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UnitedHealthcare of Ohio Inc jobs in Orlando, FL - 597 jobs

  • Manager, Medicare Claims

    Blue Cross and Blue Shield of North Carolina 4.3company rating

    New Orleans, LA job

    The Manager, Medicare Claims, oversees end-to-end claims services for provider segments, meeting business goals. This role sets performance targets, manages claims processing and financials, handles submissions, refunds, and recoveries, and ensures claims accounting and reporting. Collaboration with claims leadership ensures alignment with customer needs and contracts. What You'll Do Streamline shared processing to reduce management by exception Set operational process to address market trends, BCBSNC capabilities and customer demand Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards. Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions. Manage financial recovery activities including refunds and collections Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction. Serve as Medicare Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting. Represent Claims Operations on monthly CMS calls with CMS Account manager answering questions, providing status updates and expertise routinely and on demand. Ability to engage as requested by Compliance with regulatory entities, especially CMS on monthly calls and serve as an internal point of contact to prepare feedback on issues under CMS review. Use good judgement in understanding issues and work with compliance to prepare for discussions. Ability to represent claims as a knowledgeable SME. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 1-2 years of Medicare and Medicaid experience or a highly regulated operational environment - highly preferred Strong analytical skills with the ability to drive change and manage operations Ensure risks associated with business activities are effectively identified, measured, monitored and controlled within accordance with compliance policies and procedures What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $98,092.00 - $156,947.00 Skills Accounts Receivable (AR), Claims Analysis, Claims Management, Claims Processing, Claims Resolution, Claims Submission, Documentations, Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, Recruiting
    $98.1k-156.9k yearly 1d ago
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  • Manager, IT Category Management

    Blue Cross and Blue Shield of North Carolina 4.3company rating

    New Orleans, LA job

    The Manager, IT Category Management, is responsible for directing all sourcing and vendor contracting activities within the assigned categories. This role supervises staff engaged in the sourcing process for high-value and complex goods, services, or projects and initiatives. The incumbent focuses on reducing organizational costs by implementing effective sourcing strategies, tools, and processes. Coordination with third-party vendors, business owners, and the legal team is essential for the preparation, analysis, and negotiation of vendor contracts. Additionally, this position supports business owners across all functional areas in technology vendor selection and ensures that vendor obligations are documented in alignment with business requirements. What You'll Do Manage staff responsible for the development and execution of sourcing strategies in one or more technology categories. Direct and train staff in conducting sourcing events, including development of project work plan, category profile, category strategy, minimum requirements and evaluation criteria, solicitation Guide staff in the development and implementation assorted bid documents and requests (i.e. RFP, RFI, RFQ); and manage status reporting and performance metrics of sourcing and category management activities. Understand, analyze and forecast complex market and industry dynamics and share subject matter expertise and industry knowledge within the established portfolio of products and services Partner with stakeholders to develop business and sourcing strategy and source products and services using proven tools, processes, and analytics to drive and achieve business results. Coordinate the evaluation and analyses of sourcing results from a total cost of ownership perspective, and provide optimization recommendations Lead cross-functional teams responsible for complex vendor negotiations, including those that require specialized subject matter expertise, nonstandard risk mitigation solutions, and coordination of multiple arrangements. Proactively establish and foster successful, positive working relationships with vendor personnel. Drive vendor engagement through formal and informal transactions. Manage contract management function and facilitate effective collaboration with Corporate Compliance, Legal, Audit and Risk Management and other internal stakeholders for compliance activities to ensure regulatory conditions are met. Develop new procedures, training, initiatives, specifications and recommendations for process or policy changes and improvements, as appropriate. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 8+ years Technology procurement experience Highly Preferred Procurement experience at a healthcare company Highly Preferred Procurement experience with key vendors including IBM, Microsoft, Salesforce, ServiceNow, Cognizant, Accenture, NTT Data and HCL Technologies Experience purchasing hardware and software through Value Added Resellers What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $107,901.00 - $172,642.00 Skills IT Procurement, Negotiation, Strategic Sourcing, Vendor Procurement
    $107.9k-172.6k yearly 5d ago
  • Division Broking Leader - Commercial Lines

    World Insurance Associates 4.0company rating

    New Orleans, LA job

    WORLD DIVISION - Gulf States The Division Broking Leader is a strategic and influential senior broking leader with a proven ability to negotiate and drive optimal outcomes for clients and prospects across diverse market segments. The DBL leads and orchestrates all broking activities for new and renewal business, aligning with organizational goals for client retention and growth. The DBL demonstrates deep expertise in insurance coverages, carrier underwriting guidelines, alternative funding strategies, and evolving legislative frameworks. Builds and nurtures high-impact relationships with clients, carrier partners, and internal stakeholders, fostering collaboration and delivering exceptional value. Serves as a trusted advisor and thought leader, championing innovation and excellence in broking practices. RESPONSIBILITIES Lead placement strategy with World Client Advisors and Account Executives to achieve optimal outcomes for clients and prospective clients Drive a competitive coverage placement process and demonstrate strong negotiation skills to achieve appropriate cost, coverage, and capacity targets for clients and prospective clients Maintain productive and responsive relationships with underwriting managers, practice leaders, and business development managers of World's key Trading Partners Participate as requested in client and prospective client introductory, strategic, planning, and proposal meetings, and represent World in a professional and responsive manner Promote utilization of strategic Trading Partners critical to maintaining secure and dependable relationships for World to generate optimal outcomes for clients and prospective clients Collaborate with peers and national resources as necessary to ensure client's and prospective client's coverage needs are comprehensively addresses Manage business models in accordance with corporate KPIs Exhibit strong leadership capacity in training, developing, supervising, and appraising associates to ensure they experience a productive and fulfilling career path at World Productively and with clear vision, lead a team of diverse placement professionals who possess varying levels of expertise and skill in distant locations to achieve defined goals and objectives Serve as primary internal source of information concerning market trends, pricing practices, and other underwriting policies Assist in developing Broking Practice policies and procedures to support our commitment to continuous improvement Maintain focus on World-authorized workflow and standard operating procedures to support the delivery of a consistent service model across the World enterprise ESSENTIAL SKILLS/COMPETENCIES Comprehensive understanding of World's scope of expertise, structure, distribution strategy, and value proposition Broad and diverse knowledge of the global insurance industry marketplace including: Middle market and large account segments All property and casualty products Excess and Surplus Lines marketplace and how to access London and Bermuda market facilities Property and Casualty program designs including guaranteed cost/first dollar, deductible/retention structures, quota share & layered property programs, liability towers, risk management, and alternative risk Project/process management discipline and follow-through Compelling deductive reasoning skills Strong leadership capabilities+ Substantial inter-personal skills and associate engagement expertise Effective listening and communication skills Collaborative nature Action-oriented, ambitious, initiative-taker Analytical and creative thinker Commitment to continuous learning and development Good understanding of complex property and casualty insurance programs, risk management, and alternative risk structures Purposeful, results-driven, competitive, tenacious desire to win Understands how to identify and apply corporate resources to achieve optimal outcomes for clients and prospective clients Knowledgeable of the global insurance marketplace and keeps current with changing marketplace landscape Strong ability to influence and negotiate with trading partner peers, and achieve optimal outcomes for clients and prospective clients LEADERSHIP Committed to working in a shared leadership environment and among cross-functional teams and promoting World values of collaboration, excellence, leadership, innovation, and integrity Lead through empowerment, engagement, collaboration, feedback, and buy-in from others Collaborate with Practice Leaders, Division Leaders, Division Growth & Service Leaders to ensure Broking objectives are in accordance with World corporate objectives Stay aligned with customer acquisition strategies to ensure Broking activity effectively supports business growth initiatives Support and embed World workflow processes and procedures Represent World brand to the global marketplace in a professional manner Identify creative ways to work more efficiently with our key trading partners Identify and maintain close relationships with World's key trading partners decision-makers at regional management level Encourage other associates to align with World initiatives, values, and principles Confident to challenge those whose behavior's conflict with World values and principles WORK EXPERIENCE/JOB QUALIFICATIONS Minimum 10 years industry experience in risk management and insurance brokerage, underwriting, and carrier relationship management role; or in combination Minimum 5 years in leadership role with high-performing, successful teams, including goal setting and associate performance review responsibilities Complete Understanding of a national insurance broker's sales, service, and broking platforms COMPUTER SOFTWARE SKILLS Proficient in all Microsoft office products Mid-level expertise with excel PROFESSIONAL LICENSES/CERTIFICATIONS Preferred insurance designation such as CPCU, CIC, or ARM Licensed Property & Casualty insurance producer in resident state EDUCATION 4-year college degree from an accredited institution or equivalent professional designation #LI-HZ1 #LI-Remote
    $31k-43k yearly est. Auto-Apply 60d+ ago
  • Business Development and Agency Coordinator

