims processing procedures. Manage relationships with outsourced vendors and clients. Drive continued process improvements within the department. Requirements High School Diploma or GED equivalent. 3-5 years of claim processing experience. Previous supervisory or management experience. Strong self-direction and ability to work with minimal supervision. Excellent verbal and written communication skills. Proven leadership, organizational, and interpersonal skills. Ability to work effectively with various stakeholders. Problem-solving skills to deal with varying situations. Proficiency in reading and interpreting documents and SPDs. Flexibility and openness to process improvements. Experience with MS Excel/Word and ability to learn new systems. Benefits Flexible remote work arrangement. Opportunity for professional development and growth. Access to health and wellness benefits. 401(k) savings and pension plans. Paid time off and parental leave. Disability insurance and supplemental life insurance. Employee assistance program. Tuition reimbursement and other incentives. Annual incentive bonus plan. Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.#LI-CL1

Cottingham & Butler Claims Services (CBCS) was built upon driven, ambitious people like yourself. “Better Every Day” is not just a slogan, it is a promise we make to ourselves and our clients. We are looking to hire an experienced Southeast Work Comp Claims Supervisor to our team. We are looking for someone who is eager to motivate and develop adjusters of all levels. If you're ready to make a significant impact and drive excellence, we want to hear from you! Key Expectations for the Claims Supervisor Role: Accountability and Feedback: Ensure that the team receives regular, high-quality feedback to drive accountability. Team Metrics: Maintain weekly metrics in the green. If a team member is not meeting expectations, develop and document plans with the Claims Manager to improve performance. Quality Service Review (QSR) Scores: Achieve monthly QSR scores of 90%+ for the team and address any underperformance with actionable plans. Monthly Meetings: Arrange monthly meetings with the team to align on goals, discuss challenges, provide training, and foster collaboration. Customer Service Survey Scores: Maintain an average score of 1.30 or less. Use survey results as coaching opportunities and ensure follow-up discussions. Mentorship and Teammate Development: Act as a mentor and actively contribute to developing your team of adjusters. Experience Requirements: The ideal candidate must have substantial experience in the Southeast region and possess a strong background in achieving results. We are looking for a critical thinker who is eager to collaborate with other like-minded professionals to drive growth and strengthen our business. A minimum of 1-5 years of claims supervision is required. Do you think this might be a fit for you? Send us your resume - we'd love to talk! Pay & Benefits Salary - Flexible based on your experience level. Most Benefits start Day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/ Defined Contribution (1-year waiting period) PTO/ Paid Holidays Company-paid ST and LT Disability Maternity Leave/ Parental Leave Company-paid Term Life/ Accidental Death Insurance About the company At Cottingham & Butler Claims Services, we sell a promise to help our clients through life's toughest moments. To ensure we keep that promise, we hold ourselves to a set of principles that we believe position our clients and our company for long-term success. Our Guiding Principles are not just words on paper, they are a promise we make to ourselves and our clients. These principles have become a driving force of our culture and share many common themes with the values of our clients. First, we hire and develop amazing people that have an insatiable desire to succeed, are committed to learning, and thrive on challenges. Secondly, we pride ourselves on serving our clients' best interests through quality service, innovative solutions, and constantly evaluating our performance. Third, we have embraced and are guided by the theme of "better every day" constantly pushing ourselves to be better than yesterday. Ultimately, we get more energy from the future we are creating for our people, our clients, and our company than from our past success. As an organization, we are very optimistic about the future and have incredibly high expectations for our people and our performance. We also understand that our growth is fueled by becoming better, not bigger - growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.

The Supervisor, Claims Compliance, (Supervisor, Allied Advocate) is responsible for assisting the Allied Advocate Management Team with the monitoring and management of the daily work and other functions within Allied's cost containment department. Excellent organization, communication and planning skills are needed to create, support, and adapt workflows, processes and procedures that enable and encourage the team's optimum performance. The position will be responsible for building and sustaining long-term relationships, internally and externally, to facilitate work efforts, alignment, collaboration, and to strategize for future growth within the department. ESSENTIAL FUNCTIONS Mentor and develop employees through constructive and targeted 1:1 coaching and nurture an environment where they can excel through encouragement and empowerment; supply on-going support that paves the way for career growth. Monitor daily inventory reports to ensure all claims/calls are managed promptly and accurately. Develop and implement detailed workflows to improve the consistency and accuracy of the staff. Be aware of all behind the scenes processes such as call notes, tracking, and claim related functions. Coordinate with Client Service Team Members, and Account Managers to proactively identify escalations or impacts to clients. Coordinate with other departments QicLink coding for Allied Advocate automation. Coordinate with reinsurance carriers as to all aspects of claim cost containment including monthly claim activity reports and contract extension requests. Fosters a sense of urgency and commitment to achieve goals resulting in the ability to influence the organization to meet and exceed client, member, and partner expectations. Maintain employee work schedules including assignments and training. Assist the Manager with coordinating current processes and workflows while working to find and improve internal processes with various Allied departments. Conduct regular meetings to ensure direct reports maintain service levels and meet assigned goals. Lead refresher training as needed. Work with other Allied Advocate Supervisors to distribute and adjust team resources as required. Create and distribute weekly Allied Advocate reports to Brokers and group contacts. Work to develop standard department metrics, audits, training guides, and best practices. Adhere to and apply all applicable privacy and security laws, including HIPAA (Health Insurance Portability and Accountability) and any regulations promulgated thereto. Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent. Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed. Actively engage, coach, counsel and provide timely, and constructive performance feedback. Performs other related duties as assigned. EDUCATION High School Diploma Required, College and Advanced Degrees Preferred. Continuing education in all areas affecting group health and welfare plans is required. EXPERIENCE AND SKILLS Minimum of 3 years of in-depth knowledge of Medical Claims, Benefits, and administrative skills required. Intermediate level work experience with Microsoft Office, Word, Excel, Access, and Power Point software applications required· Ability to prioritize tasks and delegate them when appropriate. Ability to multi-task, this includes ability to understand multiple products, multiple levels of benefits within each product and work within multiple systems. The ability to easily learn other software and systems. Strong written and verbal skills. POSITION COMPETENCIES Accountability Communication Action Oriented Timely Decision Making Building Relationships/Shaping Culture Customer Focus PHYSICAL DEMANDS This is a standard desk role - extended periods of sitting and working on a computer are required. WORK ENVIRONMENT Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.

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

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

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

SUMMARY DESCRIPTION: The Residential Claims Examiner is responsible for approving and settling residential property claims from the field where an estimate of damage has been prepared, or for preparing and settling estimates, or documenting claims decisions and settling those claims with the policyholder and claimants. The role's primary duties include phone scoping, reviewing coverage, determining settlement amounts, communicating with the policyholder or their representative, and documenting the claim file as outlined by the client or RENFROE. They are also responsible for documenting all activity, submitting required claims documentation, issuing settlement payments, settling and closing the claim using fair claims settlement practices, and ensuring compliance with legal and contractual obligations. REPORTS TO: Assigned RENFROE Manager ESSENTIAL JOB FUNCTIONS: · Follows RENFROE and clients' policies and procedures to handle all assigned property claims · Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills · Assigns task work for property inspections and interacts with field adjusters and estimators to determine the scope of loss · Oversees claims files for assigned claims and updates claims as new information becomes available using the client's proprietary software · Manages the progression of claims/tasks and claim inventories assigned to them · Contacts and interacts with the policyholder or their representative to obtain documents such as purchase receipts, bills, photographs, or other documents to establish the existence, ownership, and value of the items claimed damaged · Determines coverage and amounts for additional living expenses such as rental housing, travel, meals, etc. · Sets claim reserves following the client's guidelines · Calculates settlement amounts and, within their settlement authority or after receiving requested authority from the client's designee, issues settlement checks with supporting claim documentation · Writes closing reports, including recommendations for the pursuit of subrogation or the disposal of salvage · Reviews the claim file to support and draft coverage decision letters · Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE · Does not handle claims for which they do not have client authorization or for which they are not licensed · Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes · Makes suggestions on ways to improve process efficiency · Participates in special projects and completes other duties as assigned Non-Authorized Activities: Claims Examiners should not: · Communicate training requirements to client staff adjusters and non-affiliated firms · Communicate training requirements to any claim handler who is not deployed with RENFROE · Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE · Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind EXPERIENCE/QUALIFICATIONS: · Minimum of 1 year of property claims experience is preferred · Participation in technical insurance coursework is preferred, such as CPCU · Experience using various claims processing systems is preferred · Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes · Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others · Strong analytical skills and consistent attention to detail · Knowledge of ISO forms, and client policy coverage, procedures, and systems · Communicates clearly and effectively, both verbally and in writing · Strong customer service orientation and good rapport with the insured · Well-organized and hard-working, with the ability to thrive in a fast-paced work environment · Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact · Computer skills, including but not limited to practical knowledge of Word and Excel PHYSICAL DEMANDS: · Sitting in a chair for extended periods of time · Ability to operate a telephone, computer, mouse, keyboard, and other similar equipment for extended periods of time · Extended and varying work schedules, which may include work from home or work from a centralized office · Regular attendance required, working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays · Ability to work in a fast-paced, changing, and multi-tasking environment

