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Job Description


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


POSITION PURPOSE
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


Bilingual


ADR Experience preferred but not required.


EDUCATION/CERTIFICATION:
High school diploma (2 and/or 4 year degree a plus)
IEA Certification or equivalent training/work experience
Self-Insurance Certificate


EXPERIENCE REQUIRED:


Six to twelve months work experience in the insurance, legal or health care industry.


Public Entity/Municipality experience a plus (LC 4850 and Presumption)


Litigation experience.


 


SKILLS/ABILITIES:
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


Company Description

LWP Claims Solutions, Inc. is a third party administrator dedicated exclusively to workers' compensation programs. We have full service offices in Sacramento and Glendale, California with financial services in Salt Lake City, UT. Founded in 1990, LWP is known for outstanding quality claims services for clients interested in services tailored to their specific needs. Through a combination of our claims handling expertise, prompt and fair benefit administration, consulting and training techniques, and team-based relationships with our clients, LWP has been successful in assisting our clients in achieving some of the lowest loss development rates in the industry.


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Job Description


Entry Level Claims Examiner


You will be responsible for providing support for the claims manager and excellent customer service to our clients.


Responsibilities will include:


·         Answering customer phone calls


·         Data entry


·         Resolving customer complaints


·         Processing of medical claims


Requirements for position:


·         Excellent listening, verbal and written communication skills


·         Organizational skills


·         Positive attitude


·         Experience in customer service or call center environment nice, but not required.


Self-Funded Plans, Inc. is located in Downtown Cleveland and offers free parking to staff.


Company Description

Third Party Administrator of Group Health Claims, located in Downtown Cleveland.


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Job Description


Workers Compensation Claims Examiner - Long Term Temp to Possible Hire - Immediate Need!


PRIMARY PURPOSE:


To analyze mid-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.


RESPONSIBILITIES



  • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims monitors reserve accuracy, and files necessary documentation with a state agency.

  • Develops and manages worker's compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.

  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

  • Manages the subrogation of claims and negotiates settlements.

  • Communicates claim action with claimant and client.

  • Ensures claim files are properly documented and claims coding is correct.

  • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

  • Maintains professional client relationships.


REQUIREMENTS:



  • Two to (4) years of claims management experience or equivalent combination of education and experience required.

  • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Public entity experience preferred

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Ability to work in a team environment

  • Ability to meet or exceed Service Expectations

  • SIP


Submit your resume today for immediate consideration!


Company Description

Canon Recruiting Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Canon Recruiting Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, termination, layoff, recall, transfer, leaves of absence, compensation, and training.


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Job Description


 


About WNC
WNC Insurance Services is a leading property and casualty underwriting agency. We offer a broad suite of tailored specialty risk management solutions, including private flood, construction and lender-placed products. At WNC, it’s all about our clients. Nationwide, our customers rely on our trusted, industry-leading coverages, supported by compliance expertise, superior claims management and the highest caliber of service.


Founded in 1962, WNC is a wholly owned company of Tokio Marine Kiln, one of the largest carriers in the Lloyd’s of London insurance market and a member of the Tokio Marine Group. WNC’s corporate office is located in Chicago, Ill., with operating centers in Dallas, Texas, Irvine, Calif., Miami, Fla., Naperville, Ill., and South Pasadena, Calif.


We are taking significant and transformative steps to build our leadership team, make critical investments in technology and implement strategies to achieve strategic growth in the marketplace. If you’re looking to advance your career, WNC is the perfect professional home. At WNC, you’ll have a chance to innovate with the world’s leading businesses, put your expertise into action on major projects, and work on game-changing initiatives. You’ll also make long-lasting professional connections through sharing different perspectives, and you’ll be inspired by the best.


POSITION SUMMARY: This is a trainee position for complex commercial claims handled primarily thru the London market, specifically Builders Risk.


 


Essential Duties and Responsibilities include the following. Other duties assigned as necessary.


·       Provide customer service support to lenders, borrowers, insureds, claimants and all internal and external customers.


·       Responsible for all aspects of claims adjusting including but not limited to: verifying facts of loss, policy interpretation, coverage analysis, evaluation of damages and settlement.


·       Utilize field adjusters to evaluate damages, inspect property and gain necessary information/documentation.


·       Ensure accuracy of field adjuster estimates and timely completion of assigned claims.


·       Utilize claim systems to enter all written and verbal communication with customers and all relevant parties throughout the life of the claim.


·       Enter claim and expense payments into claim systems within assigned authority. Forward payments over authority to Manager for review and approval.


·       Compose denial/partial denial letters based upon facts of the loss and relative policy information.


·       Participate in file audits and roundtable discussions. 


·       Collaborate with internal and external partners on special projects.


·       Handle intricate and complex claims, including public adjuster and/or attorney-represented losses.


·       Obtain and maintain licensing in all required states within timeline provided by management.


·       On occasion, takes claim information via telephone, fax, e-mail or regular mail and creates a record of loss in the appropriate claim system.


Education and/or Experience: 


College diploma or its equivalent; 5 years or less property insurance claims, field experience is a plus


Certificates, Licenses, Registrations:    None required initially but all state adjuster licenses are a plus


 Knowledge, Skills and Abilities Required:    



  •   Possesses a higher knowledge of specific insurance-related terminology, concepts, practices and procedures. 

  • Familiar with standard concepts, practices and procedures for auto/property claim handling


  • Computer literate (knowledge of Microsoft Outlook, Word, Excel)


  • Typing/data entry (40 w.p.m.) and 10-key skills


  • Strong oral and written communication skills, especially a pleasant telephone manner


  • Strong customer service skills including the ability to manage demanding requests


  • Excellent organizational skills


  • Detail oriented


  • Dependable


  • Experience adjudicating Builders Risk


  • Course of Construction and/or Commercial Property Claims preferred.



ADDITIONAL REQUIREMENTS:



  • Must pass a pre-employment drug test and background check


    Minorities, Females, Disabled and Veterans are Encouraged to Apply (EOE, M/F/D/V)



This  is a Temporary Telecommuting Remote Work position due to  COVID-19  for which management has determined that an employee may temporarily work remotely as a means of social distancing. Please note that applicants may asked about at-home technology specifications as part of the screening process.


Company Description

Wilshire National Corporation was founded in 1962 as a captive insurance agency owned and operated by Larwin Corporation, a large national homebuilder and community developer.

WNC Insurance Services, Inc. (WNC), the successor to Wilshire National Corporation, was incorporated in California in 1975. Since that time, WNC has operated as an independent managing general agent, managing general underwriter, program administrator, surplus lines broker and property and casualty agent.


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Job Description


Senior Workers Compensation Claims Examiner - Remote - 30-day contract - Kentucky/Tennessee/West Virginia jurisdiction.


PRIMARY PURPOSE:


To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.


RESPONSIBILITIES:



  • Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Assesses liability and resolves claims within the evaluation.

  • Negotiates settlement of claims within designated authority.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

  • Prepares necessary state fillings within statutory limits.

  • Manages the litigation process; ensures timely and cost-effective claims resolution.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.

  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management.


REQUIREMENTS:



  • Four (4) years of claims management experience or equivalent experience required.

  • Bachelor's degree from an accredited college or university preferred.

  • Professional certification as applicable to line of business preferred.

  • In-depth knowledge of appropriate insurance principles and laws for a line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Excellent negotiation skills

  • Ability to work in a team environment


Submit your resume today for immediate consideration!


Company Description

Canon Recruiting Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Canon Recruiting Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, termination, layoff, recall, transfer, leaves of absence, compensation, and training.


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Job Description


 


Overview


Summary
The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.


