claims adjudicator

State of Idaho

<p></p><div><h4 class="jobSectionHeader"><b>State of Idaho Career Opportunity<br>
</b></h4><p></p><br>
<p><b>Applications will be accepted through 11:59 PM MST on the posting end date.<br>
</b><br>
</p><p></p><p>The mission of the Idaho Department of Labor is to support individuals through career transitions, determine benefit eligibility, connect employers with workers and oversee tax and labor law compliance.
</p><p>The UI Compliance Bureau has an exciting opportunity for multiple full-time UI Claims Adjudicator positions on the Benefit Discovery and Recovery team. The UI Claims Adjudicator is instrumental in identifying, investigating, and prosecuting fraudulent activity. The ideal candidates will have an analytical approach to problem solving, excellent communication skills, attention to detail, and ability to work independently and on a team.
</p><p><b><i>*The location of these positions will be determined upon selection of the successful candidates.
</i></b></p><p><b>For questions regarding this position, please contact Daniel Hernandez-Ortiz ( </b><b>Daniel.hernandez-ortiz@labor.idaho.gov </b><b>)
</b></p><p><b>The applicant who is selected for this position will be required to pass a background check.
</b></p><p><b><i>Applicants must be authorized to work for any employer in the United States. The Idaho Department of Labor is unable to sponsor or assume sponsorship of an employment visa.
</i></b></p><p><b><i>Candidates who are fluent in both spoken and written English and Spanish are encouraged to apply, but it is not a requirement for this position.<br>
</i></b></p><p><br>
<b>Example of Duties:<br>
</b><br>
</p><ul><li>Conduct in-depth fact-finding interviews with claimants, employers and other interested parties.
</li><li>Record personal and eligibility information.
</li><li>Analyze documents, evidence and statements provided by interested parties.
</li><li>Determine eligibility for programs, services or benefits by applying laws, regulations, policies and precedents.
</li><li>Issue written eligibility determinations.
</li><li>Authorize continued payment of UI benefits.
</li><li>Prepare for and participate in administrative or legal hearings and provide testimony as an expert witness.
</li></ul><p></p><p><b>Minimum Qualifications </b><b>- You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume and/or work history to your application. Your resume and/or work history must clearly reflect how you meet the minimum qualifications for this position. Failure to provide this information may disqualify you from being considered for this position.
</b></p><p><b>Good knowledge of:<br>
</b><br>
</p><ul><li><b>I </b><b>daho and Federal statutes, regulations and policies pertaining to Unemployment Insurance benefits. </b>Typically gained by at least three months experience understanding and applying statutes, regulations and policies related to Unemployment Insurance benefits.
</li></ul><p></p><p><b>Experience:<br>
</b><br>
</p><ul><li><b>Assisting emotional, difficult or confrontational individuals from varying socio/economic/cultural backgrounds </b><b>. </b>Typically gained by at least one year of work experience assisting emotional, difficult or confrontational people.
</li><li><b>Conducting in-depth fact-finding interviews and documenting findings. </b>Typically gained by with one to two years of work experience interviewing others and documenting findings.
</li><li><b>Interpreting and applying regulations or policies and explaining them to others. </b>Typically gained by one to two years of work experience interpreting and applying regulations or policies and explaining them to others.
</li><li><b>Determining eligibility for programs and preparing written eligibility decisions. </b>Typically gained by one to two years of work experience determining eligibility or qualifications for programs and services, and written decisions.
</li><li><b>Preparing written communication. </b>Typically gained by one to two years of work experience preparing formal written communications, including creation of letters, memos and other correspondence.
</li><li><b>Performing data input and retrieval within Unemployment Insurance computer programs. </b>Typically gained by three to six months of experience performing data input and retrieval within UI computer programs.
</li></ul><p><b>Benefits:
</b></p><p></p><p><b>The State of Idaho offers a robust total compensation and benefits package, including but not limited to:
</b></p><p></p><ul><li>O ne of the top 5 retirement systems in the Nation ( PERSI ) that offers a defined lifetime benefit at retirement
</li><li>2 voluntary supplemental retirement plans including both pre-tax and Roth options
</li><li>Medical, vision and dental benefits that become effective first of the month following your hire date. All contributions can be pre-tax
</li><li>11 paid holidays Paid sick and vacation that begins accruing on your first day of employment; can be used immediately after accruing (no waiting time)
</li><li>Paid Parental Leave
</li><li>Life insurance for self, spouse, and children
</li><li>Additional perks and discounts available through medical provider
 </li><li>Public Service Loan Forgiveness (PSLF) Eligibility
</li><li>Employee Assistance Program
</li></ul><p></p><p><b>EEO/ADA/Veteran:
</b></p><p>The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.<br>
<br>
</p><p>The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email ada.coordinator@dhr.idaho.gov.
</p><p>Preference may be given to veterans who qualify under state and federal laws and regulations.</p></div>

