LWP Claims Solutions, Inc. – Glendale, CA
Position Title: Claims Examiner (CE) – Require 2+ Years CA WC Adjusting Experience
Position Locations: Sacramento, Walnut Creek and Glendale, CA
Position Supervises: None
Position Salary WC Claims Examiner/Sr CE Glendale CA: DOE
Experience: 2-3 years
Need detail oriented CE who promptly and properly addresses all claims issues to include compensability, temporary disability, permanent disability, apportionment, contribution, subrogation, medical management, rehabilitation and litigation. Utilizes ongoing contact with employers, employees, medical and other outside providers to maximize a cost-effective case resolution.
ESSENTIAL FUNCTIONS AND BASIC DUTIES
1. Assumes responsibility for the effective handling of claims / files.
a. Promptly investigate and evaluate areas of discrepancies or inconsistencies from initial notice of loss through claim conclusion.
b. Administer benefits timely and accurately pursuant to State Law, Statues and/or Regulations.
c. Handles claims consistent with LWP Best Practices.
d. Issues benefit letters or state notices timely and correctly pursuant to State Law, Statues and/or Regulations.
e. Maintains a current plan of action at all times, and ensures that plan is being followed.
f. Utilizes proactive medical management to facilitate file closure.
g. Manages and provides direction to all vendors associated with the claim file.
h. Maintains reserves on each claim that reflect the likely case outcome.
i. Evaluates permanent disability and develops appropriate settlement.
j. Stays current on claim diary system.
2. Assumes responsibility for maintaining effective communication with internal and external contacts.
a. Initiates and maintains a good rapport with new and existing clients.
b. Attends client claim reviews as requested.
c. Reports claims to employers, brokers, carriers, or other designated program managers consistent with the claims handling guidelines of that client.
d. Seeks approval or authority from employers, brokers, carriers, or designated program managers for reserves, settlements, litigation, vendor referrals or any other items documented in the claim handling instructions.
e. Provides a claim status report on any claim(s) as requested by the client.
f. Works with Management Team and Support staff to ensure work is completed timely and accurately.
g. Continually fosters a teamwork spirit.
h. Provides back up or assistance for the claims unit, as requested.
i. Communicates to direct supervisor any workflow problems, issues or backlog immediately.
j. Acknowledges and acts upon requests from any member of the management team with 48 hours, or by agreed upon deadline.
QUALIFICATIONS AND EXPERIENCE
ADR Experience preferred but not required.
High school diploma (2 and/or 4 year degree a plus)
IEA Certification or equivalent training/work experience
Six to twelve months work experience in the insurance, legal or health care industry.
Public Entity/Municipality experience a plus (LC 4850 and Presumption)
Effective interpersonal skills
Well-organized and attentive to detail
Excellent oral and written communication skills
Able to meet deadlines and manage projects
Effective problem resolution and negotiation skills
Able to handle multiple tasks in a high pressure environment
Intermediate spreadsheet and word processing skills
Strong analytical skills
Ability to operate computer, calculator, printer, copier, facsimile and other general office equipment
Handles WCAB and Rehab Unit conferences independently
Handles Client Claim Reviews independently
Able to rate all levels of permanent disability without outside assistance
Must meet the training or experience requirements per California Code of Regulation (Article 20 of Subchapter 3, Chapter 5, Title 10)
In accordance with the American with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization. Please no phone calls. Only applicants invited to interview will be contacted. EOE
Responsibilities of this position include:
* Adjudication and processing of a high volume of supplemental cancer, specified disease, heart/stroke, accident and hospital indemnity claims. Must be able to interpret policy language, review documentation submitted and apply terms of policy to determine if benefits are payable.
* This position provides customer service to a all claimants that call in with questions. Therefore, ideal candidate must have excellent customer service and telephone skills.
* Build and maintain excellent policyholder and employer group relationships.
* Prepare written correspondence to claimants.