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role We are seeking a skilled BI-LIT Claims Examiner to manage litigated files and attend trials, conferences, mediations, and arbitrations. The successful candidate will: Investigate and gather all necessary information and documentation related to claims Evaluate liability and damages Negotiate and settle claims Manage litigation cases related to auto claims disputes The BI-LIT Claims Examiner will also be responsible for maintaining electronic files, analyzing defense counsel's performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Managing legal aspects of litigated cases, including evaluation of legal process and expenses Analyzing and reviewing auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders Collaborating with defense counsel, claims counsel, and litigation claims management for strategic planning, including developing and maintaining positive working relationships with approved defense firms and other vendors in the industry Reviewing legal documents and ensuring compliance with initial suit-handling plan of action Serving as corporate representative for discovery review and depositions, and appearing as Corporate Representative at depositions and trials when needed Analyzing policy language and reaching appropriate coverage decisions, drafting frequent and complex coverage correspondence, and proactively managing primarily litigated claim files from inception to closure Directing and controlling the activities and costs of numerous outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Transportation litigation (rideshare, auto, trucking, etc) is preferred but those with personal lines experience should still apply if they meet all other requirements. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

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

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Pets Best, a subsidiary of IPH, is building a digital first pet e-commerce platform with the aim of connecting key market services such as adoption, lost pet and insurance to make pet care easy. Job Summary: Pets Best is seeking a Claims Processing Specialist who will report to the Supervisor, Claims. Claims Processing Specialists are responsible for reviewing invoices and pet medical documents and determining coverage in compliance with the current Underwriter's policy. Job Location: Remote - USA Main Responsibilities: Review individual policies to make an eligibility determination with high degree of accuracy Contact with internal departments as well as veterinarians and clinic staff Ensure compliance guidelines are met with both internal policies and procedures and contractual commitments Work independently and with others on a virtual team Drive a “Great Place to Work” culture, attend and participate in team meetings as well as engagement events Use PC based programs to enter data into claims system, communicate with leaders and teammates, and organize information Create and issue claim decisions to pet parents using proper spelling, grammar, and punctuation in line with the policy terms Calculate invoice totals, discounts, and tax rates Perform other duties and/or special projects as assigned Qualifications: High school diploma or equivalent 3+ years recent clinical veterinary experience (dog and cat) as a veterinary assistant, veterinary technician or veterinarian Knowledge of veterinary terms, abbreviations and conditions. Knowledge of medical conditions and associated symptoms, procedures, treatments, secondary conditions and pharmaceuticals used in veterinary medicine Knowledge of canine and feline breeds, anatomy and associated predispositions to illness. Ability to read and interpret medical diagnoses via medical records review both written and digital. Ability to work cross functionally with our internal and external resources Ability to handle multiple projects concurrently Ability to navigate Windows OS, Google Chrome, and corresponding applications Demonstrable Microsoft Office proficiency: Word, PowerPoint, Excel, Outlook, Teams Strong writing skills: organization, spelling, grammar and punctuation Strong mathematical and problem-solving skills #LI-Remote #petsbest All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)

Job Information State of Tennessee Job Information Opening Date/Time01/27/2026 12:00AM Central TimeClosing Date/Time02/02/2026 11:59PM Central TimeSalary (Monthly)$3,631.00 - $4,533.00Salary (Annually)$43,572.00 - $54,396.00Job TypeFull-TimeCity, State LocationClarksville, TNDepartmentHuman Services LOCATION OF (1) POSITION(S) TO BE FILLED: DEPARTMENT OF HUMAN SERVICES, REHABILITATION SERVICES - DISABILITY DETERMINATION DIVISION, MONTGOMERY COUNTY For more information, visit the link below: ****************************************************************************************************************** This is a remote position Qualifications Education and Experience: Bachelor's degree and two years of full-time professional disability claims examination work. Substitution of Experience for Education: Additional full-time professional disability claims examination work may be substituted for the required education on a year-for-year basis. Necessary Special Qualifications: * Complete a federal background check in accordance with the Homeland Security Presidential Directive 12 (HSPD-12) for issuance of an HSPD-12 compliant Personal Identity Verification (PIV) credential card. Overview This classification performs disability determination work of average difficulty. An employee in this class is responsible for determining adult and child medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits for initial claims in accordance with federal Social Security Administration (SSA) guidelines. This classification performs responsibilities at the working level under general supervision. This class differs from the Sr Disability Claims Examiner in that an incumbent of the latter are responsible adjudication of continuing disability cases and special court ordered or administratively ordered reviews and reviewing claims for compliance with pertinent laws, rules, and regulations. Responsibilities * Determines adult and child medical eligibility for Social Security Disability, Supplemental Security Income or Medicaid benefits using medical, psychiatric, vocational, and educational data for initial and reconsideration claims in accordance with federal Social Security Administration (SSA) guidelines. * Routinely conducts telephone interviews with claimants and others to obtain and/or clarify information on applications. Determines jurisdiction and proper timeframe for requests of claimant records and obtains records from relevant treatment sources. * Independently reviews and analyzes applications, medical assessments, medical records, and vocational assessments as needed for initial and reconsideration claims. Reviews prior decisions for accuracy and development of evidence and examines new allegations or evidence, redetermines medical eligibility, and issues reconsideration decisions. * Documents case notes, appointments, and general correspondence for review and adjudication. Organizes and enters claimant documentary evidence and claim decisions into an electronic case management folder. * Assesses claimant's medical conditions to identify impairments, onset issues, and limitations by reviewing medical records, statements, and other pertinent information to prepare a medical assessment. * Routinely confers with internal medical consultants and various other subject matter experts to ensure all aspects of disability claims are in accordance with federal guidelines. Selects, composes, and sends proper federal disability determination notices to claimants explaining medical and vocational decision issues to claimants and authorized representatives. * Schedules/reschedules consultative examination appointments for claimants and notifies claimants, third parties, attorneys of appointment time and date, and documents reasons for any missed exams. Authorizes payments for examinations and claimant travel. * Reviews claimant's work history to determine if claimant's past work description is adequate and contacts claimant by phone if additional work history is needed. Identifies and analyzes claimant's past relevant work by researching jobs and earnings reported to SSA and compares the claimant's residual capacity with the functional requirements of the claimant's past and other work. Competencies (KSA's) Competencies: * Customer Focus * Resourcefulness * Communicates Effectively * Instills Trust * Situational Adaptability Knowledges: * Customer and Personal Service * Medicine and Dentistry Skills: * Active Learning and Listening * Service Orientation * Critical Thinking * Judgment and Decision Making * Time Management Abilities: * Deductive Reasoning * Inductive Reasoning * Problem Sensitivity * Written Comprehension Tools & Equipment * General Office Equipment * Computer/Laptop/Tablet * Multifunction Printer (Print/Copy/Scan/Fax) * Cell Phone

Important things YOU should know: Fully Remote Opportunity Schedule: Mon - Fri 8:00am - 4:30pm CST Potential for Flex Schedule Occasional rotational weekend coverage required Exceptional Professional Growth What will YOU be doing for us? You will have the opportunity to accurately and efficiently input data from various types of insurance claim and/or authorization requests submitted by health care providers or members into data base system. What is in it for YOU? Career growth in an inclusive culture Paid training Health benefits 401 (k) What will YOU be working on every day? Enter data from insurance claim, authorization or member reimbursement requests expediently and efficiently to meet client turnaround times. Log unclean submissions so rejection letters are generated back to the servicing provider and a record is retained within the system. Ability to perform repetitive tasks with a high degree of accuracy. Navigate efficiently and effectively through the imaging software to retrieve claims and authorizations for data entry. Maintain proficiency with data entry guidelines and unique client requirements. Accurately identify specific document types that require special handling. Work collaboratively with other team members to ensure that work is completed in accordance to designated turnaround times. Support additional workflows as needed due to internal or external requirements. Utilize resources available to maintain current knowledge and understanding of client processing rules. What qualifications do YOU need to have to be GOOD candidate? Required Level of Education, Licenses, and/or Certificates High school diploma or equivalent Required Level of Experience 1+ years of experience in data entry or transcribing services. Preferably related to medical or dental claim submissions. Required Knowledge, Skills, and Abilities Successfully complete a pre-employment online alphanumeric data entry assessment Strong data entry/typing skills Excellent attention to detail High degree of accuracy Preferred Level of Experience 2+ years of experience in data entry or transcribing services. Preferably related to medical or dental claim submissions. 1+ years of successful experience working in a remote environment.

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market - to do more for clients - and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. Primary Responsibilities Adjudicate new claims and process adjustments, including denials upon receipt of additional information Review and resolve appeals and subrogation/third-party liability cases Manage individual inventory to ensure timely turnaround and production goals are met Ensure claims are processed in accordance with stop loss contract terms Respond to internal and external inquiries via email and other channels within established timeframes Follow up on missing or incomplete information to ensure claims can be accurately processed Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Minimum Qualifications Associate's degree preferred Experience with Third Party Administrator (TPA) or self-funded claims administration preferred At least 1+ year of experience in insurance claims processing Working knowledge of CPT and ICD-10 coding Basic understanding of medical terminology Strong communication and customer service skills Proficiency in Microsoft Office and general computer applications Ability to maintain confidentiality and comply with all company policies and procedures Able to work independently with minimal supervision Ability to prioritize, multitask, and work overtime as needed Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency$38,000-$41,000 USDBenefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business-and our society-stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

