Claims Analyst The Health PlanClaims AnalystCharleston, WVUnder the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines.
Adjuster, Property Insurance Claims Elevate Claims SolutionsAdjuster, Property Insurance ClaimsCharleston, West VirginiaElevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders.
Property Adjuster Insurance Claims Elevate Claims SolutionsProperty Adjuster Insurance ClaimsCharleston, West VirginiaElevate Claims Solutions is seeking an Independent Adjuster adjusters with commercial and residential property claims in Wisconsin: Greenbay Appleton and Fox Cities area. Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves.
Senior Claims Specialist - West Virginia CorVel Enterprise Claims, Inc.Senior Claims Specialist - West VirginiaCharleston, WVRemote$59,681–$96,123 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
Claims Representative II - REMOTE Ryder System IncClaims Representative II - REMOTECharleston, WVRemoteCompensation Information : The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees : If you are a current employee at Ryder, please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process.
Claims Analyst - REMOTE Ryder System IncClaims Analyst - REMOTECharleston, WVRemoteCompensation Information : The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees : If you are a current employee at Ryder, please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process.
Lost Time Claims Specialist - Workers'''' Compensation Encova Mutual Insurance GroupLost Time Claims Specialist - Workers'''' CompensationCharleston, WVOur current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate.
Claims Adjuster II, Field Property - National Catastrophe Nationwide Mutual Insurance CoClaims Adjuster II, Field Property - National CatastropheCharleston, WV$62,500–$115,500 / yearNationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. In this role, you'll conduct on-site inspections, evaluate property damages, determine policy coverage, and make timely, accurate decisions using a variety of tools and resources, including vendor estimates, independent adjusters, and self-written assessments.
Workers Compensation Claims Examiner | Dedicated Client | NY Jurisdiction Knowledge & NY Licensing Required Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Dedicated Client | NY Jurisdiction Knowledge & NY Licensing RequiredWV$90,000–$95,000 / 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 Lost-Time 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.
Sr. Technical Specialist - Workers' Compensation Claims Major Case Unit, VA & MN American International Group Inc (AIG)Sr. Technical Specialist - Workers' Compensation Claims Major Case Unit, VA & MNCharleston, WVManage indemnity, medical and legal aspects of highest valued, complex WC claims, for Virginia (VA), Minnesota (MN) and other jurisdictions, through use of various resources available (i.e., utilizing medical management services in controlling medical treatment as necessary, coordinating independent medical evaluations where appropriate). Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience.
Senior Claims Specialist - West Virginia CorVel CorpSenior Claims Specialist - West VirginiaCharleston, WVRemote$59,681–$96,123 / yearESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Receives claim, confirms policy coverage and acknowledgement of the claim • Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies • Establishes reserves and authorizes payments within reserving authority limits • Develops and manages well-documented action plans with the case manager and outcomes manager to reduce overall cost of the claim • Coordinates early return-to-work efforts with the appropriate parties • Manages subrogation and litigation of claim as it applies • Manages potential claim recoveries of all types • Reports claims to the excess carrier when applicable • Communicates claim status with the customer and claimant • Adheres to client and carrier guidelines and participates in claims review as needed • Develops and maintains professional customer relationships • Complies with rules and regulations of applicable state. KNOWLEDGE & SKILLS: • Excellent written and verbal communication skills • Ability to assist team members to develop knowledge and understanding of claims practice • Ability to identify, analyze and solve problems • Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets • Strong interpersonal, time management and organizational skills • Ability to work both independently and within a team environment • Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation.
NewClaims Adjuster Trainee The Progressive CorpClaims Adjuster TraineeCharleston, WV$54,000–$57,500 / yearFor ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://www.progressive.com/careers/how-we-hire/faq/job-scams/ . This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months.
NewIndependent Insurance Claims Adjuster in Saint Albans, West Virginia MileHigh Adjusters HoustonIndependent Insurance Claims Adjuster in Saint Albans, West VirginiaSaint Albans, West VirginiaIf you are interested in roster opportunities or would like to learn what licensing, training, and qualifications may be needed to pursue a career as an insurance adjuster, please apply today and schedule a brief informational meeting with our team. If additional licensing or training is needed, MileHigh Adjusters Houston offers career-entry training programs designed to help qualified individuals prepare for the industry.
NewIndependent Insurance Claims Adjuster in Hurricane, West Virginia MileHigh Adjusters HoustonIndependent Insurance Claims Adjuster in Hurricane, West VirginiaHurricane, West VirginiaIf you are interested in roster opportunities or would like to learn what licensing, training, and qualifications may be needed to pursue a career as an insurance adjuster, please apply today and schedule a brief informational meeting with our team. If additional licensing or training is needed, MileHigh Adjusters Houston offers career-entry training programs designed to help qualified individuals prepare for the industry.
