claim examiner

Benecard Services Inc.

<div><div><div><div><div><div>The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</div><div></div><div> 
This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week and is a Union position.</div><div></div><div> 
Key Responsibilities</div><ul><li>
Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li>
Process complex or high-dollar claims requiring supervisory overrides</li><li>
Distribute daily claim workloads and support operational workflow efficiency</li><li>
Prepare and maintain documentation for internal and external audits</li><li>
Ensure compliance with prompt pay regulations and timely filing requirements</li><li>
Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li>
Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li>
Support monthly claims reporting and departmental performance tracking</li><li>
Collaborate with leadership to meet monthly productivity and accuracy goals</li><li>
Respond promptly and professionally to internal and external communications</li><li>
Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><div></div><div> 
Required Qualifications:</div><ul><li>
5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li>
Strong knowledge of Medicaid and Medicare claim processing</li><li>
Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li>
Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li>
Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li>
In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li>
Familiarity with appeals and reconsideration processes for government payers</li><li>
Experience researching and resolving claim denials and timely filing issues</li><li>
Working knowledge of AS400 or similar claims processing systems</li><li>
Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li>
Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><div></div><div> 
Preferred Qualifications:</div><ul><li>
Previous leadership experience would be preferred</li><li>
Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li>
Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li>
Experience supporting or participating in claims audits or compliance reviews</li></ul><div></div><div> 
Why Join Us?</div><ul><li>
Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li>
Opportunity to specialize in eye care and vision insurance claims</li><li>
Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul> 
National Vision Administrators
For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.
Website: http://www.e-nva.com
We are an equal opportunity employer</div></div></div></div> 
Monday - Friday 8:30am - 5:00pm</div>

Claims Examiner

Kinsale Insurance Company

<div>As a Claims Examiner, you will play a key role in managing casualty claims from investigation through resolution. This position combines analytical thinking, decision-making, and negotiation to ensure fair and timely claim outcomes. You&rsquo;ll work closely with experienced claims professionals and legal partners while handling a diverse portfolio, including litigated claims. This is a great opportunity to grow your expertise in a fast-paced, team-oriented environment that values learning and career development.
<h4 class="jobSectionHeader">
What You&rsquo;ll Do</h4>
<ul><li>Manage a variety of casualty claims under the guidance of a Claims Supervisor</li>
<li>Conduct and coordinate investigations across all phases of the claims process</li>
<li>Evaluate liability and exposure to develop effective resolution strategies</li>
<li>Analyze policy coverage, make determinations, and draft clear coverage correspondence</li>
<li>Communicate claim decisions and updates with policyholders and key stakeholders</li>
<li>Maintain accurate, detailed, and timely documentation within claim files</li>
<li>Oversee litigated claims by appointing and managing defense counsel</li>
<li>Drive claims and litigation toward efficient and fair resolution</li>
<li>Participate in mediations, settlement discussions, and trials as needed</li>
</ul><h4 class="jobSectionHeader">What You Bring</h4>
<ul><li>Bachelor&rsquo;s degree in Business, Risk Management, or a related field</li>
<li>2+ years of experience handling commercial general liability claims involving bodily injury and property damage</li>
<li>Strong analytical, problem-solving, and decision-making skills</li>
<li>Excellent written and verbal communication abilities</li>
<li>Experience managing litigated claims and working with defense counsel</li>
<li>Ability to analyze medical records, contracts (including risk transfer provisions), property damage estimates, and litigation documents</li>
<li>Strong organizational and time management skills with the ability to multitask</li>
<li>Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint)</li>
<li>A collaborative mindset with strong negotiation skills</li>
</ul>
Adjuster licenses or industry designations are a plus.
<h4 class="jobSectionHeader">
Why You&rsquo;ll Love Working at Kinsale</h4>
<ul><li>Competitive Pay &amp; Bonus Opportunities &ndash; Rewarding performance and initiative.</li>
<li>Comprehensive Benefits &ndash; Health, dental, and vision insurance with up to $3,600 (individual) or $6,800 (family) in HSA contributions per year.</li>
<li>Work-Life Balance &ndash; Generous paid time off including 22 days of PTO and 10 paid company holidays.</li>
<li>Career Growth &ndash; Clear promotion paths, mentorship, and ongoing professional development.</li>
<li>Retirement &amp; Security &ndash; Up to 6% matching 401(k) contributions on base salary and bonus, standard life insurance, and disability coverage.</li>
<li>Continuous Learning &ndash; Annual $3,000 reimbursement for educational training and certifications.</li>
</ul><h4 class="jobSectionHeader">Integrity &amp; Responsibility</h4>