UI CLAIMS ADJUDICATOR

Infosys

<div><p><b>Warranty Claims Adjudicator</b><br>
<b>Operations Manager</b><br>
<br>
We are seeking a meticulous and detail-oriented Warranty Claims processing adjudicator to join our team in back-office operations. The primary responsibility of this role is to validate and approve warranty claims submitted by dealers globally. The ideal candidate will possess strong analytical skills, a deep understanding on Automobiles/heavy earth moving and equipment machinery and the ability to ensure adherence to warranty policies and guidelines.<br>
<br>
<b>Responsibilities</b><br>
</p><ul><li>Valid Property and Causality adjuster license for handling insurance claims for all 50 states (USA) should have at least licenses for Min states and should be able to get for rest as per requirement.</li><li>
Review and analyze warranty claims submitted by dealers, and service centers for accuracy, completeness and compliance with warranty policies</li><li>
Working knowledge on Automobiles/heavy earth moving and equipment machinery.</li><li>
Verify the authenticity of claims by examining repair orders, service records, and supporting documentation.</li><li>
Collaborate with technicians, engineers, and other stakeholders on a need basis to understand technical aspects of claims and ensure accurate assessment.</li><li>
Evaluate warranty claims against established criteria and guidelines to determine eligibility for coverage.</li><li>
Make decisions on approving or deferring warranty claims based on findings and analysis.</li><li>
Document findings, decisions and actions taken in the claims management system or database.</li><li>
Communicate with stakeholders, including dealers, and internal teams, customer service Manager (CSM) regarding claim status, decisions and additional information required.</li><li>
On a necessary basis provide support and guidance to dealers and service centers on warranty claim submission processes and requirements.</li><li>
Identify trends or recurring issues in warranty claims and collaborate with relevant teams to address root causes.</li></ul><br>
<b>
Basic Requirements</b><ul><li>
Bachelor&rsquo;s Degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of education.</li><li>
Minimum 7 years of experience related to the job description.</li></ul><br>
<b>
Preferred Requirements
</b><br>
<ul><li>Should have 7+ years experience in managing Property and Casualty Insurance Claims adjuster (preferably experienced with heavy construction machinery) and Warranty claims administration.</li><li>
Proven experience in warranty claims validation or a similar role within the heavy construction machinery industry.</li><li>
Strong technical knowledge of automotive systems, components, and repair processes.</li><li>
Excellent analytical and problem-solving skills with acute attention to detail.</li><li>
Ability to interpret technical documentation, service manuals and repair procedures.</li><li>
Familiarity with warranty policies, terms, and conditions applicable to automotive products.</li><li>
Proficient in using claims management systems or databases.</li><li>
Effective communication skills with the ability to interact professionally with stakeholders at all levels.</li><li>
Strong organizational skills with the ability to manage multiple tasks and priorities effectively.</li><li>
Ability to scrutinize and detect the anomalous claims.</li><li>
Well versed in MS office.</li></ul><p><b><br>
About Us</b><br>
<br>
<b>Who We Are</b><br>
Infosys BPM Limited, a wholly owned subsidiary of Infosys Limited (NYSE: INFY), provides end-to-end transformative business process management (BPM) services for its clients across the globe. The company&rsquo;s integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering, automation, and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.<br>
<br>
Infosys BPM has 38 delivery centers in 13 countries spread across 5 continents, with 60,966 employees from 104 nationalities, as of September, 2025.<br>
<br>
The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years. The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices. The company&rsquo;s senior leaders contribute widely to industry forums as BPM strategists.<br>
<br>
<b>EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin</b><br>
<b>Infosys is an equal opportunity employer, and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability.</b></p></div>

