analyst, healthcare medical coding - disputes, claims & investigations

appeals specialist - hospital billing, underpayments

analyst, healthcare medical coding - disputes, claims & investigations Jobs in Atlanta United States

appeals specialist - hospital billing, underpayments Jobs in Atlanta United States

billing administrator Jobs in Atlanta United States

billing administrator

billing and collections specialist Jobs in Atlanta United States

billing and collections specialist

claims adjuster,tpa oversight Jobs in Atlanta United States

claims adjuster,tpa oversight

analyst healthcare medical coding disputes claims investigations

Stout

<div>
 <strong>
  At Stout, we&rsquo;re dedicated to exceeding expectations in all we do &ndash; we call it Relentless Excellence
 </strong>
 &reg;
 <strong>
  . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
  <br/>
  <br/>
 </strong>
 <strong>
  About Stout&rsquo;s Forensics And Compliance Group
  <br/>
  <br/>
 </strong>
 Stout&rsquo;s Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.
 <br/>
 <br/>
 What You&rsquo;ll Do
 <br/>
 <br/>
 As an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
 <br/>
 <br/>
 <ul>
  <li>
   Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
  </li>
  <li>
   Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
  </li>
  <li>
   Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
  </li>
  <li>
   Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
  </li>
  <li>
   Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
  </li>
  <li>
   Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post&ndash;go-live support.
  </li>
  <li>
   Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
  </li>
  <li>
   Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
  </li>
  <li>
   Continue developing technical, analytical, and consulting skills while building credibility with clients.
  </li>
  <li>
   Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
  </li>
  <li>
   Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout&rsquo;s Healthcare Consulting team.
   <br/>
   <br/>
  </li>
 </ul>
 What You Bring
 <br/>
 <br/>
 <ul>
  <li>
   Bachelor&rsquo;s degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master&rsquo;s degree preferred.
  </li>
  <li>
   Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
  </li>
  <li>
   Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
  </li>
  <li>
   Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
  </li>
  <li>
   Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
  </li>
  <li>
   Additional certifications such as CHC, CFE, or AHFI preferred.
  </li>
  <li>
   Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
  </li>
  <li>
   Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
  </li>
  <li>
   Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
  </li>
  <li>
   Willingness to travel up to 25%, based on client and project needs.
   <br/>
   <br/>
  </li>
 </ul>
 How You&rsquo;ll Thrive
 <br/>
 <br/>
 <ul>
  <li>
   Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
  </li>
  <li>
   Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
  </li>
  <li>
   Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
  </li>
  <li>
   Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
  </li>
  <li>
   Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
  </li>
  <li>
   Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Why Stout?
  <br/>
  <br/>
 </strong>
 At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
 <br/>
 <br/>
 We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
 <br/>
 <br/>
 We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
 <br/>
 <br/>
 Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
 <br/>
 <br/>
 Learn more about our benefits and commitment to your success.
 <br/>
 <br/>
 https://www.stout.com/en/careers/benefits
 <br/>
 <br/>
 <em>
  The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
  <br/>
  <br/>
 </em>
 <em>
  Stout is an Equal Employment Opportunity.
 </em>
 <em>
  All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
  <br/>
  <br/>
 </em>
 Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
 <br/>
 <br/>
 A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - https://www.stout.com/en/careers/benefits.
</div>


Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations

Allied Universal Compliance and Investigations

<div><p>SIU Investigator</p><h2 class="jobSectionHeader"><b>
Overview</b></h2><p>
Company Overview:
</p><p>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.</p><h2 class="jobSectionHeader"><b>
Job Description</b></h2><p>
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</p><p><br>
</p><ul><li><b>Must possess a valid driver's license with at least one year of driving experience</b></li><li><b>
Georgia applicants must independently complete the 70-hour course necessary to receive a Private Investigator's license prior to applying.</b></li></ul><br>
<p></p>
<p><b>RESPONSIBILITIES:</b>
</p><ul><li>Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability</li>
<li>Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li>
<li>Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li>
<li>Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li>
<li>Run appropriate database indices if necessary and verify the accuracy of results found</li>
<li>Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following:</li><li><ul><li>
Bachelor's degree in Criminal Justice</li>
<li>High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li>
<li>Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li>
<li>Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li>
<li>Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li>
<li>Proficient in utilizing laptop computers and cell phones.</li>
<li>Special Investigative Unit (SIU) Compliance knowledge</li>
<li>Ability to type 40+ words per minute with minimum error</li>
<li>Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><ul><li>Military experience</li>
<li>Law enforcement</li>
<li>Insurance administration experience</li>
<li>Familiarity with California SIU regulations</li>
<li>One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li>
<li>Certified Insurance Fraud Investigator (CIFI)</li>
<li>Fraud Claim Law Associate (FCLA)</li>
<li>Fraud Claim Law Specialist (FCLS)</li>
<li>Certified Protection Professional (CPP)</li>
<li>Associate in Claims (AIC)</li>
<li>Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><p><b>
BENEFITS:</b>
</p><ul><li>Medical, dental, vision, basic life, AD&amp;D, and disability insurance</li>
<li>Enrollment in our company's 401(k)plan, subject to eligibility requirements</li>
<li>Seven paid holidays annually, sick days available where required by law</li>
<li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.</li></ul><h2 class="jobSectionHeader"><b>
Closing</b></h2><p>
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</p><p>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</p><h2 class="jobSectionHeader"><b>
Requisition ID</b></h2><br>
2026-1542345</div>

SIU Investigator

GI Care for Kids

<div><div><b>SUMMARY</b></div>
<div>The Billing and Collections Specialist must be customer service oriented, detailed in performing their job functions in accounts receivables with insurance companies and self-pays, and possess the ability to manage multiple tasks daily.</div>
<div><b>ESSENTIAL DUTIES</b></div>
<ul><li> Follow up on all accounts within the timely filing guidelines of the insurance company assigned to the biller.</li></ul>
<ul><li> Correcting claim issues, and/or rebilling claims to third party payers. Claims must be corrected and rebilled within the timely refiling guidelines of the insurance company assigned.</li></ul>
<ul><li> Write appeal letters.</li></ul>
<ul><li> Communicating with all departments, i.e., front desk staff, nursing and providers to ensure appropriate collection of co-pays and self-pay balances prior to patient visits.</li></ul>
<ul><li> Contact patients after obtaining auth to discuss collection of out-of-pocket expenses prior to patient visits.</li></ul>
<ul><li> Documenting the appointment desk, calling guarantors and communicating balances that need to be collected.
</li></ul><ul><li> Handles inquiries and answers questions for clerical staff, clinical staff, and insurance companies within a 24-hour turnaround time</li></ul>
<ul><li> Daily monitoring of assigned insurance A/R&rsquo;s, statuses on delinquent self-pay accounts, and all assigned WQ&rsquo;s.</li></ul>
<ul><li> Meets deadlines of completing all assigned WQ&rsquo;s prior to the end of the month.</li></ul>
<ul><li> Identifies and resolves patient billing questions in the office and incoming calls to the business office.</li></ul>
<ul><li> Daily collection and/or posting payments from insurance companies and patients as assigned daily.</li></ul>
<ul><li> Reviews accounts and makes recommendations regarding non collectible accounts when working delinquent and collection accounts.</li></ul>
<ul><li> Notifies manager of non-collectible self pays and insurance balances.</li></ul>
<ul><li> Verifies patient eligibility through various third-party sources.
</li></ul><ul><li> Understands patient benefits from various all insurance carriers and determines out of pocket and in and out of network status prior to visits in the office.</li></ul>
<ul><li> Documents payments collected, A/R, and phone call resolutions in software system.</li></ul>
<ul><li> Understands fee schedules and updates manager of fee schedule changes and effective dates timely</li></ul>
<ul><li> Monitors changes in policy and fee schedules for all insurance carriers assigned and informs manager.</li></ul>
<ul><li> Answers business office phone calls daily and on a rotating weekly schedule.</li></ul>
<ul><li> Explain out of pocket expenses to guarantor</li></ul>
<ul><li> Assist in the enrollment and explain drug rebate programs such as Care Path and Entyvio Connect and Pfizer</li></ul>
<ul><li> Assist patients in completion of paperwork, explain and follow up patient assistance programs when needed.</li></ul>
<ul><li> Communicate effectively with professional staff and patients.</li></ul>
<ul><li> Daily monitoring of personal business office phone line, business office phone calls and emails.</li></ul>
<ul><li> Ensures voicemails are returned within a 24-hour time period.</li></ul>
<ul><li> Responds to all emails and staff messages from manager, staff and patients in a 24-hour time period</li></ul>
<ul><li> Daily collection of business office mail, and routing to appropriate billers.</li></ul>
<ul><li> Filing of manually posted payments</li></ul>
<ul><li> Cross trained to fill in for other job functions on an as needed basis.</li></ul>
<ul><li> Additional duties as assigned by management.</li></ul>
<div></div><div><b>EDUCATION &ndash; EXPERIENCE- KSA&rsquo;s &ndash; OTHER QUALIFICATIONS</b></div>
<ul><li> Associate&rsquo;s degree, or equivalent, 3 to 5 years related experience, or Medical Billing Certification.</li></ul>
<ul><li> Experience working with medical payers including Medicaid, CMO&rsquo;s and Commercial insurance.</li></ul>
<ul><li> Working knowledge of medical billing systems, particularly Epic.</li></ul>
<ul><li> Working knowledge of CPT and ICD-10 coding systems.</li></ul>
<ul><li> Ability to research and problem solve A/R disputes</li></ul>
<ul><li> Customer service oriented</li></ul>
<ul><li> A productive, dependable, self-starter</li></ul>
<ul><li> Excellent organizational skills</li></ul>
<ul><li> Proficiency in Microsoft Office Suite</li></ul>
<ul><li> Excellent verbal and written skills</li></ul>
<ul><li> Knowledge of medical billing / collection practices required</li></ul>
<ul><li> Strong keyboard skills.</li></ul>
<ul><li> Works well in environment with firm deadlines; results oriented.</li></ul>
<ul><li> Perform multiple tasks effectively.</li></ul>
<ul><li> Able to work both independently and as part of a team.</li></ul>
<ul><li> Strong analytical skills required.</li></ul>
<ul><li> Capable of making timely, independent decisions</li></ul>
<div></div><div><b>COMPETENCIES</b></div>
<div></div><div>Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values.</div>
<div>Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.</div>
<div>Interpersonal Skills - focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.</div>
<div>Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values; benefits organization through outside activities; supports affirmative action and respects diversity.</div>
<div>Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.</div>
<div></div><div><b>PHYSICAL DEMANDS AND WORK ENVIRONMENT</b></div>
<div></div><ul><li> Frequent sitting, grasping, and speaking</li></ul>
<ul><li> Occasional reaching, bending and stooping</li></ul>
<ul><li> Frequent use of computer, keyboard, copy/fax machine, and phone</li></ul>
<ul><li> Possible exposure to infectious specimens (blood or bodily fluids or airborne pathogens).</li></ul>
<ul><li> May be required to wear Personal Protective Equipment (PPE).
</li></ul><ul><li> While performing the duties of this job, the noise level in the work environment is usually quiet to</li></ul>
 <div>moderate.</div>
<ul><li> Fast paced environment with occasional high pressure or emergent situations.</li></ul>
<ul><li> Work hours subject to office needs to ensure coverage during all hours of operation.</li></ul></div>

