Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Be responsible for department quality audit process related to service standards, adherence to procedural, regulatory and financial requirements.
Review the referral of, submit, monitor and track all subrogation referrals receive by the Claim department and forwarded to external vendors.
Handle overpayment, check void and refunds, including maintenance of the overpayment log.
Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With its entrepreneurial culture and a strong emphasis on analytics, they can help employers better manage their risk.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Oversee daily claim workflows ensuring accuracy, timeliness and adherence to compliance requirements within Required SLAs.
Own team performance across CSAT, Quality, Productivity, Aging, and SLA, translating results into clear action plans.
Coach and develop team members through 1:1s, performance management and targeted development plans.
Extend is revolutionizing the post-purchase experience for retailers and their customers by providing merchants with AI-driven solutions. Extend works with more than 1,000 leading merchant partners across industries and our headquarters is in downtown San Francisco.
Conducts audits of highly complex accounts substantiating accuracy of policy classifications.
Develops proper premium basis on risks adhering to strict time deadlines.
Conducts interviews with the insured to obtain information regarding the insured's operations and business model.
CNA strives to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. They are focused on success, individually and collectively and pride themselves on promoting a culture that challenges and engages people.
Researches requests for review of resolvable claims from providers.
Compiles information related to member appeals that request an Executive Review.
Provides copies of necessary documents and submits information to the Appeals and Policy Manager for review.
PEHP Health & Benefits is a division of the Utah Retirement Systems that serves Utah’s public employees through competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. They embrace both a public mission and a commitment to creating customer value.
Thoroughly verifies and explains coverage to Policyholders.
Sets reserves for anticipated losses and arranges required inspections.
Coordinates with other departments and researches customer inquiries.
Mercury Insurance has been helping people reduce risk and overcome unexpected events for over 60 years. They value their team members and offer diverse perspectives to serve customers from all walks of life.
Investigate, evaluate, analyze, negotiate, and settle residential property claims.
Maintain ongoing communication and status updates to customers until file closure.
Determine appropriate settlement amount based on independent judgment and estimates.
Max Insurance is an insurance carrier focused on providing customer experiences to Canadians. They are looking for smart, motivated claims professionals to join their energetic and rapidly growing team where they emphasize flexibility & benefits.
Build rapport with families, healthcare providers, and insurance companies in a compassionate manner.
Educate potential families about evaluation, treatment, and insurance processes.
Provide excellent customer service and expedite the process for families.
Cranial Technologies researches and treats plagiocephaly (commonly called flat head syndrome). They have treated over 300,000 babies with the DOC Band® and are the leader in pediatric cranial shaping orthoses. They also provide treatment with EarWell® to correct infant ear shapes without surgery, with 600,000+ successful outcomes.
Accountable for the full handling and control of all claim matters assigned from inception to resolution.
Consistently evaluate potential exposure present as to all claims assigned and adapt to changing circumstances as claims develop.
Provide superior customer service to all co-employees, agents, policyholders and others encountered during the claims handling process.
Crum & Forster (C&F) provides specialty and standard commercial lines insurance products through their admitted and surplus lines insurance companies. C&F has more than 2000 employees in locations throughout the United States and is part of Fairfax Financial Holdings, a global, billion dollar organization.
Resolve participant claim issues by responding to questions and resolving tickets in our ticketing system.
Process client claims and service provider invoices in case management system accurately and ensures contractual and legislative requirements are met.
Provide quality assurance for claims/invoices processed by other Claims Specialists.
They partner with governments and local agencies across Canada to create sustainable employment opportunities for people, businesses and communities. They understand that work gives hope, strengthens relationships and drives economic growth.
Accurately review denied claims to identify root causes.
Communicate directly with insurance representatives to negotiate settlements.
Monitor denial trends and provide actionable feedback to billing and clinical teams.
Mindoula is a healthcare organization. They are seeking an Account Receivable Representative and value candidates with strong communication and problem-solving skills.
Investigates and analyzes Motor Vehicle Accident accounts.
Identifies and coordinates insurance benefits, resolving outstanding balances.
Acts as a liaison between clients, attorneys, and insurance companies.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. They leverage expertise and a unified intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers nationwide.
Handle inbound calls and chat boxes from our members regarding Sidecar Health’s products and services.
Provide excellent customer service in a timely and positive manner.
Build rapport and maintain positive relationships with existing members to understand their needs and ensure a memorable member experience.
Sidecar Health is redefining health insurance with a mission to make excellent healthcare affordable and accessible. Their team comes from diverse backgrounds and shares a desire to fix a broken system, making healthcare personalized, affordable, and transparent.
Manage telephone, electronic, and face-to-face interactions professionally and efficiently.
Effectively present and discuss products and services to customers with integrity and accuracy.
Focus on customer retention by resolving concerns and enhancing the member experience.
Capital Blue Cross is committed to going the extra mile for their team and community. They are a caring team of supportive colleagues where your health and wellbeing are prioritized.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
As the first point of contact, you'll assist patients and providers.
Interwell Health is a kidney care management company that partners with physicians to reimagine healthcare. They aim to set the standard for the industry and help patients live their best lives and is committed to diversity, equity, and inclusion.
Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
Record after-call actions and perform post-call analysis for the claim follow-up.
TruBridge connects providers, patients, and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. They are a remote team that encourages their employees to push boundaries and look at things differently.
Research, verify and resolve inquiries related to Oregon Health Plan (OHP) or Medicare eligibility.
Respond and assist members with Primary Care Provider (PCP) assignments and explain OHP or Medicare benefit coverage.
Collaborate with providers, Division of Medical Assistance Programs (DMAP), and members to ensure effective customer service and the resolution of any health plan issues that arise.
CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. We are an equal opportunity employer that greatly encourages military veterans to apply and considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Review, analyze, and process moderately complex to complex workers compensation claims.
Make decisions about liability/compensability and negotiate settlements.
Manage an inventory of commercial property/casualty claims.
Liberty Mutual is a fast-growing company that consistently outpaces the industry in year-over-year growth. They offer comprehensive benefits, flexible workplace options, and professional development in an inclusive environment where everyone can thrive.