claims adjudicator

Symbria

<div>Overview:
<div></div><div>
Symbria Rx Services is seeking a team oriented. As one of the few <b>100% employee-owned</b> companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to. For more than 20 years, Symbria has been providing an outstanding work environment for talented employees to deliver patient-centered care to the geriatric population in senior-living and post-acute settings.</div><div></div><div><br>
The <b>LTC Pharmacy Adjudicator</b> is responsible for communicating to the communities when order exceptions occur such as non-formulary, expensive medications, and incomplete orders. This position works closely with the community staff to have orders clarified and medications changed to less expensive alternatives. Coordinates all adjudication on Medicare D claims where needed and to perform all functions required to maintain, update, and bill customers&rsquo; accounts timely and accurately.</div><div></div><div><b><br>
Working Schedule:</b></div><ul><li>
12:00pm-8:30PM Monday-Friday, occassionally, 2:30PM-11:00PM, and every other weekend.</li><li>
Must work rotating holidays.</li><li>
Must currently live in a state Symbria Rx Services is licensed in: AZ, CO, FL, IL, IN, KS, MA, MI, MO, PA, OH, WI.</li><li>
100% Remote</li><li>
Must have high-speed, internet access provided by a cable or fiber provider (no DSL or satellite). Internet is not provided or reimbursed by Symbria.<ul><li>
Users with no more than three (3) local devices connected, a minimum connection speed of <b>50 Mbps</b> for downloads, and<b>10 Mbps</b> for uploads is required. Latency must be below 35. Cable internet service is strongly recommended over DSL service.</li><li>
Users with four (4) or more devices such as laptops/ computers, mobile phones/ tablets, VOIP home phone, gaming systems, and streaming video systems (Netflix, Amazon Fire/ TV, Google, Roku, Apple TV, etc.), the minimum connection speed required should be <b>75 Mbps</b> for downloads and <b>10 Mbps</b> for uploads. Latency must be below 35.</li><li>
We recommend a wire connection to your home internet router. Slow or poor internet connection may impact or prohibit the ability to perform your job. The use of Wi-Fi &lsquo;air cards&rsquo; (mobile hot spots) are prohibited as your main internet connection.</li><li>
Symbria reserves the right to verify that your system will meet or exceed these requirements.</li></ul></li><li>
All requirements &amp; recommendations are subject to change with technological advances.</li></ul>
Responsibilities:
<ul><li>Initiate communication to communities regarding expensive and non-formulary medication orders and educate on less expensive alternatives identified by staff pharmacists.</li><li>
Initiate communication to community regarding incomplete orders which require further clarification.</li><li>
Keep detailed records of all orders that require communication to the community for potential follow up if needed.</li><li>
Follow up with the community per policy timeframe if the medications have not been changed or clarified. Send another supply of medication if needed.</li><li>
Communicate professionally with community management staff including Director of Nursing and Administrator via phone or email.</li><li>
Assist with data entry of orders as needed.</li><li>
Assist with answering phone calls for the data entry department.</li><li>
Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians to successfully adjudicate all claims.</li><li>
Work in conjunction with designated operations staff to prepare for formulary changes.</li><li>
Perform insurance and billing clerical duties, including review and maintenance of patient account information.</li><li>
Prepare and submit claims to various third parties either electronically or by paper.</li><li>
Identify and resolve claim denials.</li><li>
Act as liaison between patients and third parties.</li><li>
Work collaboratively with other team members and supervisor to ensure best practices are shared.</li><li>
Provide backup support to other pharmacy departments based on business needs or production levels, as needed.</li><li>
Any and all duties as assigned.</li></ul>
Qualifications:
<div><b>
To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required:</b></div><br>
<ul><li>
High School diploma or general education degree (GED).</li><li>
Pharmacy Technician License and/or Certification (CPhT) as per State requirements (must be licensed in Illinois and Massachusetts within 60 days of hire).</li><li>
Data entry experience; minimum one year.</li><li>
Excellent customer service, interpersonal, verbal and written communication skills.</li><li>
General computer knowledge including Microsoft Office: Word, Excel, and Outlook.</li><li>
Ability to maintain organization, multi-task and prioritize to manage assignments/projects.</li><li>
Strong knowledge of Brand/Generic drugs and medical terminology.</li></ul><div><b><br>
QUALIFICATIONS PREFERRED</b><br>
<ul><li>Prescription billing experience; minimum one year.</li></ul></div><div></div><div><b><br>
Why work for us?</b></div><div><b><br>
At Symbria our employees act like owners &ndash; because we are owners!</b> As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options.</div><div></div><div><b><br>
Symbria&rsquo;s Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together:</b></div><br>
<ul><li>
Integrity &ndash; Honest, Fairness and ethics</li><li>
Compassion &ndash; Commitment to serving seniors</li><li>
Stewardship &ndash; Maximizing mission and margin</li><li>
Innovation &ndash; Striving to enhance our value to your organization</li><li>
Teamwork &ndash; Working together unselfishly toward goals</li></ul><div></div><div><b><br>
As an employee-owner, Symbria&rsquo;s success becomes your success. In addition, we provide:</b></div><br>
<ul><li>
Competitive pay, aligned with market guidelines</li><li>
Full Benefits Package, including very generous paid time off plans</li><li>
Professional liability coverage</li><li>
100% employer-funded ESOP retirement plan</li><li>
401(k) and Roth(k) plans</li><li>
Continuing education</li><li>
Credit union membership</li></ul><div><b><i>
A</i></b><b><i>ll applicants will be afforded equal op</i></b><b><i>portunity without discrimination because of race, color, religion, sex, sexual orientation, marital status, order of protection status, national origin or ancestry, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service.</i></b><br>
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<i>#LI-REMOTE</i></div></div>