Billing and Collections Specialist

Aspirion

<div>Description:
<p>
For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers&rsquo; compensation, Veterans Affairs, and out-of-state Medicaid.</p><p>
At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, &ldquo;Our teammates are the foundation of our success.&rdquo; United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time.</p><p>
We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor.</p><p>
We are seeking an Appeals Specialist II to join our growing team. As an Appeals Specialist II, you will be exposed to the complex reimbursement methodology between hospitals and insurance companies. Appeals Specialists work closely with assigned project teams on the specialized retrospective recovery process. You will be exposed to the revenue cycle process and various provider clients and systems.</p><p><b>
Key Responsibilities</b></p><ul><li>
Follow-up with insurance carriers on underpaid claims by phone; complete follow-up actions as advised</li><li>
Research claim variances in hospital patient accounting systems (EPIC, Meditech, Cerner, Athena)</li><li>
Draft appeals to insurance carriers on denied or underpaid claims</li><li>
Review claim detail including coding, billing and insurance information for discrepancies</li><li>
Run claims data through various pricing software</li></ul>
Requirements:
<ul><li>Strong healthcare industry knowledge</li><li>
Ability to troubleshoot and remedy claim submission errors</li><li>
Demonstrated attention to detail</li><li>
Excellent written and verbal communication skills</li><li>
Team-Oriented and Flexible</li><li>
Creative Problem-solving skills</li></ul><p><b>
Education and Experience</b></p><ul><li>
High School Diploma or GED required; bachelor's degree preferred</li><li>
Hospital billing experience required</li><li>
Previous work from home experience</li></ul><p><b>
Benefits</b></p><p>
At Aspirion we invest in our employees by offering a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, advancement opportunities, and incentive programs.</p><p>
The US base pay range for this position <b><i>starts</i></b> at $19.00 hourly.<i> Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered.</i> In addition to base salary, a competitive benefits package is offered.</p><p><b>
AAP/EEO Statement</b></p><p>
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.</p><p>
Please note that this position is contingent upon the successful completion of a pre-employment drug screening and background check. These steps are part of our standard hiring process to ensure a safe and compliant workplace.</p></div>

Appeals Specialist - Hospital Billing, Underpayments

Hiscox

<div><div>Job Type:</div>
Permanent<div></div><div>
Build a brilliant future with Hiscox</div><div><br>
The Complex Claims Specialist is a senior level individual contributor position. This person adjudicates assigned claims within given authority and provides operational support to the claims team.</div><div></div><div>
This Person Will Also:</div><ul><li><div>
Strategize and maximize early settlement opportunities for Construction Defect and 3rd Party Property Damage Claims</div></li><li><div>
Demonstrates proficient knowledge regarding coverage triggers and time on risk allocation</div></li><li><div>
Draft and Review coverage analyses</div></li><li><div>
Manage/Partner with local defense counsel while monitoring litigation</div></li><li><div>
Drives litigation best practices to manage deployment and utilization of defense counsel</div></li><li><div>
Continually assess exposures and adequacy of claim reserves</div></li><li><div>
Demonstrates proficient knowledge regarding theories of liability and State specific negligence standards</div></li><li><div>
Accurately document claim files with all relevant correspondence, documentation, and file notes</div></li><li><div>
Demonstrates proficient knowledge of ACV vs RCV property damage assessments</div></li><li><div>
Attend mediations and/or settlement conferences where appropriate</div></li><li><div>
Identifies suspected fraudulent claims and tracks with special investigations unit</div></li><li><div>
Actively participate in the Claims/UW/Actuarial feedback loop</div></li><li><div>
Keep senior claims management adequately and appropriately informed of key issues</div></li><li><div>
Liaising directly on daily basis with insureds and brokers</div></li></ul><div></div><div>
The Team:</div><div>
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox&rsquo;s strong brand built on a long history of outstanding claims handling.</div><div></div><div>
Requirements:</div><ul><li><div>
10+ years of claims handling experience within General Liability &amp; Bodily Injury</div></li><li><div>
A JD from an ABA accredited law school may be considered as a supplement to claims handling experience</div></li><li><div>
Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation</div></li><li><div>
Expert knowledge of coverage within the team&rsquo;s specialty or focus</div></li><li><div>
Expert knowledge of litigation process and negotiation skills</div></li><li><div>
Proven track record of mentoring others</div></li><li><div>
Excellent verbal and written communication skills</div></li><li><div>
Advanced analytical skills</div></li><li><div>
B.A./B.S degree from an accredited College or University preferred</div></li></ul><div></div><div>
Hiscox Values:</div><div>
At Hiscox our spirit is in Challenging Convention and everything we do is guided by our Values.</div><ul><li><div>
Courage: Dare to take a risk</div></li><li><div>
Ownership: Passionate, commercial and accountable</div></li><li><div>
Integrity: Do the right thing, however hard</div></li><li><div>
Connected: Together, build something better</div></li><li><div>
Human: Clear, fair and inclusive</div></li></ul><div></div><div>
What Hiscox USA Offers:</div><ul><li><div>
Competitive salary and bonus (based on personal &amp; company performance)</div></li><li><div>
401(k) with competitive company matching</div></li><li><div>
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)</div></li><li><div>
Company paid group term life, short- term disability and long-term disability coverage</div></li><li><div>
24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days</div></li><li><div>
Paid parental leave</div></li><li><div>
4 week paid sabbatical after every 5 years of service</div></li><li><div>
Financial Adoption Assistance and Medical Travel Reimbursement Programs</div></li><li><div>
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program</div></li><li><div>
Company paid subscription to Headspace to support employees&rsquo; mental health and wellbeing</div></li><li><div>
Recipient of 2024 Cigna&rsquo;s Well-Being Award for having a best-in-class health and wellness program</div></li><li><div>
Dynamic, creative and values-driven culture</div></li><li><div>
Modern and open office spaces, complimentary drinks</div></li></ul><div></div><div>
**Please note that this position is hybrid and requires two (2) days in our office weekly**</div><div></div><div>
Salary range: $115-$130k</div><div><i>
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.</i></div><div></div><div>
About Hiscox:</div><div>
As an international specialist insurer, we are far removed from the world of mass market insurance products. Instead we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things.</div><div></div><div>
We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions.</div><div></div><div>
Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places.</div><div>
Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch.</div><div></div><div>
About Hiscox USA:</div><div>
Hiscox USA was established in 2006 to focus on the needs underserved and specialty commercial clients via both the regional broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.</div><div></div><div>
Today, Hiscox USA has a talent force of about 400 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber &amp; data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap &amp; ransom, commercial property and terrorism.</div><div></div><div>
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)</div><div></div><div>
#LI-RM1</div><div><i><br>
Work with amazing people and be part of a unique culture</i></div></div>

Complex Claims Specialist - General Liability

Lemieux & Associates

<div>
 <strong>
  Ready to put your surveillance skills to work for a national leader?
  <br/>
  <br/>
 </strong>
 Join
 <strong>
  Lemieux &amp; Associates
 </strong>
 , a trusted leader in investigative services, and make an impact with your surveillance expertise. Our leadership team brings over 25 years of field experience and is committed to fostering a professional, results-driven environment.
 <br/>
 <br/>
 At
 <strong>
  Lemieux &amp; Associates
 </strong>
 , we set the standard in investigative services. We are seeking experienced
 <strong>
  SIU Field Investigators
 </strong>
 in Atlanta, GA and surrounding areas on a part-time basis. Enjoy flexible hours, competitive pay, and opportunities for professional growth.
 <br/>
 <br/>
 <strong>
  Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Must have SIU/Claims investigation experience as a Private Investigator or Fraud Investigator and live in the Atlanta
  </li>
  <li>
   Resume and questionnaire required for consideration.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Write detailed, accurate reports.
  </li>
  <li>
   Obtain written and recorded statements.
  </li>
  <li>
   Conduct scene investigations.
  </li>
  <li>
   Accurately photograph evidence (accident scenes, vehicle damage, etc.).
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Skills &amp; Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Experience handling complex SIU/Claims cases.
  </li>
  <li>
   Notary license strongly (preferred).
  </li>
  <li>
   Surveillance experience a plus (preferred).
  </li>
  <li>
   Bilingual ability and/or degree in Criminal Justice or related field (preferred).
  </li>
  <li>
   Willingness to travel; flexible schedule (varied/irregular hours).
  </li>
  <li>
   Strong computer and internet skills.
  </li>
  <li>
   Valid driver's license; reliable vehicle, digital camera, and Windows‑based computer with internet.
  </li>
  <li>
   Ability to meet deadlines with high‑quality work.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Take the next step toward an exciting investigative career-apply today and become part of a team that sets the standard in surveillance excellence.
  <br/>
  <br/>
 </strong>
 Salary: $25 - $30 per hour
</div>


Atlanta, GA SIU Investigator

SageSure

<div><p><b>Overview:</b></p>
<p>
If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we're hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a <b>Claims</b> <b>Workforce Management Analyst</b>.</p>
<p><b>
What you'd be doing:</b></p>
<ul>
<li>Develop, validate, and maintain long-term and short-term staffing models for multiple claims units to support proactive staffing and hiring decisions.
</li><li>Prepare executive-ready dashboards, presentations, and reports to summarize demand and capacity insights.
</li><li>Understand complex business processes and technologies, question current workflows, and make recommendations to enhance efficiency.
</li><li>Facilitate monthly and weekly business reviews for owned models.
</li><li>Support initiatives to improve forecasting accuracy and automate capacity planning processes using analytics and data tools (Excel, SQL, Python, or Domo).
</li><li>Collaborate with HR and Talent Acquisition on headcount planning and workforce strategy.
</li><li>Act as a liaison between Workforce Management and Operations for budget alignment and reporting consistency.
</li><li>Prioritize tasks, meet critical deadlines, and manage expectations effectively.
</li><li>Perform additional tasks as needed.</li>
</ul>
<p><b>We're looking for someone who has:</b></p>
<ul>
<li>3+ years of experience as a workforce business analyst, data analyst, or in a similar role.
</li><li>Strong understanding of forecasting claims in call centers and non-traditional operations (highly preferred).
</li><li>A data-driven, detail-oriented mindset with a commitment to using facts to achieve optimal outcomes.
</li><li>Strong knowledge of Microsoft Excel.
</li><li>A degree in Mathematics, Statistics, or Business.
</li><li>Experience providing ongoing performance management by tracking key performance indicators.
</li><li>Solid understanding of contact center operations and best practices.
</li><li>Exposure to workforce management, capacity planning, and forecasting in a contact center environment.
</li><li>Experience with workforce management (WFM) software (a plus).
</li><li>Excellent analytical and problem-solving skills with a data-driven approach.
</li><li>An inquisitive nature with the ability to identify issues in data and analysis and resolve them quickly using subject matter expertise.
</li><li>Flexibility to work at any time, including nights, weekends, and holidays (base schedule is Monday&ndash;Friday).
</li><li>Availability for occasional travel.</li>
</ul>
<p><b>Highly preferred candidates also have:</b></p>
<ul>
<li>BI tool experience with Domo (preferred) or similar (Power BI/Tableau)</li>
</ul>
<p><b>About the Claims team at SageSure:</b></p>
<p>
On SageSure's Claims team, you'll be doing more than investigating and resolving losses. From the ground up, you'll be pioneering a best-in-class claims handling approach that leverages transformative technology to support our customers, agents and employees. As a part of this customer-focused, process-oriented team you will be the face of SageSure, helping our policyholders through some of their most trying times. Whether you hold a formal leadership role or are a key team player, you'll coach, mentor and engage with those around you in ways that bring out the best in people and effect change.</p>
<p>
You can easily distill complex processes in ways those outside the industry can understand and know the importance of aligning communication tools to customer preferences. You thrive on setting and exceeding expectations, and know building relationships, not completing transactions, is the heart of the insurance business.</p><div><p><b>
About SageSure:</b><br>
<br>
Named among the Best Places to Work in Insurance by Business Insurance for four years in a row (2020-2023), SageSure is one of the largest managing general underwriters (MGU) focused on catastrophe-exposed markets in the US. Since its founding in 2009, SageSure has experienced exceptional growth while generating underwriting profits for carrier partners through hurricanes, wildfires, and hail. Available in 16 states, SageSure offers more than 50 competitively priced home, flood, earthquake, and commercial products on behalf of its highly rated carrier partners. Today, SageSure manages more than $1.9 billion of inforce premium and helps protect 640,000 policyholders.<br>
<br>
SageSure has more than 1000 employees working remotely or in-office across nine offices: Cheshire, Connecticut; Chicago, Illinois; Cincinnati, Ohio; Houston, Texas; Jersey City, New Jersey; Mountain View, California; Marlton, New Jersey; Tallahassee, Florida; and Seattle, Washington.<br>
<br>
SageSure offers generous health benefits and perks, including tuition reimbursement, wellness allowance, paid volunteer time off, a matching 401K plan, and more.<br>
<br>
SageSure is a proud Equal Opportunity Employer committed to building a workforce that reflects the spectrum of perspectives, experiences, and abilities of the world we live in. We recognize that our differences make us strong, and we actively seek out diverse candidates through partnerships with organizations, institutions and communities that represent various backgrounds. We champion belonging and inclusion for all identities, including, but not limited to, race, ethnicity, religion, sexual orientation, age, veteran status, ability status, gender, and country of origin, striving to create a culture where all individuals feel valued, respected, and empowered to bring their authentic selves to work.<br>
<br>
Our nimble, highly responsive culture nurtures critical thinkers who run toward problems and engineer solutions. We relentlessly pursue better outcomes by investing in the technology, talent, and tools that position us to succeed in demanding markets. Come join our team! Visit sagesure.com/careers to find a position for you.</p></div></div>

Claims Workforce Management Analyst

Explore 420+ Analyst healthcare medical coding disputes claims investigations in Atlanta United States this March. Find roles across top companies and apply now to boost your career.