* 2-3 years of experience adjudicating supplemental policy and or medical claims
* Excellent communication skills both oral and written
* Strong organizational skills, concern for quality, accuracy and able to prioritize work
* A team player who is also comfortable working independently
* Upbeat, personable and a courteous manner while having a proactive approach with a commitment to client service excellence.
Claims Assistant for growing Third Party Administrator
Candidate should display eagerness to learn our business and provide support to the claims staff and perform other office duties associated with adjudication of Group Medical/Dental claims on Windows based proprietary clams system under multiple benefit plans.
Prior knowledge of medical terminology, ICD-10, CPT codes and claim processing experience helpful but not necessary as we will train.
Must possess ability to read and interpret medical, dental and prescription plans and be proficient at data entry.
Successful candidate should be able to determine benefits for multiple groups and process claims accurately according to corresponding Plan Documents.
Duties will also include handling correspondence and phone calls from members and providers and documentation of same as well as assisting the Department Manager.
Minimum of 6 mos professional administrative experience, preferably in the insurance industry; combination of training, education and experience.
Strong customer service skills required.
Chubb is the world's largest publicly traded property and casualty insurer. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
Chubb is seeking an Auto Claims Examiner, located at the Western Claim Service Center in Phoenix, AZ.
Calling all professional Insurance Claims Examiners who have worked in the health industry! Do you thrive in a fast - paced environment, and love working with a team to produce results? Do you enjoy communicating over the phone and assisting customers? Are you able to pacify customers who are not satisfied? Manpower is partnered with a leading Healthcare corporation in the Santa Ana are that is looking to bring a new team member to its team! If you are interested in the Insurance Claims Examiner, please read on!
What’s in it for you?
· Full Time Hours – Monday – Friday: 8:00am -5:00pm (Over time as needed)
· Competitive Pay rate: $23.00 hr
· Weekly pay checks
What you’ll be doing:
· Review and analyze claim denials to perform the appropriate appeals necessary for reimbursement.
· Receives denied claims and researches appropriate appeals steps.
· Collect required documentation, review file documentation, and make sure all items needed are requested.
· Ensure that all claim documentation is complete, accurate, and complies with company policy.
· Establish, maintain, and update files, databases, records, and other documents for recurring internal reports.
· Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials.
· Contact and communicate with clients by telephone, e-mail, or in-person.
The skills we are looking for:
· Basic knowledge in lending and the real estate industry.
· Basic knowledge of accounting processes and procedures.
· Excellent written and verbal communication.
· Strong attention to detail.
· Ability to handle multiple tasks with frequent interruption.
· Computer skills including Microsoft Office
· Associate degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education.
· 5-7 years of experience required.
Stop your job search and apply today. Do you need more information? Contact Araceli at 657-331-4067 We love referrals so please share our job with friends and family.
Half-Day Fridays! Immediate opening for an experienced Insurance Claims Examiner. Work Monday-Thursday 7:30am-4:45pm and Friday 7:30am-12:15pm.
Why Should You Apply Now?
What Will You Do as a Claims Examiner?
Claims Examiner Requirements:
For immediate consideration, please submit your resume to Missy(@) nolljobs.com
**only the most qualified candidates will be contacted***
CT -Worker's Comp License needed
Workers Compensation Claims Examiner | Direct Hire | NY License Preferred or willing to obtain one.
Manage within company best practices lower-level non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional.
ESSENTIAL JOB DUTIES:
KNOWLEDGE & SKILLS:
EDUCATION: College degree preferred, work experience can substitute for educational requirement
LICENSES: As required
EXPERIENCE: Minimum One (1) year of industry experience and claims management preferred
All candidates must be eligible to work in the United States without VISA sponsorship
Submit your resume today for immediate consideration!