Remote LTC Pharmacy Adjudication Technician

State of Washington

JOB
<br><b>Our Mission:</b> Keep Washington Safe and Working! Our Values: Customer Focus, One L&I, Respect, Diversity, Equity and Inclusion, Learning and Growth, ReliabilityPlease Note: This recruitment is being used to fill multiple permanent positions.Please Note: This position requires in office training for the first 11 months. (Office location is Tumwater, WA)Job HighlightsJoin our Workers’ Compensation Adjudicator 2 Apprenticeship program! We have several opportunities for you to join our apprentice classes starting June 16, 2026. Apply now!You have an opportunity to make a difference. Are you interested in being a part of something big? To help injured workers heal and return to work? Make workplaces safe? To help honest workers, businesses and providers by cracking down on the dishonest ones? Come start your career at Labor & Industries! ¡Los trabajadores que hablan español necesitan su ayuda! Las posiciones español bilingüe ganan un 5% adicional de salario.Your future career at Labor & Industries starts here: 22-month apprenticeship program, which includes an initial intensive classroom training period. Options for Hybrid Telework after classroom training (around 11 months).A personal coach/mentor assigned to you.Alignment with a team of experienced Claim Managers.Medical, legal and vocational professionals to assist you.Journey-level certification upon successful completion.Salary Information: $4,586.00 monthly beginning salary (87% of 50G for non-bilingual positions)$4,744.00 after six months (90% of 50G)$4,902.00 after ten months (93% of 50G)$5,271.00 after 22-months (100% of 50G Journey Level) 5% Annual Periodic Increase after completion of apprenticeship program up to $6,107.00Additional Salary Information: Spanish Bilingual jobs include a 5% salary increase for dual language responsibilities. If hired as bilingual, our top applicant will be required to pass an assessment of your ability to write and speak Spanish fluently. We do not use translating software.Permanent state employees who come into the program at or above 50G will be offered 100% 50G ($5,271).Permanent state employees who come into the program between 87% and 99% of 50G will retain their current salary until they naturally progress in accordance with standards of apprenticeship.All others will be placed at 87% of 50G, until they naturally progress in accordance with standards of apprenticeship.If accepted into this apprenticeship program, you may qualify for an apprenticeship stipend through your GI bill.The Department of Labor & Industries (L&I) is a diverse state agency dedicated to the safety, health, and security of Washington's workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the state's workers' compensation system, we are similar to a large insurance company, providing medical and limited wage-replacement coverage to workers who suffer job-related injuries and illness. Our rules and enforcement programs also help ensure workers are paid what they are owed, that children's and teens' work hours are limited, and that consumers are protected from unsound business practices.Insurance Services is the largest division within the agency and administers one of the premier workers’ compensation organizations in the nation serving over 3.8 million employees working for 260,000 employers.
<br><br>
EXAMPLE OF DUTIES
<br><b>Some of what you’ll do:</b> This job is complex. Claim Managers adjudicate and manage workers' compensation claims by authorizing or denying medical, vocational and monetary benefits and ensuring statutory time limits are met. As an apprentice you will do this while having your work checked for quality and accuracy. The right person for this job will enjoy a challenging, ever-changing environment and possess the ability to work with people needing help. And much more!
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SUPPLEMENTAL INFORMATION
<br><b>Work Schedule Options:</b> Work shifts available for the first 11 months: Onsite – Monday – Friday, 7 a.m. to 3:30 p.m. or 8 a.m. to 4:30 p.m.Other work schedules, including hybrid telework, can be considered after the 11-month classroom training is complete. Overtime may also be available after the classroom training is complete.Vacation leave during the first 13 months is limited to specific dates based on the training schedule.State employees who meet the qualifications will become eligible for a generous retirement package at the end of the employee’s career. Click on the “Benefits” tab to learn more.At L&I, your voice matters. In addition, L&I is a diverse state agency dedicated to the safety and health and security of Washington's 3.8 million workers. Take a look at this brief video and learn more about why L&I is an employer of choice.For this position, you are required to work in the office for the 11-month training period. After completion of the training, telework is dependent upon business needs and supervisor approval. The assigned duty station for this position is Tumwater, Washington.To receive more information on opportunities at L&I sign up for GovDelivery and select L&I job alerts.Application processWe will contact the top candidates directly to interview for this position. Because we base the selection on information provided by you, it is in your best interest to identify the knowledge, skills, and abilities that address the required and desirable qualifications described in the announcement.Please include the following documents with your application: A cover letter describing specific qualifications.A current resume detailing applicable experience and education.Copy of an on-line 5-minute typing assessment that meets the 40-wpm qualification and clearly shows the length of the assessment.A list of at least three professional references with current telephone numbers.