Acts as a central point of contact and provides analytical problem-solving support to Commercial and Medicare Appeals and Grievances staff.
Researches, analyzes, and implements changes to processing procedures to increase department efficiency and meet regulatory compliance.
Supports training, documentation, and compliance activities while serving as a subject matter expert on appeals module configuration.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, providing health insurance and wellness programs. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
Review appeals of adverse benefit determinations within federal and state regulatory timeframes.
Apply medical policy, coding guidelines, and contractual requirements to assess coverage decisions.
Collaborate with medical divisions and respond to state insurance department inquiries regarding benefit complaints.
Arkansas Blue Cross and Blue Shield is a health insurance provider serving Arkansas. It is consistently ranked as one of the best places to work in Central Arkansas, with an inclusive culture and an average employee tenure of 10 years.
Manage accident-related accounts from intake to resolution, coordinating no-fault and liability benefits.
Submit claims to carriers, maintain accurate records in AcciClaim, and monitor insurance portals.
Work independently, set priorities, and communicate professionally with patients and adjusters.
Revecore helps hospitals recover revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, the company combines specialized expertise with proprietary technology and fosters a supportive, innovative workplace.
Resolve unpaid, denied, or short-paid claims using company billing systems.
Review EOBs and payer correspondence; follow up via portal, phone, email, or fax.
Manage complex denials, appeals, and account resolution with clear documentation.
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. With 160 years of clinical excellence, it operates the largest O&P patient care clinic network nationwide, helping people achieve new levels of mobility.
Review, investigate, and appeal denied hospital insurance claims using clinical documentation and payer policies.
Develop evidence-based appeal letters addressing medical necessity, level-of-care, and charge discrepancies.
Collaborate with nursing, revenue integrity, and financial teams to resolve denials and prevent future rejections.
This partner company is a healthcare system that provides hospital services and focuses on revenue integrity. It supports fully remote work and values clinical expertise, collaboration, and financial sustainability.
Acquire investigative techniques and work with experts to determine accident causes and fault.
Independently manage a claims inventory, including investigations, medical record reviews, and damage evaluations.
Resolve cases by negotiating settlements with individuals or attorneys.
Liberty Mutual is a leading property and casualty insurer helping people embrace today and confidently pursue tomorrow. They are a Fortune 100 company recognized as a Great Place to Work and one of Forbes' best employers for diversity and new graduates.
Perform billing and collection accounting, including account reconciliation, invoicing, and letters of credit.
Interact with internal departments, attorneys, and customers to resolve disputes and collect outstanding balances.
Analyze account activity and identify cash flow opportunities while providing prompt, professional service.
Liberty Mutual is a global insurance company offering a wide range of insurance products and services. The company values inclusion, employee well-being, and professional development, fostering a supportive culture for its workforce.
Make high-volume outbound calls to investigate, bill, and maximize payments on medical claims to insurance companies. - Research auto accident details to determine responsible payers and submit bills and documentation. - Follow up on denied or incorrect payments and support team with reports, audits, and overall assistance.
Revecore helps hospitals recover earned revenue so they can continue serving patients and communities. Trusted by over 1,300 hospitals across 48 states, the company offers a supportive, innovative culture where employees are trusted to do their best work.
Manage accounts receivable, including analysis of aged AR and identification of root cause issues.
Investigate, resolve, and appeal insurance claim denials, contacting payer representatives as needed.
Collaborate with internal teams and care center staff to drive optimal revenue cycle performance.
Privia Health is a technology-driven physician enablement company that partners with medical groups and health systems to optimize practices and improve patient experiences. It is led by top industry talent and physician leadership with a focus on scalable operations and cloud-based technology.
Investigates and processes commercial claims, evaluating coverage and damages within assigned authority.
Communicates directly with insureds, claimants, agents, and internal customers to resolve claims.
Documents claim files, negotiates settlements, and identifies fraud or subrogation potential.
Liberty Mutual is a global insurance company offering commercial and personal insurance products and services. With a fast-growing and inclusive culture, the company values employee development, well-being, and diversity across its large national workforce.
Process medical claims and appeals accurately and timely, following health plan policies and procedures.
Maintain detailed notes, research claim issues, and communicate outcomes with claimants and teams.
Support customer success teams, escalate operational issues, and help improve claims processes.
Sana is a health plan solution built for small and midsize businesses, with integrated primary care services to make healthcare easy. Founded in 2017, the company is remote-first with a fully distributed team across the U.S., and values curiosity, ownership, and speed.
Manage the full lifecycle of PIP and Medical Payments claims, from coverage verification and investigation to settlement or denial.
Apply medical cost-containment strategies, coordinate experts, and identify subrogation opportunities while meeting compliance standards.
Work remotely within the US, maintaining accurate claim files and communicating professionally with claimants and stakeholders.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company is seeking a remote Associate PIP Claims Rep to handle Personal Injury Protection claims across multiple states in a structured, compliance-focused environment.
Monitor and manage post payment queues, conducting outreach and negotiation calls to providers.
Communicate with providers to verify understanding of NSA claims payments and regulations.
Maintain HIPAA compliance and document all conversations, payment rates, and counter offers.
Reliant Health Partners is an innovative medical claims repricing service provider that helps employers achieve maximum health plan savings. The company tailors services to each client’s needs and values a diverse, inclusive workplace.
Serve as a subject matter expert in initiating Auto and Property claims with precision and professionalism.
Provide clear, expert counsel to customers on coverage, filing options, and the claims process.
Accurately capture First Notice of Loss documentation and coordinate resources to advance claim resolution.
Liberty Mutual is a Fortune 100 insurance company that helps people safeguard their assets and navigate life's uncertainties through a wide range of insurance products. With a large, inclusive workforce, the company values diverse perspectives and supports employees through comprehensive benefits and professional development opportunities.
Investigate, evaluate, negotiate, and resolve complex property claims, including litigated and environmental losses.
Conduct coverage analysis and collaborate with legal, engineering, and restoration experts on complex files.
Provide technical guidance, mentoring, and strong customer service in a fully remote environment.
The hiring company is an insurance organization specializing in complex property claims management and customer support. It operates as a fully remote Canadian team and emphasizes flexibility, professional development, and community involvement.
Review and verify healthcare claims for accuracy, coding, eligibility, and coverage.
Approve or deny claims according to policy terms and regulations, and resolve discrepancies.
Process claims efficiently, meet performance targets, and maintain accurate records.
Blue Cross and Blue Shield of Kansas is a health insurance company providing coverage to Kansans. With over 80 years in the community, it fosters an inclusive, family-first culture and supports professional growth.
Guide customers through the claims process, investigating and processing claims for vehicle/property damage and moderate bodily injury.
Review coverage, set reserves, arrange inspections and rentals, and address customer inquiries to ensure satisfaction and retention.
Analyze medical records, negotiate settlements, and collaborate across departments and team members for a smooth claims experience.
Mercury Insurance helps people reduce risk and overcome unexpected events with auto and property insurance. As one of America's Best Midsize Employers for 2026, the company fosters a culture of growth, fun, and teamwork.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
Manage recovery files from initial review through resolution, identifying third-party reimbursement opportunities.
Investigate claims, coordinate with attorneys, adjusters, and carriers, and negotiate recovery matters.
Review plan documents, ensure HIPAA compliance, and maintain a high-volume caseload with strict deadlines.
The company focuses on recovering healthcare costs for benefit plans, ensuring affordable health benefits for employees and their families. It is recognized for an inclusive, collaborative, and respectful workplace culture, and has received regional and national workplace awards.