    Lammico 4.1company rating

    Metairie, LA job

    Responsible for coordination of Business Development Department and Agency activities. Provides administrative support to both the Business Development Department and Agency including assisting with agency accounting work and telephone inquiries relative to products and services. Reporting Relationship: Reports directly to the Insurance Operations Support Manager and takes direction from the Vice President of Business Development and Sales. Essential Functions/Responsibilities: Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO's mission and vision in daily operations Interacts courteously and professionally with all Elatas Risk Partners/LAMMICO employees, policyholders, and outside vendors; seeks to support ERP's mission and vision in daily operations Meets assigned target dates and objectives; helps ensure that department quality, service, and productivity standards are met Responsible for accounting functions in agency workflow including: UNUM deposits and commission statements, IPFS funding reports and deposits Assists in the issuance of Agency policies in accordance with agency quality standards as directed by the Customer Relations Specialist and Agency Management Specialist Distributes and files assigned Agency incoming mail and correspondence Manage and renew LAMMICO's/ Elatas' licenses/appointments with multiple states Generates and maintains prospect/client proposals developed by the Agency Management Specialist Prepares new business/renewal policies Handles COI's relating to ERP clients Maintain Agency AMS database(updates), form letters, client and agency files Assists Vice President of Business Development and Sales and Senior Marketing Analyst with a variety of tasks, including data entry of annual budget numbers Assists the Senior Marketing Analyst with the Business Development Department budget throughout the year; reconciles quarterly Business Development Department budget with Finance's quarterly actual expenses Coordinates Business Development Department events with external/internal audiences including the state, parish and specialty medical societies, the state Medical Managers Associations, and our independent agents, including the Agents Advisory Council and training meetings Responsible for contacting and scheduling attendance for the Business Development staff at conventions and meetings, including completion of required paperwork, payments and other necessary logistics Coordinates Business Development Department workshops, educational seminar registrations, travel arrangements, and maintains master calendar of all departmental events and appointments for staff Tracks and assists Vice President of Business Development and Sales with updating of association agreements and handles distribution of funds Obtains current medical society/association corporate mailing lists each year and updates as necessary for Business Development Department mailings Responsible each month to verify and identify insureds on the Association Membership lists that are due to renew their policy with LAMMICO for the following month Coordinates scheduling and logistics for Regional Advisory Panel (RAP) meetings and ensures that information is disseminated properly Serves as ImageRight Coordinator for the department by maintaining files through ImageRight for specific department information Responsible for making certain that Business Development documents are scanned and stored into the ImageRight system/department network drive Responsible for; maintaining Producer Portal registration forms and contacts, communicating with both the Underwriting and IT Departments concerning the addition of products, resolving any discrepancies concerning the website registration and completed forms Responsible for ordering and maintaining promotional items that are used at business development conferences and events as well as ordering departmental supplies Responsible for entering new business applicants into Sales Force Represents the Agency and the Marketing department at business functions as needed Backup Functions/Responsibilities: Responds to telephone inquiries related to ERP's products and/or services Markets quotes/renewals to insurance carriers and brokers Agency accounting; assists LAMMICO Finance department in reconciling accounts Works with accounting agency specialist on the processing of Agency's operating and trust cash receipts and disbursements including coding, preparing checks, issuing, mailing and maintaining the vendor files in AMS Nurtures and maintains relationship with insurance carriers/brokers; assures files and contracts are properly maintained Serves as a consultant/agent to the CFO for LAMMICO's insurance policies Coordinates and manages the screenings and appointments for any new LAMMICO agent Secondary Functions/Responsibilities: Other responsibilities and special projects as assigned Assists Business Development Department staff by fielding phone calls Assists Insurance Operations Support Manager with backup support in all Operations Departments as needed Serves as the Business Development Department's representative on the company Switchboard Team, covering the receptionist's desk as needed. Qualifications Education, Experience and Skills Required: Active P&C license, or in the process of obtaining; license must be obtained within 60 days from date of hire High school diploma Bookkeeping or administrative experience Strong customer focus and team orientation Ability to appropriately handle confidential and sensitive company information Excellent written and oral communication skills with the ability to interact and work effectively with employees at all levels within the organization Ability to manage time, set priorities and work independently Proficiency in the use of Microsoft Office Programs Desired: Bachelor's Degree Insurance industry experience
    $46k-76k yearly est. 7d ago
  • Workday Business Analyst