**To see a typing assessment that meets the requirements visit www.typing.com/student/tests. Select and take the 5-minute assessment. Take a screen shot of your result, save, and attach during the online application process. Please do not send a link. (Your application will be considered incomplete without this assessment.)Note: Applicants selected to move forward in the hiring process will be contacted by phone or email to schedule a skills assessment. Assessments are held in person at the L&I Headquarters Office location is Tumwater, WA. Please do not attach or place any medical information (vaccination status included) within the application, resume, or cover letter. If you do, we will have to reject your application to safeguard others from receiving your confidential information. You will have to remove the confidential information before you can apply again.To learn more about our hiring process timeline at L&I please visit our L&I recruiting page at Hiring Process at L&I. If you would like to read our website in a language other than English, scroll up to the top of the page to select your language of choice from the banner.Background Check Notice: Prior to a placement in this position, a background check, including criminal history record will be conducted. Information from your background check will not necessarily preclude employment but will be considered in determining your eligibility to perform the requirements of the position. Other informationFor positions requiring travel, you must have a valid unrestricted driver's license and have insurance if driving a privately owned vehicle on state business.This position is represented by the Washington Federation of State Employees (WFSE).Candidates who are offered a job with L&I must possess work authorization that does not require sponsorship by the employer for a visa now or in the future.The Department of Labor & Industries complies with the employment eligibility verification requirements of the federal employment eligibility verification form, I-9. The selected candidate must be able to provide proof of identity and eligibility to work in the United States consistent with the requirements of that form on the first day of employment.Please note: L&I may use this announcement to fill multiple permanent and/or non-permanent positions.Applicants selected to move forward in the hiring process will be contacted by phone or email to schedule a skills assessment. Assessments are held in person at the L&I Headquarters Office location is Tumwater, WA. Did You Know?Washington is America's Top State to live, play, and work, according to U.S. News (2021). Join the L&I team and enjoy all the Evergreen State has to offer.In addition to offering a positive balance between life and work, L&I provides one of the most competitive benefits packages in the nation. We also believe your voice matters. We value our employees and their work-life balance by encouraging flexible schedules. L&I is a diverse state agency dedicated to the safety and health and security of Washington's 3.8 million workers.Veterans PreferenceApplicants wishing to claim Veterans Preference should attach to their application a copy of their DD-214 (Member 4 copy), NGB 22, or signed verification of service letter from the United States Department of Veterans Affairs. Please blackout any personally identifiable data such as Social Security numbers. For further information, contact L&I’s Jobs@lni.wa.gov.Diversity, Equity, and Inclusion EmployerL&I employees come from all walks of life. We strive to hire great people from a wide variety of backgrounds. 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.We believe in the importance of recognizing the value each of us contributes to the success of the agency mission. Having a diverse workforce is this agency’s greatest source of strength and knowledge. It is through the combination of talents and abilities that we can pursue finding effective measures to provide the best customer service. We are committed to building a diverse and inclusive workplace for everyone and we strongly mean everyone.The State of Washington is an equal opportunity employer. Persons with a disability who need accommodation in the application process or testing process, or those needing this announcement in an alternative format, may call 360-902-5700. TTY users should first call 711 to access the Washington Relay Service.You are welcome to include the name and pronoun you would like to be referred to in your materials, and we will honor this as you interact with our award-winning diverse and inclusive organization.For more InformationIf you have any questions regarding this job posting, program, or the agency, please contact Angela Laramie at HRBTU@lni.wa.gov.

