4735 claims jobs found

Summary Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly. Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable. Required...

Bright Vision Technologies has an immediate opportunity for Property Field Claims Adjuster. This position is a Field Position so while it is listed as remote it means in the field within the assigned territory (Superior, Duluth, Brainerd, St. Cloud and surrounding areas Job Title: Property Field Claims Adjuster Job Location: Minneapolis, MN, US Job Type: Remote/Field Job Required Skills: Ability to thrive in a remote-work environment Multilingual is preferred Working knowledge of Microsoft WORD and Excel (or their equivalents), Xactimate, and/or other claims estimating software (as applicable) Possesses competent knowledge with residential and commercial construction techniques Typically requires 7 years of relevant experience or a combination of related experience, education and training Maintains the appropriate adjuster's licensing as required by the states in which we do business. This job operates in a work from home and virtual office...

Description SUCCESSFUL FORTUNE 500 PHARMACEUTICAL COMPANY HIRING REMOTE MEDICAL CLAIMS SPECIALISTS*** APPLY NOW!!! PAID TRAINING!!!! MUST BE ABLE TO PICK UP EQUIPMENT IN IRVING*** Pay: $19/hr. Weekly Pay plus Benefits Schedule: 7 am-8pm CST. M-F. (8hr Shift between these hours) Start Date: TBD Benefits: WEEKLY PAY, EQUIPMENT PROVIDED, MEDICAL BENEFITS & ABILITY TO WORK FROM HOME Job Details Inbound/outbound calls. Review pharmacy claims – Denials, Status, & Reimbursements Request Prior Authorizations. Advocate for Patients and their prescriptions. Using computer skills for data entry. Gathering and reviewing patient billing and medical information. Operating according to the guidelines of the Federal Health Care Program. Working with carriers to ensure coverage of medication on behalf of the patient. MUST HAVE AT LEAST A YEAR OF MEDICAL BILLING AND CODING. Medical Call Center experience is a plus but not required....

Description Are you looking for an amazing work from home opportunity? Our Fortune 500 Pharmaceutical Client is looking for driven, friendly, and experienced Medical Reimbursement & Claims Specialist to Join their REMOTE TEAM! !!Don’t miss out on this opportunity!! !!APPLY TODAY!!! Position: Medical Reimbursement & Claims Specialist Pay: $19/hr. Weekly Pay plus Benefits Schedule: 8am-9pm EST. M-F (8hr Shift between these hours) Equipment Provided and shipped directly to your home** Start Date: October start dates. Job Details Processing medical claims via electronic fax. May perform some outbounds calls and take some inbound calls assisting patients with medical related inquiries. Perform medical benefits investigations Using computer skills for data entry. Gathering and reviewing patient billing and medical information. Operating according to the guidelines of the Federal Health Care Program. Working with carriers...

Description Are you looking for an amazing work from home opportunity? Our Fortune 500 Pharmaceutical Client is looking for driven, friendly, and experienced Medical Reimbursement & Claims Specialist to Join their REMOTE TEAM! !!Don’t miss out on this opportunity!! !!APPLY TODAY!!! Position: Medical Reimbursement & Claims Specialist Pay: $19/hr. Weekly Pay plus Benefits Schedule: 8am-9pm EST. M-F (8hr Shift between these hours) Equipment Provided and shipped directly to your home** Start Date: October 2024 Job Details Processing medical claims via electronic fax. May perform some outbounds calls and take some inbound calls assisting patients with medical related inquiries. Perform medical benefits investigations Using computer skills for data entry. Gathering and reviewing patient billing and medical information. Operating according to the guidelines of the Federal Health Care Program. Working with carriers to ensure...

Description Now hiring a Remote Medical Reimbursement & Claims Specialist Start date: October 2024 Work from home – $19/hr TTH Responsibilities Perform medical benefits investigations Processing medical claims via electronic fax and using computer skills for data entry. May perform some outbounds calls and take some inbound calls assisting patients with medical related inquiries. Operating according to the guidelines of the Federal Health Care Program. Collecting critical patient demographic data and information. Gathering and reviewing patient billing and medical information. Work with insurance carriers to ensure medication coverage on behalf of the patient while operating according to Federal Health Care Program guidelines. Work Hours Monday through Friday Must be available to work any 8-hour shift between 7am – 8pm CST Required Experience Insurance verification experience is required. Must have reliable high speed...

At AIG, we are reimagining the way we help customers to manage risk. Join us as a Senior Analyst, Claims Analytics to play your part in that transformation. It’s an opportunity to grow your skills and experience as a valued member of the team. Make your mark in Analytics for Claims 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. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency. About the role Become a part of the transformative claims insights and analytics team in the global claims operations group. As a member of the Claims Analytics team, your role will span AIG’s global reach. The role will be responsible for supporting the delivery of the claims data and...

Description RemX is hiring remote Medical Claims Specialist for our client who is a Fortune 500 Pharmaceutical company. Ideal candidate will have a minimum of 1 year of experience processing medical claims, prior authorizations, and benefits investigations. Job Details Processing medical claims. Review pharmacy claims – denials, status, & reimbursements Request prior authorizations. Outbounds calls/ inbound calls assisting patients with medical claims related inquiries. Perform medical benefits investigations. Gathering and reviewing patient billing and medical information. Operating according to the guidelines of the Federal Health Care Program. Working with carriers to ensure coverage of medication or procedure on behalf of the patient. Requirements Must have 1 year or more of medical claims or benefit verification experience (NO EXCEPTIONS) Professional communication skills Medical Claims processing Insurance Verification...

ABOUT HUB INTERNATIONAL: HUB International Limited ("HUB") is the 5th largest global insurance and employee benefits broker, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. With over 18,000 employees in 500+ offices throughout North America, HUB has grown substantially, in part due to our industry leading success in Mergers and Acquisitions. WHAT WE OFFER YOU: At HUB we believe in investing in the future of our employees. Our entrepreneurial culture fosters an environment of open feedback and improvement that empowers our people to make the best decisions for our customers and organization. We offer: Competitive salaries and benefits offerings Medical/dental/vision insurance and voluntary insurance options Health Savings Account funding 401k matching program Company paid Life and Short-Term Disability Plans Supplemental Life and Long-Term Disability Options...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey. Our Claims organization is seeking a VP of Claims Finance, Data Analytics, and Insights to join our growing team in a remote, hybrid work arrangement in MA or open to relocation to MA. This is a full-time exempt role. SUMMARY: As a member of the Claims Senior Leadership team and direct report to the Chief Claims Officer, the VP of Claims Finance, Data Analytics, and Insight influences the strategy and day to day operations of a large and critically important component of the company. She/He will oversee annual financial planning, staffing analysis, budgeting, and approvals for a $182M operation. Provides data and insight to corporate Finance and LOB financial officer's critical to making well informed financial judgements and decisions impacting...

Aon is looking for a Claims Specialist II Do you have experience in claims adjudication and enjoy resolving issues for clients? If you'd like to grow your experience with a globally respected firm, this may be the next step in your career! As part of an industry-leading team, you will help empower results for our clients by delivering innovative and effective solutions as part of our Travel Practice business group within Aon Affinity. This position has 4 weeks of virtual training followed by a hybrid or 100% remote work schedule. How this role is different: Our leaders pride themselves in outlining growth paths for our colleagues and helping colleagues reach their career goals. In this position, there are various career tracks, such as advancing to the Claims Professional role, which offers more authority and discretion, and the Managerial track, which supervises, mentors and coaches other colleagues. Responsibilities: Review and service claims in accordance with plan...

Full job description Under general supervision, manages claims and contains costs associated with work related injuries and illnesses, in accordance with State of Illinois Workers’ Compensation Laws. Qualifications PRIMARY RESPONSIBILITIES Manages cases of employees injured on the job. Updates and maintains investigation reports, medical records, and case notes to determine compensability. Sets reserve levels, monitors claims costs, and generates payments to service providers and injured employees to cover injury related costs. Identifies and initiates subrogation activity to recover payment from at-fault third parties. Manages medical care including coordinating needed services and monitoring appointments. Negotiates claims within designated authority level. Testifies before the Workers’ Compensation Commission on claims denials. Directs activities of Third Party Administrator and provides claims...

With more than $1Billion won for our clients in 20 years of business, we are an ever-growing firm with extensive experience handling first-party claims such hail storms. We place a strong emphasis on the culture within our company, creating a family atmosphere with work/life balance and an open environment. We are seeking an experienced First-Party Property Attorney to join our team and assist with first-party cases in both pre-lit and active litigation. Apply today and take your career to the next level! Top Reasons to Work with Us Very strong compensation ($110-150,000/year) DOE Commission from piece of settlement! No billable hour requirement At our firm, you will have the opportunity to work with a team of professionals who are committed to delivering the highest standard of service to our clients. Our firm offers a challenging and stimulating work experience designed to help you grow your legal career. We understand that our success is dependent on our...

With more than $1Billion won for our clients in 20 years of business, we are an ever-growing firm with extensive experience handling first-party claims such hail storms. We place a strong emphasis on the culture within our company, creating a family atmosphere with work/life balance and an open environment. We are seeking an experienced First-Party Property Attorney to join our team and assist with first-party cases in both pre-lit and active litigation. Apply today and take your career to the next level! Top Reasons to Work with Us Very strong compensation ($110-150,000/year) DOE Commission from piece of settlement! No billable hour requirement At our firm, you will have the opportunity to work with a team of professionals who are committed to delivering the highest standard of service to our clients. Our firm offers a challenging and stimulating work experience designed to help you grow your legal career. We understand that our success is dependent on our...

Full job description Job Number 7082 Workplace Type : Office Full-Time Orange , California Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us? At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical...

Full job description 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. Grade 3 POSITION PURPOSE Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Accountable for complying with all laws and regulations that are associated with duties and responsibilities. NATURE AND SCOPE This role does not manage people This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist I must...

We are currently seeking an Epic Analyst that is experienced in the Professional Billing/Claims setting to assist with planning, analyzing, designing, implementing tests and maintaining Epic software applications. Candidates will collaborate with user departments to anticipate and resolve problems, develop and modify procedures to solve complex data processing problems and prepare detailed specifications from which programs are written. Requirements: Experience in Professional Billing, Claims, Revenue Cycle or Health Information Management preferred Bachelor’s degree in an HIM, Information Technology, Finance, or related field is preferred. If applicable, must have necessary clinical licensure required by the State of Louisiana.  Applicable Epic certification highly desirable. Experience in clinical and/or financial applications within a healthcare/physician practice environment preferred OR 1-3 years of relevant clinical, business or technical experience....

As Head of Business Transformation, Group Claims you will be responsible for leading and driving the Group Claims value stream on the Absence Comprehensive Experience project, while also being responsible for the leadership, launch, and delivery of other Group Claims transformation initiatives related to our systems and technology. You will develop a team that works on complex efforts and supports cross-functional collaborations to deliver solutions to both internal and external customers. You will understand, analyze, document, and refine business needs and requirements, apply standard methodologies and processes, and engage with subject matter authorities to ensure alignment against business priorities and initiatives. You will lead the team as a forward-thinker, innovator, and change agent, responsible for using continuous improvement and organizational change practices to drive successful adoption and increase effectiveness across Group Claims. You will build the frameworks...

At AIG, we are reimagining the way we help customers to manage risk. Join us as a Senior Analyst, Claims Analytics to play your part in that transformation. It’s an opportunity to grow your skills and experience as a valued member of the team. Make your mark in Analytics for Claims 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. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency. About The Role Become a part of the transformative claims insights and analytics team in the global claims operations group. As a member of the Claims Analytics team, your role will span AIG’s global reach. The role will be responsible for supporting the delivery of the claims data and...