NewAuto Claims Adjuster Allstate Insurance CompanyAuto Claims AdjusterWV$50,000–$74,350 / yearAuto Insurance, Auto Insurance Claims, Case Management, Claims Administration, Claims Resolution, Claims Review, Coverage Analysis, De-Escalation, Insurance Administration, Insurance Claims, Insurance Coverage, Insurance Coverage Analysis, Insurance Policies, Insurance Policy Review, Policy Interpretation, Task Management, Time Management, Time Prioritization. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
NewMedical Claim Analyst CVS Health CorpMedical Claim AnalystWV$18.50–$35.29 / hourThis function includes, but is not limited to the following: Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician. The Medical Claim Analyst will be part of the Provider Coding and Reimbursement (PCR) team who reviews provider coding and reimbursement denial disputes from providers.
Senior Analyst Claim Reporting and Special Services CVS Health CorpSenior Analyst Claim Reporting and Special ServicesWV$46,988–$112,200 / yearPosition Summary: We are looking for a highly motivated candidate who can effectively and accurately oversee and coordinate rework projects, work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims. The candidate will serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns.
General Liability Claim Representative The Travelers Companies IncGeneral Liability Claim RepresentativeCharleston, WV$67,000–$110,600 / yearInvestigates each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
NewMgr, Business Consultant CVS Health CorpMgr, Business ConsultantWV$60,300–$132,600 / yearThe Manager will be responsible for ensuring the accuracy, completeness, and timeliness of encounter data submissions while partnering closely with internal business and technical teams, as well as external vendors, to meet regulatory and operational requirements across multiple states. As the Dual Special Needs Plan (DSNP) business continues to expand, we are seeking an experienced Manager, Encounter Data & State Submission Operations to lead the end-to-end management of encounter and claims data submissions to state agencies.
Accounts Receivable Specialist Mountain State Oral & Facial SurgeryAccounts Receivable SpecialistHurricane, WV$38,000–$47,000Our company has been a prominent provider specializing in oral and maxillofacial surgery throughout the state of West Virginia for over 25 years with recent expansion into the Kentucky and Virginia regions. Our skilled surgeons utilize advanced oral and facial surgical techniques to deliver exceptional care.
Insurance Billing Specialist Mountain State Oral & Facial SurgeryInsurance Billing SpecialistHurricane, WV$38,000–$47,000Our company has been a prominent provider specializing in oral and maxillofacial surgery throughout the state of West Virginia for over 25 years with recent expansion into the Kentucky and Virginia regions. Our skilled surgeons utilize advanced oral and facial surgical techniques to deliver exceptional care.
NewAD, Access & Reimbursement (ADAR) CV - Lexington, KY NovartisAD, Access & Reimbursement (ADAR) CV - Lexington, KYCharleston, West VirginiaRemoteAccess And Reimbursement Strategy (Inactive), Agility (Inactive), Analytical Skill (Inactive), Analytical Thinking, Cross-Functional Collaboration, Customer-Centric Mindset (Inactive), Employee Development, Finance, Go-to-Market Strategies, Healthcare Policies, Healthcare Sector Understanding (Inactive), Health Economics, Health Technology Assessment (HTA), Innovation, Inspirational Leadership, Market Access Strategies, People Management, Process Management, Project Management, Public Affairs, Real World Evidence (RWE), Regulatory Compliance, Risk Management, Value Propositions Interact with large, complex accounts to support patient access within their aligned therapeutic area product(s), proactively provide face-to-face education on programs to providers and staff in order to support integration of those products into office processes and workflows.
Cost Accounting Analyst MRC Global IncCost Accounting AnalystCharleston, WVMRC Global serves the oil and gas industry across the upstream, midstream and downstream sectors as well as the chemical and gas distribution market sectors worldwide. This role supports our financial operations by analyzing costs, evaluating production efficiency, and assisting in inventory and margin analysis.
Regulatory & Quality Oversight Specialist -- WVPHO ADMINISTRATION -- Northgate-400 Association Dr. Charleston Area Medical Center Health System IncRegulatory & Quality Oversight Specialist -- WVPHO ADMINISTRATION -- Northgate-400 Association Dr.Charleston, WVThe Regulatory & Quality Oversight Specialist ensures that Payer Enrollment and affiliated functions maintains compliance with CMS, Medicaid, Medicare Advantage, and commercial payer requirements. The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages.
Psychologist - (Part-time) - Charleston, WV Commonwealth Medical ServicesPsychologist - (Part-time) - Charleston, WVCharleston, WVWhether you are an experienced psychologist seeking a more flexible role or looking to transition into a lower-stress practice setting, this opportunity offers the ability to continue making a meaningful impact while maintaining work-life balance. Step away from the demands of traditional clinical practice and enjoy a structured, low-stress environment with 1099 compensation , work-life balance, and built-in support.
