Claims Representative
Bellevue, WA jobs
LHH Recruitment Solutions is seeking an Claims Representative for our client in Bellevue, WA 98008 Our client is a leading asset manager dedicated to helping individuals, financial professionals and institutions design better portfolios.
Title: Claims Representative
Location: Bellevue, WA 98008
Pay: $26.00 - $40/hr
Hybrid: In-office Tuesday, Wednesday, Thursday
Summary
The Claims Representative manages and resolves property/casualty insurance claims efficiently and fairly. This role requires prior adjusting experience and focuses on training candidates on company-specific policies and systems-not basic claim handling. Active state adjuster license(s) are a plus.
Day-to-Day Responsibilities
Investigate and maintain claims: Gather reports, statements, photos, and estimates.
Evaluate claims: Assess coverage, damages, and liability.
Communicate with stakeholders: Policyholders, agents, legal reps; provide updates and explain processes.
Negotiate settlements: Ensure fairness within policy limits.
Document and report: Maintain accurate records for compliance.
Collaborate with other departments: Legal, underwriting, special investigations.
Ensure compliance: Adhere to state regulations and company guidelines.
Deliver excellent customer service: Professional and empathetic communication.
Qualifications
Education: Bachelor's degree not required.
Experience:
6 months to 3 years of property/casualty claims adjusting experience.
Must have verifiable adjusting experience; ready for advanced training.
Position- Claims Representative
📍
Location:
Bellevue, WA 98008
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Pay:
$26.00 - $40/hr
Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to ******************************************* The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
The California Fair Chance Act
Los Angeles City Fair Chance Ordinance
Los Angeles County Fair Chance Ordinance for Employers
San Francisco Fair Chance Ordinance
Lost Time Claims Examiner
New Haven, CT jobs
About the Role:
Job Title: Claims Examiner-Lost Time
Duration: 3 months
Job Schedule: 5 days on-site
Job Hours: 8:30am-5:00pm EST
Interview Process: 1 round of interview - Virtual
Duties and Responsibilities:
- Handles all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
- Reviews claim and policy information to provide background for investigation.
- Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
- Evaluates the facts gathered through the investigation to determine compensability of the claim.
- Informs insureds, claimants and attorneys of claim denials when applicable.
- Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
- Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team
Leader throughout the life of the claim.
- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
- Works with attorneys to manage hearings and litigation
- Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
- Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
- Files workers' compensation forms and electronic data with states to ensure compliance with statutory regulations.
- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
- Works with in-house Technical Assistants, Special Investigators, Nurse
Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
Technical Skills & Competencies:
- Lost Time Claim Examiner position with prior experience in workers' compensation as a medical only examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability or as a claim technical assistant for lost time claims.
- Requires knowledge of workers' compensation statutes, regulations and compliance.
- Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
- Exceptional customer service and focus.
- Ability to openly collaborate with leadership and peers to accomplish goals.
- Demonstrates a commitment to a career in claims.
- Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
- Use analytical skills to find mutually beneficial solutions to claim and customer issues.
- Ability to prepare and make exceptional presentations to internal and external customers.
- Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
- Willing to take ownership and tackle obstacles to meet Client's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
- Superior verbal and written communication skills.
Member Claims Associate
Lehi, UT jobs
Medical Claims Associate What You'll Do
Execute the daily operations of a health plan, including processing medical claims, researching and responding to our members' most complicated questions, tracking your accuracy around core metrics, and troubleshooting the many operational challenges that affect our business
Be part of the team that is continuously adapting to improve efficiency and scalability
Think critically and strategically to continually boost teamwork and communication across offices
Gain additional skills across different areas of our business over time
Develop in-depth industry expertise in the healthcare economy
Cultivate a culture that aligns with our values and incorporates the unique aspects of our team
Reporting to the Manager of Member Claims, this is an essential role on our Customer Experience team
To be successful in this role, you'll need:
Above all, you are driven, curious, and take ownership for everything you do
You can become proficient with a large volume of information quickly
You are a committed team player
You are excited to build and adapt to the adventures of working on a growing team
You are passionate about being a part of a fast-growing company
You have a passion for our mission to transform the health insurance experience for employers and their employees
Nice to have:
Bachelor's degree or 1 or more years of work experience
Compensation: $21.50 per hour
Litigation Claims Examiner
Jersey City, NJ jobs
About the Role
Job Title: Claims Examiner
Schedule: Hybrid (4 days in office, 1 day remote)
Hours: 9:00 AM - 5:00 PM (30-minute lunch break)
Interview Process: Single-round interview
Education & Experience
• Minimum 5 years of experience as a licensed claims professional with specialised expertise in:
o Litigation management
o Complex coverage issues
o High-exposure and/or long-term exposure claims
o Coverage litigation
• Law degree preferred, but not required.
Claims & Benefits Resolution Specialist
West Valley City, UT jobs
Job Title: Claims & Benefits Resolution Specialist
Pay Rate: $25.00-$26.00
(Training Onsite; Remote After Training with 1 Required Onsite Day/Month)
Department: Revenue Cycle Management - Central Business Office
Assignment Length: 3 Months (Potential Extension)
Top Things Needed:
Minimum 2-3 years of experience in healthcare revenue cycle, claims processing, eligibility/benefits, or authorizations.
Strong understanding of payer rules, reimbursement methodologies, and claims adjudication.
Familiarity with Epic, payer portals, and other claims/RCM systems.
High accuracy in auditing and error resolution work.
Experience resolving complex claim issues across multiple systems.
Ability to work independently, troubleshoot problems, and drive claims to completion
Strong communication skills for interacting with payers, internal teams, and leadership.
Comfortable with onsite onboarding and required monthly onsite days.
Experience working in a Central Business Office or Shared Services model.
Prior experience supporting Utah-based payer populations or multi-state payer networks.
JOB DESCRIPTION:
Our client is seeking a Claims & Benefits Resolution Specialist for a contract opportunity. This role performs comprehensive audits and resolution activities across the claims lifecycle, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. The specialist will handle complex claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong revenue cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify root-cause errors in a high-volume environment.
This is an operational “fix-it” position - the manager needs someone who doesn't just process claims but can find what's broken and correct it without hand-holding.
Key Responsibilities:
Claims Audit & Correction
Perform comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors.
Correct claim discrepancies within established turnaround times.
Ensure claim data accuracy, compliant coding, and alignment with the member's plan benefit.
Timely & Accurate Claims Processing
Process claims quickly and accurately according to organizational benchmarks.
Apply reimbursement rules based on the member's benefits and plan specifications.
Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.).
Complex Follow-Up & Dispute Resolution
Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed.
Investigate processing delays, missing information, or system errors and implement corrective action.
Refer cases to clinical management teams when medical review is required to ensure appropriate reimbursement.
Eligibility, Benefits & Authorization Coordination
Verify and document member eligibility, benefits coverage, and authorization requirements.
Identify discrepancies in coverage or authorizations that impact payment determinations.
Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information.
Cross-Functional Collaboration
Work closely with leadership, clinical review staff, and the CBO team to ensure timely resolution of claim issues.
Participate in problem-solving discussions related to claim trends or systemic issues.
Support training and onboarding efforts as needed during onsite sessions.
Required Skills & Experience:
Minimum 2-3 years of experience in healthcare revenue cycle, claims processing, eligibility/benefits, or authorizations.
Strong understanding of payer rules, reimbursement methodologies, and claims adjudication.
Familiarity with Epic, payer portals, and other claims/RCM systems.
High accuracy in auditing and error resolution work.
Experience resolving complex claim issues across multiple systems.
Ability to work independently, troubleshoot problems, and drive claims to completion
Strong communication skills for interacting with payers, internal teams, and leadership.
Comfortable with onsite onboarding and required monthly onsite days.
Experience working in a Central Business Office or Shared Services model.
Prior experience supporting Utah-based payer populations or multi-state payer networks.
Litigation Claims Examiner
Philadelphia, PA jobs
About the Role
Job Title: Claims Examiner
Schedule: Hybrid (4 days in office, 1 day remote)
Hours: 9:00 AM - 5:00 PM (30-minute lunch break)
Interview Process: Single-round interview
Education & Experience
• Minimum 5 years of experience as a licensed claims professional with specialised expertise in:
o Litigation management
o Complex coverage issues
o High-exposure and/or long-term exposure claims
o Coverage litigation
• Law degree preferred, but not required.
Claims Specialist
Plano, TX jobs
Duration:6 Months+
Roles & Responsibilities
Maximize customer satisfaction by providing prompt actions to customer's need and obtain quality photos/data to determine root cause of claim to defend or accommodate customer's claim
Provide efficient solutions to customer-facing agents by developing and operating guide and contents
Use various tools/dashboard/systems to quantify the agent's performance of customer care and develop appropriate actions to improve performance and quality
Spanish speaking agent recommended but not a requirement.
[Customer Experience Management] Analyze end-to-end processes that customers experience and participate in providing suitable resolutions accordingly and in controlled & monitored turnaround time for each action of customer claim process
[Quality Management] Monitor and review customer calls/tickets for customer care quality control, carry out activities to secure quality competitiveness of our company and customers
Maintains and improves operational quality by monitoring system performance; identifying and resolving problems; preparing and completing action plans.
Qualifications & Experience
College Graduate
3~5 Years in customer experience
Case management for MX/CE claims
CE Tender management
Pending Management (KPI, LTP)
Case Tracker Management for special issue
CPSC claim management (Customer care/tracker) (CE)
Monitoring FCCM report quality (ACQ/OS Reports)
Special Projects
Customer Care Resolution
EnR Submission/Management
Work to de-escalate customer situations while finding an appropriate solution; involve upper management as needed
Skills
Customer Care Experience (Call Center)
Claims Management Experience
Insurance Claims or Adjuster background beneficial
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details:
Name: P Praveen Chary
Email: ****************************
Internal Id: 25-54476
Casualty Claims Adjuster
Hingham, MA jobs
Responsibilities:
Conduct in-depth investigations into complex bodily injury claims, determining coverage, establishing liability, and evaluating damages by analyzing medical records, police reports, and witness statements.
Develop and execute effective negotiation strategies to achieve fair and timely settlements with claimants, attorneys, and other parties.
Manage litigated files, including developing defense strategies, communicating with legal counsel, and attending mediations, arbitrations, and trials as necessary.
Maintain meticulous and accurate claim file documentation in compliance with company standards and regulatory requirements.
Provide exceptional customer service, guiding insureds and claimants through complex claim processes with professionalism and empathy.
Candidate & SkillsTop 3-5 Skills:
5 + years of direct experience handling casualty claims, with a strong focus on bodily injury (BI) claims across various lines (Auto, Homeowners, Commercial).
Proven ability to investigate, analyze, and evaluate complex BI claims, including understanding medical terminology and injury causation.
Solid understanding of insurance policies, relevant state laws, and the litigation process.
Strong negotiation and conflict resolution skills, with a track record of successful settlements.
Takes ownership of files, even when litigation is involved.
Soft Skills:
Exceptional communication (verbal and written), interpersonal, and customer service skills.
Ability to work independently, manage a challenging caseload, and make sound judgments.
Strong analytical, problem-solving, and decision-making abilities.
Meticulous attention to detail and excellent organizational skills.
An eagerness to learn, adapt, and embrace new technologies
Ability to work effectively both independently and as part of a supportive team.
Certifications/Licenses/Education:
Active Adjuster License in CT, MA, RI - willing to get additional licenses as needed (company to assist)
A bachelor's degree is preferred, or equivalent work experience.
Commencement Coordinator
New York, NY jobs
Estimated 4 months
5 days on site
Must Haves:Bachelor's Degree
2+ years of relevant experience
Proficiency in Microsoft Office, Google Workspace, Zoom, and Airtable.
Familiarity with digital design tools such as Canva and Social Tables.
Strong data management and organizational skills, with experience maintaining registration forms and guest lists.
Preferred Skills:Demonstrated experience in event planning, logistics, staffing, or project coordination in a fast-paced environment.
Commencement Coordinator
The University Ceremonies Office is responsible for organizing and executing some of the university's most significant events. These include Commencement ceremonies, Inauguration, Trustee-related events, and other key ceremonial occasions that celebrate the university's achievements and traditions.
We seek a proactive and detail-oriented individual to join our team. This individual will be instrumental in managing logistical, programmatic, and communication aspects related to Commencement week. The role provides support with event planning, ceremony materials and participant outreach, volunteerism, and staff training and management, to contribute to the smooth and efficient execution of various projects.