    Lammico 4.1company rating

    Metairie, LA job

    The Business Analyst typically gathers business requirements, configures and tests the Workday system, and provides ongoing support for Workday and Adaptive modules. This role also involves troubleshooting issues, developing reports and dashboards, and collaborating with various stakeholders to ensure the system meets business needs. Reporting Relationship: Reports directly to the VP of Finance & Controller Essential Functions/Responsibilities: Requirements Gathering and Analysis: Work with Finance teams, business stakeholders, and other relevant parties to understand business needs and translate them into clear, actionable requirements for Workday system enhancements and configurations. Workday Configuration and Testing: Configure Workday modules based on requirements. Thoroughly test configurations and ensure they meet quality standards before deployment. System Support and Troubleshooting: Provide ongoing support to users on Workday functionality, resolve system issues, and troubleshoot problems related to the Workday system and its integrations. Reporting and Analytics: Develop reports and dashboards within Workday to track key Finance metrics and provide insights to support data-driven decision-making. Integration Support: Collaborate with IT and other teams to ensure seamless integration of Workday with other systems, including data exchanges and system connectivity. Documentation and Training: Maintain documentation for system configurations, processes, and procedures. Conduct training sessions for end-users on new features and functionality. Collaboration and Communication: Act as a key liaison between Finance, IT, and other stakeholders. Effectively communicate technical concepts to non-technical audiences. System Maintenance and Updates: Participate in Workday releases and upgrades, assess the impact of new features, and implement necessary changes to ensure operational continuity. Data Integrity and Security: Ensure data accuracy and compliance within the Workday system. Implement security measures and monitor for potential risks. Process Improvement: Evaluate and improve existing business processes to optimize efficiency and effectiveness within the Workday system. Qualifications Education, Experience and Skills Required: Bachelor's Degree in Accounting, Finance, IT or related field Strong understanding of Workday Financials and Adaptive Planning and related modules Experience financial statements and processes Experience with requirements gathering, system configuration, and testing. Proficiency in Workday reporting and data analysis tools. Excellent communication, collaboration, and problem-solving skills. Experience with Workday integrations is often preferred. Knowledge of Finance processes and best practices. Ability to adapt to new technologies and Workday updates. Desired: Accounting experience
    $54k-78k yearly est. 7d ago
  • Commercial Lines Associate Client Representative

    World Insurance Associates 4.0company rating

    Lake Charles, LA job

    The Associate Client Representative supports the daily management of a high-volume Commercial Lines book of select business. Under the direction of a lead servicer, this position consistently provides excellent customer service to external and internal clients to ensure client satisfaction and retention. Primary Responsibilities Supports lead servicer in effectively managing a high-volume book of business ensuring all required tasks are completed accurately and on-time to meet the client needs. Set up and maintain accurate account details, contacts, and policy information in EPIC Attach, organize, and name documents in EPIC Leverage templates and system generated letters and forms to produce standard communications to clients and carriers, including BOR, proposal letters, change requests, proofs of insurance etc. Endorse policy in EPIC Create activities in EPIC and assign applicable team-member. Order loss runs Position Specific Skills/Qualifications Work Experience 0-2 years' experience in Commercial Property and Casualty Professional Licenses/Certifications Licensed or obtaining state Property & Casualty insurance license within a specified time frame Essential Skills/Competencies Knowledge of Excel, Word, and other MS Office products to include basic formatting Able to learn coverage fundamentals. Dedicated to meeting the expectations and requirements of co-workers and clients. Able to quickly find common ground and solve problems. Seeks to obtain industry information, new product information, coverage, and technology to continuously improve knowledge performance. Strong written, oral, and interpersonal communication skills. Able to follow a well-established and familiar set of activities and/or process to derive a solution. Sets priorities and manages workflow to ensure effective, timely, and efficient service delivery. Works to achieve stated objectives and delivers results at the close direction of a senior team member. Education HS Diploma or equivalent Physical Demands & Working Conditions Office work involves working at a desk most of the time, using a stand-up/sit-down adjustable desk. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects. Typing, grasping, and repetitive motion typically is required every day, and walking and standing are required occasionally. Equal Employment Opportunity At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business. #LI-HZ1
    $22k-27k yearly est. Auto-Apply 9d ago
  • Licensed Insurance Customer Service

    State Farm Agency-New Orleans 3.9company rating

    Metairie, LA job

    Job Description Successful State Farm Agent is seeking a qualified professional to join their winning team for the role of Licensed Customer Service Representative - State Farm Agent Team Member. Active Property and Casualty license is required. We seek a licensed energetic professional interested in helping our business grow through value-based conversations and remarkable customer experience. Responsibilities include but not limited to: Establish customer relationships and follow up with customers, as needed Provide prompt, accurate, and friendly customer service. Service can include responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification Use a customer-focused, needs-based review process to educate customers about insurance options Maintain a strong work ethic with a total commitment to success each and every day What we provide Minimum salary $18.00/hour; salary will be increased dependent upon experience, licensing and performance. Once licensed, bonuses and commissions will be paid on sales performance. Paid time off (vacation) Retirement plan (after first year) Valuable experience Growth potential/Opportunity for advancement within my office Requirements Property & Casualty license (required) Life and Health license (required) Excellent interpersonal skills Excellent communication skills - written, verbal and listening People-oriented Organizational skills Self-motivated Detail oriented Proactive in problem solving Dedicated to customer service Able to learn computer functions Pride in getting work done accurately and timely Ability to work in a team environment Ability to multi-task Provide timely and thorough activity reports to agent Selected candidate is expected to remain current in product changes, licensing, technical developments, and continuing education If you are motivated to succeed and can see yourself in this role, please submit your resume. We will follow up with you on the next steps in the interview process. This position is with a State Farm independent contractor agent, not with State Farm Insurance Companies. Employees of State Farm agents must be able to successfully complete any applicable licensing requirements and training programs. State Farm agents are independent contractors who hire their own employees. State Farm agents employees are not employees of State Farm.
    $18 hourly 21d ago
  • Account Advisor I