Responsibilities


Essential Duties and Responsibilities:
- Reviews and adjudicates medical claims based on health policy provisions and established guidelines
- Requests additional information from members and providers as needed
- Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
- Documents fully claims referred to senior staff for review and determination
- Maintains company production and quality standards
- Participates in training

Other Responsibilities:
- Adheres to the policies and procedures of Premier Administrative Solutions
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned

Supervisory Responsibilities: None

Competencies:
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Detail oriented
- Ability to multi-task and work independently
- Knowledge of medical and dental coding systems
- Knowledge of medical terminology


Qualifications


Qualifications:
Minimum one (1) year of medical claims processing experience

Education and/or Experience:
High school diploma or equivalent is required

Certificates, Licenses, Registrations:

None

Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook


Company Description

The CSI companies has been voted one of the best places to work in Jacksonville for the past 5 years, In business for the last 25 years we are a cut above your average staffing firm and are here to aid you in your search for the next great job opportunity in your professional career. We offer competitive pay, a great benefits package, and consistent career advice to help you achieve maximum professional growth.


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Job Description


 The Claims Examiner properly applies plan/guidelines provisions. This position is responsible for processing medical, dental and vision claims, and answers questions in accordance with relevant terms and established procedure. This position works closely with other departments to proactively research concerns and resolve to the satisfaction of the client. This position will handle complex claims issues, assist with team workflow management and any special projects as assigned. This position maintains a comprehensive understanding of the plan document(s)/guidelines under their scope of responsibility.
Essential Job Duties:
• Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents
• Claims Processing
o Interpret plan documents/guidelines
o Determine eligibility by reviewing, researching and analyzing information
o Process, deny, allow or pend claims
o Manage a moderate volume and complexity of groups and members
o Use critical thinking and reasoning to manage workload with above average level of financial risk
o Provide training to new and assigned employees
• Correspondence
o Maintain and enter information into system as information is received
o Forward all records to the appropriate parties
• Group Contacts
o Record and respond to calls/e-mails from Groups
o Maintain high level of knowledge to answer specific plan/guideline and claim questions
o Establish relationships with Team Members for each group
o Review issues as they arise
• Appeals and Inquiries
o Note system when appeals and inquiries are established
o Record all information on appeals and inquiries in the database
o Note in system if claim is going to a committee or to outside review
• Customer Service
o Serve as a role model in demonstrating core values of customer service
o Provide timely and thorough responses to internal and external customers
 Respond to member and group correspondences regarding plan/guideline or claim questions within 24 hours
o Escalate difficult issues to the appropriate chain of command
• Quality Assurance
o Ensure compliance with service standards
o Follow trends within assigned scope and alert appropriate parties of any that fall outside quality parameters
o Develop and execute plans to meet established goals
o Provide continuous feedback to strengthen and optimize quality performance
o Work cross-departmentally to improve or streamline procedures
o Maintain up to date knowledge on industry trends and look for new data sources
o Develop or improve current internal processes to improve overall quality
• Special projects as assigned
Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers,

Skills/Abilities:
• Excellent verbal and written communication skills with high attention to detail
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Confident decision-making abilities
• Demonstrated ability to work independently, prioritize workloads and manage priorities to meet deadlines


Physical Requirements:
• Indoor office environment with moderate noise
• Intermittent physical effort may include lifting up to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
• Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing
• Normal vision abilities required including close vision and ability to adjust focus



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Job Description


Senior Property Claims Adjuster / Examiner – Reporting To Omaha, NE or Jacksonville, FL Offices


Telecommuting Job Opportunity


Join our hardworking, collaborative team where your contributions will be celebrated and valued.


Why Stillwater?  We’re a national insurance provider that offers a full suite of insurance products and services. We strive to be the most respected insurance provider in the United States and that respect starts with our employees.


We’re looking for candidates with at least five years of claims processing experience. You’ll be responsible for overseeing all aspects of the insurance claims process for first party homeowner losses. This includes determining coverage, investigating claims and negotiating a timely and fair settlement.


Qualifications:



  • Bachelor’s degree in business, insurance or a related field.

  • 5 or more years Property & Casualty claims processing experience.

  • Prior work experiences in claims examination with Commercial Lines preferred.

  • Excellent verbal and written communication skills.

  • Knowledge of property/casualty insurance claims management process, systems and regulatory requirements.

  • Highly developed analytical and negotiation skills.

  • Ability to multi-task and prioritize.

  • Effective team player.

  • Strong customer service skills.


Stillwater offers:



  • Business casual work environment – wear your jeans to work.

  • Newly remodeled office near I-80 on I Street – convenient to shopping and dining.

  • Medical, dental, vision and life insurance benefits to keep you and your family protected.

  • 401(k) Plan to help you plan for your retirement.

  • Gym/Fitness Center on site (Omaha) to support your commitment to staying healthy, gym reimbursement for telecommuting employees.

  • Generous Paid Time Off (PTO) program to help you maintain your work/life balance.


Apply today to start your journey of being celebrated and valued with Stillwater Insurance Group.


Offer is contingent upon a favorable response from both a pre-employment background investigation and a drug screen.


Stillwater Insurance Group is an equal opportunity employer and a drug free workplace.


 


 


Company Description

Join our hardworking, collaborative team where your contributions will be celebrated and valued.

Why Stillwater? We are a national insurance provider that offers a full suite of insurance products and services. We strive to be the most respected insurance provider in the United States and that respect starts with our employees.

Stillwater offers:

1. Medical, dental, vision and life insurance benefits to keep you and your family protected.
2. 401(k) Plan to help you plan for your retirement.
3 Generous Paid Time Off (PTO) program to help you maintain your work/life balance.
4. Gym and fitness reimbursement for your general wellness..
5. The convenience of telecommuting to work.
Apply today to start your journey of being celebrated and valued with Stillwater Insurance Group.


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Job Description


 


Claims Examiner- Dental                             


Full-Time:  International Benefits Administrators


Company Description


International Benefits Administrators- IBA is Third Party Administrator that specializes in the design, implementation & administration of self funded medical and dental plans. IBA also provides medical and dental claims paying support for several medical insurance carriers.


Job Description


 We are seeking a “seasoned” dental examiner with knowledge of processing dental claims by reviewing, interpreting and analyzing imaged dental claim documentation. Accountable for making decisions and developing the correct course of action in processing dental claims, have extensive knowledge of dental coding and the ability to work independently.


Qualifications:


·         General knowledge of claims adjudication


·         Knowledge with ADA codes


·         Knowledge of HIPAA regulations


·         Knowledge of PC applications and systems


·         Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents.


·         Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists


·         Excellent keyboarding skills


·         Ability to perform basic math functions – addition, subtraction, multiplication, and division.


·         Ability to work and communicate effectively in a team environment.


·         Ability to work under pressure.


·         Ability to work in an environment with fluctuating workloads.


·         Ability to work effectively with employees, employers, and providers.  Able to deal with problems in varying situations and reach reasonable solutions.


Education & Experience:


·         High School diploma or GED equivalent required.International Benefits Administrators


·         A Minimum of 10 years experience working for either a TPA or Insurance Carrier


Job Location:  Nassau County – Garden City, NY (across from Roosevelt Field Mall)V


Company Description

International Benefits Administrators (“IBA”) is a TPA, founded in 1972, that specializes in the design, implementation & administration of self funded health and dental plans. IBA also provides claims paying support for several medical insurance carriers.


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Job Description


Senior Workers Compensation Claims Examiner - Remote - 30-day contract - Kentucky/Tennessee/West Virginia jurisdiction.


PRIMARY PURPOSE:


To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.


RESPONSIBILITIES:



  • Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Assesses liability and resolves claims within the evaluation.

  • Negotiates settlement of claims within designated authority.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

  • Prepares necessary state fillings within statutory limits.

  • Manages the litigation process; ensures timely and cost-effective claims resolution.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.

  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management.


REQUIREMENTS:



  • Four (4) years of claims management experience or equivalent experience required.

  • Bachelor's degree from an accredited college or university preferred.

  • Professional certification as applicable to line of business preferred.

  • In-depth knowledge of appropriate insurance principles and laws for a line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Excellent negotiation skills

  • Ability to work in a team environment


Submit your resume today for immediate consideration!


Company Description

Canon Recruiting Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Canon Recruiting Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, termination, layoff, recall, transfer, leaves of absence, compensation, and training.


See full job description

Job Description


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.



See full job description

Job Description


Senior Workers Compensation Claims Examiner - Long Term Temp to Possible Hire - Texas License Required 


PRIMARY PURPOSE:


To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.


RESPONSIBILITIES:



  • Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Assesses liability and resolves claims within the evaluation.

  • Negotiates settlement of claims within designated authority.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

  • Prepares necessary state fillings within statutory limits.

  • Manages the litigation process; ensures timely and cost-effective claims resolution.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.

  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management.


REQUIREMENTS:



  • Four (4) years of claims management experience or equivalent experience required.

  • Bachelor's degree from an accredited college or university preferred.

  • Professional certification as applicable to line of business preferred.

  • In-depth knowledge of appropriate insurance principles and laws for a line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Excellent negotiation skills

  • Ability to work in a team environment


Submit your resume today for immediate consideration!


Company Description

Canon Recruiting Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Canon Recruiting Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, termination, layoff, recall, transfer, leaves of absence, compensation, and training.


See full job description

Job Description


MedPOINT Management


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 personnel@medpointmangement.com


 


Summary:


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


 


 



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Job Description Job Summary Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. Knowledge/Skills/Abilities Meets and consistently maintains production standards for Claims Adjudication. Supports all department initiatives in improving overall efficiency. Identifies and recommends solutions for error issues as it relates to pre-payment of claims. Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication and recommending solutions to resolve these issues. Monitors the medical treatment of claimants. Keeps meticulous notes and records for each claim. Manages a caseload of various types of complex claims. Procures all medical records and statements that support the claim. Meets department quality and production standards. Meet State and Federal regulatory Compliance Regulations on turnaround times and claims payment for multiple lines of business Job Qualifications Required Education High School or GED Required Experience 3-5 years claims processing required Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 5-7 years claims processing preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


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Job Description


DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.



  • Investigates claims by interviewing employers, injured workers, medical providers and witnesses

  • Gathers information, determines compensability and resolves all claim issues within state guidelines.

  • Coordinates light-duty availability by communicating with medical providers, employers and injured workers

  • With only general supervision, develops and carries out a plan of action for resolution of all claim issues, and keeps clients well informed of all issues.

  • Establishes claim reserves and works closely with employers, employees, medical providers and other outside providers to maximize a cost-effective case resolution.

  • Manages claim to closure

  • Identifies issues that might necessitate transfer of claim to Indemnity Examiner

  • Handles medical & future medical files.


EDUCATION/CERTIFICATION:



  • High school diploma (2-4 year college a plus)

  • IEA Certification or equivalent training/work experience (helpful)


EXPERIENCE REQUIRED:


Must meet the training or experience requirements per California Code of Regulation (Article 20 of Subchapter 3, Chapter 5, Title 10)


No phone calls please. Only applicants invited to interview will be contacted. EOE


Company Description

LWP Claims Solutions, Inc. is a third party administrator dedicated exclusively to workers' compensation programs. We have full service offices in Sacramento and Glendale, California with financial services in Salt Lake City, UT. Founded in 1990, LWP is known for outstanding quality claims services for clients interested in services tailored to their specific needs. Through a combination of our claims handling expertise, prompt and fair benefit administration, consulting and training techniques, and team-based relationships with our clients, LWP has been successful in assisting our clients in achieving some of the lowest loss development rates in the industry.


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Job Description


We are seeking a Medical Claims Examiner to become a part of our organization! You will review mental health payment requests for the Victim Compensation Program and identify and request any documents needed to verify and determine payment amount(s) reimbursable to the claimant and/or provider. This will work 8-10 hours per week.


The Contractor will ensure that any payment adheres to applicable Victim Compensation law and administrative rules. The Contractor will review each provider’s professional qualification(s) to determine reimbursement eligibility. In addition, the Contractor will review additional payment request supporting documentation, such as treatment plans and session summary notes, to determine if psychological treatment is directly related to the psychological injuries (trauma) suffered as a result of the crime on which the victim compensation claim is based. The Contractor will calculate any amounts reimbursable and submit to staff for the next step in payment processing. The Contractor may also assist with training(s) associated with the mental health payment process when needed.


Responsibilities:



  • Correspond and interview with medical specialists, agents, witnesses, or claimants to compile information

  • Take accurate and detailed statements from all involved parties

  • Calculate and approve payment of claims within a certain monetary limit

  • Coordinate with legal counsel in handling cases correctly


Qualifications:



  • Previous coding experience in mental health setting.

  • may be an LCSW or an LPC.

  • Excellent written and verbal communication skills

  • Deadline and detail-oriented



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Job Description


Full-time Claims Examiner to work in South Suburb of Denver, CO - Direct Hire


 


Our client, a large claims administrator, is looking for a claims examiner to work in their Greenwood office. You must have four years of claims management experience. Credit security clearance, confirmed via a background credit check, is required for this position.


 


Responsibilities:



  • Analyze complex or technically difficult claims to determine benefits due

  • Work with high exposure claims involving litigation and rehabilitation

  • Ensure ongoing adjudication of claims within service expectations,

  • Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim

  • Manage claims through well-developed action plans to an appropriate and timely resolution.

  • Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.

  • Ensures claim files are properly documented and claims coding is correct.

  • Travel as required.


 


Experience and Education:



  • Bachelor's degree from an accredited college or university preferred.

  • Professional certification as applicable to line of business preferred.

  • Four (4) years of claims management experience or equivalent combination of education and experience required.

  • In-depth knowledge of appropriate insurance principles and laws for the line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business


 


If you or anyone you know of is interested in this position, please email all resumes to us for immediate consideration.


Company Description

We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements


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Job Description


UNEMPLOYMENT CLAIMS EXAMINER


Unfortunately, no time to train. Must have Texas Workforce Commission or HR Generalist experience with extensive TWX UI response exposure and win ratio.



  • Background working as a hearing officer / Claims Examiner III (or higher) with the Texas Workforce Commission, or,

  • 3-5 Years’ experience in high-volume (30-50 weekly claims) Texas and New Mexico unemployment claims administration, including appeal hearings required.


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?


Position Requirements:



  • 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!



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.


 



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Job Description


 Job Description: 


Maintain a diary of personal injury cases for filing claims against numerous Personal Injury Trusts.  Requires frequent communication with clients, Trust representatives, and co-workers to develop case information, exposure evidence, and settlement options; tracking cases, curing deficiencies and serving clients by assisting in resolving claims.


Duties:


★    Become well versed in  provisions of applicable Trust Distribution Procedures.
★    Complete claim forms by interpreting and providing relevant medical reports and exposure documentation.
★    Evaluate settlement offers against settlement criteria, re-categorize claims to appropriate compensation levels, cure claim deficiencies by supplying additional claims information.
★    Keep cases organized by establishing and organizing files; monitoring diary; meeting deadlines; documenting actions; inputting/updating information into file database.
★    Maintain and protect confidential client data and firm operations.
★    Keep clients informed by maintaining contact and communicating case progress. 
★    Update job knowledge by participating in educational opportunities.
.


Skills/Qualification:
Reporting Skills, Research and Writing Skills, Client Relationships, Organization, Attention to Detail,  Dependability, Client Confidentiality, Analyzing, Thoroughness, Customer Service, Working Knowledge of Computers, Computer navigational Skill, Data Entry .



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Job Description


Senior Workers Compensation Claims Examiner - Remote - 30-day contract - Kentucky/Tennessee/West Virginia jurisdiction.


PRIMARY PURPOSE:


To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.


RESPONSIBILITIES:



  • Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Assesses liability and resolves claims within the evaluation.

  • Negotiates settlement of claims within designated authority.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

  • Prepares necessary state fillings within statutory limits.

  • Manages the litigation process; ensures timely and cost-effective claims resolution.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.

  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management.


REQUIREMENTS:



  • Four (4) years of claims management experience or equivalent experience required.

  • Bachelor's degree from an accredited college or university preferred.

  • Professional certification as applicable to line of business preferred.

  • In-depth knowledge of appropriate insurance principles and laws for a line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Excellent negotiation skills

  • Ability to work in a team environment


Submit your resume today for immediate consideration!


Company Description

Canon Recruiting Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Canon Recruiting Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, termination, layoff, recall, transfer, leaves of absence, compensation, and training.


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