Title: Claims Representative I (Health & Dental) Location: This position will work a hybrid model (remote and office) . The ideal candidate will live within 50 miles of our Elevance Health PulsePoint location at 6087 Technology Pkwy, Columbus, GA 31820. This position will have on-site training and will require you to be in the Columbus, GA office. After training, you will be required to work in the office 3 days per week. Hours: 8:00 am-5:00 pm EST, M-F Must have 100% attendance during the first 12 weeks of training. Start date: 11/4/2024. The Claims Representative I will be responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. Must pass the appropriate pre-employment test battery. How you will make an impact: Learning the activities/tasks associated with his/her role. Works...

We are currently seeking an Epic Analyst that is experienced in the Professional Billing/Claims setting to assist with planning, analyzing, designing, implementing tests and maintaining Epic software applications. Candidates will collaborate with user departments to anticipate and resolve problems, develop and modify procedures to solve complex data processing problems and prepare detailed specifications from which programs are written. Requirements: Experience in Professional Billing, Claims, Revenue Cycle or Health Information Management preferred Bachelor’s degree in an HIM, Information Technology, Finance, or related field is preferred. If applicable, must have necessary clinical licensure required by the State of Louisiana. Applicable Epic certification highly desirable. Experience in clinical and/or financial applications within a healthcare/physician practice environment preferred OR 1-3 years of relevant clinical, business or technical experience....

We are looking for Guidewire Automation Tester (Claims Center) for our client in San Antonio, TX / Plano, TX Job Title: Guidewire Automation Tester (Claims Center) Job Location: San Antonio, TX / Plano, TX Job Type: Contract Job Description: Analyze and identify the topics/events in Guidewire. Analyze the Automation approach for QA automation, Selenium , Unit/Functional testing using Junit/JMeter. Must be hands on experience with Guidewire Claims Center. Good to have hands on experience in GTUI Framework. Prepare Test Data strategy based on Claim Center and legacy system. Strong expertise in Testing integrations and core functionalities. Expertise in claims center migration, must be hands on with post migrations experience. Knowledge and experience on basic SQL queries. Strong automation expertise working Selenium, Jmeter and TDD. Perform validation between Guidewire Data model and customer...

Full job description Why choose between doing meaningful work and having a fulfilling life? At MITRE, you can have both. That's because MITRE people are committed to tackling our nation's toughest challenges—and we're committed to the long-term well-being of our employees. MITRE is different from most technology companies. We are a not-for-profit corporation chartered to work for the public interest, with no commercial conflicts to influence what we do. The R&D centers we operate for the government create lasting impact in fields as diverse as cybersecurity, healthcare, aviation, defense, and enterprise transformation. We're making a difference every day—working for a safer, healthier, and more secure nation and world. Our workplace reflects our values. We offer competitive benefits, exceptional professional development opportunities, and a culture of innovation that embraces diversity, inclusion, flexibility, collaboration, and career growth. If this sounds like the...

2025 Guardian Summer Intern, Group Life & Disability Claims Our 2025 Internship Program is a paid 10-week learning experience where you will be immersed in the daily environment of a thriving global financial services company. You will gain invaluable industry and organizational knowledge through daily business interactions and job assignments, in addition to engaging in projects that directly affect our business, interact with senior leaders in conversational settings, and network with employees and interns across our offices. This 10-week internship provides you with realistic experiences and information of what it is like to work at Guardian. Internship Dates: The internship program will run from Monday, June 2, 2025- Friday, August 8, 2025 . We review applications on a rolling basis, and we encourage you to apply as soon as you are ready. The application window will close on Sunday, November 17th, 2024, at 11:59PM ET or when role(s) have been filled, whichever comes...