Warranty Claims Adjudicator

Capital Region ESD 113

<div><p><b>Senior Claims Adjudicator</b></p><p><b>
Best to apply by 4/18/2026. Job open until filled.</b></p><p>
This position is 260 days/year, 8 hours/day. Work calendar is Monday- Friday.</p><p>
Benefits include: Medical/Vision/Dental Insurance; FSA/DCAP; Life/AD&amp;D Insurance; LTD Insurance; EAP; Retirement; DCP; Annual/Sick Leave, Holiday Pay and Personal Leave.</p><p><b>
Required attachments: Transcript, Resume and Cover Letter</b></p><p><b>
Please see the job description below for a list of Essential Functions</b>.</p><h3 class="jobSectionHeader"><b>
Purpose Statement</b></h3><p>
The job of Senior Claims Adjudicator is done for the purpose/s of evaluating eligibility and processing workers compensation claims in compliance with WCT and state regulations; documenting actions; conveying information regarding claims and benefits; providing testimony as may be required in benefit disputes and acts in the capacity of Claims Administrator as directed in that person's absence; and operating relatively autonomously in bringing claims to closure.</p><p>
This job is distinguished from similar jobs by the following characteristics: Per the essential functions and educational requirements listed below.</p><p>
This job reports to Workers' Compensation Claims Administrator</p><h3 class="jobSectionHeader"><b>
Essential Functions</b></h3><p><b>
Claims Adjudication</b> Adjudicates worker compensation and related benefit claims (e.g. validity, compensation amount, medical aid benefits, closure of claims, etc.) for the purpose of ensuring fair and thorough treatment of claims while complying with district, state, and federal policies and regulations.</p><p><b>
Claims Analysis</b> Analyzes a variety of claims-related information and processes (e.g. workers compensation claim status, litigation and sidebar cost, benefit eligibility, etc.) for the purpose of determining exposure, identifying high cost areas, and developing plans for remediation.</p><p><b>
Meeting Attendance</b> Attends a variety of meetings (e.g. legal training on compensation and related benefits disputes, seminars, conferences, continuing education courses in workers' compensation, etc.) for the purpose of ensuring information is shared and received.</p><p><b>
Stakeholder Collaboration</b> Collaborates with a variety of stakeholders (e.g. other staff, ESD 113 Safety &amp; Health team, defense counsel, etc.) for the purpose of developing solutions to resolve concerns while meeting the goals of the program.</p><p><b>
Record Maintenance</b> Maintains worker compensation files and records for the purpose of documenting actions and ensuring compliance with district policies, and state and federal regulations.</p><p><b>
Document Preparation</b> Prepares a variety of information, documents, and files (e.g. statistical summaries, evaluations, reports to excess carrier, written summaries, etc.) for the purpose of providing information and documenting activities.</p><p><b>
Information Processing</b> Processes a variety of complex information (e.g. employability assessments, claims information required, conservatory procedures, legal files going to legal authorities, etc.) for the purpose of ensuring employees are treated fairly while complying with district, state, and federal policies and regulations.</p><p><b>
Attendance</b> Regular and reliable attendance is required for the purpose of maintaining department operations.</p><p><b>
Trust Representation</b> Represents the trust in a variety of situations (e.g. in mediation at the Board of Industrial Insurance Appeals, etc.) for the purpose of providing accurate and responsible representation of the trust.</p><p><b>
Research</b> Researches a variety of work-related topics (e.g. relevant policies, current practices, claims data, changing federal requirements, etc.) for the purpose of providing information and recommendations to the district.</p><p><b>
Inquiry Response</b> Responds to inquiries from a variety of stakeholders regarding worker compensation and employee benefits (e.g. employees, regulatory personnel, insurance companies, etc.) for the purpose of facilitating communication among parties and providing information and direction.</p><p><b>
Order Review</b> Reviews determinative orders for the purpose of ensuring the accurate representation of the Trust's interpretation of the facts of a claim and appropriate actions taken as warranted.</p><p><b>
Training</b> Trains claims adjudicators for the purpose of providing orientation for new claims adjudicators and encouraging the development of professional skills.</p><h3 class="jobSectionHeader"><b>
Marginal Functions</b></h3><p><b>
Personnel Assistance</b> Assists other personnel as may be required for the purpose of supporting them in the completion of their work activities.</p><p><b>