L&I Workers' Compensation Adjudicator 2/Claim Manager Apprentice

Care One Pharmacy Services

<p>Job Summary</p><p>The Adjudication Specialist is responsible for submitting and adjudicating third-party prescription claims in real time and resolving claim rejections or issues that impact timely billing and delivery of medications to long-term care (LTC) facilities. This role focuses on accurate claim processing, timely follow-up on denials and prior authorizations, effective communication with facilities, authorized representatives, and payers, and adherence to established policies, procedures, and payer requirements. The Adjudication Specialist plays a critical role in supporting revenue integrity, minimizing write-offs, and ensuring uninterrupted patient care.</p><p>Education &amp; Experience Requirements</p><p>&middot; High school diploma or equivalent required.</p><p>&middot; Prior experience in pharmacy adjudication, billing, or healthcare revenue cycle preferred.</p><p>&middot; Long-term care pharmacy experience strongly preferred.</p><p>&middot; Current State Pharmacy Technician license required.</p><p>&middot; Experience with FrameworkLTC preferred.</p><p>&middot; Strong attention to detail and accuracy.</p><p>&middot; Effective analytical and problem-solving skills.</p><p>&middot; Ability to manage multiple priorities in a fast-paced environment.</p><p>&middot; Strong written and verbal communication skills.</p><p>&middot; Professional, customer-focused demeanor.</p><p>&middot; Ability to work independently and collaboratively.</p><p>Essential Job FunctionsClaim Processing &amp; Adjudication</p><p>&middot; Review, submit, and adjudicate third-party prescription claims accurately and efficiently in real time.</p><p>&middot; Identify, troubleshoot, and resolve denied or rejected claims in a timely manner which may include outbound calls for resolution.</p><p>&middot; Work claims in accordance with established timelines, payer rules, and internal policies and procedures.</p><p>&middot; Initiate prior authorizations as required based on claim rejections, payer requirements, or medication criteria.</p><p>&middot; Follow up on pending prior authorizations with prescribers, facilities, and third-party payers to ensure timely resolution.</p><p>&middot; Rebill rejected or reversed claims throughout the shift as scheduled.</p><p>&middot; Run and work assigned reports, including Negative Margin Reports and other daily adjudication-related reports, as directed.</p><p>&middot; Provide facility price quotes as requested by staff at LTC facilities</p><p>&middot; Process new admissions throughout the day, verifying payer status to accurately determine medication quantities and appropriate days&rsquo; supply.</p><p>&middot; Any and all other duties as assigned by leadership team.</p><p>Communication &amp; Documentation</p><p>&middot; Communicate professionally and effectively with facility staff, residents, authorized representatives, powers of attorney, third-party payers, prescribers, and internal team members.</p><p>&middot; Correspond with designated facility staff regarding high-dollar medication approvals, prior authorizations, and adjudication-related issues.</p><p>&middot; Provide clear and timely updates to customers regarding claim status, delays in sending medications, prior authorization status.</p><p>&middot; Create and distribute communication memos regarding billing or adjudication issues to facility management and nursing staff when required.</p><p>&middot; Document claim activity, prior authorization status, payer communications, and facility-specific requirements accurately for follow-up and audit purposes.</p><p>&middot; Update reference materials as needed and share payer rule changes with teammates and management.</p><p>Workflow Support &amp; Prioritization</p><p>&middot; Work according to facility delivery schedules and prioritize claims to support on-time medication delivery.</p><p>&middot; Support preparation and expediting of STAT and urgent deliveries.</p><p>&middot; Assist other team members to maintain workflow and department productivity.</p><p>&middot; Demonstrate strong time-management, multitasking, and communication skills to effectively collaborate with team members, maintain workflow efficiency, and meet delivery deadlines.</p><p>Compliance &amp; Professional Standards</p><p>&middot; Follow established guidelines, payer-specific requirements, and facility-specific billing instructions.</p><p>&middot; Maintain an active State Pharmacy Technician license in good standing.</p><p>&middot; Obtain PTCB or ExCPT certification within 12 months of hire if newly licensed; ensure timely renewals if certified.</p><p>&middot; Adhere to all company&rsquo;s policies, procedures, and code of conduct.</p><p>Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time as needed.</p><p>Job Type: Full-time</p><p>Pay: $21.89 - $29.50 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li></ul><p>Application Question(s):</p><ul><li>Are you willing to work 1PM-9:30 PM CST with rotating weekends and holidays?</li></ul><p>License/Certification:</p><ul><li>Are you a licensed pharmacy technician? (Preferred)</li></ul><p>Shift availability:</p><ul><li>Night Shift (Preferred)</li></ul><p>Work Location: Remote</p>

Adjudication Specialist (1PM- 9:30 PM CST, ROTATING WEEKENDS/HOLIDAYS )