Responsibilities
Develop and update program-related materials including seating diagrams and floor plans, academic procession documents, cue cards, scripts, and other assets as needed.
Support and manage outreach to key event participants, including speakers, honorees, university leadership, and other guests. Set up registration forms, track responses, and communicate all logistical details.
Conduct research and develop materials in support of Trustee-related events. Source potential venues, draft budget estimates and proposals, collect attendee biographies, fulfill supply needs, and prepare event checklists and other communications as needed.
Serve as a primary event staff lead, coordinating the hiring, training, scheduling and management of event staff who will support the Ceremonies team onsite, leading up to and during Commencement week events.
Oversee the recruitment, training, logistics and day-of management of University volunteers dedicated to supporting Commencement stage participants and VIP guests onsite. Develop training materials and lead all communications to this group.
Provide administrative and logistical support before, during, and after assigned events.
Perform additional duties as assigned to support the overall success of the University Ceremonies team and the Office of the Secretary.
Minimum Qualifications
Bachelor's degree and a minimum of two years of related experience.
Proficiency in Microsoft Office, Google Workspace, Zoom, and Airtable.
Familiarity with digital design tools such as Canva and Social Tables.
Strong data management and organizational skills, with experience maintaining registration forms and guest lists.
Demonstrated ability to work under pressure while maintaining accuracy and attention to detail.
Availability to work early mornings, evenings and weekends as required during peak event periods.
Preferred Qualifications
Exceptional written and verbal communication skills.
Strong organizational skills with high attention to detail and the ability to manage multiple priorities simultaneously.
Demonstrated experience in event planning, logistics, staffing, or project coordination in a fast-paced environment.
Proven ability to collaborate effectively with colleagues and vendors.
Commitment to professionalism, discretion, and high standards of customer service.
Forensic Coordinator - Waukesha
Pewaukee, WI jobs
Wisconsin Community Services Forensic Coordinator - Waukesha and Milwaukee Counties
Provide ongoing service coordination, treatment planning, advocacy and monitoring to residents of Milwaukee, Waukesha, Racine, and Kenosha counties who are participants in the OARS Program (Opening Avenues for Re-entry Success), Conditional Release Program (CR), Outpatient Competency Restoration Program (OCRP) and/or Jail-Based Competency Restoration Program (JBCR).
Essential Duties and Responsibilities
Coordinate, plan, and ensure follow-through with community treatment for individuals participating in the OARS, CR, OCRP and/or JBCR Programs.
Engage and develop a supportive one-to-one therapeutic relationship with each participant.
Incorporate evidence-based practices into the provision of services including but not limited to Motivational Interviewing (MI), Trauma Informed Care (TIC), and Person-Centered Planning.
Utilize MI skills as a primary approach to enhance participant participation and success.
Monitor ongoing treatment needs and compliance with treatment for all program participants by providing assessment, treatment planning, assertive case management, symptom management, medication monitoring, crisis-intervention, and coordination of multi-disciplinary team meetings as per program protocols and the Department of Health Services (DHS) contract.
Responsible for developing and submitting court documents for CR and Competency participants as required:Predisposition Investigation, Treatment Plan, Treatment Plan Adjustment, Adjustment Summary, Discharge/Transition Plan as well as all Status Report documents.
Coordinate team staffings with DHS/Department of Community Corrections (DCC) and other treatment team members.
Maintain safety practices and continually assess potential risk when in the community and when working with participants.
Coordinate community support services (referrals) and/or directly aid participants with activities of daily living to include, but not limited to, coaching and hands on assistance in the areas of housing, money management, vocational/educational pursuits, scheduling and transportation for appointments.
Encourage and assist each participant with the development of a natural support system including family members, neighbors, friends, the community, etc.
Create and maintain participant service documents including but not limited to case notes, assessments, Adult Family Home/Rent Justification forms, release plans, Individual Service Plans (ISP), Quarterly Progress Notes (QPN), crisis plans, budgets, suicide risk assessments (SRA), trauma assessments, other risk assessments, and release of information (ROI) forms within expected program timeframes.
Comply with program and DHS quality standards, DHS Connect (EHR) and SharePoint protocols, format requirements and timeframes for all documents and communications.
Ensure maximum participant financial contribution and third-party payment toward cost-of-service provision by applying for appropriate insurance benefits, fully utilizing available assistance programs, county services and community resources.
Provide on-going communication and coordination with treatment providers, DOC/DCC, mental health institution staff, court personnel, prison/jail staff, and other service agencies, reviewing and responding to emails and phone messages within 24 hours.
Frequent home visits and transportation of participants in the community using personal vehicles.
Develop and practice MI skills through training, coaching, and participant contact to attain basic fidelity within 12 months/advanced fidelity within 24 months of employment as outlined in the program contract.
Participate in MI coaching sessions and complete DHS surveys as required.
Complete MI audio recording and written Test of Knowledge as required.
Build and nurture positive relationships with stakeholders and funder(s).
Timely collection of necessary medical records, lab results and information for participants per program protocol.
Rotational crisis line coverage.
Appear and testify at court hearings.
Attend training, meetings, and staffings.
Participate in new staff shadowing rotation.
Other job-related duties may be necessary to carry out the responsibilities of the position.
Remote staff may be required to work from the Forensic office in Milwaukee.
On the last day of employment, staff will turn in all agency equipment to the supervisor/program director.
Required Qualifications
Bachelor's degree in social work, psychology, or related Human Services field.
Experience in case management and service coordination; experience serving people with a mental illness, substance use disorder, or other special populations required
Valid driver's license, automobile, and insurance sufficient to meet agency requirements required.
Meet all the employee requirements including references, criminal background check, and driver's license check.
Knowledge, Skills and Abilities
Communication - ability to provide information effectively with a diverse population - the persons we serve, supervisor, colleagues, and program partners in writing and oral communications.
Technological Aptitude - Ability to use general technological skills throughout daily job i.e., Email, Internet, company specified systems, (ex. Microsoft 365, Windows, Word, Excel).
Managing Priorities/Deadlines - Ability to maintain schedules, meet deadlines and manage multiple projects.
Problem-Solving Skills - Ability to think critically and be solution-oriented in a fast-paced environment and adapt to program changes and challenges.
Adaptability - Ability to manage change, deal with situations as they arise and work independently or as part of a team.
Teamwork - Ability to work as a team participate productively while also managing independent contributing duties and responsibilities.
Motivation - Possess a commitment to the assigned job, mission and core values of the organization while also supporting a respectful and harmonious work setting.
Professionalism - Ability to conduct oneself with a high level of integrity, ethics and boundaries.
Multicultural Sensitivity - The role involves working in the community and interacting directly with diverse populations, including clients, partners, and service providers. As such, the employee must demonstrate professionalism, cultural sensitivity, and strong interpersonal skills while representing the organization in a variety of settings.
Program Specific Knowledge, Skills and Abilities - Clinical skills and knowledge related to community based services for individuals who have a mental illness including assessment, treatment planning, monitoring and supportive services.
Knowledge of and experience in mental health and substance use services including assessment, treatment plan development, psychotropic medications, side effects and symptom management
knowledge of the legal system and forensic psychiatric issues; risk management; resourcefulness and flexibility responding to changing participant needs
Knowledge of substance abuse disorders; psychotropic medications; entitlements such as Medicaid, SSI/SSDI, Medicare, and Veterans benefits.
PHYSICAL DEMANDS:
Driving throughout the southeastern WI region, the mental health institutions in Madison and Oshkosh and prisons statewide. Position requires the ability to drive for periods of time on any given day. Office work involves sitting at a desk and conducting computer work.
WORK ENVIRONMENT:
The job is performed in a combination of an office setting, and in the field throughout the four-county region (including the inner city of Milwaukee). Requires travel to DHS, mental health institutions in Madison and Oshkosh and prisons statewide. Provides supervisory backup for 24hr Crisis Line when needed and be accessible to staff and/or program participants.
Wisconsin Community Services, Inc. is an equal opportunity employer. All applicants will be considered for employment without attention to race, ethnicity, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
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Sourcing Coordinator
Los Angeles, CA jobs
We are seeking an experienced Product Development Sourcing Coordinator to join a fast-paced apparel organization focused on innovation, speed, and scalable production. This is a highly hands-on role supporting both seasonal core lines and customer-driven programs, with ownership over sourcing strategy, novelty development, costing, and execution.
This position plays a critical role in bringing new materials, embellishments, and construction techniques to market while partnering closely with Design, Sales, Production, and global suppliers. The ideal candidate is equally comfortable working in unstructured, creative development environments and structured, process-driven production workflows.
Key Responsibilities
Source, vet, and manage suppliers, sub-suppliers, and contractors, including counter-sourcing, costing, compliance, and ongoing vendor management
Develop and source fabrics, yarns, trims, packaging, and new technologies for seasonal and customer-driven programs
Set up and maintain all raw materials and components in PLM, including costing, testing, documentation, and material records
Lead novelty development such as screen print innovations, embroidery applications, garment dye and wash techniques, and all-over print capabilities
Own sourcing timelines and direct offshore development teams to ensure timely execution
Partner closely with Design and Sales to assess feasibility, execution methods, technical parameters, and cost targets
Create BOMs, tech packs, and decoration processes in collaboration with Technical Design
Coordinate and manage sampling workflows, including proto, fit, quality, and sales samples
Own costing and negotiation for catalog and blank styles across domestic and full-package production
Maintain physical and digital development libraries for fabrics, trims, and embellishments
Co-manage development calendars and hold cross-functional partners accountable to milestones
Qualifications
Minimum 5 years of experience in apparel Product Development and/or Sourcing
Strong understanding of garment construction, technical components, and the apparel lifecycle
Experience sourcing fabrics, trims, embellishments, and novelty components
Proficiency with PLM systems, Adobe Illustrator, and MS Office
ERP experience preferred
Strong communication skills; Spanish bilingual a plus
Highly organized, adaptable, self-motivated, and able to manage multiple priorities
Willingness to travel internationally and maintain local mobility
Sample Coordinator
Los Angeles, CA jobs
We are seeking a detail-oriented and organized Merchandise Sample Admin to support a fast-paced apparel headquarters team. This role is ideal for someone who enjoys hands-on work, thrives in a collaborative environment, and is comfortable managing multiple priorities and deadlines.
Responsibilities:
• Receive, process, and distribute all incoming and outgoing product samples across multiple categories
• Manage internal tracking systems to maintain real-time sample status and accuracy
• Perform monthly inventory and organization of sample closets
• Pull, prepare, and hand off product samples for fittings, marketing, and cross-functional use
• Partner with Product Development, Technical Design, Merchandising, Marketing, and PR teams to ensure seamless sample flow
• Support team operations with Excel tracking, system updates, and clear communication across departments
• Must be able to stand or move around 70-90% of the time, depending on system proficiency
Qualifications:
• High school diploma or equivalent required; college coursework preferred
• Strong organizational skills and ability to manage multiple priorities
• Proficiency in Microsoft Excel, Word, and Outlook
• Excellent attention to detail and time management
• Comfortable working in a physical, fast-paced environment
Schedule: Monday-Friday, Full-Time (40 hours per week)
Duration: 3 months (with potential to extend)
Work Environment: 100% On-site
Sample Coordinator
Los Angeles, CA jobs
A well-known apparel brand is seeking a highly organized and detail-oriented Freelance/Part-Time Sample Coordinator to support the Product Development team. This role is ideal for someone who thrives in a fast-paced environment, enjoys working cross-functionally, and has strong communication and organizational skills.
Responsibilities:
• Coordinate salesman sample orders and update tracking tools (Excel and PLM)
• Manage receipt, organization, and storage of Proto through SMS samples
• Prepare samples for fittings, meetings, and seasonal presentations
• Maintain sample libraries, tagging, hanging, labeling, and shipment records
• Communicate with overseas vendors regarding sample delivery schedules
• Track and report vendor on-time performance and identify timing risks
• Support Merchandising, Creative, PD, Production, and Technical Design teams
• Prepare, ship, and receive sample packages (DHL)
Qualifications:
• 1-2 years of experience in the apparel industry preferred
• Strong organizational skills with the ability to manage multiple priorities
• Excellent attention to detail and follow-through
• Strong communication skills, both written and verbal
• Proficiency in Microsoft Office (Excel, Outlook, Word)
• PLM system experience is a plus
• Understanding of garment construction and product development processes preferred
Sample Coordinator
Los Angeles, CA jobs
Apparel Pre-Production/Sample Coordinator Assistant
About J&G INC
J&G Inc. is a rapidly growing apparel manufacturing company based in Downtown LA specialized in Women's Junior and Contemporary Fashion. We collaborate with distinguished leaders in the fashion industry, delivering our stylish and contemporary designs nationwide to valued customers and passionate fashion enthusiasts.
What You'll Be a Part Of:
The Pre-Production Assistant/Sample Coordinator supports the design and production teams by managing garment samples throughout the development cycle. You would be responsible for tracking samples, coordinating fittings, maintaining accurate records, and ensuring timely delivery of samples for fittings, reviews, and sales meetings.
Responsibilities
Track, receive, organize, and distribute all garment samples (proto, fit, SMS, TOP, and sales samples).
Maintain accurate sample logs, tracking sheets, and inventory systems.
Ensure samples are properly labeled, prepped, and stored.
Standing, walking, and moving samples throughout the day.
Coordinate sample shipments between vendors, factories, design teams, showrooms, and photoshoots.
Communicate sample status updates with internal teams and external partners.
Follow up with vendors and factories to ensure on-time delivery of samples.
Maintain sample calendars and deadlines.
Support general administrative tasks as needed by the design or production team.
Qualifications
Strong understanding of fabrics, garment construction, and textiles.
Recent graduates/approaching graduation with a degree in Fashion Design, Apparel Production, Textile Design, or a related field.
Proficient in Microsoft Office, Google Suite, and Adobe Illustrator.
Strong organizational skills with attention to detail.
Willingness to learn, collaborate, and take initiative in a fast-paced environment.
A passion for fashion!
Trend-savvy with a strong sense of market awareness
Ability to lift and carry sample boxes and garment racks (up to 25 lbs).
What You'll Gain
Hands-on experience in apparel product development and pre-production.
Exposure to cross-functional collaboration with design, sourcing, and production teams.
Professional development opportunities.
Why Join Us?
Competitive pay and benefits
Health Insurance
Paid vacation and holidays
Opportunities for growth and advancement
Supportive team culture
Job Type: Entry Level Full-Time
Pay: $19 per hour
Work Location: On-site
Equal Opportunity Statement
We are committed to diversity and inclusivity in our hiring practices.
Textile Coordinator
New York, NY jobs
Job Title: Textile Coordinator (Contract - 2-3 Months)
Type: W2 Contract
Duration: 2-3 Months
Pay Rate: $15-$20 per hour (W2)
About the Role
We are seeking a Textile Coordinator to support the textile development team in all aspects of fabric and color development. This role is ideal for someone with a background in textiles who enjoys hands-on work with materials, maintaining organization, and supporting technical processes that ensure high-quality finished products.
You will work closely with Textile Technologists and product development teams to ensure fabrics, colors, and components meet performance and quality standards before they move into production.
Key Responsibilities
Assist in all stages of fabric development, including organization of swatches, reviewing fabric submissions, and helping evaluate performance and quality.
Support the color development process by tracking lab dips, maintaining color libraries, and organizing color submissions/approvals.
Prepare fabric and trim samples for testing; assist with basic textile quality checks such as shrinkage, colorfastness, and hand-feel evaluations.
Maintain accurate records and documentation within internal systems, spreadsheets, and tracking tools.
Coordinate sample shipments, deliveries, and vendor submissions as needed.
Help maintain the fabric library, color standards, and sample room organization.
Provide day-to-day administrative and operational support to the Textile Technologists and product development team.
Ensure all materials meet quality requirements before approval for production.
Required Qualifications
Degree in Textile Science or equivalent experience in textile materials, textile R&D, or fabric development.
2-3 years of experience working in textiles, raw materials, fabric testing, product development, or a related technical field.
Strong understanding of fibers, yarns, fabric construction, dyes, finishes, and basic textile testing methods.
Excellent attention to detail, organizational skills, and time-management abilities.
Ability to work hands-on with fabrics, swatches, and color samples in a fast-paced environment.
Proficiency in Excel and basic tracking tools; familiarity with PLM systems is a plus.
Who Will Succeed in This Role
Someone early in their career with strong technical textile knowledge.
A candidate who enjoys working with materials and colors in a structured, detail-driven environment.
Individuals who can multitask, stay organized, and support multiple development tasks simultaneously.
Work Environment
This is a fully onsite role in Manhattan, NY.
You will work in a collaborative product development environment with daily interaction with the textile/materials team.
Benefits that Russell Tobin offers:
Russell Tobin offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.
Showroom Coordinator
Stamford, CT jobs
Adecco Creative is partnering with a global electronics company to recruit for an Experience & Showroom Coordinator. This position will be 5 days onsite in Stamford, CT. The role is ongoing contract and requires flexibility to work weekends and holidays as needed.
Job Summary:
We are looking for an organized and customer-focused Showroom Coordinator to manage the day-to-day operations of our kitchen appliance showroom. The ideal candidate will be responsible for ensuring the showroom runs smoothly, assisting customers with product inquiries, and supporting the events & marketing team. This role requires excellent communication, organizational skills, and attention to detail to create a positive customer experience.
Our environment is not a typical corporate event space. You will be part of a team with a strong collaborative work ethic that is passionate about putting their skills to work.
Key Responsibilities:
Maintain a clean, organized, and visually appealing showroom environment.
Greet customers warmly and assist with any inquiries.
Support the marketing & culinary team with administrative tasks, including scheduling appointments, tours, managing customer follow-ups, ordering supplies, fulfilling small appliance sales, event set up/breakdown.
Monitor inventory levels and communicate restocking needs with the manager.
Assist with operations of events, demonstrations, or training sessions held in the showroom.
Help curate new experiences at the brand to drive traffic and sales leads.
Handle customer service tasks, including addressing concerns and ensuring a seamless shopping experience.
Stay informed about product updates, promotions, and industry trends to better assist customers.
Develop and maintain relationships with event-related vendors & contractors including, but not limited to creative, external caterers, chefs, talent and support staff.
Assist with developing recap reports post event.
Assist with content capture of all events and assist with socializing on social platforms and website.
Facilitate on-going tours of facility
General administrative duties.
Qualifications:
Previous experience in retail, showroom, or customer service roles.
Strong organizational skills and attention to detail.
Excellent interpersonal and communication abilities.
Ability to multitask and manage time effectively in a fast-paced environment.
Basic knowledge of kitchen appliances or willingness to learn about product features and functionality.
Proficient in basic computer applications, inventory systems and other software solutions like Canva, Mailchimp, Envoy, Shopify, Toast.
Digital / Social media expertise (Facebook, Instagram, Twitter, YouTube, TikTok)
Flexibility to work weekends and holidays as needed.
Ability to lift up to 25lbs+
Claims Manager - Professional Liability
Remote
Claims Manager (Professional Liability)
Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk .
As a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider for our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share.
YOU WILL
Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes.
Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you.
Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution.
Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters).
Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards.
Support our data collection efforts and models by effectively using our Agentic Claim Experience (ACE) system to fully and accurately capture critical details about each claim assigned to you.
Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments.
Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems.
Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision.
YOU HAVE
At least 10 years of professional experience, with at least 5 years of experience litigating or managing professional liability claims. Previous carrier experience is a plus.
Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred.
Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire.
Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed.
High level of personal initiative and leadership skills.
Exceptional time management, problem solving and organizational skills.
Comfort and skill operating in a paperless claims environment. Familiarity with Google Workplace is preferred, but not required.
Willingness to quickly adapt to change and use creative thinking and data-driven insights to overcome obstacles to resolution.
Strong communication skills, both verbal and written.
Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%).
WHO YOU WILL WORK WITH
Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group.
Jaclyn Vogt, Senior Claims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College.
Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims.
WHAT WE OFFER
Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan.
Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members.
401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement.
Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay.
Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it.
Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year.
Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories.
Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.)
Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests.
Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise.
No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones.
Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart.
COUNTERPART'S VALUES
Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others.
Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met.
Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal.
Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected.
Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there.
Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life.
Our estimated pay range for this role is $150,000 to $180,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience.
We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives.
We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.
Auto-ApplyMedical Coding Appeals Analyst
Miami, FL jobs
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Coding Appeals Analyst
Richmond, VA jobs
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyMedical Coding Appeals Analyst
Norfolk, VA jobs
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-Apply