claims associate

First Help Financial

<div><p><b>First Help Financial</b> (FHF) is a fast-growing and culturally diverse company in the U.S. We provide auto loans to the underserved and care for our customers and partners with exceptional service. Through flexible financing options and tri-lingual support, we offer consumers an easier way to finance their first car. We lend to and support our portfolio which has consistently grown 30%+ each year over the last nine years.<br>
</p><p>Here you will find hard-working colleagues who come from over 20 countries. We hold ourselves to the highest standards of professionalism but also enjoy our work. Our culture and benefits are geared towards making you successful in life and comfortable at work.
</p><p></p><p><b>Your Title: </b>GAP Claims Associate</p><p><b>
Your Location:</b> Remote/Anywhere within the U.S
</p><p><b>You Report To: </b>GAP Claims Associate
</p><p><b>Schedule: </b>Monday to Friday 9:00am to 5:30pm EST</p><p><b>
Compensation:</b> $20.16/hour + bonus</p><p><b>
Learn more about our awesome </b><b>Servicing Operations team!</b></p><p><b><i>
About the Opportunity:</i></b></p><p>
First Help Financial, voted and certified as a &ldquo;<b>Great Place to Work</b>&rdquo; by our workforce for five years in a row, is adding a new partner to our Servicing Operations department to accommodate our remarkable growth! We are seeking a highly motivated GAP Claims Adjuster to support the administration and resolution of Guaranteed Asset Protection (GAP) claims. In this role, you will be responsible for managing GAP claims from initiation through final resolution, ensuring timely and accurate claim handling while maintaining compliance with company policies and regulatory requirements. This position plays a critical role in mitigating losses and delivering excellent service to our customers, dealers, and insurance partners. The ideal candidate is detail-oriented, organized, and able to work independently while collaborating cross-functionally.</p><b><br>
Requirements</b><p></p><p><br>
 <b><i>What you will do:</i></b></p><p><b><i>
Your duties include but are not limited to</i></b></p><ul><li>
Review, process, and adjudicate GAP claims in accordance with company guidelines and contract terms</li><li>
Communicate with customers, insurance carriers, dealerships, and third-party administrators to obtain required claim documentation, including settlement letters, payment histories, police reports, and loan information</li><li>
Calculate GAP deficiencies and validate claim eligibility and payment amounts</li><li>
Submit claims to GAP administrators and follow through to resolution</li><li>
Monitor claim status and proactively follow up to ensure timely completion and payment</li><li>
Update internal CRM systems with claim status, documentation, and detailed notes</li><li>
Investigate and resolve discrepancies related to insurance settlements, loan balances, and claim eligibility</li><li>
Provide professional customer service by responding to inquiries related to GAP claim status and outcomes</li><li>
Identify trends and assist management in improving GAP claim workflows, recovery rates, and operational efficiency</li><li>
Ensure compliance with company policies, audit requirements, and regulatory standards</li></ul><p></p><p><b><i>
What you bring:</i></b></p><ul><li>
High School Diploma/GED equivalent required</li><li>
Prior minimum of 1+ years of experience in GAP claims, auto finance, insurance claims, or loan servicing preferred</li><li>
Strong analytical and problem-solving skills</li><li>
Excellent written and verbal communication skills</li><li>
High level of attention to detail and accuracy</li><li>
Ability to manage multiple claims and meet deadlines in a fast-paced environment</li><li>
Proficiency in Excel and experience working with CRM systems</li><li>
Ability to work independently and exercise sound judgment</li>
Proficiency with MS Office Suite<br>
<li>
</li></ul><br>
<br>
<b>Benefits</b><p><b><i><br>
FHF Benefits:</i></b></p><ul><li>
Great Perks &ndash; We offer generous salaries, competitive health and welfare benefits (medical, dental, vision, LTD/STD, Identity theft, paid parental leave and much more), paid vacation, 401(k) match, tuition reimbursement, social activities, monthly lunches, a robust employee recognition and talent development program to enhance your career with us.</li><li>
Culture - We are believers in maintaining a healthy work-life balance. While we work hard and care deeply about our customers and partners, we want you to have room for your family, friends, and yourself.
</li><li>Growth - Company growth provides unprecedented career growth. FHF&rsquo;s extraordinary year over year growth in revenue and new markets provides opportunity for you to establish and develop your career growth. We engage each employee to build a career plan that benefits everyone and we have a proven record of investing in <i>you</i>.<br>
</li></ul><p><b><i>Diversity and Inclusion</i></b></p><p>
FHF is committed to building a culture that respects and embraces all walks of life, inclusive of gender, race, culture, age, sexual orientation, and other identities. We will make accommodations when interviewing anyone with special needs.</p></div>

GAP Claims Associate

Marsh McLennan

<div><h2 class="jobSectionHeader"><b>Company:
</b></h2>Marsh Risk
<p></p><h2 class="jobSectionHeader"><b>Description:
</b></h2><p></p><div><div><p>We are seeking a talented individual to join our Claims Advocacy team at Marsh. This role will be based in Chicago and is a hybrid role that has a requirement of working at least three days a week in the office.
</p></div><p></p><div><p>The <b>Marsh </b><b>Early Career </b><b>Program </b>is a program designed to provide you with the appropriate skills you will need to accelerate your career at Marsh. As part of the <b>Claims Advocacy </b>track, you will be exposed to a variety of claim advocacy disciplines, including workers' compensation, auto liability, general liability/products liability, environmental, product recall, and property claims . Specific deliverables can include claim reporting, coverage analysis for claim acceptance, claim reviews, broker request for proposal, and assisting clients with general claim servicing issues. You will be part of a team solving challenging issues, get access to professional development opportunities, participate in client meetings, gain broad business exposure to the firm&rsquo;s leadership and talented team, and more!
</p></div><p></p><div><p><b>WE WILL COUNT ON YOU TO </b><b>:
</b></p></div><div><ul><li><p>Assist our clients to mitigate risks, maximize recoveries, and optimize total cost of risk across their portfolio
</p></li></ul></div><div><ul><li><p>Engage client claims program and deploy creative strategies to resolve claims issues effectively
</p></li></ul></div><div><ul><li><p>Liaise with insurers and their advisors on most queries and policy coverage discussions
</p></li></ul></div><div><ul><li><p>Support the lead facilitator in meetings with the client, insurers and their advisors
</p></li></ul></div><div><ul><li><p>Aid in claims discussions during renewal meetings and RFP's
</p></li></ul></div><div><ul><li><p>Navigate insurance policies and provide recommendations about coverage and claims exposures<br>
</p></li></ul></div><p></p><div><p><b>WH </b><b>AT </b><b>MAKES YOU STAND OUT:
</b></p></div><div><ul><li><p>Client or customer focused mindset with the ability to build relationships internally and externally
</p></li></ul></div><div><ul><li><p>Comfortable collaborating in team environments while also taking ownership of individual responsibilities
</p></li></ul></div><div><ul><li><p>Interest in risk management, insurance, or financial services<br>
</p></li></ul></div></div><p></p><div><div><p><b>WHAT YOU NEED TO HAVE:
</b></p></div><div><ul><li><p>Progress towards a bachelor&rsquo;s degree with a graduation date of Winter 2025 or Spring 2026
</p></li></ul></div><div><ul><li><p>Degree program in Business, Finance, Risk Management Insurance, Analytics, Economics, Mathematics, Liberal Arts, or a related field
</p></li></ul></div><div><ul><li><p>Authorized to work in the U.S on an ongoing basis without sponsorship now or in the future
</p></li></ul></div><div><ul><li><p>Experience engaging with diverse stakeholders and building positive relationships with the ability to communicate effectively across different audiences
</p></li></ul></div><div><ul><li><p>Exposure in technical and analytical tools with the ability to apply data to inform decision (e.g., Power BI)
</p></li></ul></div><div><ul><li><p>Organized, detail-oriented, and able to manage multiple responsibilities effectively
</p></li></ul></div><p></p><div><p>The base salary for this role is $73,000 . Please note that the salary is standardized and not subject to negotiation.
</p></div><p></p><div><p><b>WHY JOIN OUR TEAM
</b></p></div><div><ul><li><p>We help you be your best through professional development opportunities, interesting work, and supportive leaders.
</p></li></ul></div><div><ul><li><p>We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have an impact on colleagues, clients and communities.