Moda Health

<div><p><b>Let&rsquo;s do great things, together!</b></p><p><b>
About Moda</b><br>
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let&rsquo;s be better together.</p><p><b><br>
Position Summary</b><br>
Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims. Answer internal questions from various departments and respond to correspondence from providers when necessary. <b>This is a FT WFH role.</b><br>
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<b>Pay Range</b><br>
$21.30 - $23.96 hourly (depending on experience) *Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.</p><p><b><br>
Please fill out an application on our company page, linked below, to be considered for this position.</b></p><p>
https://j.brt.mv/jb.do?reqGK=27772651&amp;refresh=true</p><p><b><br>
Benefits</b><b>:</b></p><ul><li>
Medical, Dental, Vision, Pharmacy, Life, &amp; Disability</li><li>
401K- Matching</li><li>
FSA</li><li>
Employee Assistance Program</li><li>
PTO and Company Paid Holidays</li></ul><p></p><p><b><br>
Required Skills, Experience &amp; Education:</b></p><ul><li>
High School diploma or equivalent.</li><li>
1-2 years medical claims processing experience.</li><li>
10-key proficiency of 135 wpm.</li><li>
Type a minimum of 35 wpm.</li><li>
Knowledge of medical terminology, CPT codes and ICD-10 codes.</li><li>
Strong verbal, written, and interpersonal communication skills.</li><li>
Analytical, problem solving and organizational skills.</li><li>
Ability to work well under pressure.</li><li>
Maintain confidentiality and project a professional business image</li><li>
Ability to maintain balanced performance in areas of production and quality.</li></ul><p><b><br>
Primary Functions</b><b>:</b></p><ul><li>
Review, process and adjust Commercial and Medicaid inpatient claims.
</li><li>Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.</li><li>
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
</li><li>Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS).
</li><li>Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
</li><li>Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
</li><li>Contact providers and other outside sources for additional information.</li><li>
Adjudicate claims to achieve quality and production standards applicable to the position.</li><li>
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.</li><li>
Review Policy and Procedures (P&amp;P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.</li><li>
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.</li><li>
Perform other duties as assigned.</li></ul><p><b><br>
Working Conditions &amp; Contact with Others</b></p><ul><li>
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.</li><li>
Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.</li></ul><p><b><br>
Together, we can be more. We can be better.</b><br>
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Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.<br>
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For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.</p></div>

