claims associate

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Liability Claims Associate | Blue Ash, OH - Hybrid
<div><div><div>Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
 
<ul><li>A stable and consistent work environment in an office setting
</li><li>Career development and promotional growth opportunities through increasing responsibilities
</li><li>A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs
</li></ul></div>PRIMARY PURPOSE OF THE ROLE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.
OFFICE LOCATION/SCHEDULE
Blue Ash, OH
Open to Hybrid after onboarding and training period
37.5 hour work week
ARE YOU AN IDEAL CANDIDATE? We are looking for an enthusiastic candidate to fill a Liability Associate position. Ideal candidates will thrive in a collaborative team environment, show motivation and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
<ul><li>Handles lower-level liability and/or physical damage claims under close supervision.
</li><li>Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
</li><li>Processes general liability claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
</li><li>Communicates claim action/processing with claimant, client and appropriate medical contact.
</li><li>Ensures claim files are properly documented and claims coding is correct.
</li><li>May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
</li><li>Maintains professional client relationships.
</li></ul>QUALIFICATIONS
<ul><li>Education &amp; Licensing: High school diploma or GED required
</li><li>Skills: Strong oral and written communication, computer literate &ndash; including Microsoft Office, organizational skills required
</li><li>Experience: Clerical or customer service experience, experience in medical office preferred or equivalent combination of education and experience preferred 
</li></ul> 
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul></div><div></div><div>WORK ENVIRONMENT REQUIREMENTS INCLUDE
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
</div>.
</div>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Liability Claims Associate | Blue Ash, OH - Hybrid

Marsh McLennan Agency

<div><h2 class="jobSectionHeader">Company:</h2>
Marsh McLennan Agency
<h2 class="jobSectionHeader">Description:</h2>
Graham Company, a division of Marsh McLennan Agency, is an insurance brokerage and consulting firm committed to creating a healthy, safe, and prosperous tomorrow.
We value empathy, discipline, integrity, courage, and tenacity - and we are seeking professionals who share these values to join our team.
JOB FUNCTIONS &amp; RESPONSIBILITIES:
<ul><li>Act as the lead consultant on a book of business while also supporting a Claims Consultant&rsquo;s book of business. This is a hybrid role. The Responsibilities listed below will either be with guidance from a more senior Claims Consultant on the team or the responsibility will be solely on the Senior Associate Claims Consultant.</li>
<li>Review first reports of loss to identify the potential impact the claim may have on our client. For claims with higher potential impact or coverage issues, consult with Claims Consultant regarding coverage and overall management/direction and diary as appropriate to monitor.</li>
<li>Obtain the Renewal Strategy from the Account Manager Team and consult with the Claims Consultant regarding preparation of Customized Claims Servicing Standards and Claims Made Polling procedures.</li>
<li>Prepare the Unit Stat Review and Consult with the Claims Consultant on any significant trends or increases. Prepare claims status updates as required.</li>
<li>Participate and provide input for Internal Client Service Plans as directed by the Claims Consultant.</li>
<li>Assist in management of claims from first notice of loss to resolution, providing customer service to clients throughout the claims process, as directed by the Claims Consultant.</li>
<li>Communicate effectively with clients and carrier partners to gather necessary information, provide updates on claim status, and address any concerns promptly and professionally.</li>
<li>Serve as point of contact for clients regarding their claim inquiries.</li>
<li>Review Reservation of Rights/Denial Letters and the related policies, in preparation for the Claims Consultant.</li>
<li>Set up conference calls and provide required documentation for difficult claims at the direction of the Claims Consultant.</li>
<li>Evaluate/review monthly loss information as prepared by the Claims Assistant for both for accuracy and to identify trends and issues requiring follow up.</li>
<li>Prepare/review monthly open claim action plans and reports as directed by the Claims Consultant.</li>
<li>Review Suit Letters and Umbrella/Excess Notifications on behalf of the Claims Consultant.</li>
<li>Obtain and Review Claims Statuses/Loss Analysis/Claim Review Materials for Claims Strategy Meetings for the Claims Consultant.</li>
<li>Provide legacy claims support and management at the direction of the Claims Consultant</li>
<li>Assist with the handling and advocacy of Personal Lines claims (for current clients) at the direction of the Claims Consultant.</li>
<li>Provide feedback for Carrier Report Card review.</li>
<li>Collaborate with Internal Teams to ensure a comprehensive approach to claims handling.</li>
<li>Communicate relevant and important claim and loss information to Internal Teams as directed by the Claims Consultant.</li>
<li>Provide value added advice and assistance to clients on claim developments, changes in laws and procedures, etc. as directed by the Claims Consultant Provide Emergency Claims On call during monthly rotation.</li>
<li>Shadow and provide assistance, at the direction of the Claims Consultant, for prospect and new client onboarding meetings.</li>
<li>Participate in training and development opportunities to enhance professional skills, knowledge, and industry trends.</li>
<li>Such other duties and projects as may be established and assigned by The Graham Company&rsquo;s managerial personnel.</li>
</ul>JOB SPECIFICATIONS:
<ul><li>3 years of experience in a claims unit preferred or relevant education experience</li>
<li>Willingness to travel/visit clients as needed</li>
<li>Maintain valid driver&rsquo;s license or alternate, efficient and effective meant to visit clients.</li>
<li>Ability to exercise independent judgment and discretion.</li>
<li>Holds required and appropriate insurance license(s).</li>
<li>Excellent verbal and written communication skills.</li>
<li>Strong analytical, problem-solving, and presentation skills.</li>
<li>Ability to plan, prioritize, and organize effectively.</li>
<li>Professional Designation (CPCU/AIC) preferred.</li>
<li>Strong attention to detail required.</li>
<li>Excellent management skills and ability to deal with people.</li>
<li>High level of organization ability.</li>
<li>High degree of self-discipline and motivation.</li>
<li>Mature, professional and self-confident.</li>
<li>Professional demeanor.</li>
<li>Proficient in Graham standard computer applications.</li>
<li>Regular and predictable attendance in accordance with the limitations and reporting procedures established by The Graham Company from time to time.</li>
<li>Employees are required to be fit-for-duty which includes not being under the influence of drugs and/or alcohol. This includes any drugs that might impact an employee&rsquo;s ability to safely perform their job.</li>
</ul>The applicable base salary range for this role is $64,300 to $75,000.
 
The base pay offered will be determined on factors such as experience, skills, training, location, certifications, and education. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.
 
We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.
Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age background, disability, ethnic origin, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, veteran status (including protected veterans), or any other characteristic protected by applicable law. If you have a need that requires accommodation, please let us know by contacting reasonableaccommodations@mmc.com
Marsh McLennan and it affiliates are
EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.
#MMAE
#LI-Hybrid</div>

Associate Claims Consultant

USAA

<div>
 
 Why USAA?
 
 
 
 At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
 
 
 Embrace a fulfilling career at USAA, where our core values &ndash; honesty, integrity, loyalty and service &ndash; define how we treat each other and our members. Be part of what truly makes us special and impactful.
 
 
 We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs.
 
 
 
 The Opportunity
 
 
 
 As a dedicated Property Adjuster Specialist, you will work within defined guidelines and framework, investigate, evaluate, negotiate, and settle complex property insurance claims. You will confirm/analyze coverage, recognize liability exposure and negotiate equitable settlement in compliance with all state regulatory requirements. You will recognize and empathize with members&rsquo; life events, as appropriate.
 
 
 Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling. USAA also provides a company vehicle to physically inspect losses within your locally assigned territory. Field Adjusters may travel outside of their local territory to respond to claims in other regions when needed. This is an hourly, non-exempt position with paid overtime available.
 
 
 This is a
 
 field-based role in the New York City area
 
 . Candidates who are willing and able to work in this area are encouraged to apply.
 
 
 
 What You'll Do
 
 
 
 <ul>
 <li>
 Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability.
 </li>
 <li>
 Partners with vendors and internal business partners to facilitate complex claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance.
 </li>
 <li>
 Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.
 </li>
 <li>
 Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing information involving complex policy terms and contingencies.
 </li>
 <li>
 Determines and negotiates complex claims settlement within authority limits. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes.
 </li>
 <li>
 Maintains accurate, thorough, and current claim file documentation throughout the claims process.
 </li>
 <li>
 Advance knowledge of estimating technology platforms and virtual inspection tools. Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims.
 </li>
 <li>
 Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
 </li>
 <li>
 May be assigned CAT deployment travel with minimal notice during designated CATs.
 </li>
 <li>
 Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
 </li>
 <li>
 Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience.
 </li>
 <li>
 Adjusts complex claims with attorney involvement.
 </li>
 <li>
 Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.
 </li>
 <li>
 May require travel to resolve claims, attend training, and conduct in-person inspections.
 </li>
 <li>
 Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
 