Kinsale values strong financial responsibility. A credit check may be conducted as part of the selection process for roles that require sound judgment and trustworthiness.
<h4 class="jobSectionHeader">
Ready to Apply?</h4>

If you&rsquo;re a detail-oriented claims professional who thrives in a collaborative and fast-paced environment, this is your opportunity to grow your career with Kinsale Insurance. Join a company that values innovation, excellence, and continuous learning.

Apply today and take the next step in your career!</div>

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Examiner - Liability | Property Damage | Licensing: Reciprocal required | Jurisdiction: Multi State - Hybrid
<div><div><div>Job Description
</div></div><div><div><div><div><div><div><div><div><div>Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
<ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.
</li></ul>ARE YOU AN IDEAL CANDIDATE? To analyze complex or technically difficult property damage 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.
PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Responsible for end‑to‑end management of complex property damage claims, from investigation through resolution, ensuring accurate liability assessment and timely outcomes
</li><li>Oversees reserve strategy, settlement negotiations, payments, and statutory filings while maintaining compliance with authority levels and regulatory requirements
</li><li>Manages litigation, vendor partnerships, excess carrier reporting, and recovery efforts to drive cost‑effective claim resolution
</li><li>Serves as a primary point of contact for claimants and clients, maintaining clear communication, strong relationships, and well‑documented claim files
</li><li>Collaborates with leadership to escalate complex matters appropriately and support strategic claim handling decisions
</li><li>Ensures adherence to internal quality standards, regulatory compliance, and best practices while contributing to continuous improvement initiatives
</li></ul>QUALIFICATIONS
Education and Licensing: Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</div></div></div></div></div></div></div></div></div></div>WORK ENVIRONMENT
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Claims Examiner - Liability | Property Damage | Licensing: Reciprocal required | Jurisdiction: Multi State - Hybrid

Athens Administrators

<div>
 ATHENS POSITION DETAILS
 
 
 
 Position Title:
 
 
 
 Assistant Claims Examiner - Flex
 
 
 
 Department:
 
 
 
 Workers&rsquo; Compensation
 
 
 
 Reports To:
 
 
 
 Claims Supervisor
 
 
 
 FLSA Status:
 
 
 
 Non-Exempt
 
 
 
 Job Grade:
 
 
 
 6
 
 
 
 Career Ladder:
 
 
 
 Next step in progression could include Future Medical Examiner or Claims Examiner Trainee
 
 
 
 ATHENS ADMINISTRATORS
 
 
 
 Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!
 
 
 
 Position Summary
 
 
 
 Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers&rsquo; Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday &ndash; Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule.
 
 
 The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens.
 
 
 
 Primary Responsibilities
 
 
 
 Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
 
 
 <ul>
 <li>
 Process new claims in compliance with client&rsquo;s Service Agreement
 </li>
 <li>
 Issue all indemnity payments and awards on time
 </li>
 <li>
 Process all approved provider bills timely
 </li>
 <li>
 Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.
 </li>
 <li>
 Answer questions over the phone from medical providers regarding bills
 </li>
 <li>
 Contact treating physician for disability status
 </li>
 <li>
 Contact employer for return-to-work status or availability of modified work.
 </li>
 <li>
 Contact injured worker at initial set up
 </li>
 <li>
 Send DWC notices timely
 </li>
 <li>
 Issue SJDB Notices timely
 </li>
 <li>
 Request Job Description from Employer
 </li>
 <li>
 Handle Medical Only claim files
 </li>
 <li>
 Calculate wage statements and adjust disability rates as required
 </li>
 <li>
 Keep diary for all delay dates and indemnity payments
 </li>
 <li>
 Documents file activity on computer
 </li>
 <li>
 Update information on computer, i.e., address changes, etc.
 </li>
 <li>
 Schedule appointments for AME, QME evaluations
 </li>
 <li>
 Send appointment letters, issue TD/mileage, send medical file
 </li>
 <li>
 Schedule interpreter for appointments, depositions, etc.
 </li>
 <li>
 Request Employer&rsquo;s Report, DWC-1, Doctor&rsquo;s First Report if needed
 </li>
 <li>
 Verify mileage and dates of treatment for reimbursement to claimant
 </li>
 <li>
 Subpoena records
 </li>
 <li>
 File and serve documents on attorneys, WCAB, doctors
 </li>
 <li>
 Serve PTP&rsquo;s with medical file and Duties of Treating Physician (9785)
 </li>
 <li>
 Request PD ratings from DEU
 </li>
 <li>
 Draft Stipulated Awards and C&amp;R&rsquo;s
 </li>
 <li>
 Submit C&amp;R, Stipulated Awards to WCAB for approval with documentation
 </li>
 <li>
 Process checks &ndash; stop payment, cancellations, void, journal payments
 </li>
 <li>
 Handle telephone calls for examiner as needed
 </li>
 <li>
 Complete penalty calculations and prepare penalty worksheets
 </li>
 <li>
 Complete MPN, HCO and/or EDI coding
 </li>
 <li>
 Complete referrals to investigators
 </li>
 <li>
 Complete preparation of documents for overnight delivery
 </li>
 <li>
 Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners
 </li>
 <li>
 Contact with clients, injured workers, attorneys, doctors, vendors, and other parties
 </li>
 <li>
 Provide updates of claims status to Senior Claims Examiners and Athens management
 </li>
 <li>
 Prepare professional, well written correspondence and other communications
 
 
 
 </li>
 </ul>
 
 Essential Position Requirements
 
 
 
 The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
 
 
 <ul>
 <li>
 High School Diploma or equivalent (GED) required for all positions
 </li>
 <ul>
 <li>
 AA/AS or BA/BS preferred but not required
 </li>
 </ul>
 <li>
 2+ years&rsquo; Claims Assistant experience supporting a workers compensation examiner or team preferred
 </li>
 <li>
 Medical Only Adjuster designation required
 </li>
 <li>
 Continuing hours must be current
 </li>
 <li>
 Mathematical calculating skills
 </li>
 <li>
 Completion of IEA or equivalent courses
 </li>
 <li>
 Administrators Certificate from Self-Insurance Plans preferred
 </li>
 <li>
 Knowledge of workers compensation laws, policies, and procedures
 </li>
 <li>
 Understanding of medical and legal terminology
 </li>
 <li>
 Must demonstrate accuracy and thoroughness in work product
 </li>
 <li>
 Ability to sit for prolonged periods of time
 </li>
 <li>
 Well-developed verbal and written communication skills with strong attention to detail
 </li>
 <li>
 Excellent organizational skills and ability to multi-task
 </li>
 <li>
 Ability to type quickly, accurately and for prolonged periods
 </li>
 <li>
 Proficient in Microsoft Office Suite
 </li>
 <li>
 Ability to learn additional computer programs
 </li>
 <li>
 Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
 </li>
 <li>
 Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
 </li>
 <li>
 Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
 </li>
 <li>
 Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
 </li>
 <li>
 Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
 </li>
 <li>
 Athens&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
 </li>
 <li>
 Must be able to reliably commute to meetings and events as required by this position
 
 
 </li>
 </ul>
 
 APPLY WITH US
 
 
 
 We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf
 
 
 This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
 
 
 Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
 
 
 
 THANK YOU!
 
 
 
 We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!
 
 
 Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses &amp; certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at
 
 https://www.athensadmin.com/careers/why-work-here
 
</div>

Assistant Claims Examiner - Remote or Hybrid in CA

State of Utah

<div>Claims Examiner I, Career Service Exempt
FT / PT Status &ndash; Full-Time 
Salary &ndash; $18.00 - $31.61 Hourly Wage
 
Remote Work / In-Office &ndash; Hybrid (After ample training, may qualify for hybrid/remote) 
 
Recruiter &ndash; Liz Vander Linden | evander@utah.gov | 801-957-7232 
Application Deadline &ndash; 4/26/2026 
Key Responsibilities 
The Utah Unclaimed Property Division seeks a full-time Claims Examiner I, Career Service Exempt to join our committed, creative, and enthusiastic team. We return tens of millions of dollars of unclaimed property to rightful owners every year. 
Our next Claims Examiner I will assist many Utahns in recovering their lost money. Some claims are very easy and others are like solving a huge puzzle to determine who is the rightful owner. Look us up at: mycash.utah.gov.
Please note this is an entry level position.
Do you:<ul><li>
Strive for accuracy and precision?</li><li>
Perform best with clear direction, rules, and structure?</li><li>
Enjoy being a resource of knowledge &amp; information for others?</li><li>
Embrace opportunities to work independently?</li><li>
Relish Solving problems and pivoting to meet the current need?</li><li>
Avoid chaos and drama and instead focus on facts and data?</li><li>
Prefer to work alone on tasks rather than in a group?</li><li>
Are you a skeptical person who requires volumes of information before forming a firm opinion?</li><li>
Find that your communication style is more informative and factual than socially oriented?</li><li>
Possess a natural sense of urgency &amp; move quickly between tasks?</li><li>
Communicate directly, factually &amp; in a no-nonsense manner?</li><li>
Desire change, new challenges, &amp; variety over routine?</li><li>
Perform better in an orderly work environment that is free of clutter?</li></ul>
If this is you, we should talk.
First, go to this page: https://go.cultureindex.com/p/n6hu69Wz715hd3rCdf1H to take a quick 8-10 minute survey and attach your resume.
If we determine that you are a great fit, we will follow up with more information and a full description of responsibilities and benefits. 
About the Role
Location &ndash;
 
168 North 1950 West, Suite 102 
Salt Lake City, UT, 84116 
United States
 
Background Check Required &ndash; No 
Drug Test Required &ndash; No
 
Schedule Code &ndash; AC - Employees in Offices of Elected Officials
Schedule: Monday - Friday 8 hour shift
Why You Should Join Our Team 
In Utah, we believe hard work is important, but balance is essential. Finding work/life balance is a vital element to our culture. To find out more about WHY Utah, click here. Other benefits may include:<ul><li>
Job Stability: Enjoy the security and reliability of employment within a well-established organization.</li><li>
Career Growth: Develop valuable skills and gain opportunities for leadership within a large organization.</li><li>
Meaningful Work: Contribute to an important service that benefits the community and supports organizational goals.</li><li>
Supportive Work Environment: Be part of a team that values cooperation, strong work ethics, and mutual support.</li></ul>
The Agency 
Millions of dollars in lost or unclaimed money are turned over to the State of Utah every year. This money comes from places like dormant bank accounts, old stock certificates, and uncollected insurance checks. This is the official government website for managing and returning this unclaimed property to the residents of Utah.
EEO Statement 
The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, please contact (801) 957-9390.</div><div></div>

Claims Examiner I, Career Service Exempt

DOCTORS HEALTHCARE PLANS, INC.

<div>The Claims Examiner III is a senior-level claims professional responsible for the accurate and timely adjudication of complex professional and institutional claims in accordance with regulatory requirements, contractual agreements, and internal policies. This role supports departmental workflow oversight, assists leadership with productivity and quality monitoring, and serves as a subject matter resource to team members to ensure operational excellence and compliance with CMS and organizational standards. 
 