Related Duties</b> Performs other related duties as assigned for the purpose of ensuring the efficient and effective functioning of the work unit.</p><h2 class="jobSectionHeader"><b>
Job Requirements: Minimum Qualifications</b></h2><h3 class="jobSectionHeader"><b>
Skills, Knowledge and Abilities</b></h3><p><b>
Skills Required</b> Skills are required to perform single, technical tasks with a need to occasionally upgrade skills in order to meet changing job conditions. Specific skill based competencies required to satisfactorily perform the functions of the job include: operating standard office equipment including pertinent software applications; and preparing and maintaining accurate records.</p><p><b>
Knowledge Required</b> Knowledge is required to perform basic math, including calculations using fractions, percents, and/or ratios; read technical information, compose a variety of documents, and/or facilitate group discussions; and solve practical problems. Specific knowledge based competencies required to satisfactorily perform the functions of the job include: worker compensation programs; state and federal worker compensation regulations and laws; medical and legal terminology related to worker compensation; industrial insurance laws, medical aid rules, fee schedules, and appeals procedures; and basic anatomy and physiology.</p><p><b>
Abilities Required</b> Ability is required to schedule a number of activities, meetings, and/or events; routinely gather, collate, and/or classify data; and consider a number of factors when using equipment. Flexibility is required to independently work with others in a wide variety of circumstances; analyze data utilizing a variety of complex processes; and operate equipment using a variety of standardized methods. Ability is also required to work with a significant diversity of individuals and/or groups; work with data of widely varied types and/or purposes; and utilize a variety of job-related equipment. Problem solving is required to analyze issues and create action plans. Problem solving with data requires analysis based on organizational objectives; and problem solving with equipment is moderate.</p><p>
Specific ability based competencies required to satisfactorily perform the functions of the job include: communicating with diverse groups; working with frequent interruptions; working with detailed information; maintaining confidentiality; establishing effective relationships; adapting to changing work priorities; thinking analytically and critically; and willing to travel throughout the Worker Compensation Trust service area.</p><h3 class="jobSectionHeader"><b>
Responsibility</b></h3><p>
Responsibilities include: working under limited supervision using standardized practices and/or methods; directing other persons within a small work unit; monitoring budget expenditures. Utilization of resources from other work units may be required to perform the job's functions. There is some opportunity to impact the organization's services.</p><h3 class="jobSectionHeader"><b>
Work Environment</b></h3><p>
The usual and customary methods of performing the job's functions require the following physical demands: occasional lifting, carrying, pushing, and/or pulling, some stooping, kneeling, crouching, and/or crawling and significant fine finger dexterity. Generally the job requires 85% sitting, 5% walking, and 10% standing. This job is performed in a generally clean and healthy environment.</p><h3 class="jobSectionHeader"><b>
Education and Experience Requirements</b></h3><p><b>
Experience:</b> Job related experience with increasing levels of responsibility is required.</p><p><b>
Education (Minimum):</b> High school diploma or equivalent.</p><p><b>
Equivalency:</b> AA degree and 5 years' experience in claims adjudication is preferred, though may be waived in lieu of nay combination of education and experience that provides the required knowledge, skills, and abilities of the position. Must hold a valid WA State Self-Insured Claims Administrator certification, per WAC 296-15-360.</p><h3 class="jobSectionHeader"><b>
Position Information</b></h3><p><b>
FLSA Status:</b> Non Exempt</p><p><b>
Salary Grade:</b> 56</p><h3 class="jobSectionHeader"><b>
Required Testing, Certificates and Licenses</b></h3><p><b>
Required Testing:</b></p><ul><li>
None Specified</li></ul><p><b>
Certificates and Licenses:</b></p><ul><li>
Valid Driver's License and Evidence of Insurability</li><li>
Valid WA State Self-Insurance Certification at time of hire or promotion</li></ul><p><b>
Continuing Education and Training:</b></p><ul><li>
Maintains Certificates and/or Licenses</li><li>
Recertification test every 5 years</li></ul><p><b>
Clearances:</b></p><ul><li>
Criminal Justice Fingerprint/Background Clearance</li><li>
WA State Sexual Misconduct Disclosure Release</li></ul><p></p><p><i><br>
Capital Region ESD 113 is an Equal Opportunity Employer</i></p></div>

