Claims Jobs - Remote Work From Home & Flexible
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Featured13 days agoAnalyzing and processing索赔through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on theclaim. Negotiating settlement of索赔within designated authority.
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22 days agoCollaborate with CX to provide customer service, guidance, and education to policyholders through every step of the索赔process. Review veterinary bills for accuracy and to determine whether coverage applies forclaimedcosts. Investigate索赔to...
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1 week agoStop LossClaimsAnalysts are accountable for evaluating索赔received, ensuring they are reimbursed correctly and all cost containment opportunities are identified by engaging the clinical team prior to adjudicating a reimbursement. Prior experience...
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13 days agoFollows written procedures and scripts. Uses proprietary software tools to access and reviewclaimdocuments, enterclaimdecisions, and create escalations when needed. Communicates immediately to leadership all obstacles to completing work. Meets and...
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23 days agoFollows written procedures/scripts. Uses proprietary software tools to access & reviewclaimdocuments, enterclaimdecisions, create escalations when needed. Data entry and verification of information. Drafts claimant facing communication. Verifies data.
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30+ days agoLooking for aClaimsAdjuster to adjudicate索赔in accordance with best practice guidelines and regulatory requirements from FNOL through to resolution. You will be an ambassador of our customer centered索赔journey and will maintain clear lines...
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22 days agoReviews索赔for other possible coverage as provided by vehicle manufacturers or parts and labor warranties provided by previous repairer. Providesclaimpayment authorizations based on the correct parts and labor amounts using the available data...
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23 days agoHandle the intake of severe cyber events, including the coordination with breach counsel, forensic investigators and other vendors.Evaluate full pending of索赔in affiliation with the posting and recommending accurate reserves. Maintain documentation.
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New!YesterdayCorresponds through verbal/written communication with policyholders, claimants, travel coordinators, etc. to gather important information to supportclaimdecision. Serve as a customer advocate in all interactions to provide an outstanding customer...
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New!YesterdayAs aClaimsSpecialist, you are experienced in working for a Third Party Administrator (TPA), or Insurance Carrier having dealt with the fullclaimlife cycle from open to close. You're familiar with managing, litigating, and adjusting索赔...
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20 days agoYou will review and evaluate out-of-pocket expenses submitted by our members, including expenses made with their Card. Working closely with our Reimbursements and Care Navigation teams, you will ensure that索赔are processed accurately and efficiently.
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30+ days agoThis job is responsible for demonstrating proficiency in first party estimating, investigation, evaluation and negotiation at the most reasonable cost. Satisfy customer needs and ensure file quality. Applying and explaining applicable coverage to all...
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30+ days agoAs a team member, you will work closely with insurance payers to ensure that payment for applicable care is coordinated accurately and efficiently. You will also be a part of our larger Member Success team, collaborating with colleagues from diverse...
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New!2 days agoHelp customers resolve auto索赔involving up to two vehicles. This is not a field position. Primarily over the phone, you'll accurately document索赔details, interview those involved in an accident, make coverage and liability decisions, and...
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Featured1 week agoYou are responsible for analyzing submitted documentation, making outbound calls to obtain required information, and processing Medicare Part D索赔per CMS regulations. This position requires methodical attention to detail, strong analytic thinking...
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25 days agoYour role would be to investigate and adjust workers' compensation索赔with the highest potential exposure. We take an extremely aggressive and pro-active approach in索赔adjusting and are looking for the person who not only knows their...
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8 days agoThis position requires working with insurance companies, creating and submitting insurance索赔, processing insurance索赔, and any necessary follow-up work for rejected索赔. Additional responsibilities: cash application, and the revision of..
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13 days agoPartner with Product and Data Engineering to update our索赔data model. Map data from current and existing payors to our canonical data model. Develop data quality testing strategies on payor data. Develop reports related to索赔data. Work with ...
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25 days agoUnder direct supervision, analyze information/documentation received to determine how to proceed with aclaimreview & determine methods of obtaining additional information from alternative sources.Review索赔and outside sources used in the review.
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New!3 days agoClaimsProcessing. AdjudicatingClaims. Reviewing incoming medical索赔for members from hospitals and physicians' offices. Analyzing and processing medical索赔. Researching and resolving any discrepancies. A minimum of 2 years of experience a...
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30+ days agoGuide our customers from the First Notice of Loss through the resolution of theirclaim. Confirm coverage and monitor repairs of low-complexity索赔. Maintain a general understanding of索赔解决程序和时间。地址customer...
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30+ days agoAs a team member, you will work closely with insurance payers to ensure that payment for applicable care is coordinated accurately and efficiently. You will also be a part of our larger Member Success team, collaborating with colleagues from diverse...
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24 days agoReceives and adjudicates medical索赔/bills for payment/denial. Research索赔/bills for appropriate support documents &/or documentation. Analyzes and adjusts data and benefits criteria for payment. Responds to and researches vendor and member...
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30+ days agoManage to conclusion all reported & outstanding索赔& incidents in all areas of operation. Summarize & make recommendation on each newly reportedclaimto determine if it should be self-handled, assigned to outside counsel & reported to the insurance.
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29 days agoOversee and ensure the overall client satisfaction, staff management and profitability of the regional operations center. This includes but is not limited to reaching and exceeding financial & referral goals, properly managing staffing efficiencies.
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30+ days agoServes as a customer service representative for theclaimdepartment by promptly and professionally addressing customer questions and concerns, which may include: Triage and route callers to the appropriate department; Answersclaimstatus and payment...
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New!TodayHandles both 1st party and 3rd party索赔under multiple policy types and numerous endorsements. Conducts on-site inspections when needed, evaluates damages, and handlesclaimnegotiations with insureds, claimants, attorneys, and public adjusters.
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30+ days agoAudit索赔daily statistically valid sampling method, using prescriber audit criteria. Performs simple adjustments as necessary.Conduct in-depth索赔audits on performance groups, as well as focus audits for specifically identified situations.
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New!2 days agoManage a high volume ofclaimfiles from beginning to end. Resolve and document auto索赔as quickly and accurately as possible. Interview all involved in an accident to determine coverage and liability decisions. Validate damage is consistent with...
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23 days agoClaimhandling responsibilities will include the following: reviewing assigned索赔, contacting the insured and other affected parties, setting expectations for the remainder of theclaim, and initiating documentation in theclaimhandling system.
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30+ days agoClaimsAdjuster license required and will be obtained during training. Investigate and adjust索赔according to applicable laws and policy provisions. Conductclaiminvestigations including but not limited to recorded statements, securing public...
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30+ days agoProficient with the rules, regulations, amendments and Guidelines of CMS for executing索赔processing. Must be able to verify that索赔are paid in accordance with correct contractual provisions, regulatory guidelines and all company and...
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8 days agoProvide best-in-class索赔experience through exceptional resolution ofclaimfiles. Investigate, manage and resolve assigned索赔while making decisions consistent with internal best practices. Operate independently, managing a high volume of...
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9 days agoResponsible for Hospital索赔billing. Hospital索赔follow-up. Hospital索赔denials resolution. Responsible for reconciliation of the accounts receivable by working assigned reports and must be able to produce high volumes.
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10 days agoConsistently process entry level and intermediateclaimqueues with a 99% or greater accuracy rate. Adhere to approvedclaimworkflow requirements to maximize efficiency. Serve as backup toClaimAdministration team for entry-level adjustments...
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12 days agoSubmit Provider Reconsideration tickets to multiple health plans. Evaluate disputed索赔in Reconsideration process and share findings with senior staff to determine scope. Uploading health plan determination letters to appropriate Reconsideration...
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30+ days agoTheClaimsSpecialist will play a critical role in ensuring qualityclaimfile management, service level agreements are met, and regulatory requirements are satisfied all while helping to create and provide an industry leading customer索赔...
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New!2 days agoAssists in the direction of the索赔branch to minimize indemnity and expense impact, to ensure appropriate reserve levels, and to implement索赔objectives, policies and procedures. -Supervise the professional staff in the handling of property...
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30+ days agoTheClaimsSpecialist will play a critical role in ensuring qualityclaimfile management, service level agreements are met, and regulatory requirements are satisfied all while helping to create and provide an industry leading customer索赔experience.
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FeaturedNew!TodayOversees索赔clerical activities including filing, data entry, setup and distribution of new索赔as well as processing of incoming and outgoing mail. 3-5 years of clerical experience, with 1-3 years of supervisory experience required.
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30+ days agoAs a First Party PropertyClaimsAdjuster, you will review property damageclaiminformation from the Outside Adjuster, complete the investigation, and resolve theclaim. Minimum of 1 year of property or industry equivalent experience.
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2 weeks agoRespond to concerns from the Department of Insurance (DOI), Better Business Bureau (BBB), and social media within regulatory guidelines. Minimum of 2-3 years prior Homeowners Property Insurance experience required. Property索赔adjusting...
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30+ days ago创建报告,以评估质量和效率within the索赔team. Develop and present reports on Key Performance Indicators (KPIs). Leverage data to highlight areas needing improvement. Utilize data to prepare Cost/Benefit analysis for potential...
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30+ days agoBe responsible for ensuring索赔are handled in accordance with established guidelines and service instructions. Ensures timely completion of file reviews, calibration sessions and analysis reports. Identifyclaim-handling trends by applying...
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30+ days agoInvestigates and evaluates moderately complex auto and casualty索赔. Documentsclaimactivities, reserve analysis, summaries of reports. Identifies, investigates, and pursues opportunities for recovery. Handles litigated files of low complexity.
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18 days agoInvestigate liability索赔thoroughly by gathering relevant information, reviewing policy coverage, and conducting interviews with all parties involved. Analyze and evaluate liability索赔to determine the extent of our company's responsibility...
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23 days agoManages a personal caseload of索赔, which may include litigation, to ensure the proper adjudication or settlement of those索赔, and they are handled according to Company policies and procedures, within the Company's contractual and legal liability.
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New!2 days agoManage a caseload of complex pollution accounts. Timelyclaimmanagement of new loss assignments and reassignments. Develop account strategies and manage both litigated and non-litigated pollution索赔. Evaluate and resolve cases.
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25 days agoEvaluate and analyze documentation forclaimpayments or denials according to the policy/certificate provisions and state regulations, with limited authority limits. Under direct supervision, analyze information/documentation received to determine...
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FeaturedNew!TodayPrepares and processesclaimand expense payments for theclaimdepartment. Processes incoming and outgoing correspondence. Completes data entry and initial file setup for new索赔. High School diploma required. 1-3 years of experience. Good verbal...
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