    Blue Cross and Blue Shield of Louisiana 4.1company rating

    Baton Rouge, LA job

    We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. **Candidate must be local to the Baton Rouge Corporate Office.** **Are you searching for your next career opportunity? Do you have a passion for providing excellent customer service? Would like you like to work from home?** **We are actively recruiting for a Call Center Class beginning in** **March 2026** **! Apply today and join us in supporting our mission to improve the health and lives of Louisianans.** **What does an Account Advisor do?** Serve as first point of contact for the organization. The Account Advisor handles incoming calls from members and providers answering questions and offers guidance via the telephone with individuals in a prompt, courteous, and professional manner. **What is a must have?** + Customer Service experience or equivalent + Must be available to report to the Baton Rouge Corporate Campus for the onsite components of new hire training. + Commitment to training program + Hardwired internet connection with speeds greater than 5MB upload and 10MB download **What's in it for you?** + A comprehensive new hire training program designed to help set you up for success + Competitive pay + Excellent benefits package including medical, dental, vision, life insurance, an amazing Wellness Program, 401k contributions in addition to paid time off, and paid holidays + Professional development opportunities and access to grow your career **POSITION PURPOSE** Resolves benefit and claims inquiries received via the telephone, in person, or other acceptable receipt method from our members or providers in the call center. Promotes and maintains a positive company image through direct contact with customers. Complies with all laws and regulations associated with duties and responsibilities. **NATURE AND SCOPE** + This role does not manage people + This role reports to this job: SUPERVISOR, CUSTOMER SERVICE + Necessary Contacts: Enrollment & Billing, Claims, Provider Relations, Benefit Operations, Network Administration, Sales/Marketing, Accounting, Medical Management, Pharmacy, and Legal departments as well as members, providers, groups, brokers, other plans, insurance companies, Social Security Administration and Centers for Medicare and Medicaid Services (CMS). **QUALIFICATIONS** **Education** + High School Diploma or equivalent preferred **Work Experience** + Prior experience as listed below required: + 1 year of customer service or medical office experience required + Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC, can be used in lieu of the one year of experience. + A certificate in medical office assistant or medical coding can be used in lieu of the one year of experience + Previous experience in a call center is preferred **Skills and Abilities** + Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook , etc.) and related software as other corporate software progrms and applications. + Demonstrated verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism. + Familiarity with medical and health insurance terminology preferred + Conflict resolution skills and remains calm under pressure/stressful situations + Must be able to to demonstrate critical thinking and problem solving skills + Demonstrate attention to detail + The ability to actively listen and ask appropriate questions, to effectively understand issues that are presented from customers. + Reading comprehension skills are required due to the high amount of direct customer contacts and the need to understand customer contract benefits and training materials. + Effective organizational and interpersonal skills are required. Must have the ability to multi-task and handle work independently as well as organize and prioritize multiple customer issues. + Ability to take ownership of issues from the beginning, seeking First Call Resolution (FCR) + Must be able to verbally communicate on the telephone in a call center environment approximately 95% of the time in the Customer Care Center. + Employees may be expected to work during inclement weather or other emergency situations when needed. + Must have ability to successfully complete Customer Service training, with demonstrated proficiency in training materials. **Licenses and Certifications** + None Required **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; researches multiple computer systems/applications to verify data/information accuracy. + Responds to inquiries regarding adjustments, refunds, edits and/or payment registers to ensure completeness, accuracy and customer satisfaction to members or providers. + Maintains knowledge of required lines of business, changes to applicable company policies/procedures, recent laws and regulations, and related computer systems to ensure information is current and accurate when providing service to members or providers on the telephone in the call center. + Meet Customer Service performance goals/expectations in the areas of efficiency, accuracy, quality, production, customer satisfaction, and attendance + The ability to verbally communicate on the telephone approximately 95% of the time. + Account Advisor Is who work on the Medicare LOB must be able to follow CMS (Center for Medicare and Medicaid) standards including but not limited to: following a defined process for handling Medicare Grievances, identify differences between an inquiry, grievance, & appeal, and meet specific schedule requirements (may have to work nights, weekends and/or holidays). **Additional Accountabilities and Essential Functions** _The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions_ + Perform other job-related duties as assigned, within your scope of responsibilities. + Job duties are performed in a normal and clean office environment with normal noise levels. + Work is predominately done while standing or sitting. + The ability to comprehend, document, calculate, visualize, and analyze are required. **An Equal Opportunity Employer** **All BCBSLA EMPLOYEES please apply through Workday Careers.** PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) **Additional Information** Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact ********************* for assistance. In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. _Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner._ _Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results._ **JOB CATEGORY:** **Customer Service & Contact Center Operations**
    $72k-105k yearly est. 2d ago
  • Controls Technician

    Cis Industries LLC 4.6company rating

    Baton Rouge, LA job

    Throughout our 20-year history, we have worked hard to make CIS Industries an enjoyable and rewarding place to work. In addition to competitive salaries, comprehensive benefits, and tangible career growth, our people enjoy a stability and loyalty envied in the industry. With average employee tenure of 10+ years, our culture encourages people to maximize their skills and potential. Our company culture is professional yet relaxed; we understand that going to work every day should be a gift, not a burden. Join our growing team today! POSITION PURPOSE The Controls Service Technician role primarily involves starting up, trouble shooting and repairing complex controls on HVAC equipment consisting of primarily, but not limited to, Variable Refrigerant Flow (VRF) systems, dedicated outside air units, hot water boilers, computer room units, water source heat pumps, VAVs, packaged rooftops and split DX units. A service technician is also expected to meet with end-users monthly as part of service contracts to maintain their system and assist with their needs. This position in based out of Baton Rouge and requires out of state travel, up to 5% of the time. Controls Service Technician Job Skills: Familiarity with instruments and the ability to acquire information such as temperature, humidity, static pressure, voltage, amperage, air flow, etc. Understanding of control systems including wiring, thermostats, and end devices. Perform troubleshooting steps of both IP and Serial Communication Protocols Effectively communicates verbally and in writing with customers and co-workers. Able to read wiring schematics and diagrams for all equipment. Effectively present training material to owners and contractors in a classroom environment. Documents service and installation activities by completing work orders for each job, maintenance checklist and daily time sheets. Maintains rapport with customers by addressing complaints and identifying solutions. Maintains a safe and clean working environment by complying with established policies, procedures, rules and regulations. Above average computer skills. Ability to learn and use proprietary software needed to start-up, configure or trouble shoot HVAC equipment. Independently manages daily business needs by identifying parts to order for repairs and determines the urgency of the requirement. Keeps current on products concerning installation, operation, maintenance, service, and repair of HVAC systems and components. Flexibility to work outside normal work hours, as required. Qualifications: Associate degree or equivalent from a Technical / Trade School with a certificate in Heating, Ventilation, and Air Conditioning and two (2) years related experience; or five (5) years related experience; or equivalent combination of education and experience. Operating knowledge of Microsoft office software and working proficiency with handheld computer (i.e., Smartphone, iPad). Valid Driver's License with no major traffic violations for the previous 5 years. Physical Requirements Routine sitting, lifting, bending, and kneeling Ability to lift 50 lbs. from floor to countertop and countertop to floor Ability to climb ladders and perform job duties at required heights Benefits: Benefits include paid vacation, 401K match program up to 4% of gross pay, Safe Harbor company contribution 3% of your annual salary, a company supplemented health insurance program, plus employer paid life insurance, short- and long-term disability. Dental and Vision options are available. Pay: Pay commensurate with job experience.
    $44k-65k yearly est. Auto-Apply 60d+ ago
  • Senior RM Education Specialist

    Lammico 4.1company rating

    Metairie, LA job

    Responsible for the Risk Management continuing education program which includes authoring and editing medical and nursing RM education. Using an inquisitive mindset and a structured design methodology, the Specialist conducts thorough, complex literature searches across medical, nursing, and risk management sources to build a foundational understanding of the content to develop CME/CNE programs and newsletter articles. The Specialist collaborates with outside medical writers to refine/edit content as needed, ensuring alignment with learning outcome/objectives and professional standards. This position also oversees LAMMICO's ACCME and ANCC accreditation activities including NAB and MOB criteria. Reporting Relationship: Reports directly to the VP of Risk Management & Patient Safety Essential Functions/Responsibilities: Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO's mission and vision in daily operations Contributes to the development of the department's strategic and operating planning and meets assigned target dates and objectives; helps ensure that department quality, service and productivity standards are met Promotes and encourages innovation in processes, procedures, products, and services in the organization Responsible for the successful maintenance of ACCME and ANCC accreditation programs Oversees the Maintenance of Certification and NAB credit programs Responsible for the assessment of needs of the local and national physician and nursing audiences to strategically plan, implement, measure, and evaluate the effectiveness of the RM loss prevention education program Serves as medical education expert and editor for RM publications and education programs designed for a local and national physician and nursing audience Mentors and evaluates physician and nursing medical writers' content to ensure the development of well-designed, high-quality education courses/presentations Oversees the production of all presentations including live (in person), webinars, video and other multimedia assets. Guides and mentors RM Education Specialists (nurse planner) to ensure the adherence to the accreditation standards of ACCME and ANCC Partners with physicians, risk managers, claim representatives, and legal counsel to provide specific technical RM education consultation to LAMMICO insureds Evaluates and analyzes individual learning activities, aggregates data from all activities to assess the effectiveness of the overall program and initiates relevant quality improvement processes Pursues own professional development by attending regional/national conferences for educators and remains current with the ACCME and ANCC accreditation standards Secondary Functions/Responsibilities: Other responsibilities and special projects as assigned Oversees development of video presentations Qualifications Education, Experience and Skills Required: Masters or Doctorate degree in education or in a healthcare related field Bachelor's Degree in nursing Current license in nursing Knowledge and training in the specific area of technical expertise Minimum of 5-10 years combined experience in Risk Management, quality improvement, nursing, education, and accreditation Highest level of technical skills in RM and adult educational theories and training Professional level writing and editing skills and authorship in relevant healthcare and professional publications ARM, CPHRM or other relevant certification Formal presentation skills to small and large audiences; ability to determine effectiveness of presentation Experience with data analysis, determine technical needs to implement RM strategies Ability to manage multiple projects simultaneously Strong customer focus and team orientation Ability to appropriately handle confidential or sensitive company information Commitment to continuing industry education Strong motivation decision making skills Excellent communication skills with the ability to interact and work effectively with insureds, prospective insureds, and employees at all levels within the organization Ability to manage time, set priorities, and work independently; ability to organize, analyze, and interpret information Proficiency in the use of Microsoft Office Desired: Insurance industry experience
    $77k-116k yearly est. 7d ago
  • Accounting Assistant Generalist

    Lammico 4.1company rating

    Metairie, LA job

    Performs general accounting functions and customer services calls related to premium customer service functions for the Company and the RRG subsidiary. The employee will be responsible for assisting in general accounting functions, such as accounts receivable and accounts payable back-up, invoicing, and banking activities, as well as assisting insureds with questions regarding payments to LAMMICO; its bank lockbox, invoice questions, assistance with online and premium finance payments or financing. The employee will work in a team environment with members of the Finance department and with other departments in the organization such as the Underwriting and IT departments, researching and resolving the proper application of premiums to policies and to resolve issues with online payments. Reporting Relationship: Reports directly to the VP of Finance & Controller Essential Functions/Responsibilities: Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO's mission and vision in daily operations Meets assigned target dates and objectives; helps ensure that department quality, service, and productivity standards are met. Will prepare monthly deductible billing, ensuring invoices and supporting documentation is mailed timely to insureds and payments are properly posted and deposited. Work under the direction of Senior Accountants on any issues, past due payment calls or notices, and customer service calls related to deductibles Maintain and audit the listing of insureds with Letters of Credit and correspond with the Underwriting department on any issues, follow-up with insureds on renewals of Letters of Credit Reconcile loss fund accounts in Workday accounting system and communicate with Senior Accountant regarding any account balance deficiencies Deposit and log all miscellaneous deposits received Responsible for daily insured invoice process Serve as a back up for insured premium receivable posting and daily cash balancing activities Serve as a backup for accounts payable processing in Workday accounting system Update the daily cash activity for subsidiary companies Answers calls daily from insureds related to payments and payment related issues Works with the Finance, IT and Underwriting Departments to investigate and resolve customer payment related issues Assists customers with service issues from the current online payment vendor Maintain a strong working relationship with the online payment provider Understand the various finance options and be able to assist customers with questions Directs customer service issues that are not payment related to the appropriate department Timely follow up with insureds on payment related issues Responsible for working with the bank on premium related payment issues Responsible for researching issues with the online payment company vendor using their reports platform and working with key individuals at the vendor Suggests and implements new controls and process improvements in the customer service and online payment areas Assists in the annual financial statement audit and state examinations by providing necessary documentation and testing support, as well as answering questions Printing of invoices for customers who request copies Responsible for learning the OASIS core operating system- Accounts Receivable function Serve as a back up for cash reconciliations in Workday Review of vendors and insureds for compliance with OFAC regulations by utilizing the compliance software Secondary Functions/Responsibilities: Other responsibilities and special projects as assigned Other reporting as required by the VP of Finance and Controller Serve as a back up to the Insurance Payable functions Serve as a back up for certain banking activities Serve as a back up to the Sr. Accounting Assistant Other account reconciliation functions as needed Assists Sr. Accounts Receivable Coordinator as needed Assists with testing of Core Operating system upgrades Qualifications Education, Experience and Skills Required: High school diploma or Associate Accounting Degree Prior experience working in an accounting department Strong customer focus and team orientation Understanding of internal controls Ability to appropriately manage confidential and sensitive company and insured information Excellent communications skills with the ability to interact and collaborate effectively with employees at all levels within the organization Ability to manage customer service calls from insureds and provide excellent customer service to both internal and external customers Ability to manage time, set priorities, and work independently Proficiency in the use of Microsoft Office programs, including Teams Desired: Insurance industry experience Accounts Receivable and Payables experience Three years general accounting experience Working knowledge of Medical Professional Liability products/coverages Working knowledge of the OASIS System (core system) Experience with Workday accounting system
    $49k-75k yearly est. 3d ago
  • Sales Executive - Commercial Lines

    World Insurance Associates, LLC 4.0company rating

    Madisonville, LA job

    Job DescriptionWorld Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions. Insurance Sales Producer - Commercial Lines Client Advisor Position Overview World's Client Advisors bring risk management solutions to businesses and individuals. Your primary focus is identifying, prospecting, cultivating, and closing new commercial clients (small, medium, large) leveraging World's unique niche. While your focus is selling commercial lines risk solutions, you also are empowered to help clients with personal lines insurance, employee benefits, 401(k) and related retirement solutions, and payroll and human resources outsourcing solutions. World's investments in a broad range of solutions means you can prospect any company of any size to provide value to your client. Imagine the potential. Primary Responsibilities Identify, prospect, and cultivate new business, with a focus on commercial accounts Engage in all sales and marketing tactics (with extensive corporate marketing support) to move prospects through your funnel to closing Track all sales activities in HubSpot and leverage HubSpot to its fullest potential Utilize World's broad platform to bring risk management solutions to individuals and business owners. At World, you will have access to resources to help any client solve any challenge, including traditional commercial lines insurance, high net worth / private client, employee benefits, human capital and payroll outsourcing, and retirement financial services. Qualifications Must have proven experience with a range of insurance solutions to bring value to clients Must be willing to become each client's trusted risk management advisor and bring the entire World platform to each client (P&C, Employee Benefits, Retirement Plans, Wholesale, and Payroll and Human Resources outsourcing services) Must maintain all relevant insurance licenses from the first day of employment to be positioned to manage an existing book of business It is meaningful, but not mandatory, if you have: Sold commercial insurance for a top broker. Based on your experience, World will enhance your expertise through the company's training program; Used an insurance agency management software platform, like AMS360 and Epic, and have experience with a sales CRM (World uses HubSpot); and Built and presented client “pitch decks” / presentations. Compensation As a World Insurance Client Advisor, your compensation is tied to your effort and your performance. We offer a base salary plus commissions as well as a full suite of employee benefits, including a 401(k) match that is immediately fully vested. The base salary range for this role is $80,000 to $200,000+. The base salary depends on your experience and your ability to drive revenue. Your base salary grows as your book of business grows, with tremendous potential to significantly exceed the top of this range. Equal Employment Workforce and Workplace World celebrates and supports differences amongst its employees. World knows employing a team rich in diverse thoughts, experiences, and opinions allows World's employees and World's work environments to flourish. World is honored to be an equal opportunity workplace, dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, World makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of World's business. TO EXECUTIVE SEARCH FIRMS AND STAFFING AGENCIES: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department. #LI-MS1 Powered by JazzHR IfAASWnE7I
    $60k-96k yearly est. 10d ago
  • Administrative Assistant Finance