Inpatient Claims Processor I

Delta Dental

<div><div><b>About Us</b></div><div></div><div><br>
Delta Dental of New Jersey and Delta Dental of Connecticut are proud to be leaders in the dental insurance industry, offering a wide range of plans to meet the needs of individuals and employers alike. As New Jersey&rsquo;s largest dental coverage provider, we are committed to delivering high-quality, cost-effective solutions designed to meet the diverse needs of our customers and our team is growing.</div><div></div><div><br>
In Connecticut, Delta Dental of Connecticut, Inc. provides fully insured dental coverage, while Delta Dental of New Jersey administers self-funded dental benefit programs. We proudly serve over 1.7 million individuals through more than 1,800 groups, including commercial, school board, and government programs.</div><div></div><div><br>
Since 1969, Delta Dental has been at the forefront of innovation, offering programs that control costs while ensuring the highest level of benefits.</div><div></div><div><br>
As a member of the national Delta Dental Plans Association, we provide national dental coverage to over 75 million people across 139,000 groups. Our commitment to excellence is reflected in our prestigious Standard &amp; Poor&rsquo;s &ldquo;A+&rdquo; rating for financial strength. Join us and be a part of a trusted company with a rich history of delivering quality dental benefits to millions.</div><div>
We value our associates and support everyone with learning and development, active wellness and diversity initiatives, and volunteer opportunities at causes that you care about.</div><div></div><div><b><br>
About the Position</b></div><div></div><div><br>
Our Claims Examiners are provided with established company guidelines and examine and adjudicate dental claims using these guidelines, with expected levels of quality and productivity.</div><div></div><div><br>
During the first five weeks of employment, you will participate in full‑time, paid training conducted in the office five days per week, Monday through Friday, from 8:30 a.m. to 4:30 p.m. Following the completion of training, this role will transition to a full‑time, hybrid schedule working Monday through Friday from 8:00 a.m. to 4:30 p.m., with in‑office days on Tuesday and Wednesday and remote work on Monday, Thursday, and Friday. This position starts at $22.05 per hour and is benefits-eligible.</div><div></div><p><br>
The expected Start date for this position is April 20th, 2026.</p><div></div><div><b><br>
Essential Functions &amp; Responsibilities</b></div><div><ul><li>
Accesses systems and keys claim data and other information and notations from work queues. Suspends, routes and adjudicates claims and performs research as required. Also, inputs fee filing data, as required</li></ul></div><div><ul><li>
Creates and processes claims for pre-treatment estimates with payments.</li></ul></div><div><ul><li>
Maintains and updates subscribers files with information obtained through inquiries and submitted claims and documents, i.e., family on hold codes applied or removed, student status deferred, addresses updated. Reports file discrepancies to management.</li></ul></div><div><ul><li>
Responsible for researching and retrieving all documentation and resolving all claims in question, including student documentation, provider research, some coordination of benefits, diagnostics materials, etc.</li></ul></div><div><ul><li>
Understands rejects and applies appropriate RFS codes as well as processing policies on applicable claims.</li></ul></div><div><ul><li>
Requests information from providers and subscribers through telephone contact or written correspondence.</li></ul></div><div><ul><li>
Resolves claims related system generated error and adjustment reports.</li></ul></div><div><ul><li>
Supports and participates in completing claims related projects.</li></ul></div><div><ul><li>
Acquire necessary skills through in-house training for Claim Examiner II position. Achieve Level II position within 36 months from start of Claims Examiner I.</li></ul></div><div><ul><li>
When necessary, refers inquiries to management, dental consultants or appropriate outside organizations.</li></ul></div><div><ul><li>
Provides management with required production figures as requested.</li></ul></div><div><ul><li>
Other duties as assigned</li></ul></div><div></div><div><b><br>
Essential Qualifications</b></div><div></div><div><b><br>
Competencies</b></div><div></div><div><div><div><br>
Adaptability-Flexibility</div><div><br>
Communication Skills</div></div><div><div><br>
Computer Skills</div><div><br>
Customer Focus</div></div><div><div><br>
Dependability</div><div><br>
Job Knowledge</div></div><div><div><br>
Productivity</div><div><br>
Quality</div></div><div><div><br>
Teamwork</div></div></div><div></div><div><b><br>
Technical and Functional</b></div><ul><li>
Personal computer skills with the ability to type 25 words per minute</li><li>
Possess the ability to use Microsoft Word and Excel</li><li>
Excellent written and oral communication skills</li><li>
Ability to research and troubleshoot problems</li><li>
Demonstrate good analytical and proofreading skills</li><li>
Attention to detail</li><li>
Good organizational skills</li></ul><div><b>
Key Performance Indicators</b></div><ul><li>
Meet-exceed CPH of 30 or above</li><li>
Maintain TQM of 99% or higher</li></ul><div><b>
Required Physical Abilities</b></div><div>
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div><br>
<div></div><ul><li>
Ability to sit and perform extensive close keyboard and PC work</li><li>
Ability to walk, talk or hear</li><li>
Occasionally required to stand and reach with hands and arms</li></ul><div><b>
Working Environment</b></div><ul><li>
Ability to meet deadlines and attendance standards.</li><li>
The noise level in the work environment is usually moderate.</li><li>
This classification will be required to sign a confidentiality agreement.</li></ul><div></div><div><b><br>
Experience, Education and Certifications Required</b></div><div></div><div><b><br>
Experience Required</b></div><ul><li>
1-3 years claims processing or related service experience</li><li>
Dental Assistant education/experience preferred</li></ul><div><b>
Required Educational Level</b></div><div><ul><li>
Requires high school diploma or equivalent.</li></ul></div></div>

Claims Examiner

Staffing Now

<div>
 <p>
  SNI Companies has partnered with an amazing organization in North Austin for a unique role as a
  <strong>
   Mechanical Claims Specialist!
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  Combine your Administrative support, Mechanical and Customer Service skills with the ability to handle a volume of inbound calls, multi-tasking ability and technical skills in this fast-paced fulltime role with growth potential, benefits and incentives.
 </p>
 <p>
  In this role you will be processing and adjudicating automotive mechanical claims in a professional environment.
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   Minimum 1-2 years of Mechanical Claims experience in a call center environment or relevant field
  </li>
 </ul>
 <p>
  <strong>
   <u>
    Essential Job Functions:
   </u>
  </strong>
 </p>
 <ul>
  <li>
   Complete and finalize initial claim reports submitted by service writers/advisors, their representatives, or directly from contract owners to complete the adjudication process.
  </li>
  <li>
   Properly, efficiently, and accurately document loss report by establishing part and labor costs by utilizing approved pricing standards and/or labor and parts guides.
  </li>
  <li>
   Properly manage and maintain claim loss reports to ensure files are being settled and closed.
  </li>
  <li>
   Provide claim information/status to existing open or pending claims and communicate updates to service advisors
  </li>
 </ul>
 <p>
  <strong>
   <u>
    Why work here:
   </u>
  </strong>
 </p>
 <ul>
  <li>
   Amazing leadership team!
  </li>
  <li>
   Small training classes with personal one on one attention and group training by a seasoned and experienced coach and trainer.
  </li>
  <li>
   Fully equipped breakroom with beverages, breakfast, lunch and dinner options available to all employees
  </li>
  <li>
   Friendly and fun environment with excellent employee culture
  </li>
  <li>
   GROWTH potential
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <em>
   Apply today for immediate consideration!
  </em>
 </p>
</div>


