NewClinical Claims Reviewer/ RN Sentara Healthcare IncClinical Claims Reviewer/ RNVARemote$93,350.40–$132,433.60 / yearRN Clinician is responsible for reviewing provider post-payment inquiries and claim reconsiderations to ensure accurate coding in accordance with established coding guidelines, CMS guidelines, Health Plan Coding Payment Policy, and Claim Payment Policy. Ensures compliance with health plan policy and other regulatory agencies such as Bureau of Insurance (BOI), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and Virginia Department of Medical Assistance Services (DMAS).
Workers Compensation Claims Representative | Medical Only Workers Compensation | VA Jurisdiction Sedgwick Claims Management Services, Inc.Workers Compensation Claims Representative | Medical Only Workers Compensation | VA JurisdictionVARemote$45,000–$60,000 / yearPRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Workers Compensation Claims Examiner | VA Jurisdiction Experience Required | Remote Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | VA Jurisdiction Experience Required | RemoteVARemote$80,000–$90,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. To analyze Virginia Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OWashington, DC$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&OWashington, DC$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Claims Counsel (Insurance Defense) Williams & Connolly LLPClaims Counsel (Insurance Defense)Washington, DC$165,000–$180,000 / yearResponsibilities include, but are not limited to:* Developing a case strategy* Answering complaints* Drafting and responding to discovery* Client communications* Handling all communications with opposing counsel* Hiring and managing expert witnesses as needed* Drafting motions and responses to motions* Conducting and defending depositions* Drafting mediation statements* Conducting mediations* Appearing in court as needed* Pre-trial preparations* Conduct trials* Drafting settlement agreements* Administrative duties related to case tracking and reporting . This position requires the ability and flexibility to manage a high-volume caseload in cooperation with firm management, partners, associates, other Claims Counsel, and firm employees in a professional manner as well as the ability to manage and prioritize a large volume of work assignments, meeting all deadlines.
Claims Appraiser - Auto Estimatics State FarmClaims Appraiser - Auto EstimaticsGaithersburg, Maryland$69,398.62–$91,000 / yearFull timeWith the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! Additional Details: Employees must successfully complete all required training, including applicable proficiency, licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s).
Senior Claim Adjuster - Workers' Comp FCCI Insurance GroupSenior Claim Adjuster - Workers' CompVA Field, VA$75,528–$116,313 / yearCurrently seeking an experienced Senior Work Comp Claim Adjuster to provide quality, cost efficient, and timely investigation of liability claims and provide exceptional customer service. The selected candidate will evaluate coverage/compensability and may need to complete field investigations with a focus on quality claim handling leading to file resolution.
Claims Resolution Representative Metasys TechnologiesClaims Resolution RepresentativeMcLean, VARemote$18.62–$23.27 / hourThis position serves as a crucial liaison between members, providers, agencies, and the internal claims department, demonstrating leadership, collaborative skills, and commitment to achieving results. Review paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers.
Senior Construction Defect Technical Claims Specialist Argo Group International Holdings IncSenior Construction Defect Technical Claims SpecialistDCRemote$137,496–$164,934 / yearBoston metro area, California outside of Los Angeles & San Francisco metro area, Connecticut, Chicago metro area, Denver metro area, New Jersey (outside of New York City metro area), New York State (outside of New York City metro area, including but limited to Albany county), Washington, D. C. Essential Responsibilities: Working under limited oversight under broad management direction, adjudicate construction defect claims at the highest authority limits on assignments reflecting the highest degree of technical complexity, potentially with major impact on departmental results.
Claims Resolution Representative Iconma LLCClaims Resolution RepresentativeVAReview paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers. Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeDCEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
Medical Claims (Billing) Team Leader GT Independence CareersMedical Claims (Billing) Team LeaderSilver Spring, MarylandGT Independence is a family-founded, leading national Financial Management Services (FMS) provider that supports individuals participating in self-direction programs, helping them manage their long-term care and support services at home and in community-based settings. Dedicated to promoting personal choice, independence, and quality of life, GT Independence delivers reliable, person-centered financial and administrative services that empower individuals to direct their own care.
WFRP Claims Specialist Endurance Services LimitedWFRP Claims SpecialistWashingtonThe employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes. As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States.
False Claims Act (FCA) Litigation Partner / Counsel Orion PlacementFalse Claims Act (FCA) Litigation Partner / CounselWashington D.C., WashingtonRemoteYou will have the flexibility to work remotely, lead sophisticated matters, build meaningful client relationships, mentor attorneys, and play an important role in the continued growth of a nationally focused False Claims Act and complex litigation practice. Note: Candidates must have 10+ years of private practice legal experience, including 5+ years of substantive False Claims Act investigations and/or litigation experience, and a portable book of business of at least $250,000.
Principal Data Scientist, Customer Protection Agentic Claims Data Science Capital OnePrincipal Data Scientist, Customer Protection Agentic Claims Data ScienceMcLean, VirginiaCurrently has, or is in the process of obtaining one of the following with an expectation that the required degree will be obtained on or before the scheduled start date: A Bachelor's Degree in a quantitative field (Statistics, Economics, Operations Research, Analytics, Mathematics, Computer Science, or a related quantitative field) plus 5 years of experience performing data analytics. As a Data Scientist at Capital One, you’ll be part of a team that’s leading the next wave of disruption at a whole new scale, using the latest in computing and machine learning technologies and operating across billions of customer records to unlock the big opportunities that help everyday people save money, time and agony in their financial lives.
Claims Consultant CoreTechsClaims ConsultantBethesda, MDRemote$110,000–$160,000 / yearSUMMARY/OBJECTIVE: The Claims Consultant will be responsible for conducting impact analysis, analyzing risk on complex projects, and performing forensic schedule and cost analysis consisting of identifying critical path delays, schedule disruptions, evaluating labor productivity, and pricing general conditions costs. Perform construction claims forensic analysis including document review and organization, key issue identification, schedule analysis, labor productivity studies, general conditions calculations, pricing, and graphic exhibits for input to expert reports.
Senior Construction Claims Analyst (Full Time) Mcdonough Bolyard Peck IncSenior Construction Claims Analyst (Full Time)Vienna, VA$107,000–$150,000 / yearMBP is looking for Senior Construction Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration.
Claims Data Consultant Deloitte Touche Tohmatsu LtdClaims Data ConsultantArlington, VA$80,300–$133,900 / yearFrom strategy to execution, this team delivers integrated, end-to-end support and advisory services covering valuation modeling, cost optimization, restructuring, government operations modernization, business design and transformation, infrastructure and real estate, mergers and acquisitions (M&A), and sustainability. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
UNEMPLOYMENT COMPENSATION CLAIMS EXAMINER District Of ColumbiaUNEMPLOYMENT COMPENSATION CLAIMS EXAMINERWashington, DC$62,158–$80,032 / yearReviews, examines, investigates, develops, and adjudicates the full range of unemployment claims to verify the work performed by other claims examiners, to assess the errors found in writing and recommend ways to avoid such errors. Interviews and assists individuals regarding erroneous claims against the District of Columbia and other jurisdictions; makes a determination concerning the claimant''s eligibility and entitlement to the benefits or disqualifications, when necessary.