Nurse Practitioner - South Charleston, WV - Part Time - 2 days per week Commonwealth Medical ServicesNurse Practitioner - South Charleston, WV - Part Time - 2 days per weekSouth Charleston, WVWho We’re Looking For: Whether you’re a new graduate looking to kickstart your career or an experienced provider seeking a slower, more flexible pace, this role is for you! We offer competitive guaranteed pay, a supportive environment, and the flexibility you’ve been looking for.
Senior Applied & Agentic AI Engineer Sedgwick Claims Management Services, Inc.Senior Applied & Agentic AI EngineerWVNewsweek Recognizes Sedgwick as Americas Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance. Design secure tool integration layers connecting agents to claims systems, policy platforms, data warehouses, document repositories, and external data services.
Personal Lines Account Manager Insurance Office of AmericaPersonal Lines Account ManagerCharleston, WVRemote$50,000–$60,000 / yearFull timePlease note: If this position is posted as either fully remote and/or hybrid, in accordance with company policy, individuals residing within a 50-mile radius of a branch location may be required to work onsite in a hybrid capacity. Managing incoming correspondence and facilitating effective team communication are vital aspects of the role, including delegating work to Account Associates.
Cost Accounting Analyst MRC Management CoCost Accounting AnalystCharleston, West VirginiaMRC Global serves the oil and gas industry across the upstream, midstream and downstream sectors as well as the chemical and gas distribution market sectors worldwide. This role supports our financial operations by analyzing costs, evaluating production efficiency, and assisting in inventory and margin analysis.
NewSenior Quality Specialist CVS Health CorpSenior Quality SpecialistWV$18.50–$38.82 / hourActs as an advocate and subject matter expert guiding the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency. Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements as well as daily operations and programs to consistently drive optimal results.
Insurance Account Position - State Farm Agent Team Member Frank Yeigh III - State Farm AgentInsurance Account Position - State Farm Agent Team MemberSouth Charleston, WVAs our Insurance Account Position - State Farm Agent Team Member, your knowledge of insurance products and industry trends equips you to communicate directly with customers, identify their needs, and market products or services that maximize value. ROLE DESCRIPTION: Frank Yeigh State Farm Insurance is searching for a competitive Producer who can recognize opportunities and strategically turn leads into long-lasting customer relationships.
Customer Service Representative - State Farm Agent Team Member Colby Johnson - State Farm AgentCustomer Service Representative - State Farm Agent Team Memberst albans, WVAs a Customer Service Representative - State Farm Agent Team Member with Colby Johnson - State Farm Agent, you will generate the kind of exceptional customer experiences that reinforce the growth of a successful insurance agency. You will enhance your career while resolving customer inquiries, coordinating with other agency team members, and anticipating the needs of the community members you support.
Freezer, Cooler and Deli Stocker Associate Walmart IncFreezer, Cooler and Deli Stocker AssociateSouth Charleston, WV$16–$23 / hourMaintains the Sales Floor and merchandise presentation in the Freezer/Cooler/Deli area in accordance with Company policies and procedures by properly handling claims and returns; zoning the area; receiving and stocking merchandise; setting up, cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise appropriately; completing required audits, paperwork, logs, and other required documentation; and securing fragile and high-shrink merchandise. Follows Company policies and procedures related to Freezer/Cooler area by complying with food handling policies; operating, repairing, and sanitizing equipment; following Cold Chain procedures when stocking merchandise; cleaning freezer /cooler/deli area (for example, windows, mirrors, display cases and coolers); monitoring freezer/cooler fans, drains and doors for proper operation; and reporting issues to Management.
Customer Service Representative - State Farm Agent Team Member Wade Walters - State Farm AgentCustomer Service Representative - State Farm Agent Team MemberNitro, WVAs a Customer Service Representative - State Farm Agent Team Member with Wade Walters - State Farm Agent, you will generate the kind of exceptional client experiences that reinforce the growth of a successful insurance agency. You will enhance your career while resolving customer inquiries, coordinating with other agency team members, and anticipating the needs of the community members you support.
Medical Director MPO CVS Health CorpMedical Director MPOWV$174,070–$374,920 / yearIn this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. Additional responsibilities may include: Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services.
Registration Specialist, Internal Medicine West Virginia University MedicineRegistration Specialist, Internal MedicineWVCollects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification.
Registration Derm West Virginia University MedicineRegistration DermWV4. Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification.
PRN Registration Specialist Dermatology West Virginia University MedicinePRN Registration Specialist DermatologyWVCollects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification.
Registration Specialist - Heart & Vascular Institute West Virginia University MedicineRegistration Specialist - Heart & Vascular InstituteSouth Charleston, WVCollects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification.