CLAIMS EXAMINER I MSO North East Medical ServiceCLAIMS EXAMINER I MSOBurlingame, CAESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Working knowledge of managed care and/or healthcare claim reimbursement or medical billing in Medi-Cal and Medicare Advantage program preferred.
Senior Claims Specialist, Workers Compensation Tokio Marine America Insurance CompanySenior Claims Specialist, Workers CompensationPasadena, CA$115,000–$120,000 / yearWe provide unique insurance and risk management tools from our experienced staff of account executives, underwriters and loss prevention engineers and fair and timely claim settlement from a skilled team of claim professionals. About Tokio Marine: Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed in all states, Puerto Rico and the District of Columbia, and write all major lines of Commercial Property and Casualty Insurance.
NewClaims Representative I (Workers' Compensation) Society Insurance CompanyClaims Representative I (Workers' Compensation)Fond du Lac, WIRemoteThis role will investigate, evaluate, and resolve mildly complex Workers’ Compensation claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating appropriate claim resolutions in accordance with company guidelines, policy provisions, and state regulations. Determines insurance coverage by examining claim forms, policies, and other records; interviewing claimants/injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting with experts when appropriate.
Sr. Technical Claims Specialist W. R. Berkley CorpSr. Technical Claims SpecialistHouston, TXThis includes specialized coverages, risk services that complement existing safety practices, and claims management that reflects our in-depth knowledge of hazards and losses normal to this industry. Technical Claims Specialist position will be responsible for handling, negotiating and resolving third party commercial general liability and automobile bodily injury and property damages claims to conclusion.
Medical Billing Claims Specialist Summit SpineMedical Billing Claims SpecialistLawrenceville, FloridaRemoteCompany Overview: Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management practice providing comprehensive clinical, surgical, and imaging services. With locations across Georgia, North Carolina, South Carolina, Tennessee, Florida, and Texas, our team is committed to delivering exceptional, patient-centered care through collaboration, innovation, and clinical excellence.
Sr Claims Representative Argo Group International Holdings IncSr Claims RepresentativeAlbany, NY$43,452–$67,500 / yearThis includes analyzing coverage, contacting the customers, investigating the facts surrounding the loss, arranging inspection, experts, and third parties. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses.
Medical Claims Reviewer (RN) Broadway VenturesMedical Claims Reviewer (RN)Remote$60,000–$63,000 / yearWhere that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget.
Insurance Claims & Customer Service Analyst (Full-Time, Monday - Friday, 8:00Am-4:30Pm) Washington Regional Medical CenterInsurance Claims & Customer Service Analyst (Full-Time, Monday - Friday, 8:00Am-4:30Pm)Fayetteville, ARHunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country.
Manager, Claims Amalgamated LifeManager, ClaimsWhite Plains, NYStrong written and verbal communication skills, including empathetic listening and a high level of customer service, are vital for this role which interacts with Claimants and stakeholders. They lead a small team responsible for the entire claims lifecycle, including but not limited to evaluating medical records, coordinating with providers, and communicating with claimants to determine eligibility for benefits.
Claims Examiner Kinsale ManagementClaims ExaminerRichmond, VirginiaYou’ll work closely with experienced claims professionals and legal partners while handling a diverse portfolio, including litigated claims. 2+ years of experience handling commercial general liability claims involving bodily injury and property damage.
NewClaims Representative II (Workers Compensation) Society Insurance CompanyClaims Representative II (Workers Compensation)Fond du Lac, WIRemoteThis role will investigate, evaluate, and resolve moderate-to-severe complex Workers’ Compensation claims by determining coverage and liability, coordinating with injured workers, employers, and medical providers, and negotiating appropriate claim resolutions in accordance with company guidelines, policy provisions, and state regulations. Determines insurance coverage by examining claim forms, policies, and other records; interviewing claimants/injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting with experts when appropriate.
NewAdmin Processor n Global Channel ManagementAdmin Processor nPalm Harbor, FloridaAdmin Processor duties: Follow up with customers, verifying the clients information, sending emails, utilizing product and pricing information to assist in answering questions. Proficient in medical billing clearinghouse Availity and Emdeon (Change Healthcare) Accounts payable and receivable knowledge is a plus.
MSO Claims Manager North East Medical ServiceMSO Claims ManagerBurlingame, CAThis role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Workers' Compensation Claims Coordinator INVO CLAIMS ADMINISTRATORSWorkers' Compensation Claims CoordinatorOak Ridge, TNYou'll be the liaison between employees, supervisors, insurance carriers, healthcare providers, and legal representatives - ensuring timely processing, regulatory compliance, and effective return-to-work programs. Associate's or Bachelor's in HR, Business Administration, Risk Management, or related field preferred.
Associate, Claims Receipt Processor Ametros Financial CorpAssociate, Claims Receipt ProcessorWilmington, MA$20–$23 / hourAmetros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds.
Director, Claims Operations Medica Health Plans IncDirector, Claims OperationsMadison, WI$113,400–$170,100 / yearA skilled people and operations leader, the Director, Claims Operations ensures high-quality, timely, and accurate service delivery for customers, members, and providers across all lines of business in a dynamic, growth-oriented environment. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the positions scope and responsibility, internal pay equity and external market salary data.
Claims Analyst W. R. Berkley CorpClaims AnalystNJRemote$70,000–$80,000 / yearThe key to Berkley's success is our nimble approach to risk - our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident.
Sr Claims Representative Argo Group International Holdings Ltd.Sr Claims RepresentativeOmaha, NE$43,452–$67,500 / yearFarm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.
Claims Processor II InnovAgeClaims Processor IIDenver, Colorado$22.84–$27.40 / hourFull timeInnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.
Claims Adjuster Medley NewVine Employment GroupClaims Adjuster MedleyMedley, FloridaThe successful candidate will investigate incidents, assess liability and value, negotiate with claimants and suppliers, and work closely with internal stakeholders to support excellent customer service and cost-effective claim resolution. Authorise payments, agree settlements and negotiate with claimants, solicitors and third-party representatives to reach timely resolutions.
NewAdmin Processor Global Channel ManagementAdmin ProcessorPalm Harbor, FloridaAdmin Processor duties: Follow up with customers, verifying the clients information, sending emails, utilizing product and pricing information to assist in answering questions. Proficient in medical billing clearinghouse Availity and Emdeon (Change Healthcare) Accounts payable and receivable knowledge is a plus.
Claims Specialist-Journal Center, (783) TriCore Reference LaboratoriesClaims Specialist-Journal Center, (783)Albuquerque, NMResponsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
Insurance Payment Processor Smile Brands Group IncInsurance Payment ProcessorSan Antonio, TX$16–$18.50 / hourThis onsite role plays a critical part in supporting accurate and timely insurance payment posting and account reconciliation across multiple practice management systems. Smile Brands is seeking an experienced and detail-oriented Insurance Payment Processor to join our Central Billing Office team in San Antonio, TX.
Claims Examiner I Metroplus Health Plan IncClaims Examiner INew York, NY$50,000–$54,194 / yearPerforms other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars. Scope of Role & Responsibilities: Process claims involving medical and/or surgical services; screens for complete member/provider information.
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.
Claims Specialist- Journal Center, (784) TriCore Reference LaboratoriesClaims Specialist- Journal Center, (784)Albuquerque, NMResponsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
NewMailroom Document Processor Conduent Commercial Solutions, LLCMailroom Document ProcessorSpringfield, MA$18Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. Perform repetitive duties in a high-speed environment such as removing staples, rubber bands, repairing torn documents or copying document types and inserting the appropriate patch sheets to separate the claims.
Claims Training Coordinator Viva Health, Inc.Claims Training CoordinatorBirmingham, ALVIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nations Best Places to Work by Modern Healthcare. The Claims Training Coordinator provides non-supervisory support to the claims trainer by assisting with the coordination, reinforcement, and documentation of training activities for claims examiners.
Medical- Dental Claims Specialist Mountain State Oral & Facial SurgeryMedical- Dental Claims SpecialistHurricane, WVOur 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.
Director, Claims Training and Development W. R. Berkley CorpDirector, Claims Training and DevelopmentScottsdale, AZThe Director will collaborate with Claims Leadership on strategies that support the organization's current and long-term talent development objectives, address capability gaps, and create consistent, repeatable learning solutions for Claims personnel including new hire onboarding. The Director also leads the Claims Training Program from recruitment through graduation of new trainees, including direct personnel management and oversight of their low severity claim handling, integral to their training.
Claims Processor AND Customer Service Representative Addison GroupClaims Processor AND Customer Service RepresentativeTulsa, Oklahoma$20–$22 / hourAbout Our Client: Addison Group is partnering with our client, a well-established organization in the employee benefits and healthcare administration space, to hire a Claims Processor/Customer Service Representative. This role involves reviewing and processing healthcare claims, verifying eligibility, explaining benefit coverage, and resolving claim-related inquiries with accuracy and professionalism.
NewClaims Coordinator LotSolutions, Inc.Claims CoordinatorJacksonville, FLPart timeAdditional responsibilities include preparing and managing correspondence, troubleshooting operational issues, and performing administrative tasks, ensuring collaboration across teams to advance Fortegra's claims processes. This role is responsible for generating and distributing reports, communicating with internal teams and external partners, and verifying claims information.
Claims Call Center Specialist Warrior Insurance NetworkClaims Call Center SpecialistBedford Park, IL$16–$22 / hourFull timeWhether you bring prior insurance experience or a strong customer service background, Warrior Insurance Network (WIN) offers the training, development, and career growth opportunities needed to build a successful future in claims and insurance operations. Support departmental operations by processing tow bills, ordering police reports, mailing claim payments, handling unmatched mail, and completing other administrative tasks.
Claims Auditing Subject Matter Expert | AI Evaluation Specialist (On-Call) Volga PartnersClaims Auditing Subject Matter Expert | AI Evaluation Specialist (On-Call)RemoteWhether your background is in Investment Banking, FP&A, Fixed Income Research, Quantitative Finance, Claims Auditing, Forensic Auditing, Insurance Risk, Contract Compliance, or Commercial Disputes , this is an opportunity to apply your professional expertise in a unique and innovative way while working remotely on a flexible schedule. Volga Partners is seeking experienced finance, audit, insurance, compliance, and legal professionals to join our growing network of on-call AI Evaluation Specialists supporting the development, training, and evaluation of next-generation artificial intelligence models.
Third-Party Medical Claims Processor Hire Up Staffing ServicesThird-Party Medical Claims ProcessorFresno, CAIdeal Candidate: The perfect fit for this role has at least 3 years of experience in medical billing or claims processing especially if that experience includes working with a third-party administrator (TPA) within an insurance company . Prior TPA exposure is highly preferred due to the nature of this employers group benefit processing.
Claims Representative Jackson National Life Insurance CoClaims RepresentativeLansing, MIIndependently processes a range of transactions including those which are moderately complex using documented procedures and multiple software applications. Communicates with internal associates and external customers or agents regarding outstanding requirements, or transaction issues and problems.
NewClaims Examiner I Lee Hecht HarrisonClaims Examiner ISacramento, AL$20–$23 / hourAvailable paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
NewWarranty Claims Specialist CMG MSS, LLCWarranty Claims SpecialistWest Monroe, LAPart timeThis position works closely with service technicians, dispatch, project managers, manufacturers, and customers to ensure warranty claims are submitted accurately, resolved promptly, and documented thoroughly. The ideal candidate is highly organized, communicates effectively, and enjoys working with multiple priorities while maintaining exceptional attention to detail.
NewClaims Operations Quality Assurance Specialist Pacific LifeCorpClaims Operations Quality Assurance SpecialistOmaha, NE$32–$37 / hourHow You'll Make an Impact: Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA, including claim payment accuracy, interest review and calculation, post-death interest, initial claim setup, documentation, beneficiary/payee information, follow-up requirements, and completion of required claim actions. How you'll help move us forward: Consistently apply sound judgment and accountability when evaluating pay accuracy, interest review and calculation, post-death interest, claim setup completeness, follow-up activity, documentation quality, and adherence to claims procedures.
HUMAN RESOURCES SPECIALIST VI (EMPLOYEE CLAIMS) - OAHU State of HawaiiHUMAN RESOURCES SPECIALIST VI (EMPLOYEE CLAIMS) - OAHUHonolulu, HI$6,914–$8,414Staff Specialist or Supervisory Experience: One (1) year of Staff Specialist or Supervisory Experience of the type and quality described below: A. Staff Specialist Experience: Human resources specialist experience performing work regularly encompassing difficult and complex situations and problems in a given human resources specialty with responsibility for furnishing advisory services to management in the overall aspects of program development and evaluation; or human resources specialist experience performing extensive and intensive work in a given area of specialization, working on the most complex and difficult assignments in the areas of program development and evaluation, development of new and revised procedures, review of working situations to be sure that departments are following guidelines for sound human resources practices, recommending legislation or studying impact of proposed legislation, and engaging in human resources research aimed towards improving the human resources system. Selective Certification - Workers Compensation Claims Management Experience: Three and one-half years (3-1/2) years of experience in the area of workers compensation, which involved investigating and monitoring questionable claims, recommending/determining the employers position, preparing and recommending settlement offers and negotiating settlements, developing the employers case and representing the employer in hearing and on contested cases.
Auditor, Insurance Claims Pacific Dental Services IncAuditor, Insurance ClaimsIrving, TX$22–$29.80 / hourThe primary purpose and function of the Auditor, Insurance Claims is to adjudicate, re-bill and rebut insurance claims in order to ensure accurate and maximum reimbursement for patient treatment from insurance carriers. Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community.
Claims Coordinator, PSA Collectors Universe, Inc.Claims Coordinator, PSASanta Ana, CA$20.50–$23 / hourOur services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia. We grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
Claims Supervisor Health Source MSOClaims SupervisorAlhambra, CAFull timeProviding expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates.
Claims Auditor Health Source MSOClaims AuditorAlhambra, CAFull timeResponsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates. Job Description : Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
NewClaims Specialist LSI StaffingClaims SpecialistPapillion, NEWe are currently looking for a full-time Claims Specialist to join our team in the Papillion area . If you're interested in joining our team, we'd love to hear from you!
Remote Medical Claims Processor I (Temporary role) Broadway VenturesRemote Medical Claims Processor I (Temporary role)Remote$20–$23 / hourAs an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget.
NewTechnical Business Analyst - Claims Module 2 The Computer Merchant, LtdTechnical Business Analyst - Claims Module 2Remote$60–$62.50 / hourContractorWhile an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Drive the claims module and process, domain knowledge, performs analysis of business requirements, designs and develops documentation, ensures quality process, coordinates with customers.
Medical Billing Claims Specialist Caddis Capital ManagementMedical Billing Claims SpecialistSalt Lake City, UTFull timeWe are currently seeking Medical Billing/Claims Specialist who will be responsible for billing insurance claims to patient's insurance companies, following up on Accounts Receivable and coordinating collections on unpaid claims, as well as answering billing inquiries and assisting patients on their accounts as necessary. What We'd Also Like to See: While not required, some big marks in your favor would include: prior experience with medical insurance providers, any previous HME experience, an Associate's degree, and bilingual skills (Spanish/English).
Medical Only Claims Specialist CorVel Enterprise Claims, Inc.Medical Only Claims SpecialistOverland Park, KSRemote$16.74–$26.92 / hourPart 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. The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of the Claims Department and of CorVel.
Medical Billing & Claims Manager (DHPI98) Tuba City Regional Health Care CorporationMedical Billing & Claims Manager (DHPI98)Tuba City, ArizonaFull timeProvides technical assistance to management, medical providers, patients and other facility personnel by obtaining information relative to medical billing requirements, covered services, audit reports, or billing statistics, Coordinates and oversees work of staff; has the responsibility of distributing workloads as. Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job.