*Calling all professional Insurance Claims Examiners who have worked in the health industry! Do you thrive in a fast - paced environment, and love working with a team to produce results? Do you enjoy communicating over the phone and assisting customers? Are you able to pacify customers who are not satisfied? Manpower is partnered with a leading Healthcare corporation in the Santa Ana are that is looking to bring a new team member to its team! If you are interested in the Insurance Claims Examiner, please read on!
*What's in it for you?
* Full Time Hours - Monday - Friday: 8:00am -5:00pm (Over time as needed)
* Competitive Pay rate: $23.00 hr
* Weekly pay checks
*What you'll be doing:
* Review and analyze claim denials to perform the appropriate appeals necessary for reimbursement.
* Receives denied claims and researches appropriate appeals steps.
* Collect required documentation, review file documentation, and make sure all items needed are requested.
* Ensure that all claim documentation is complete, accurate, and complies with company policy.
* Establish, maintain, and update files, databases, records, and other documents for recurring internal reports.
* Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials.
* Contact and communicate with clients by telephone, e-mail, or in-person.
*The skills we are looking for:
* Basic knowledge in lending and the real estate industry.
* Basic knowledge of accounting processes and procedures.
* Excellent written and verbal communication.
* Strong attention to detail.
* Ability to handle multiple tasks with frequent interruption.
* Computer skills including Microsoft Office
* Associate degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education.
* 5-7 years of experience required.
*Stop your job search and apply today. Do you need more information? Contact Araceli at 657-331-4067 We love referrals so please share our job with friends and family.
Welcome to one of the toughest and most fulfilling
ways to help people, including yourself. We offer the latest tools, most
intensive training program in the industry and nearly limitless opportunities
for advancement. Join us and start doing your
life's best work.SM
an opportunity that’s all about where you’ve been. Your experience. Your
potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career
changing. No company has put together better teams of passionate, energetic and
all out brilliant Claims Representatives. This is where you come in. We’ll look
for your experience and expertise to help keep our service levels and accuracy
extremely high. We’ll also look for your ideas on how to constantly evolve our
claims processes. We’ll back you with the great training, support and
opportunities you’d expect from a Fortune 6 leader.
a challenging role that takes an ability to thoroughly review, analyze and
research complex health-based insurance claims in order to determine policy
benefits are appropriately applied. You’ll need to be comfortable navigating
across various computer systems to locate critical information. Attention to
detail is critical to ensure accuracy which will ensure timely processing of the
be rewarded and recognized for your performance in an environment that will
challenge you and give you clear direction on what it takes to succeed in your
role as well as provide development for other roles you may be interested in.
at UnitedHealthcare Employer & Individual. We all want to make a difference
with the work we do. Sometimes we're presented with an opportunity to make a
difference on a scale we couldn't imagine. Here, you get that opportunity every
day. As a member of one of our elite teams, you'll provide the ideas and
solutions that help nearly 25 million customers live healthier lives. You'll
help write the next chapter in the history of healthcare. And you'll find a
wealth of open doors and career paths that will take you as far as you want to
go. Go further. This is your life’s best
creates a healthier atmosphere: UnitedHealth Group is an Equal Employment
Opportunity/Affirmative Action employer and all qualified applicants will
receive consideration for employment without regard to race, color, religion,
sex, age, national origin, protected veteran status, disability status, sexual
orientation, gender identity or expression, marital status, genetic
information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free
workplace. Candidates are required to pass a drug test before beginning
Keywords: Healthcare, health care, Claims, Claims
Examining, Customer Service, Medical Billing
