Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OTimonium, MD$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 Recovery Specialist I (Remote) CareFirstClaims Recovery Specialist I (Remote)Baltimore, MDRemote$35,712–$65,472 / yearInvestigates and performs Investigates and performs adjustments to claims to reflect cash returned by members and/or providers in order to reduce and accurately reconcile customer accounts. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Claims Director - Professional Liability CRC Insurance Services, LLCClaims Director - Professional LiabilityMD$140,000–$200,000 / yearPlease review the following job description: The position is responsible for maintaining active oversight of open claims and/or incident reports, driving regular communication with carrier claims departments and adjusters, and ensuring significant claim developments are promptly communicated to Negley management and underwriting personnel. The position is expected to dig into open files, challenge claim handling when appropriate, identify issues requiring escalation, and maintain continuous visibility into claim status, litigation strategy, reserves, settlement activity, coverage concerns, and emerging loss trends.
Claims Inventory Manager ApolisClaims Inventory ManagerBaltimore, MDRemote$90–$95 / hourThe ideal candidate will have a strong understanding of the claims lifecycle, the ability to bridge business and technical teams, and proven experience leading cross-functional initiatives in a healthcare environment. We are seeking an experienced Claims Inventory Manager with expertise in healthcare claims processing and Facets configuration.
Healthcare Claims Processor J29, IncHealthcare Claims ProcessorMillersville, MDRemoteThe Junior Healthcare Claims Analyst/Adjudicator will complete routine claims processing activities, verify claim and member information, review claims for completeness and accuracy, apply documented processing rules, and escalate exceptions or complex issues to senior team members. FLSA Status : Non-Exempt, Full-Time Reports To: Claims Supervisor Overview: J29 is an employee centered health and human service management consulting company that specializes in processing, reviewing, and analyzing claims, records, disputes, and audits.
NewSenior Healthcare Claims Processor J29, IncSenior Healthcare Claims ProcessorMillersville, MDRemoteFull timePreferred Experience Experience supporting a limited health benefit program, specialty benefit program, occupational health program, workers compensation program, or other program in which coverage is tied to defined eligibility and covered conditions. 3-5+ years of experience leading claims supervisors, examiners, analysts, operational teams, or claims quality programs, including responsibility for productivity, performance, and accountability initiatives.
Claims Recovery Specialist II (Remote) CareFirstClaims Recovery Specialist II (Remote)Baltimore, MDRemote$42,624–$78,144 / yearSpecialist will assist to maximize recovery amounts due to refund of payments made in error to members and/or providers, retro terms and/or focused provider audits. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Senior Claims Benefit Specialist CVS Health CorpSenior Claims Benefit SpecialistMD$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
Remote Claims Representative -581888 Metro Public AdjustmentRemote Claims Representative -581888Baltimore, MDRemoteMetro Public Adjustment is looking for customer-oriented individuals to join our team of claims representatives. Once reviewed, If you want a face-to-face interview, we typically conduct them on Zoom: For Interview time and location, use the link below:
Remote Professional Claims Writer -581888 Metro Public AdjustmentRemote Professional Claims Writer -581888MarylandRemoteMetro Public Adjustment is looking for customer-oriented individuals to join our team of claims representatives. Once reviewed, If you want a face-to-face interview, we typically conduct them on Zoom: For Interview time and location, use the link below:
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 TimeMDEpic 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 LeaderBaltimore, 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.
Senior Provider Experience Program Manager - Healthcare Claims CVS Health CorpSenior Provider Experience Program Manager - Healthcare ClaimsMD$106,605–$284,280 / yearWhat you will do: Lead enterprise delivery of multiple, highly complex business process and technology initiatives aligned to the Provider Experience / Provider NPS program, supporting all lines of business. Drive Agile delivery of Provider Experience / Provider NPS initiatives, supporting business process and technology improvements across multiple lines of business.
IT Production and Systems Support Engineer (Mainframe and Claims Processing) MindlanceIT Production and Systems Support Engineer (Mainframe and Claims Processing)Columbia, MDThe ideal candidate will combine mainframe expertise, application support, data analysis, and incident management skills to support both legacy and modern platforms while delivering high-quality service to internal teams and external plan vendors. This role is responsible for ensuring stability, performance, and continuous improvement of applications supporting claims vouchering, adjudication, and EDI processing.
Workers'''' Compensation Claim Representative/Senior Claim Representative The Hartford Insurance Group IncWorkers'''' Compensation Claim Representative/Senior Claim RepresentativeMaryland, MDRemote$56,391–$84,587 / yearOur dynamic team of claim professionals provide superb customer service with the valuation, disposition and settlement of worker compensation claims while consistently adhering to our corporate claim settlement policies. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role.
NewMedical Claims Adjustor Zenith American SolutionsMedical Claims AdjustorSparks, MarylandZenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
Claims Recovery Specialist I (Remote) Blue Cross and Blue Shield AssociationClaims Recovery Specialist I (Remote)Baltimore, MDRemote$35,712–$65,472 / yearCareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
Senior Product Manager - Medicare Claims Systems SME Tria FederalSenior Product Manager - Medicare Claims Systems SMEWoodlawn, MDRemoteTria is seeking a Senior Product Manager and Medicare Claims Systems SME to support the Centers for Medicare & Medicaid Services (CMS) system that maintains Medicare beneficiary entitlement and utilization data and validates fee-for-service claims. 5+ years as a product owner, product manager, or business analyst in Agile software delivery, working with sprint teams and tools such as Jira and Confluence to capture requirements and develop business process models.
Claim Counsel - Design Professional Claim The Travelers Companies IncClaim Counsel - Design Professional ClaimHunt Valley, MD$111,600–$184,200 / yearTravelers'' Professional Liability Team offers errors and omissions liability products to various market segments including accountants, design professionals, lawyers, real estate agents, property managers, and miscellaneous professional liability. Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
Associate Claim Rep, Auto Blend The Travelers CompaniesAssociate Claim Rep, Auto BlendHunt Valley, MD$45,400–$74,900 / yearThis position focuses on developing your skills and knowledge to successfully manage personal and business insurance damage claims involving various types of automobiles as well as heavy equipment, mobile equipment, and property damage. As an Associate Claim Rep, Inside Auto, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals.