claims analyst

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview 
<ul><li>
Jurisdictions: NY, MA</li><li>
Licenses: Must have state license or reciprocal.</li><li>
Location: This role is fully remote work.</li></ul>
 
How you'll make an impact 
<ul><li>
Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims.</li><li>
Interact extensively with various parties involved in the claim process to ensure effective communication and resolution.</li><li>
Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process</li><li>
Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements.</li></ul><div>
Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file</div> 
 
About You<div> 
Ideal candidates for this position will have:
 
<ul><li>Claims Background: Minimum 3 years of experience adjusting a workers compensation desk, including lost time/indemnity and litigation.</li><li>Jurisdictional Experience: NY, MA</li><li>Active Adjusters' licenses: Must have state license or reciprocal.</li></ul>
As a key member of our experienced Claims Adjuster team, you will:</div> 
<ul><li>
Investigate, evaluate, and resolve complex workers compensation claims applying your analytical skills to make informed decisions and bring claims to resolution.</li><li>
Work in partnership with our clients to deliver innovative solutions and enhance the claims management process.</li><li>
Think critically, solve problems, plan, and prioritize tasks to optimally serve clients and claimants.</li></ul><div> 
REQUIRED QUALIFICATIONS: 
 
<ul><li>High School Diploma.</li><li>Minimum of 3 years related claims experience.</li><li>Appropriately licensed and/or certified in all states in which claims are being handled.</li><li>Knowledge of accepted industry standards and practices.</li><li>Computer experience with related claims and business software.</li></ul></div><div> 
DESIRED: 
<ul><li>Bachelor's Degree</li></ul></div> 
#LI-Remote
#LI-AB2 
 
Compensation and benefits 
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you&rsquo;ll get, depending on your job level these benefits may improve:
<ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div>
Other benefits include:</div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</div><div></div><div> 
We value inclusion and diversity</div>
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</div>

Claims Adjuster Workers Compensation - NY, MA

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview<div> 
Role specifics: 
<ul><li>Jurisdictions: United States</li><li>Licenses: Required</li><li>Location: This role is eligible for fully remote work.</li></ul></div> 
 
How you'll make an impact 
<ul><li>
Apply claims management experience to execute decision-making to analyze claims exposure and litigation, plan the proper course of action, and appropriately resolve claims.</li><li>
Interact extensively with various parties involved in the claim process to ensure effective communication and resolution.</li><li>
Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process</li><li>
Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements.</li><li>
Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file.</li></ul>
 
About You<div> 
Potential candidates should have the following: 
<ul><li>Claims Background: Inland Marine, Cargo</li><li>Jurisdictional Experience: US</li><li>Active Adjusters' licenses: Required</li></ul> 
As a key member of our Claims Adjuster team, you will:</div><ul><li>
Investigate, evaluate, and resolve complex Inland Marine, Cargo claims, applying your claims experience and analytical skills to make informed decisions and bring claims to resolution.</li><li>
Work in partnership with our clients to deliver innovative solutions and enhance the claims management process.</li><li>
Think critically, solve problems, plan, and prioritize activities to optimally serve clients.</li></ul><div></div><div> 
REQUIRED QUALIFICATIONS: 
 
<ul><li>High School Diploma.</li><li>Minimum of 5 years related claims experience.</li><li>Appropriate licensing and/or certification in all states in which claims are being handled.</li><li>Knowledge of accepted industry standards and practices.</li><li>Computer experience with related claims and business software.</li></ul></div><div> 
DESIRED: 
<ul><li>Bachelor's Degree.</li></ul></div><div></div><div> 
#LI-DR1</div><div>
#LI-Remote</div> 
 
Compensation and benefits 
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you&rsquo;ll get, depending on your job level these benefits may improve:
<ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div>
Other benefits include:</div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</div><div></div><div> 
We value inclusion and diversity</div>
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</div>

Executive General Adjuster – Inland Marine

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary 
The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the negotiation role, and understanding (U&amp;C) calculated rates and benchmarking of medical costs. The individual will be developing their role as a negotiator, working with training staff, and team members as more complex cases and strategies are developed.
What you will do<ul><li>
Learn to navigate the systems, and create networking, for this role</li><li>
Develop filing, naming conventions, and documentation processes</li><li>
Conduct checklist workups and manage outbound communications via phone, fax, and email to facilitate negotiations.</li><li>
Work up and organize daily cases</li><li>
Make outbound calls, develop provider contacts, and understand production metrics</li></ul> 
Required Qualifications<ul><li>
3-5 years of experience in a medical claim background with demonstrated ability and strong understanding of benchmarking costs for medical services, supplies, and drugs.</li><li>
Previous medical provider/business office phone call handling history.</li><li>
Strengths in mathematical, written, and verbal skills.</li></ul> 
Preferred Qualifications<ul><li>
Coding experience, CMS, and/or CPC Certification.</li><li>
Proficient in Usual and Customary (calculations) and cost-benchmarking for drugs, supplies, and services.</li></ul>
Education<ul><li>
Associates/High School graduate, or equivalent professional work experience.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$43,888.00 - $102,081.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/24/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Negotiator Analyst (Level I)

TEEMA Group

<div>Commercial Auto &amp; General Liability Claims Examiner
Full-Time | Permanent
Remote 
Salary: $85,000 - $95,000 
Description
Our client is seeking an experienced Commercial Auto &amp; General Liability Claims Examiner to join their growing team. In this role, you will manage and resolve Commercial Auto, No-Fault/PIP, and General Liability claims from initial intake through final disposition.
You&rsquo;ll play a key role in assessing exposure, guiding claim strategy, and delivering high-quality outcomes for all stakeholders. This position is ideal for a professional who thrives on independent decision-making while collaborating with legal counsel and external partners in a fully remote environment. 
What You&rsquo;ll Be Doing<ul><li>
Review and interpret policy coverage to determine liability and exposure</li><li>
Investigate, evaluate, and manage Commercial Auto, PIP, and General Liability claims</li><li>
Coordinate with outside investigators, legal counsel, and third-party vendors</li><li>
Maintain accurate claim documentation and manage file diaries</li><li>
Assess claim exposure and establish appropriate reserves</li><li>
Develop and execute settlement strategies, including negotiation</li><li>
Prepare detailed loss reports covering liability, damages, and coverage</li><li>
Identify and pursue subrogation and risk transfer opportunities</li><li>
Deliver high-quality communication and service to internal and external stakeholders</li></ul> 
What You Must Have<ul><li>
2+ years of experience handling Commercial Auto and General Liability claims</li><li>
Strong knowledge of claims handling practices, coverage analysis, and litigation management</li><li>
Excellent written and verbal communication skills</li><li>
Proven ability to evaluate claims, make sound decisions, and negotiate effectively</li><li>
Strong organizational and time management skills</li><li>
Proficiency with claims management systems and standard computer applications</li></ul>
Preferred Qualifications:<ul><li>
Experience handling No-Fault/PIP claims</li><li>
Bachelor&rsquo;s degree or equivalent professional experience</li><li>
Familiarity with multi-jurisdictional claims handling</li><li>
Ability to work independently in a fast-paced, remote environment</li></ul> 
Why Join the Team
This is an opportunity to join a stable and growing organization where your expertise will directly impact meaningful claims outcomes. You&rsquo;ll handle complex cases, collaborate with experienced professionals, and have the autonomy to manage your work in a fully remote setting. 
Who Will Excel in This Role<ul><li>
Independent thinkers who take ownership of their claims from start to finish</li><li>
Strong analytical professionals who understand exposure and risk</li><li>
Confident communicators who can collaborate effectively with legal and external partners</li><li>
Detail-oriented individuals who can manage multiple files without sacrificing quality</li><li>
Claims professionals who enjoy problem-solving and strategic decision-making</li></ul> 
Salary &amp; Perks<ul><li>
Salary Range: $85,000 &ndash; $95,000 (based on experience)</li><li>
100% Remote Work Environment</li><li>
Comprehensive benefits package (medical, dental, vision)</li><li>
Generous PTO and paid holidays</li><li>
401(k) with company participation</li><li>
Stable organization with long-term growth potential</li><li>
Opportunity to handle complex, meaningful claims work</li></ul> 
By applying to any TEEMA job on any portal implies entering into a business relationship with us and therefore grants TEEMA consent to send you further job updates or industry and company related information.
#Workwolf #TEEMA_3219</div>

Claims Examiner (Commercial Auto & General Liability)

<div><h2 class="jobSectionHeader">Commercial Auto &amp; General Liability Claims Examiner II</h2><h3 class="jobSectionHeader">
Role Summary</h3>
Empower your professional journey in a role that values intellectual curiosity and file ownership over high-volume &quot;churn.&quot; As a Claims Examiner II, you will manage and resolve complex Commercial Auto, No-Fault/PIP, and General Liability claims from initial intake through final disposition. This position is perfect for a strategic thinker who excels at evaluating exposure, guiding investigative strategy, and collaborating with legal counsel to achieve fair and efficient resolutions. You will join a stable, rapidly growing organization that prides itself on autonomy, high-quality claims administration, and a professional work environment.
Key Duties:<ul><li>
Technical Policy Analysis: Review and interpret complex insurance policies to accurately determine liability and coverage exposure.</li><li>
Comprehensive Claims Management: Independently investigate and evaluate Commercial Auto, PIP, and General Liability claims to ensure high-quality outcomes.</li><li>
Litigation Oversight: Direct and coordinate efforts with outside investigators, legal counsel, and various vendors to drive claim strategy.</li><li>
Financial Management: Evaluate total claims exposure to establish and maintain appropriate financial reserves.</li><li>
Negotiation &amp; Settlement: Develop and execute sophisticated settlement strategies and communicate recommendations to key stakeholders.</li><li>
Strategic Reporting: Prepare detailed loss reports that synthesize liability, damages, and coverage issues.</li><li>
Recovery Initiatives: Identify and pursue subrogation and risk transfer opportunities to protect client interests.</li><li>
Professional Communication: Provide elite-level service and maintain transparent communication with both internal and external stakeholders.</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
Experience: 2+ years of dedicated experience handling Commercial Auto and General Liability claims.</li><li>
Technical Mastery: Strong understanding of claims handling practices, coverage analysis, and litigation management.</li><li>
Communication: Exceptional written and verbal communication skills.</li><li>
Decision Making: Proven ability to evaluate complex data, make independent decisions, and negotiate effectively.</li><li>
Organizational Skills: Superior time management skills and proficiency with claims management software and standard computer applications.</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Specialized Expertise: Direct experience managing No-Fault/PIP claims.</li><li>
Education: Bachelor&rsquo;s degree or equivalent professional experience.</li><li>
Jurisdictional Knowledge: Familiarity with multi-jurisdictional claims handling requirements.</li><li>
Remote Proficiency: Ability to work productively and independently in a fast-paced, 100% remote environment.</li></ul><h3 class="jobSectionHeader">
Location and Work Type</h3><ul><li>
Location: 100% Fully Remote</li><li>
Work Type: Full-Time | Direct Hire</li><li>
Schedule: Standard Business Hours</li><li>
Benefits: Full suite of premium benefits, including medical, dental, vision, and Paid Time Off (PTO).</li></ul>
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you! 

#Workwolf</div>

Commercial Auto & General Liability Claims Examiner II

VillageCare

<div>Senior Financial Data Analyst - Healthcare
Salary: $87,647.11 - $98, 603.00
Must reside in NY, NJ or CT 
Join VillageCare as a Full-Time Senior Financial Data Analyst in the dynamic healthcare sector and play a pivotal role in shaping the financial strategies that impact our community. This position offers work-from-home flexibility, allowing you to balance your professional responsibilities with your personal life while contributing to meaningful healthcare solutions. Based in New York, NY, you will be part of a dedicated team that values excellence and customer-centricity in its mission to provide outstanding healthcare services. Your analytical expertise will drive decision-making in an energetic and forward-thinking environment.
With a competitive salary range of $87,647.11 to $98,603.00, this opportunity not only offers rewarding challenges but also financial recognition for your skills and contributions. Take the chance to apply and further your career in a company that embraces innovation and integrity.<h3 class="jobSectionHeader">
VILLAGECARE: OUR STORY</h3>
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.<h3 class="jobSectionHeader">
MAKE A DIFFERENCE AS A SENIOR FINANCIAL DATA ANALYST - HEALTHCARE</h3>
As a Senior Financial Data Analyst at VillageCare, you will play a crucial role in developing, documenting, and maintaining reports and analytics that empower leadership with key insights to drive financial success. You will ensure the accuracy and timeliness of routine and ad hoc reports, collaborating closely with both internal and external customers to guarantee successful report roll-ups and high customer satisfaction. Utilizing advanced tools such as SQL, Tableau, and RedShift, you will create customized dashboards for the Finance department, while working with the IT team to automate these reports for efficient metric monitoring. Your responsibilities will also include supporting the monthly close process, conducting claim reserve analysis, and creating member economics reports to aid strategic decision-making.
Additionally, you will lead medical claims reinsurance reporting, support the preparation of provider group financial statements, and ensure compliance with regulatory reporting requirements, all while demonstrating VillageCare's commitment to Service Excellence.<h3 class="jobSectionHeader">
DOES THIS SOUND LIKE YOU?</h3>
To excel as a Senior Financial Data Analyst at VillageCare, you will need a robust skill set and a solid professional background. A minimum of five years of relevant experience, particularly in an actuarial role focused on claims reserves, claims triangles, and IBNR estimation, is essential. Your ability to conduct complex data analyses and develop insightful reports and dashboards in a healthcare environment will be crucial. Proficiency in technical tools such as MS Excel, SQL, Tableau, Access, and Python is required, enabling you to manipulate and present data effectively. Additionally, the capacity to multi-task while maintaining a high level of attention to detail is vital for success in this role.
Strong communication skills, both verbal and written, along with robust presentation capabilities, will enhance collaboration with internal and external stakeholders. A Bachelor's degree in Healthcare, Finance, or a related field is required, or equivalent years of experience, to support your analytical and problem-solving abilities in a fast-paced setting.
Knowledge and skills required for the position are:<ul><li>
Minimum 5 years of relevant professional work experience</li><li>
Experience working in an actuarial function with a focus on building the claims reserve updating claims triangles and IBNR estimation</li><li>
Ability to perform complex data analysis and report/dashboard development in a health care setting</li><li>
Excellent technical skills (MS Excel, SQL, Tableau, Access, Python, etc.)</li><li>
Capacity to multi-task at high detail-oriented level</li><li>
Strong communication skills (verbal, written, presentation, interpersonal)</li><li>
Strong analytical and logical skills paired with strong attention to detail</li><li>
Bachelor's degree in Healthcare, Finance or relevant field or equivalent years of experience required.</li></ul><h3 class="jobSectionHeader">
MAKE YOUR MOVE</h3>
If you think this role will suit your needs, great! Applying is a piece of cake. Good luck - we're excited to meet you!</div>