Claims Examiner Commercial Property Location: Overland Park, KSZip Code: 66210Length of Assignment: Direct HireCompensation: $70,000 to $100,000 Annually, Depending on ExperienceJob Description:Our client, a fast growing Commercial Carrier, is looking for an Inside Commercial Property Examiner for their direct hire opening in Overland Park, Kansas.Apply now to hear more about this exciting opportunity!Required Qualifications: 5+ years of managing complex and severe property claims up to and exceeding $100K, in and out of litigation Evaluate property damage, negotiate, and settle assigned claims Previous experience with business income claims as a Staff Adjuster a must Experience with Xactimate Preferred Qualifications: College Degree
Claims Examiner Commercial General Liability Location: Berkeley Heights, NJZip Code: 07069Length of Assignment: Direct HireCompensation: $70,000 to $80,000 Annually, Depending on ExperienceJob Description:Our client is currently seeking to add a Commercial General Liability Claims Examiner to their New Jersey office located in the Berkeley Heights area. This person would be responsible for handling mid to complex Commercial General Liability and Auto claims from inception to close. The ideal candidate will have an active Adjuster License in multiple states.Company Benefits:Bonus EligibleCompetitive Medical, Dental, and Vision PlansMatching 401KOpportunity to work from home after initial training periodPTOOpportunity for GrowthRequired Qualifications: 5+ years of Commercial General Liability claims handling experience Experience handling claims in multiple states Carrier and/or TPA claims handling experience Active Adjuster License Ability to work independently Exceptional customer service and organizational skills Preferred Qualifications: Bachelor's Degree
A+ rated long standing property and casualty insurance company is seeking a property claims professional to join their growing staff. Individual will investigate and handle property claims as assigned. 5+ years of commercial property claims examiner experience. Bachelor’s degree required. Must work well under pressure while adhering to deadlines. Intermediate MS Office experience. Experience using ImageRight is a plus.
Role: Claims Analyst
Location: Fort Washington, PA
Expected Duration: 6+ months
· Candidates must have strong decision making skills
· Candidates must have strong written communication skills-grammar, flow, and cohesion.
· Experience in auto, homeowners, medical billing (encoding), workers comp or travel is needed
· 1 - 3 years of CLAIMS ADJUDICATION experience preferred in either the travel, Medical, or Auto insurance industry
· Ability to make decision with minimal guidance based on provided training
· Strong oral and written communication skills with the ability to draft correspondence that is clear, concise and effective. Solid verbal communication skills.
· Sound computer skills, including knowledge of (MS Office, Internet searches, Email correspondence programs)
· Ability to manage time effectively and focus on multiple projects concurrently.
· Work without significant guidance
· Production environment experience a plus
• College preferred, or equivalent work experience
• Writes clearly, concisely and effectively
• Communicates verbally effectively and with impact
• Detail oriented. Ability to multi-task. Manages time effectively
• Committed to superior customer servicing. Ability to work independently, a self-starter.
Job Title: Claims Examiner / Processor
Duration: 6 months contract assignment to permanent
Location: Phoenix, AZ 85021
Schedule: Monday to Friday 8 AM - 5 PM
Pay Range: $16 - $18 per hour
Looking for a real “team” environment? Strong general liability, habitational, real estate, condo and high-end apartment building accounts experience. One-on-one client contact requires claims expertise, knowledge, litigation management and strong negotiating and presentation skills! Must be willing to do on-site investigations and field work handle claims from start to finish! Minimum 5-10+ years previous general liability claim experience. New York Adjuster’s license desired or must be willing to obtain one.
Workers Compensation Claims Examiners - Term Temp to Possible Hire - Immediate Need - Starting Next Week!
To analyze mid-and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
Submit your resume today for immediate consideration!
Greater New York Mutual Insurance Company ("GNY") is an A+ rated, financially stable and growing property and casualty insurance company with locations throughout the Northeast. We are seeking an experienced General Liability Claims Examiner. Responsibilities include but are not limited to the following:
This is a temporary full time position for our insurance client in New Haven, CT.
Workers' Compensation Medical Only Examiner.
Connecticut License preferred, NY, NJ will be considered.
• Deliver superior customer service and satisfaction through effective interactions with insureds, claimants, agents, underwriters, and others.
• Contribute to collaborative environment by consistently demonstrating teamwork, high motivation, behavior and effort to achieve goals and objectives.