 
 </li>
 </ul>
 
 What You Have
 
 
 
 <ul>
 <li>
 High School Diploma or General Equivalency Diploma.
 </li>
 <li>
 2 years of relevant property claims adjusting experience of moderate complexity losses that includes writing estimates, involving dwelling and structural damages.
 </li>
 <li>
 Advanced knowledge of estimating losses using Xactimate or similar tools and platforms.
 </li>
 <li>
 Proficient knowledge of residential construction.
 </li>
 <li>
 Proficient knowledge of property claims contracts and interpretation of case law and state laws and regulations.
 </li>
 <li>
 Proficient negotiation, investigation, communication, and conflict resolution skills.
 </li>
 <li>
 Proven investigatory, analytical, prioritizing, multi-tasking, and problem-solving skills.
 </li>
 <li>
 Ability to travel 50-75% of the year (local &amp; non-local) and/or work catastrophe duty when needed.
 </li>
 <li>
 Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
 </li>
 <li>
 Successful completion of a job-related assessment may be required.
 
 
 </li>
 </ul>
 
 What Sets You Apart
 
 
 
 <ul>
 <li>
 Hands-on experience in the field handling high-severity and complex property claims such as fire, water damage, vandalism, malicious mischief, foreclosures, earth movement, collapse, and liability.
 </li>
 <li>
 Residential property field adjusting experience with dwelling, structure and additional living expenses.
 </li>
 <li>
 Experience working directly for a standard insurance carrier handling claims from start to finish (first notice of loss, reviewing policy, making coverage decisions)
 </li>
 <li>
 Proficient in using estimating platforms and virtual inspection tools like Xactimate, ClaimXperience and XactAnalysis
 </li>
 <li>
 Insurance industry designations such as AINS (Associate in General Insurance), CPCU (Chartered Property Casualty Underwriter), AIC (Associate in Claims), or SCLA (Senior Claims Law Associate) or actively pursuing
 </li>
 <li>
 Active Property &amp; Casualty adjuster license
 </li>
 <li>
 Currently reside in the New York City area, enabling quicker response times for local claims and a better understanding of regional risks
 </li>
 <li>
 US military experience through military service or a military spouse/domestic partner
 
 
 </li>
 </ul>
 
 Physical Demand Requirements
 
 
 
 <ul>
 <li>
 May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.
 </li>
 <li>
 May need to meet all USAA safe driving requirements including verification of driving record through MVR &amp; possession of valid driver&rsquo;s license.
 </li>
 <li>
 May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.
 </li>
 <li>
 May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics.
 
 
 </li>
 </ul>
 
 Compensation range:
 
 The salary range for this position is: $85,050 - $130,410.
 
 
 
 USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
 
 
 
 
 Compensation:
 
 USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
 
 
 Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
 
 
 The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
 
 
 
 Benefits:
 
 At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
 
 
 For more details on our outstanding benefits, visit our benefits page on USAAjobs.com
 
 
 
 Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
 
 
 
 
 USAA is 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, or status as a protected veteran.
 
</div>

Property Adjuster Specialist - Field

Allied Universal Compliance and Investigations

<div>SIU Investigator<h2 class="jobSectionHeader">
Overview</h2><div> 
Company Overview:
</div><div>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you&rsquo;re ready to grow with the best, explore a career with us and make a difference.</div><h2 class="jobSectionHeader"> 
Job Description</h2><div> 
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</div><div>
</div><ul><li>Must possess a valid driver's license with at least one year of driving experience
</li><li>Candidate must reside in state listed in job posting
</li><li>Pay Rate: $27 - $32 / hr
</li></ul><div></div><div>RESPONSIBILITIES:</div><ul><li>
Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers&rsquo; compensation, general liability, property and casualty and disability</li><li>
Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li><li>
Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li><li>
Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li><li>
Run appropriate database indices if necessary and verify the accuracy of results found</li><li>
Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><div>
QUALIFICATIONS (MUST HAVE):</div><ul><li>
Must possess one or more of the following:</li><li><ul><li>
Bachelor&rsquo;s degree in Criminal Justice</li><li>
High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li><li>
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li><li>
Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li><li>
Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li><li>
Proficient in utilizing laptop computers and cell phones.</li><li>
Special Investigative Unit (SIU) Compliance knowledge</li><li>
Ability to type 40+ words per minute with minimum error</li><li>
Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><div>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</div><ul><li>
Military experience</li><li>
Law enforcement</li><li>
Insurance administration experience</li><li>
Familiarity with California SIU regulations</li><li>
One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li><li>
Certified Insurance Fraud Investigator (CIFI)</li><li>
Fraud Claim Law Associate (FCLA)</li><li>
Fraud Claim Law Specialist (FCLS)</li><li>
Certified Protection Professional (CPP)</li><li>
Associate in Claims (AIC)</li><li>
Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><div>
BENEFITS:</div><ul><li>
Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li><li>
Seven paid holidays annually, sick days available where required by law</li><li>
Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"> 
Closing</h2><div> 
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</div><div>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</div><h2 class="jobSectionHeader"> 
Requisition ID</h2> 
2026-1609926</div>

SIU Investigator

MCS HEALTHCARE HOLDINGS, LLC

<div>Evaluador(a) De Perfiles De Salud 
Regular
Non-Exempt 
GENERAL DESCRIPTION:
Responsible for evaluating CHRA (Comprehensive Health Risk Assessment) forms received from Classicare policyholders and coding the documented clinical information according to the guidelines established by the Unit.
ESSENTIAL FUNCTIONS:<ul><li>Performs coding of diagnoses documented in the CHRA (Comprehensive Health Risk Assessment) and registers the data into the appropriate application. Identifies and informs the Supervisor about areas of opportunity to avoid errors that reduce rejected data and may represent a risk to compliance with established coding guidelines.</li><li>Works on post-payment audits of adjudicated claims based on the information contained in the Comprehensive Health Risk Assessment comparing it to the information required, following the operational guidelines established by the unit.</li><li>Generates referrals throughthe electronic app used in the Unit with providers and/or billing representatives, related to CHRA document management, to guide them and/or request correction of medical diagnoses due to incorrect coding, and inadequate, ambiguous, or incomplete medical documentation.</li><li>Process adjustments received for corrections in the CHRA, following the established operational guidance.</li><li>Identifies claims that require the support of the Claims and/or Providers department to be processed.</li><li>Provides weekly, monthly, and quarterly reports to the supervisor on audits performed as required.</li><li>Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.</li><li>May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.</li></ul>
Minimum Qualifications:
Education and Experience: Two (2) years of college education equivalent to sixty (60) approved credits from an accredited university or an Associate degree. At least one (1) year of medical billing experience with ICD-9 and ICD-10 coding.
OR
Education and Experience: Associate Degree in Health Information Management Technology from an accredited university. At least six (6) months of experience performing clinical billing and coding processes.
&ldquo;Proven experience may be replaced by previously established requirements.&rdquo;
Certifications / Licenses: A valid Medical Billing Certification and/or ICD-9, ICD-10, and/or other health-related Certifications are preferred.
Other: Knowledge of medical billing processes and ICD-9-CM, ICD-10-CM coding.
Languages:
Spanish &ndash; Intermediate (comprehensive, writing and verbal)
English &ndash; Intermediate (comprehensive, writing and verbal) 
&ldquo;We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.&rdquo;</div>

Evaluador(a) De Perfiles De Salud

Saudi Global Ports

<div>
 
 
 Location: Dammam.
 
 
 
 
 Job title: Commercial Executive.
 
 
 
 
 Department: Commercial.
 
 
 
 
 
 
 
 Job Purpose:
 
 
 
 
 
 
 Support the Commercial Manager to coordinate and works closely with various departments to resolve contractual and commercial issues and claims. Maintain relation between business partners. Keep in touch with Shippers / Consignees brokers / Transporters and insurance company and claims.
 