ESD 113-Senior Claims Adjudicator-Workers Compensation

State of Washington

<div><div><div><h2 class="jobSectionHeader"><b>Description</b></h2></div>
<p></p><div><p><b>Our Mission: </b>Keep Washington Safe and Working!<br>
<b> Our Values: </b>Customer Focus, One L&amp;I, Respect, Diversity, Equity and Inclusion, Learning and Growth, Reliability</p><p><b>
Make a real difference for injured workers when they need it most.</b></p><p>
When someone is injured on the job, the workers&rsquo; compensation system can feel overwhelming, frustrating, and at times, unfair. That&rsquo;s where you come in.</p><p>
As an <b>Ombuds Assistant</b>, you won&rsquo;t just manage claims, you&rsquo;ll advocate, investigate, and help resolve complex issues for injured workers navigating the self-insured system. You&rsquo;ll be a trusted voice for people and help bring clarity, fairness, and resolution to concerns.</p><p>
This is not a traditional claims role.</p><p>
You&rsquo;ll bring your claims expertise, but apply it in a way that is:</p><ul><li><b>
People-centered</b> &ndash; working with individuals who are often frustrated, emotional, or facing hardship</li><li><b>
Impartial and fair</b> &ndash; balancing the needs of all parties while ensuring compliance with the law</li><li><b>
Solution-driven</b> &ndash; resolving issues, not just processing them</li></ul><p>
We&rsquo;re looking for someone who leads with:</p><ul><li>
Compassion and patience</li><li>
Active listening and empathy</li><li>
Strong judgment and professionalism</li></ul><p>
This role is ideal for someone who knows workers&rsquo; comp inside and out but is ready to step beyond traditional claims management and into true advocacy work.</p><p>
Work-life balance is a priority at L&amp;I. We support a hybrid work model and offer flexible work schedules which may include 4/10&rsquo;s, 9/80&rsquo;s or 5/8&rsquo;s. This position is primarily telework but may require in-office presence in Tacoma, Washington. Employees will be responsible for travel and expense from their residence to their assigned office and on their personal time.</p><p>
We offer great benefits which include paid leave, tuition imbursement, infants at work, generous retirement package and much more. Select on the &ldquo;Benefits&rdquo; tab to learn more.</p><p>
L&amp;I is a diverse state agency dedicated to the safety, health, and security of Washington's workers. We strive to hire people with a wide variety of backgrounds in life and work experience. Take a look at this brief video and learn more about why L&amp;I is an employer of choice.</p></div><p></p>
<div><h2 class="jobSectionHeader"><b>Duties</b></h2></div>
<p></p><div><p><b>Some of what you&rsquo;ll do:</b></p><p>
You&rsquo;ll operate as a senior-level resource and problem-solver, working across stakeholders to ensure fair outcomes:</p><ul><li>
Advocate for injured workers to ensure they receive the benefits they&rsquo;re entitled to under Washington&rsquo;s workers&rsquo; compensation laws</li><li>
Investigate complaints and concerns with objectivity, urgency, and attention to detail</li><li>
Analyze complex claims (including wage calculations, permanent disability, and death benefits) and make independent determinations</li><li>
Mediate and resolve disputes between injured workers, employers, third-party administrators, attorneys, and providers</li><li>
Guide and influence claims practices by working collaboratively with internal teams and external partners</li><li>
Document and track cases in agency systems, identifying patterns and opportunities for systemic improvement</li><li>
Step in as a program resource providing mentorship, guidance, and operational support when needed</li><li>
And much more!</li></ul></div><p></p>
<div><h2 class="jobSectionHeader"><b>Qualifications</b></h2></div>
<p></p><div><p><b>Required:</b></p><ul><li>
A total of <b>8 years combined education and/or experience*</b>.</li></ul><ul><li><i>Experience is defined as adjudication of time loss workers&rsquo; compensation claims; or additional experience working with insurance claims, claims/insurance adjusting, claims investigations, disability management, claims risk management/loss control, medical billing, medical insurance, paralegal personal injury services.</i> This may look like the following:</li></ul><ul><li>
Successful completion of the Department of Labor and Industries Workers&rsquo; Compensation Adjudicator 2 Apprenticeship program <b>and one year</b> of experience as a Workers Compensation Adjudicator 4</li></ul><p>
OR</p><ul><li>
Bachelor&rsquo;s degree from an accredited college or university <b>and four years</b> of experience*</li></ul><p>
OR</p><ul><li>
Associate&rsquo;s degree <b>and six years</b> of experience*</li></ul><p>
AND</p><ul><li>
Comprehensive knowledge of RCW, WAC, case law, and ability to apply and explain WA industrial insurance rules, policies and procedures.</li><li>
Strong non-verbal, verbal and written communication skills. Must have good listening skills and ability to demonstrate patience, objectivity, and empathy, especially when dealing with an upset customer during a difficult situation.</li><li>
Ability to learn new systems, including Self-Insurance Ombuds Database (SIOD), LINIIS, ORION and standard Microsoft programs (Outlook, Excel, Word, PowerPoint).</li><li>
Strong problem resolution and analytical skills; ability to know when to escalate complex cases to the appropriate level within the organization.</li><li>
The ability to take action to learn and grow.</li><li>
The ability to take action to meet the needs of others.</li></ul><p><b>
Desired:</b></p><ul><li>
Prior experience with Self-Insurance</li><li>
Prior experience in advocacy roles</li><li>
Prior experience with mediation or alternative dispute resolution</li></ul><p>
Every case you handle represents a real person trying to navigate a difficult situation. Your ability to listen, understand, and act can directly impact someone&rsquo;s financial stability, health, and trust in the system.</p><p><b>
If you&rsquo;re ready to use your expertise to advocate, not just adjudicate, this is the role for you.</b></p></div><p></p>
<div><h2 class="jobSectionHeader"><b>Supplemental Information</b></h2></div>
<p></p><div><p><b>Application process</b></p><p>
Complete the online application and attach the following documents. Your application may be considered incomplete if you do not include the following:</p><ul><li>
A cover letter describing your experience, skills and contributions you will bring to this role.</li><li>
A current resume detailing applicable experience and education.</li></ul><ul><li>
A list of at least three professional references with current telephone numbers.</li></ul><p>
Do not attach or place any medical information in the application, resume, or cover letter. If you do, we must reject your application to safeguard others from receiving your confidential information. You must remove the confidential information before you can apply again.</p><p>
For top candidates, references will not be checked without a release form.</p><p>
Learn more about our hiring process on L&amp;I&rsquo;s website.</p><p>
If you need an accommodation for the application or hiring process, please call 360-902-5700. TTY users should first call 711 to access the Washington Relay Service.</p><p>
L&amp;I is an equal opportunity employer and doesn&rsquo;t discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, pregnancy, national origin, genetics, disability, age or veteran status.</p><p><b>
Background Check Notice</b></p><p>
Prior to placement in a position at L&amp;I, a background check, including criminal history record will be conducted. The results might not disqualify candidates. L&amp;I understands some situations may require further explanation. In these situations, candidates will have the opportunity to talk with the L&amp;I Assistant Director of the Office of Human Resources.</p><p><b>
Other information</b></p><ul><li>
This is a union represented position, covered by<b> </b>the<b> </b>Washington Federation of State Employees (WFSE) contract.</li><li>
Candidates who are offered a job with L&amp;I must possess work authorization that does not require sponsorship by the employer for a visa now or in the future.</li><li>
L&amp;I 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.</li><li>
L&amp;I may use this announcement to fill multiple permanent and/or non-permanent positions.</li></ul><p><b>
Veterans Preference</b></p><p></p><p><br>
Applicants 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&amp;I&rsquo;s Talent team.</p><p><b>
For more Information</b></p><p>
If you have any questions regarding this job posting, program, or the agency, please contactLori Hensin at lori235@lni.wa.gov.</p><p>
To receive more information on opportunities at L&amp;I sign up for GovDelivery and select L&amp;I job alerts.</p></div></div></div><p></p>

L&I Worker’s Compensation Self-Insurance Ombuds Assistant (WCA5)