• Provide accurate and timely expense and loss assessments on Medical Only claims
• Timely and appropriately communicate with internal and external customers
• Consistently demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage, loss assessment, and case management.
• Ensure the establishment, documentation, and execution of appropriate strategies to bring early resolutions to assigned claims.
• Recognize and properly address coverage issues, potential fraud, and subrogation; follow guidelines and completion of reporting forms.
• Keep all files on a current diary system in order to monitor new developments, follow up on requests, update management and respond to all other diary activities in a timely manner.
• Prior experience handling medical only workers compensation claims• A personal commitment to superior performance that adds value to our company and our customers.
• An ability to work effectively with a wide variety of people.
• An aptitude for evaluating, analyzing and interpreting information.
• Superior telephonic skills
• Excellent organizational skills a must.
• The ability to multi-task along with proven time management skills.
• An ability to work well in teams.
• Demonstrated critical thinking and decision making ability.
• Excellent verbal and written communication skills.
Title: Claims Examiner
MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to email@example.com
Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with ability to research, review.
Duties and Responsibilities:
1. Accurately review all incoming Provider claims to verify necessary information is available.
2. Meets production standards of 100-150 Hospital claims per day and 200-250 IPA claims as established by claims management
3. Assists in other IPA’s when needed
4. Accurately enter claims data information into the computerized claims adjudication system.
5. Maintain all required documentation of claims processed and claims on hand.
6. Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
7. Maintain production standards established by claims management.
8. Coordinate resolution of claims issues with other Departments or Payers.
9. Assist Providers, Members and other Departments in claims research.
10. Provide backup for other examiners within the Department.
11. Assist in training of new claims personnel.
12. Promote a spirit of cooperation and understanding among all personnel.
13. Attend organizational meetings as required
14. Adhere to organizational policies and procedures.
15. Process Customer Care Inquires
16. Performs other tasks as assigned by supervisor/manager
Minimum Job Requirements:
High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.
Knowledge, Skills and Abilities Required:
· Experience in a managed care environment preferred.
· ICD-9 and ICD-10 and CPT-4 coding knowledge preferred.
· Must be detail oriented and have the ability to work independently
Busy insurance company located in North Scottsdale near Scottsdale Road and Greenway seeks an experienced Claims Examiner. 2-3 yrs + of claims processing experience is required. Must be organized, detailed, and have basic knowledge of medical terminology. Basic knowledge of ADA, CPT, HCPCS, & Diagnostic coding needed. Full time, Monday-Friday, 8am-5pm. Starting pay rate is $17/hr. with great benefits after 90 days!
Duties to include:
Keenan & Associates is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success and are positioned to lead the industry into the 21st century. We currently have an exciting, career opportunity for a Senior Claims Examiner based out of our Torrance, CA office. They are responsible for the administration of indemnity claims with strong litigation management experience and ability to handle complex claims issues. Must have strong customer service skills, ability to resolve routine claims without legal representation and possess lien resolution abilities. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Timely reporting of excess files to Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. MINIMUM SUGGESTED QUALIFICATIONS: Minimum of five (5) years as a California Claims Examiner experience and a Self-Insurance Certificate required. WCCP preferred. Experience in handling school district claims is preferred. Effective in verbal and written communication. SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative people working together is what makes Keenan a success. We invite you to share in the commitment of preserving our warm tradition, reputation and dedication to our clients. After all…What you do makes a difference! Please apply online at For more information, visit our website at www.keenan.com. Keenan provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, veteran, marital, or domestic partner status. Keenan is committed to a diverse workforce and is an affirmative action employer.
Workers Compensation Claims Examiners - Long Term Temp to Possible Hire - Immediate Need!
To analyze mid-and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
Submit your resume today for immediate consideration!