Through our dedicated associates, Arsenault delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Remote Data Entry Associate Equipment Provided Temp with chance to convert to full time Salary: $15-$20 HR. Hours: 8:00 am to 4:30 pm EST, M-F Would you enjoy being part of a team that makes a difference in people's lives Do you love helping people solve complex problems and delivering solutions? About The Role As a member of the team, you will be processing FSA and HSA claims. You will review and research the claim and process them on a web-based application. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.We have 3 different classes with the 1st one starting in early October. A successful candidate will be computer literate, maintain good attendance, and have the right attitude and discipline to work from home. You will take pride in being a contributing member of a busy team. Meet your quality and volume requirements consistently. This starts as temporary position. You will receive fully paid training of 4-6 weeks. Based on performance and attendance you may be converted to a permanent employee with benefits. What You Will Be Doing Review and research claims Determine if the claim is valid to approve Process claims on a web-based application Completes assignments using multiple source documents to verify data or use additional information to do the work. Follows up on pending documents involving analysis. Requirements Be computer literate able to set up equipment and operate with ease Have own highspeed internet connection: 25 download and 5 upload Must be at least 18 years of age or older. Must have a high school diploma or general education degree (GED). Must be eligible to work in the Los Angeles, CA. Must be able to clear a criminal background check and drug test. Arsenault is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply. Work Schedule Remote Monday through Friday, 8:30 AM to 5:00 PM EST Must be able to work 8am - 5pm Eastern Standard Time Responsibilities Claims Review and Processing Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. Critical Analysis Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. Timely Processing Ensure prompt claims processing to meet client standards and regulatory requirements. Identify and resolve any barriers using effective problem-solving strategies. Issue Resolution Collaborate with internal departments to proactively resolve discrepancies and issues. Use analytical skills to identify root causes and implement solutions. Confidentiality Maintenance Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. Detailed Record Keeping Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. Trend Monitoring Analyze and report trends in claim issues or irregularities to management. Assist Team Leads with reporting to contribute to continuous process improvements. Audit Participation Engage in audits and compliance reviews to ensure adherence to internal and external regulations. Critically evaluate and recommend process improvements when necessary. Mentoring Mentor and train new claims processors as needed. Requirements High school diploma or equivalent. Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. Billing experience doesn't count towards years of experience qualification Familiarity with ICD-10, CPT, and HCPCS coding systems. Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker's compensation claims is a plus). Strong attention to detail and accuracy. Ability to interpret and apply insurance program policies and government regulations effectively. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Ability to work independently and collaboratively within a team environment. Commitment to ongoing education and staying current with industry standards and technology advancements. Experience with claim denial resolution and the appeals process. Ability to manage a high volume of claims efficiently. Strong problem-solving capabilities and a customer service-oriented mindset. Flexibility to adjust to the evolving needs of the client and program changes. Benefits 401(k) with employer matching Health insurance Dental insurance Vision insurance Life insurance Flexible Paid Time Off (PTO) Paid Holidays What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring, the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. NTT DATA is seeking to hire a **Remote Claims Processing Associate** to work for our end client. **NOTE** : This is a US based, W-2 project. All candidates will be paid through NTT DATA only. **In this Role the candidate will be responsible for:** + Processing of Professional claim forms files by provider + Reviewing the policies and benefits + Comply with company regulations regarding HIPAA, confidentiality, and PHI + Abide with the timelines to complete compliance training of NTT Data/Client + Work independently to research, review and act on the claims + Prioritize work and adjudicate claims as per turnaround time/SLAs + Ensure claims are adjudicated as per clients defined workflows, guidelines + Sustaining and meeting the client productivity/quality targets to avoid penalties + Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as priority work + Correctly calculate claims payable amount using applicable methodology/ fee schedule **Requirements:** + 3 year(s) hands-on experience in **Healthcare Claims Processing** + **In-depth, hands-on, practiced experience processing COB claims** + **Demonstrated experience with institutional and professional claims** + 2+ year(s) using a computer with Windows applications using a keyboard, **navigating multiple screens and computer systems, and learning new software tools** + High school diploma or GED. + **Previously performing remote - in P&Q work environment; work from queue** + Key board skills and computer familiarity - + **Toggling back and forth between screens** /can you navigate multiple systems. + Working knowledge of MS office products - Outlook, MS Word and **MS-Excel** . + Must be able to work **7am - 4 pm CST** online/remote (training is **required on-camera** ). + Effective **troubleshooting where you can leverage your research, analysis and problem-solving abilities** + **Time management with the ability to cope in a complex, changing environment** + **Ability to communicate (oral/written) effectively** in a professional office setting **Preferred Skills & Experiences:** + Amisys &/or Xcelys Preferred **About NTT DATA** NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long-term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at us.nttdata.com (************************* NTT DATA endeavors to make ********************** (**********************/en) accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at **********************/en/contact-us . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here (**********************/en/compliance#eeos) . If you'd like more information on your EEO rights under the law, please click here (**********************/en/compliance#know-your-rights) . For Pay Transparency information, please click here (**********************/en/compliance#ppnp) .