Blue Cross Blue Shield of Wyoming

<div><h1 class="jobSectionHeader"><b>Deep Roots. Solid Growth. Caring People.
</b></h1><p></p><p><b>Rooted in Wyoming!</b> We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming.
</p><p></p><p><b>Our Vision:</b> We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve.</p><p></p><p><b>
Our Mission:</b> provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home.</p><p></p><p><b>
If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill:</b></p><p></p><p>
Claims Specialist</p><p></p><p>
If you are a passionate and detail-oriented professional looking to make a difference in the community, apply to be a BCBSWY Claims Specialist today.</p><p></p><p>
As a claims adjudicator you will be responsible for reviewing, assessing, and processing health plan claims to ensure accuracy, compliance with regulations, and adherence to company policies.</p><p></p><p>
In this role, you will key, review, evaluate, and process health plan claims received electronically and via mail. You&rsquo;ll collaborate with the Claims Management Team to ensure adjudication accuracy when needed. Our team approach requires interacting with other departments to solve problems and achieve common goals.</p><p></p><p>
To be successful, you must be able to navigate between multiple systems at the same time and communicate effectively in writing and verbally. You will also need to be well organized and detail oriented.</p><p></p><p>
Requirements include a high school, or equivalent, education and a willingness to help others.</p><p></p><h1 class="jobSectionHeader"><b>
BCBSWY Employees Enjoy</b><b>:
</b></h1><p><b>Best-In-Class Health Insurance</b> at minimal to no-cost for BCBSWY employees! <b>PLUS</b> many other benefits along with highly competitive compensation!</p><p></p><p>
Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions.</p><p></p><p>
At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of <b><i>&quot;Dress for Your Day!&quot;</i></b> which can mean jeans every day <i>(depending on your role)</i>.</p><p></p><h1 class="jobSectionHeader"><b>
Serving Those Who Call Wyoming Home</b><b>.</b></h1><p>
Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility <i>(for those positions that are offered limited WFH, there will be a </i><b><i>required</i></b><i> number of In-Office days per week/month depending on department). </i><b>Executive level employees are required to reside full-time in Wyoming.</b></p><p></p><h1 class="jobSectionHeader"><b>
Our Selection Process</b><b>:
</b></h1><p>Typically includes the following <i>(NOTE: process steps may differ depending on role applied for)</i></p><div><div><div><div><ul><li>
Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment.</li><li>
Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.</li><li>
Recruiter Phone Screen.</li><li>
Possible Self-Assessment and/or Questionnaire.</li><li>
Initial interview with Hiring Manager.</li><li>
Possible 2nd Interview with Hiring Manager and/or additional Team members.</li><li>
Comprehensive Background Check.</li></ul><p></p><p>
BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors.</p><p></p><p>
We use E-Verify to confirm employment eligibility; we <b>DO NOT</b> sponsor applicants for work visas.</p></div></div></div></div><p></p><p>
BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: <i>HR@BCBSWY.com</i></p></div><p></p>

Claims Specialist 1

Trinity Health

<b>Employment Type:</b><br>
Full time
<br><br>
<b>Shift:</b><br>
Day Shift
<br><br>
<b>Description:</b><br>
Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.
<br><br>
Perform Quality Auditing of Claim Adjudicators and Customer Service Representatives. Audit capitation deductions, preparing summary of findings and disputes to the various HMOs. Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.
<br><br>
<ul>
<li>Review claims for accuracy of information into the claims processing system and ensure Standard Operating procedures (SOPs) have been followed. Provide feedback to staff as errors are identified, including where procedures can be found on correct handling when appropriate.</li>
<li>Work closely with Operations Manager to identify areas requiring additional training, either on an individual basis or overall.</li>
<li>Review authorization/claim history to determine handling and appropriateness of deductions. Enter disputed deductions into Excel or Access, depending on the health plan. Review outstanding deductions and follow up with the health plan as needed. Update CHS files upon receipt of health plan’s response to indicate whether or not a credit was received.</li>
<li>Research, document and respond to HMO inquiries within appropriate time frames to avoid future capitation deductions. Responsible for contacting HMO for copies of claims that are not in claims processing system and require entry/adjudication. Responsible for contacting providers when claims have been processed to verify status of accounts.</li>
<li>Enhance department productivity by recommending improvements to the work flow processes and organizational structure. Contribute to team effort by accomplishing related results as determined by management. Attend meetings as necessary either internally or with the HMOs</li>
</ul>
<b>Position Requirements:</b><br>
<b>Minimum Education:</b><br>
<b>Required:</b> Associate Degree or 5-10 years of claims auditing and/or Managed care experience
<br><b>Preferred:</b> Bachelor Degree
<br><b>Specify Degree(s):</b> AAPC certification
<br><b>Residency:</b> N/A
<br><br>
<b>Minimum Experience:</b><br>
<b>Required:</b> 3-5 years of previous job-related experience
<br><b>Preferred:</b> 6-10 years of previous job-related experience
<br><b>Details:</b> Previous job related experience in a managed care environment, claims processing, claims auditing, analysis of claims errors. Familiarity with managed care products. Able to track errors and provide training if needed.
<br><br>
<b>Licensure/Certifications:</b><br>
<b>Preferred:</b> Certified Professional Coder (AAPC)
<br><b>Other:</b> RHIA, RHIT and AAPC
<br><br>
<b>Required Skills:</b><br>
Ability to plan, coordinate and develop multiple projects
<br><br>
<b>Compensation:</b><br>
<b>Pay Range:</b> $21.02 - 32.59 per hour
<br>Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.
<br>Trinity Health Benefits Summary
<br><br>
Our Commitment
<br><br>
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

CLAIMS AUDITOR

Tata Consultancy Services (TCS)

<div></div><div><div><div><div><div>Responsibilities:</div><br>
<div><br>
</div><div>To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
</div><div>Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
</div><div>Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
</div><div>Approval or denial on FMLA claims as per Insurance carrier, and employer&rsquo;s guidelines
</div><div>Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
</div><div>Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
</div><div>Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
</div><div>Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
</div><div>Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
</div><div>Refers cases as appropriate to team lead and clinical case management
</div><div>Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
</div><div>Provide ideas to management on continuous improvement and service level management
</div><div>Performs other duties or participates in special projects as assigned</div><br>
<div><br>
</div><div>Requirements:</div><br>
<div><br>
</div><div>1+ year of Disability/FMLA/PFL claims or insurance claims experience
</div><div>Experience working with FINEOS
</div><div>Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
</div><div>Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
</div><div>Excellent oral and written communication, including presentation skills
</div><div>Strong Analytical, decision making, problem solving, and people management skills
</div><div>Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
</div><div>Willingness to embrace change in a fast paced work environment
</div><div>A strong desire to continuously learn and improve
</div><div>Identify escalated cases and work with Team Leader to develop a plan to address key issues.</div><div><br>
</div>
<div></div><br>
<div>TCS Employee Benefits Summary:
</div><ul><li> Discretionary Annual Incentive.
</li></ul><ul><li> Comprehensive Medical Coverage: Medical &amp; Health, Dental &amp; Vision, Disability Planning &amp; Insurance, Pet Insurance Plans.
</li></ul><ul><li> Family Support: Maternal &amp; Parental Leaves.
</li></ul><ul><li> Insurance Options: Auto &amp; Home Insurance, Identity Theft Protection.
</li></ul><ul><li> Convenience &amp; Professional Growth: Commuter Benefits &amp; Certification &amp; Training Reimbursement.
</li></ul><ul><li> Time Off: Vacation, Time Off, Sick Leave &amp; Holidays.
</li></ul><ul><li> Legal &amp; Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.</li></ul><br>
<div><br>
</div><div>Salary Range: $40,000 - $48,000 per year
</div></div></div></div><div><div><div><b>Location</b></div>
<div>Charlotte, NC</div>
</div><div><div><b>Job Function</b></div>
<div>BUSINESS PROCESS SERVICES</div>
</div><div><div><b>Role</b></div>
<div>Workflow Specialist</div>
</div><div><div><b>Job Id</b></div>
<div>406184</div>
</div><div><div><b>Desired Skills</b></div>
<div>Insurance</div>
</div><div><div><b>Salary Range</b></div>
<div>$40,000-$48,000 a year</div>
</div></div><p>Desired Candidate Profile
</p><div><div><b>Qualifications</b> : Diploma</div></div></div><div></div>

Claims Specialist

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