    Lammico 4.1company rating

    Metairie, LA job

    Provides administrative support to the VP of Finance & Controller and accounting assistance and support to the Finance Department and Information Technology Department. Includes a wide variety of administrative/clerical type duties. Reporting Relationship: Reports directly to the VP of Finance & Controller Essential Functions/Responsibilities: Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO's mission and vision in daily operations Meets assigned target dates and objectives; helps ensure that departmental quality, service, and productivity standards are met Providing excellent customer service to both internal and external customers Prepares business correspondence, memorandums, forms, and various reports Courteously handles incoming telephone calls, mail, and sets up department meetings and lunches as directed by VP of Finance & Controller and VP of Information Technology Assist VP of Finance & Controller with the preparation and organization of Board and Committee Meetings, including updating of information packet in Diligent Board Books for the Investment and Budget Committee meetings Circulate minutes for approval to Board and Committee members Updates power point presentations, meeting agendas and meeting minutes for VP of Finance & Controller Performs bank transfers, monitors and reports bank balances daily Serves as an Administrator for the banking platform and is responsible for ensuring that roles and responsibilities are up to date Works cooperatively with the bank personnel on any banking related issues Maintains check books in Excel for all companies daily Input and maintain the logging and collection of letters of credit for reinsurance. Sets up and maintains accounting files in electronic document retention software. Coordinates travel, meeting and appointment arrangements for Finance and IT Department staff, as necessary Prints all operating checks and obtains second signature approval, if needed Electronically filing of all check registers, check copies and other documents as requested by the Controller, timely Processes and notifies the department of updates to Finance Department Accounting Manual Aids and assists with requests from independent auditors, as needed Assists in preparation of the necessary letters to be included in the mailing of Annual and Quarterly Statements to State Insurance Commissioner Brings all filings to be mailed by certified mail to the post office Secondary Functions/Responsibilities: Serves as a backup for remote deposit Primary backup with the mailing of invoices Assists in the dividend payment process Assists Senior Accounting staff with special projects Other responsibilities and special projects as assigned Qualifications Education, Experience and Skills Required: High school diploma Minimum two years general accounting and administrative experience Strong customer focus and team orientation Ability to appropriately handle confidential or sensitive company information Excellent communication skills with the ability to interact and work effectively with employees at all levels within the organization Ability to manage time, set priorities, and work independently Excellent organizational skills Proficiency in the use of Microsoft Office Programs, Teams and Sharepoint Desired: Insurance industry experience General knowledge of medical professional liability insurance products/coverages
    $32k-45k yearly est. 3d ago
  • SIU Investigator - Underwriting & Premium Fraud

    CNA Financial Corp 4.6company rating

    Metairie, LA job

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Under minimal direction, initiates and manages suspected fraudulent underwriting and insurance premium investigations involving the highest complexity matters. Provides advice, direction, and support to underwriters, auditors, business unit leadership, corporate investigations and other stakeholders across the organization on the detection, investigation, and litigation of suspected underwriting matters. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Leads the detailed analysis and completion of thorough and timely investigations of suspected underwriting fraud by following Best Practice Guidelines and collaborating with business stakeholders. * Develops and executes investigation strategy either independently or in collaboration with underwriting professionals, counsel, experts, insureds, and other stakeholders. * Manages investigation activities independently and/or coordinates/oversees vendor service partner activities in the field. * Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions. * Makes recommendations for resolution by presenting evidence-based findings and proposing solutions of moderate to complex scope. * Identifies opportunities and participates in the design and implementation of process or procedural improvements. * Leads or directs efforts to build and enhance and oversees organizational capabilities by developing and delivering fraud awareness or regulatory compliance training and mentoring SIU staff. * Leads or directs the preparation of cases for appropriate reporting to outside agencies; leads or directs pursuit of criminal or civil actions through gathering and documenting relevant data, organizing and summarizing facts and testifying on behalf of the company in civil or criminal matters. * Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations. May perform additional duties as assigned. Reporting Relationship Typically Manager or Director Skills, Knowledge and Abilities * Solid knowledge of property and casualty claim handling practices * Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations), strong technical knowledge of respective specialty practices is required. * Strong interpersonal, oral, and written communication skills; ability to clearly communicate complex issues * Ability to interact and collaborate with internal and external business partners, including outside agencies * Ability to work independently, exercise good judgment, and make sound business decisions * Detail oriented with strong organization and time management skills * Strong ability to analyze complex, ambiguous matters and develop effective solutions * Proficiency with Microsoft Office applications and similar business software, and understanding of relational databases information querying techniques * Ability to adapt to change and value diverse opinions and ideas * Developing ability to implement change * Ability to travel occasionally (less than 10%) Education and Experience * Bachelor's degree or equivalent professional experience. * Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field. * Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar). #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $54k-103k yearly Auto-Apply 31d ago
  • Director, Revenue Assurance

    TSG Resources 4.2company rating

    Lafayette, LA job

    At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care. Why you will love working here: - Strong track record of providing excellent work/life balance. - Comprehensive benefits package and competitive compensation. - Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect. Primary Duties and Responsibilities: Provide strategy, leadership and accountability for the Arbitration and Recovery departments, ensuring alignment with organizational objectives and driving operational efficiencies across all functions. Develop, refine, and execute strategic plans focused on revenue protection, optimization, and regulatory compliance to maximize financial performance and mitigate risk. Oversee the delivery and interpretation of data, analytics and performance reporting, regularly presenting actionable insights and recovery outcomes to executive leadership and key stakeholders. Foster partnerships across SCP departments including Managed Care, Finance, Legal, and RCS, driving collaboration to design and implement innovative recovery initiatives and process improvements. Collaborate with Analytics, IT and Systems to ensure oversight of large-scale datasets, complex reporting structures, and analytics frameworks to support decision-making and operational transparency. Overseeing the maintenance and auditing of financial data such as the chargemaster file, adhering to all relevant regulatory and compliance standards. Champion cross-departmental collaboration, fostering innovation, and promoting professional development to enhance team capabilities and knowledge depth. Manage strategic vendor relationships to support arbitration processes, automation efforts, drive cost efficiencies, and maintain service quality. Establish and oversee training programs to ensure staff onboarding, continuous learning, and skill advancement align with evolving departmental and organizational needs. Revenue Recovery, Appeals & Arbitration Oversight Lead the strategic development and execution of Federal and State Arbitration programs, ensuring all processes align with regulatory guidelines and organizational objectives to maximize financial returns. Drive continuous evaluation and enhancement of arbitration workflows, focusing on identifying eligible claims, improving cost efficiency, and optimizing return on investment. Oversee the integration and effective use of technology solutions to track and report claim statuses throughout the arbitration lifecycle, maintaining comprehensive federal and state historical arbitration data. Collaborate within SCP and with external vendors (onshore and global) to develop and manage supporting documentation, ensuring compliance with state and federal arbitration rules. Manage functions associated with arbitration, including timely payment of arbitrator fees, accurate tracking of offers and submissions, and maintaining tools to ensure compliance with state laws and contractual obligations. Direct the management and maintenance of the Payer Contracting Module (PCM) and other contract databases, so that all eligible claims are appealed promptly and effectively. Communicate critical appeals trends and challenges to leadership, escalating complex payer issues as necessary. Collaborate with analytics to identify payer trends, appeal results, and recovery opportunities, providing actionable insights to inform strategic decisions. Approve audit findings and collaborate with executive leadership to address claims issues, ensuring alignment with corporate compliance and revenue goals. Contribute to automation and efficiency initiatives to streamline arbitration and non-contracted appeals processes, continuously driving cost reduction, workflow optimization, and improved appeal turnaround times. Present key findings and performance metrics during Monthly Operating Reviews (MORs) to inform leadership and drive strategic decision-making.
    $72k-97k yearly est. Auto-Apply 60d+ ago
  • Solar Sales Consultant

    South Coast Solar 4.0company rating

    Metairie, LA job

    Job Responsibilities: Generate new sales opportunities by following up with all leads provided as well as by networking and gathering referrals Compose and deliver sales proposals to customers, utilizing tools provided Establish and maintain current and new customer relationships by providing professional, knowledgeable and courteous customer service Meet or exceed minimum monthly sales goals Generate and submit all required and appropriate paperwork using company processes and CRM Learn details of local utilities, interconnection requirements, state and local tax incentives Prepare and present in home sales presentations Work with other SCS departments to achieve mutual objectives Participate in ongoing training and professional development Attend expos, fairs, shows and other marketing events Adhere to all processes and procedures as trained Job Requirements: 2 years of sales experience, preferably outside sales Reliable vehicle with proper insurance; personal vehicle is used for sales calls within the designated sales area Strong written and verbal communications skills Willingness and eagerness to learn Professional appearance Ability to work a variety of hours, including evenings and weekends Computer literacy including Microsoft Outlook, Word, Excel, PowerPoint College degree preferred South Coast Solar is an EEO Employer - M/F/Disability/Protected Veteran Status View all jobs at this company
    $42k-73k yearly est. 60d+ ago
  • Residential Property Inspector - New Orleans, LA.

    CIS Group of Companies 4.6company rating

    New Orleans, LA job

    Looking to Supplement Your Income or Just Be Productive? Become an Independent Residential Insurance Inspector with CIS Group! Are you looking for a flexible, rewarding opportunity that allows you to be your own boss and take control of your schedule? CIS Group is seeking motivated, detail-oriented individuals to join our team as 1099 Property Insurance Inspectors. If you own an LLC and are looking to diversify your work, this might be the perfect opportunity for you! Why Work With Us? Since 1996, CIS Group has been one of the largest and most trusted names in the insurance inspection industry. We offer a platform that allows Independent Contractors to create and grow their own businesses, work flexible hours, and take on a variety of inspections. Whether you're supplementing your current work or looking for a new venture, this position offers flexibility and autonomy. What You'll Do: Travel to residential homes to complete exterior (interior photos here and there) property inspections. Take photos, collect property data, and upload your findings using your smartphone or tablet. Provide high-quality, professional service that delivers accuracy and on-time service, with exceptional communication. Maximize this opportunity by utilizing your unique skillset What We're Looking For: 1099 Independent Contractors - Be your own boss, set your own schedule! Flexible Hours - Work during daylight hours, Monday through Saturday. Comfortable Working Outdoors - This role requires you to work in various weather conditions. Tech-Savvy - A recent smartphone or tablet capable of taking and storing hundreds of photos. Computer Access - Wi-Fi-enabled for uploading data. Reliable Vehicle & Driver's License - Travel to residential properties within your area. Strong Communication Skills - You're a professional and a persistent communicator. You're not someone who just disappears when things get tough. Microsoft Excel Familiarity - Basic computer skills are necessary for managing your inspections. Compensation: Independent Contractors - You get paid per inspection. Fees - Vary based on location and inspection type, allowing for higher earning potential as you demonstrate competency. Why This Is Perfect for You: You've taught yourself how to solve problems and take on new challenges, and you're driven to succeed no matter the obstacles. This opportunity will allow you to create and or build your own business, and the flexibility to grow your income in an industry that remains resilient even through economic downturns. Ready to take control of your future and join a company that values your persistence and resourcefulness? Submit your resume now and become part of the CIS Group team! Job Types: Part-time, Contract Pay: $215.00 per month Benefits: Flexible schedule Compensation Package: 1099 contract Work Location: On the road
    $32k-48k yearly est. Auto-Apply 4d ago
  • Commercial Lines Account Processor

    AWS Insurance 3.8company rating

    Metairie, LA job

    COMPANY INFORMATION Organization Name: Aparicio, Walker & Seeling, Inc. About Our Organization: AWS Insurance, serving the Gulf Coast region, provides services in all aspects of insurance including commercial business insurance, risk management, car insurance, home or property insurance, flood insurance, natural disaster, marine insurance, liability insurance, employee health benefits, and payroll services. We offer our employees excellent health benefits to attract and retain high-quality employees. Website: ************************ Position Title: Commercial Lines Account Processor Hiring Manager Job Title: Commercial Lines Manager Employment Status: Full-Time Regular Primary Location: Metairie, LA Job SUMMARY Assists Producers and Account Executives by providing all processing duties associated with servicing a book of business, including, reviewing, and issuing Certificates of Insurance, reviewing contracts, processing renewals, policies and change requests, invoicing, and online rating. ESSENTIAL JOB FUNCTIONS These duties include but are not limited to: Handles typical account service activity including processing mail, endorsements, audits, ordering MVR's & elevation certificates, creating finance agreements, invoicing, etc. Performs functions on agency management system proficiently Responsible for the processing and review of new and renewal policies within thirty (30) days of receipt. Responsible for the preparation of all Master Certificate Templates & expedited issuance of all requested Certificates of Insurance & Evidence of Property Responsible for online rating and preparation of proposals as requested Responsible for ordering loss runs and creating loss matrices Review of client contracts to ensure compliance with existing coverage, to identify additional uninsured exposures and to ensure client is avoiding unnecessary transfer of liability where possible. Assists with preparation of new and renewal client files as requested Maintains working knowledge of all rating products and processes Assists with filing claims and aiding in claim resolution as necessary Assists in the preparation of Summaries of Insurance and Statement of Values as requested Assists in the preparation of Premium Breakdowns as requested Performs additional assigned duties as necessary QUALIFICATIONS/REQUIREMENTS: At a minimum, applicants will need: High school diploma or General Education Degree (GED) Proficiency with Microsoft Office Suite, specifically Word, Excel, and Outlook Proficiency in Adobe Acrobat Pro Excellent oral and written communication skills Possess the following team player characteristics, collaborative, dependable and reliable, flexible, consistency, and communicative Ability to self-direct learning as necessary Detail oriented nature with strong ability to multi-task and prioritize work Ability to learn, analyze and make recommendations specific to client needs Strong interpersonal skills to build rapport with customers and underwriters Highly effective communication and negotiation skills Service clients effectively and efficiently through active listening, time management, and problem solving Ability to provide discretion, confidentiality, diplomacy, and tactfulness with respect to both agency and client information Competency in interacting with and collaborating with a variety of colleagues and underwriters Ability to always maintain and exhibit positive and professional attitude, treating clients, prospects, colleagues, and underwriters with respect. Willingness to work beyond scheduled hours, as necessary, to ensure client satisfaction and to meet agency retention and growth goals. Technology savvy PREFFERED REQUIREMENTS: Louisiana Property and Causality Licensed Agent 1+ year(s) of Commercial Lines experience. 1+ year(s) of experience with commercial online rating Prior experience with Applied EPIC Management System CLOSING This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. The company is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. AWS Insurance, serving the Gulf Coast region, provides services in all aspects of insurance including commercial business insurance, risk management, car insurance, home or property insurance, flood insurance, natural disaster, marine insurance, liability insurance, employee health benefits, and payroll services. We offer our employees excellent health benefits to attract and retain high-quality employees. We offer competitive salaries and benefits, including: Educational expense reimbursement Flexible working hours Cafeteria plans Medical & dental plans Life & accident insurance 401K plan AWS is an Equal Opportunity Employer and hires staff without regard to race, color or creed. Fill out the form to the right to begin. Please call our office ************** or email if you have any questions.
    $32k-44k yearly est. Auto-Apply 60d+ ago
  • Insurance Sales

    State Farm Agency-New Orleans 3.9company rating

    Metairie, LA job

    Job Description State Farm Agency, located in New Orleans, LA has an immediate opening for a full-time Sales Representative. Insurance experience is not required as we will train the right person. If you are a motivated self-starter who thrives in a fast-paced environment, then this is your opportunity for a rewarding career with excellent income and growth potential! Please submit your resume and we will follow up with the next steps. Responsibilities include, but not limited to: Develop insurance quotes, makes sales presentations, and close sales. Establish client relationships and follow up with clients, as needed. Develop ongoing networking relationships. Provide prompt, accurate, and friendly client support. Maintain a strong work ethic with a total commitment to success each and every day. Develop new opportunities with both existing and new clients. What we provide Minimum salary $18.00/hour; salary will be increased dependent upon experience, licensing and performance. Once licensed, bonuses and commissions will be paid on sales performance. Paid time off (vacation) Retirement plan (after first year) Valuable experience Growth potential/Opportunity for advancement within my office Outstanding preparation if you aspire to be a State Farm agent in the future. Requirements: Property & Casualty license (licensing must be completed and exam passed within 40 days of hire date) Life & Health license (licensing must be completed and exam passed within 40 days of hire date). 1-2 Years of Sales Experience (preferred) Demonstrated successful track record of meeting sales goals and quotas required. Enthusiasm and belief about the role insurance and financial products play in peoples lives. Proven track record of trustworthiness, dependability and ethical behavior. Excellent communication skills: written, verbal and listening. Must be awesome at opening doors and getting appointments from a cold start.
    $18 hourly 15d ago
  • Senior Loss Control Consultant (IA/NE)

    Great American Insurance Group (DBA 4.7company rating

    Iowa, LA job

    Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Here's who we are. Strategic Comp is part of Great American Insurance Group, which was established in 1872. Based in Cincinnati, Ohio, the operations of Great American Insurance Group are engaged primarily in property and casualty insurance focusing on specialty commercial products for businesses. The members of the Great American Insurance Group are subsidiaries of American Financial Group, Inc. AFG's common stock is listed and traded on the New York Stock Exchange ("NYSE") and NASDAQ under the symbol "AFG". Here's what we do. We provide workers' compensation coverage for large companies, using our deductible program. Our service in claims and loss control is second to none. We've found that a large majority of our customers feel the way our employees do. Our renewal retention is 90+%, meaning our customers don't want to leave us either! Here's what you would be doing if hired for the loss control position. Currently we have an opening for a Senior Loss Control Consultant in Iowa/Nebraska. This role will provide technically competent Loss Control Services in accordance with company policies and procedures and to provide support services within the territory to help acquire and retain profitable business in accordance with our company objectives. The person hired for this position will work from their home and will be required to travel up to 60% of the time including some overnight travel. A company car is provided. In addition to a competitive total rewards program, we offer an annual discretionary bonus for this position. Essential Job Functions and Responsibilities * Surveys and services commercial risks of any size and/or complexity for workers' compensation coverage. * Originates and manages all service account scheduling and activities for the assigned territory. * Meets or exceeds all service standards. * Accomplishes risk improvement by providing management consultation services, developing recommendations for hazard control, and providing direct support services to the insureds. * Conducts loss control services and training for customers to help reduce losses. Participates in team activities designed to help retain accounts. * Maintains specialized state-of-the art professional capabilities in loss control support for workers' compensation products. * Maintains specialized knowledge of company/department manuals and procedures, and relevant Federal, State, and other pertinent codes and regulations applicable to Property, Liability, and Casualty lines of coverage. * Performs other duties as assigned. Job Requirements/Qualifications: * Bachelor's degree and at least 10+ years of loss control experience working for a major writer of workers' compensation insurance is preferred. * The successful candidate will reside in Iowa or Nebraska. * Strong workers' compensation knowledge is required along with the ability to conduct training programs and classes for our clients. * Basic knowledge of underwriting and product management skills. * Broad knowledge of commercial lines of insurance coverage, engineering principles and loss control concepts, and safety standards and codes. * Strong consideration will be given to candidates with industry designations, including ARM, CPCU, Certified Engineering Technician, and Certified Safety Professional. * Extensive use of computers and software programs is required of this position. * Strong verbal and written communication skills is a must. Business Unit: Strategic Comp Salary Range: $100,000.00 -$130,000.00 Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits. Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at **************************** * Excludes seasonal employees and interns.
    $100k-130k yearly Auto-Apply 22d ago

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