Senior Financial Data Analyst - Healthcare

EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Perform provider and member outreach to reconcile member records and validate data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise. Facilitate provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. Daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care. Support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities. Track calls for all lines of business related to the MTM, OMW, and Medication Adherence quality measures, reporting weekly completion statistics. Produce and process department mailings to members and physicians. Monitor internal mailboxes for department faxes and calls. Collaborate with internal departments in order to administer the MTM, OMW, and Medication Adherence quality measures.</div><div>
Responsibilities</div><ul><li>
Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for outreach who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program. 
</li><li>
Perform daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care supporting Enterprise goals. 
</li><li>
Perform daily provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. 
</li><li>
Prepare and execute member and provider mailings. 
</li><li>
Collaborate with providers and internal departments to ensure the receipt and correct processing of all supplemental data related to HEDIS claims and records and assist in correcting discrepancies. 
</li><li>
Maintain high data integrity while adhering to HIPAA standards and protecting patient information. 
</li><li>
Perform provider outreach to verify and document member&rsquo;s appropriate medical diagnoses and subsequent treatments both by telephone and in writing. 
</li><li>
Coordinate call tracking and provide statistics to stakeholders. 
</li><li>
Intake and organize data from other departments while ensuring proper compliance with all CMS regulations, policies and procedures. 
</li><li>
Other duties/projects as assigned.</li></ul>
<div><div>Qualifications</div><ul><li>
High School Diploma (Required) 
</li><li>
College Degree (Preferred) 
</li><li>
Pharmacy Technician License (Preferred) 
</li><li>
Minimum of 1 year direct customer service experience in a healthcare setting (Required) 
</li><li>
Excellent telephonic and customer service skills (Required) 
</li><li>
Experience analyzing data and building action plans based upon data outcomes (Required) 
</li><li>
Personal motivation to achieve set goals (Required) 
</li><li>
Flexibility and ability to adjust workflow to achieve company goals (Required) 
</li><li>
Experience with or knowledge of Electronic Medical Records (Preferred) 
</li><li>
Knowledge of or experience with HEDIS, STAR ratings, and/or quality improvement (Preferred) 
</li><li>
Experience in a managed care health services environment (Preferred) 
</li><li>
Experience in data collection, data entry and analysis (Preferred) 
</li><li>
Knowledge of Excel and other analytical tools (Preferred)</li></ul>
</div><div>Additional Information
<ul><li>Requisition ID: 1000003045</li>
<li>Hiring Range: $39,960-$70,200</li></ul></div></div>

Quality Outreach Specialist - Remote

Explore 141+ Claims analyst in New York this April. Find roles across top companies and apply now to boost your career.