Service Advisor

Naphcare, Inc.

<div>Overview:
<div><b>
NaphCare</b> has an excellent opportunity for a <b>Claims Consolidation Specialist</b> to join our <b>Corporate Headquarters</b> in <b>Birmingham, AL</b>.</div><div></div><div><br>
NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 36 years. Come join our team of over 7000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.</div><div></div><p><br>
NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system</p><p></p><p><b><br>
NaphCare Benefits for Full-Time Employees Include:</b></p><ul><li><b>
Prescriptions free of charge</b> through our health plan</li><li>
Health, dental &amp; vision insurance that <b>starts day one</b>!</li><li>
Lowest Cost Benefits! <b>$44 for single, $105 for family!</b></li><li>
Employment Assistance Program (EAP) services</li><li>
401K and Roth with company contribution that <b>starts day one!</b></li><li>
Tuition Assistance</li><li>
Referral bonuses</li><li>
On-site education</li><li>
Free Continuing Education!</li><li>
Term life insurance at no cost to the employee</li><li>
Generous paid time off &amp; paid holidays</li></ul><p>
NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up to date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing.</p><p></p><div><br>
With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.</div><div></div><div><br>
We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.</div>
Responsibilities:
<p><b>
Responsibilities for</b> <b>Claims Consolidation Specialist:</b></p><br>
<p></p><ul><li>
Review authorization and Medical Records in order to identify services rendered and expected claims.</li><li>
Utilize medical terminology knowledge to review medical records and authorization scenarios.</li><li>
Develop and maintain provider billing contacts to pursue claims for all authorizations.</li><li>
Properly organize and designate claims as &ldquo;ready-to-bill&rdquo; and distribute to appropriate NaphCare sites.</li><li>
Receive statements and ensure that authorizations have been loaded to match the corresponding statements.</li><li>
Demonstrate an ability to prioritize, meet deadlines, and multitask while promoting efficiency and effectiveness within daily workload.</li><li>
Exhibit a high comfort level in working with large volumes of data.</li><li>
Demonstrate a strong attention to detail and a commitment to customer service throughout the claims process.</li><li>
Additional duties and specific projects as assigned.</li></ul>
Qualifications:
<p><b>
Qualifications for</b> <b>Claims Consolidation Specialist:</b></p><br>
<p></p><ul><li>
Associate's degree or higher or equivalent work experience.</li><li>
Minimum of two (2) years of recent experience in claims processing and/or medical records review.</li><li>
Working knowledge of medical terminology and medical billing.</li><li>
Specific experience working with UBs and 1500s is preferred.</li><li>
Medical billing, claims processing/adjudication, medical records review, and/or coding experience preferred.</li><li>
Proficiency in Microsoft Office Suite and strong written and verbal communication skills are also required.</li></ul><div>
We know you may have questions before applying. <b>To speak to a recruiter directly, email your questions and/or resume to</b> <b>CorporateHR@naphcare.com</b> <b>with the position and location you&rsquo;re interested in.</b></div><div></div><div><i><br>
Equal Opportunity Employer: disability/veteran</i></div></div>

Claims Consolidation Specialist

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