 
 
 
 
 
 
 
 
 Key Responsibilities:
 
 
 
 
 
 <ul>
 <li>
 Work distribution &amp; supervise internal and external departments.
 </li>
 <li>
 Organizing, planning and implementing strategy.
 </li>
 <li>
 Managed projects understand the importance of delegation.
 </li>
 <li>
 Monitor daily / weekly / monthly work plan of employees.
 </li>
 <li>
 Follow up instruction on daily basis.
 </li>
 <li>
 Documentations of claims statistics and coordination with lines brokers transporters under supervision of Sr. Officer and Asst. Manager.
 </li>
 <li>
 Accountable job responsibilities and achieving goals.
 </li>
 <li>
 Obey company&rsquo;s policies, when necessary.
 </li>
 <li>
 Follow up claims and complaints and update weekly and monthly basis.
 </li>
 <li>
 Government relation and authorities and update social on daily to management.
 </li>
 <li>
 Being connected through strong social network sites and monitor closely.
 </li>
 </ul>
 
 
 
 
 
 
 
 
 Experience &amp; Qualifications:
 
 
 
 
 
 <ul>
 <li>
 A Bachelor's degree or an associate degree.
 </li>
 <li>
 Minimum of 1-3 years&rsquo; and above experience in industry.
 </li>
 </ul>
 
 
 
 
 
 
 
 
 Required Skills:
 
 
 
 
 
 <ul>
 <li>
 Proficient in Microsoft applications (MS Office, MS Word, MS Excel, MS PowerPoint).
 </li>
 <li>
 
 Mandarin Language Skill.
 
 </li>
 <li>
 Know how to drive vehicle flexibility and a talent for negotiation.
 </li>
 <li>
 Fluent in speaking/writing English.
 </li>
 <li>
 Ability to recommend initiative and lead employees.
 </li>
 <li>
 Great attention to detail with resolve to follow through on all tasks.
 </li>
 <li>
 Highly organized and able to multitask.
 </li>
 <li>
 Excellent team-player mindset with ability to skills and delegate jobs effectively.
 </li>
 <li>
 Skilled in conflict resolution with strong customer service focus.
 </li>
 <li>
 Must have commercial and social network.
 </li>
 <li>
 Good operational experience.
 </li>
 <li>
 Have good relations/Network in local industries.
 </li>
 <li>
 Social involvement locally is beneficiary for company.
 </li>
 <li>
 Good command on TOS and SOP/Work flow.
 </li>
 <li>
 Good experience in customer care.
 </li>
 <li>
 Must know the local working culture and good relations in local market.
 </li>
 </ul>
</div>

Commercial Executive

POINT C

<div><div>Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market &ndash; to do more for clients &ndash; and take them beyond the standard &quot;Point A to Point B.&quot; We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.</div>
Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments.

Primary Responsibilities
<ul>
<li>Adjudicate new claims and process adjustments, including denials upon receipt of additional information</li>
<li>Review and resolve appeals and subrogation/third-party liability cases</li>
<li>Manage individual inventory to ensure timely turnaround and production goals are met</li>
<li>Ensure claims are processed in accordance with stop loss contract terms</li>
<li>Respond to internal and external inquiries via email and other channels within established timeframes</li>
<li>Follow up on missing or incomplete information to ensure claims can be accurately processed</li>
<li>Maintain minimum production, financial, and procedural accuracy standards on a monthly basis</li>
</ul>
Qualifications
<ul>
<li>Experience with Third Party Administrator (TPA) or self-funded claims administration preferred</li>
<li>1-2 years of experience in insurance claims processing required</li>
<li>Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies</li>
<li>Ability to interpret and apply plan documents to ensure accurate claims adjudication</li>
<li>Experience with VBA systems preferred</li>
<li>Working knowledge of CPT and ICD-10 coding</li>
<li>Basic understanding of medical terminology</li>
<li>Strong communication and customer service skills</li>
<li>Proficiency in Microsoft Office and general computer applications</li>
<li>Ability to maintain confidentiality and comply with all company policies and procedures</li>
<li>Able to work independently with minimal supervision</li>
<li>Ability to prioritize, multitask, and work overtime as needed</li>
<li>Associate Degree Preferred</li>
</ul><div><div>Benefits:</div>
<ul><li>Comprehensive medical, dental, vision, and life insurance coverage</li>
<li>401(k) retirement plan with employer match</li>
<li>Health Savings Account (HSA) &amp; Flexible Spending Accounts (FSAs)</li>
<li><div>Paid time off (PTO) and disability leave</div>
</li><li>Employee Assistance Program (EAP)</li></ul> 


Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business&mdash;and our society&mdash;stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.</div></div>

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