Key Responsibilities:<div><ul><li>
Review, analyze, and adjudicate professional and institutional claims, including high-dollar and complex cases.</li><li>
Process Member Reimbursement claims in accordance with plan benefits and regulatory guidelines.</li><li>
Ensure claims are processed accurately, timely, and in compliance with CMS regulations, state guidelines, and internal policies.</li><li>
Assist the Claims Manager and/or Assistant Director in monitoring daily, weekly, and monthly workflow to meet production and quality targets.</li><li>
Generate and analyze reports to track productivity, aging inventory, and pending items.</li><li>
Provide guidance and clarification to team members regarding claims processing rules, contract interpretation, and system functionality.</li><li>
Support the implementation and enforcement of departmental policies and procedures.</li><li>
Collaborate with leadership to ensure production, accuracy, and turnaround time metrics are consistently met.</li><li>
Communicate departmental goals, workflow strategies, and performance improvement initiatives to staff.</li><li>
Promote a positive work environment that supports staff engagement, accountability, and teamwork.</li><li>
Maximize system capabilities by ensuring proper utilization of claims processing tools and platforms.</li><li>
Identify process improvement opportunities and escalate system or configuration issues as needed.</li><li>
Perform additional duties as assigned.</li></ul><div>
Qualifications:</div></div><ul><li>
High School Diploma or GED</li><li>
Minimum of 3+ years of experience as a Medical Claims Examiner.</li><li>
Experience processing Medicare Advantage and/or managed care claims preferred.</li><li>
Strong experience with contract interpretation and benefit application.</li><li>
Working knowledge of CMS guidelines, Medicare regulations, and healthcare claims processing standards.</li><li>
Strong analytical and problem-solving skills.</li><li>
Proficiency in Windows-based systems and claims processing applications. 
</li></ul><div>
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.</div>
No Third Party Agencies or Submissions Will Be Accepted. 
 
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP 
 
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
3hOLMnYaLt</div>

Claims Examiner III

ECP, Inc.

Automotive Claims Specialist (Appraisal &amp; Appearance Protection)Job Description: ECP Incorporated is currently seeking a detail-oriented Automotive Claims Specialist, preferably with technical appraisal experience. We are searching for a representative capable of defining problems and collecting data, specifically regarding appearance protection claims (Paint, Windshield, and Interior).The ideal candidate has a background in automotive damage estimation and a strong understanding of repair software and consumer correspondence. This is a professional office-based role focused on technical adjudication rather than retail service writing.Summary: Responsible for adjudicating appearance protection warranty claims by corresponding with customers, body shops, and glass/upholstery technicians.Essential Duties and Responsibilities:<ul><li>Receives and processes appearance claims (Paint, Fabric/Leather, and Windshield) from customers.</li><li>Sets up digital files and maintains detailed technical notes on claim progression.</li><li>Reviews and audits damage estimates using CCC ONE or similar appraisal platforms to ensure repair accuracy.</li><li>Corresponds with customers, vendors, body shops, and PDR (Paintless Dent Repair) technicians regarding claim status and coverage.</li><li>Negotiates labor rates and service costs with providers to ensure the most cost-effective remedy is utilized.</li><li>Coordinates with inspection centers and appraisers on complex or problem claims.</li><li>Initiates professional approval and denial letters based on contract specificities.</li><li>Inputs claim check requests for administrative approval.</li><li>Interacts professionally and courteously with customers.</li></ul>Education and Experience:<ul><li>1-4 years of related experience in automotive damage appraisal, body shop estimating, or claims adjudication.</li><li>Proficiency in CCC ONE is highly preferred.</li><li>Equivalent combinations of education and technical field experience will be considered.</li></ul>Benefits: ECP offers competitive Benefits: Comprehensive Health Insurance Coverage, Dental, Vision, Life Insurance, 401(k) Matching, and Paid Time off.About ECP: Since 1969, ECP Brands have been seen on over 45 million vehicles. Over 14 thousand automobile dealers and carwash operators use ECP products, programs and services. Our heritage has been in the manufacturing, packaging and distribution of protective coatings, detailing, prep, carwash and service chemicals and supplies, and in providing the administration of product warranties and financial services programs to produce aftermarket sales opportunities and cost savings for automobile dealers and related businesses.ECP is proud to be an Equal Opportunity Employer. All employees and applicants will receive consideration for employment without regard to age, color, disability, gender, national origin, race, religion, sexual orientation, gender identity, protected veteran status, or any other classification protected by federal, state, or local law. ECP participates in the E-Verify process for all new hires.Job Type: Full-timePay: $45,000.00 - $55,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>Automotive claims : 1 year (Preferred)</li><li>Customer Service: 1 year (Preferred)</li></ul>Work Location: In person

Automotive Claims Representative I

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Claims Examiner

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Claims Examiner III

Automotive Claims Representative I