This position will be responsible for the investigation, evaluation and disposition of all professional liability claims and selected liability coverages. All coverages related to municipality/public entity – school leaders, D&O, EPLI, police professionals, etc. Juris Doctor preferred. General Adjustor’s license or obtain within 6 moths from hire required. Proficient use of PC. Valid driver’s license and occasional travel required. Ability to organize and prioritize work activities timely and efficiently. Good written and verbal communication skills. Negotiation skills. Knowledge of the litigation process.
The successful candidate is responsible for managing complex legal issues, litigation prevention and control, negotiation of settlements, lien resolutions and cost containment.
· Examiners with 3+years’ experience with indemnity files. Able to handle a caseload between 90 to 150 files.
· Self-Insured Administrator’s Certification (SIP) preferred.
· Strong, demonstrable,Client Service Skills.
· We would like to see candidates who have experience with government entities; 4850 experience.
· A sense of humor is greatly appreciated, almost revered.
As the position is classified as temporary, only government-mandated benefits are provided (i.e. Medicare, social security, workers’ compensation coverage, etc.) in addition to a competitive hourly wage rate.
Are you an experienced medical claims professional? Are you organized, detail-oriented, and efficient? If you have experience with medical claims within a managed care setting. My client, A rapidly growing healthcare organization in Alhambra is looking to expand its Claims department.
Process and adjudicates facility UB04 and professional CMS-1500 claim in accordance with all claims policies, contracts, keeping in compliance with industry regulations and guidelines
.ESSENTIAL DUTIES AND RESPONSIBILITIES, include the following:
• Adjudication for Projects and Priority Claims, Health Plan Demand Letters, Correspondences, Hospital, Anesthesia, ER, Unaffiliated Specialists and Medicare claim to include the accurate
• Apply all claims policies, contracts, practices and keep in compliance with industry regulations and guidelines
• Comply with claims timeliness guidelines: commercial 45 working days; Medi-Cal 30 calendar days; Medicare non-contracted 30 calendar days and Medicare contracted 60 calendar days
.• Proficient in and performs the application of “Coordination of Benefits”
.• Proficient with all Federal and state requirements in claim processing
.• Proficient understanding of AB1455 Claims Settlement Practice & Dispute and Resolution regulations.
• Proficient in rate application for outpatient PPS & Inpatient DRG facility, ASC, APC, Interim Rate and CMAC Rates of Payment methods to applicable lines of business. (Medicare, Commercial, Medi-Cal, Healthy Families and Healthy Kids)
• Ability to resolve claims issues on identified processing errors and make recommendations for improvements to avoid error
• Resolve any grievances and complaints received through Customer Services
• Prompt and accurate response to claims related questions from Management.
• Recognize the difference between Shared Risk and Full Risk claims.
EDUCATION and/or EXPERIENCE
High school diploma or general education degree (GED).
Two years of related experience and/or training in the HMO/Healthcare field.
UNEMPLOYMENT CLAIMS EXAMINER
3-5 Years’ experience in high-volume (30-50 weekly claims) unemployment claims administration, including appeal hearings. A background working as a hearing officer / Claims Examiner III (or higher) with the Texas Workforce Commission is perfect.
The Unemployment Claims Examiner will ensure compliance with unemployment loss prevention program. You will be responsible for reducing the costs of fraudulent or malingering unemployment claims through proactive / preventive claims management, procedural awareness and team training.
Help reduce unemployment claims assessment modifier by appropriately responding to, and prevailing on multiple daily claims activity. The Unemployment Claims Examiner is also responsible for managing all unemployment claims and appeal hearings, employee records retention, storage. retrieval and management.
We are full-service Human Resource outsourcing service to many professional Clients and Corporations in Texas and New Mexico. Join our HR team and we will cross-train you in many other areas of HR, including Worksite injury claims processing, Human Resources laws and regulations, safety and risk management, employee benefits. Would you like to learn more about working in one of these areas after bringing your expertise to our company and teaching others?
3-5 years’ experience in high-volume (30-50 weekly claims) unemployment claims administration, including appeal hearings; Current knowledge of dealing with the Texas Workforce Commission (TWC) or the New Mexico Department of Labor in contested claims hearings;
Must be able to effectively speak, read and write in Spanish and English. Will have to “argue" claims appeals in both English and Spanish;
A demonstrated knowledge of TWC response requirements, paperwork, forms and deadline procedures required. Prefer claims III (or better) Examiner background with the TWC;
Internal knowledge of the TWC & NM Department of Labor – how charge-backs to the Employer are monitored / calculated, Base Period calculations, etc. Will keep detailed spreadsheets on claims won / lost / appealed / charged-back, etc.;
Monitor Company’s and Client’s employee handbooks to close loop-holes in unemployment claims awards.
Proficient in MSWord / Excel needed. If you are extremely proficient in computer software we can cross-train you in many other areas in HR if you are interested!
Need to hire now.
Why work for us?
Join the supervisory team of a 40 year old, very well-establish and stable full-service Human Resource Outsourcing Company;
Work in a plush corporate offices with assistants. We offer health / medical benefits, 401(k) plan, paid vacations & holidays + advancement within a large Human Resources Division, cross-training in other Human Resource functions and more! Salary depends upon your experience.
For more information, call Connie at 532-1981 or send your resume to now. Unfortunately, no time to train. Must have Texas Workforce Commission or HR Generalist experience with extensive TWX UI response exposure and win ratio.
Growing, south shore S.I. based, Healthcare Co. seeks an experienced senior medical claims examiner.
The ideal candidate will possess strong, comprehensive working knowledge of medical claims adjudication including medical protocol & diagnostic billing standards (CPT, HCPCS & ICD-9 coding). Experience processing hospital (UB) medical claims along with interpreting medical records / op reports is essential.
We’re looking for an organized, detail-oriented, professional who thrives in a productivity & quality conscious environment. You must be pc/Windows literate and possess a working knowledge of MS Office.
This full time position offers a competitive salary, a comprehensive benefit package and a friendly, stable, professional workplace.
Prestigious health insurance business partner in Madison, Wisconsin seeks a medical claims examiner to handle claim determinations from start to finish!
Even if you do not have prior experience doing claim examinations or determinations, if you have worked with health insurance claims in any capacity, our client is willing to train you to be a full-fledged medical claims examiner!
Position is full-time (40 hours per week) and is temporary-to-permanent for the right candidate. The position will pay in the mid-30s + full benefits on a permanent basis.
To be considered for this exciting opportunity, please email your resume and summary of relevant skills to: firstname.lastname@example.org, or call #608-827-7770
We offer Facetime and Skype interviews!
Did you know OfficeTeam offers benefit programs like medical insurance, tuition reimbursement, and free training resources to our temporary employees? Call today to register and learn more!
--Quick and accurate data entry
--Able to work 40 hours per week, between the hours of 7 am and 6 pm
--At least some prior experience working with health insurance claims (e.g., processing claims)
All candidates required to undergo background check and all candidates required to undergo drug screening for this position.
OfficeTeam is the world's leader in professional staffing for office support jobs, focusing exclusively on the temporary and temporary-to-full-time placement of professionals in the administrative field. We are faster at finding you work because of the depth of our client network. Specifically, our professional staffing managers connect with thousands of hiring managers in North America every week to find your office support job opportunities. We evaluate all of our OfficeTeam temporaries' skills and match them with the needs of top employers in their area.
Apply for this job now or contact us today at 888.490.4154 for additional information.
All applicants applying for U.S. job openings must be authorized to work in the United States. All applicants applying for Canadian job openings must be authorized to work in Canada.
2019 OfficeTeam. A Robert Half Company. An Equal Opportunity Employer M/F/Disability/Veterans.
Salary: $15.68 - $18.15 / Hourly
Location: MADISON, WI
Date Posted: November 21, 2019
Employment Type: Temporary
Job Reference: 04620-0011271584
Staffing Area: OfficeTeam