</p></li></ul></div><div><ul><li><p>Our scale enables us to provide a range of career opportunities, as well as benefits and rewards to enhance your well-being.<br>
</p></li></ul></div><p></p><div><p><b>(REQUIRED) APPLICATION INSTRUCTIONS
</b></p></div><p></p><div><p>Before submitting your application, we encourage you to review the instructions below including the cover letter details. All documents should be uploaded to the document attachment section as part of your application. When uploading files, please use the following naming convention or similar:
</p></div></div><p></p><div><div><p>FirstName LastName Marsh Cover Letter (or Resume)
</p></div><p></p><div><p><b>RESUME TIPS
</b></p></div><div><p>Your resume helps us understand your experiences and interests . We review resumes holistically and value a wide range of academic, professional, and extracurricular experience s.
</p></div><p></p><div><p><b>COVER LETTER
</b></p></div><div><p>Please respon d to the questions below in the cover letter . We encourage thoughtful, authentic responses that reflect your interests, experiences, and alignment with Marsh.
</p></div><div><ul><li><p>Elaborate on your interest in starting a career at Marsh, and why does t he Chicago location appeal to you?
</p></li></ul></div><div><ul><li><p>Marsh works with clients and colleagues from diverse industries and backgrounds. Share an experience where you worked with people different from yourself and explain the importance of this in client-focused professional services.
</p></li></ul></div><div><ul><li><p>Tell us about a project, leadership role, or experience that resonate d with you strongly and help ed shape you as a person. This can be a professional or personal experience.<br>
</p></li></ul></div><p></p><div><p><b>WHAT&rsquo;S NEXT
</b></p></div><div><p>Applicants selected to advance in the process will receive an email from the recruitment team to schedule a phone interview with a recruiter.
</p></div></div><p></p>Marsh Risk is a business of Marsh (NYSE: MRSH), a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries. With annual revenue of over $27 billion and more than 95,000 colleagues, Marsh helps build the confidence to thrive through the power of perspective. For more information about Marsh Risk, visit marsh.com, or follow us on LinkedIn and X.
<p></p>Marsh 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, family duties, 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.
<p></p>Marsh is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one &ldquo;anchor day&rdquo; per week on which their full team will be together in person.</div><p></p>

Claims Advocacy Associate – Chicago – College Program 2026

Rimon, P.C.

<div><p><b>Position Overview</b></p><p>
We are seeking a detail‑oriented and motivated Trusts &amp; Estates Associate with 2-5 years of experience to join our Boston office. The ideal candidate will have a strong foundation in drafting estate planning documents, preparing estate tax returns, and administering probate estates. The associate will support a partner with a significant and expanding client workload and should be comfortable managing multiple matters in a fast‑paced environment.</p><p><b>
Compensation:</b>
</p><p>Salary range of $120,000 - $150,000. Final compensation will be based on the candidate&rsquo;s experience, skills, and overall qualifications.</p><p><b>
About Rimon:</b></p><p>
Founded 15 years ago in Silicon Valley, Rim&ocirc;n is a highly selective, international law firm with more than 200 lawyers working across five continents.</p><p>
The firm is widely known as being at the vanguard of legal innovation for its decentralized, distributed business model and leading-edge technology. Our model is disruptive and our culture dynamic. While many traditional law firms are downsizing, Rim&ocirc;n is experiencing explosive growth year-over-year.</p><p>
This is an ideal time to join a dynamic and growing firm!</p><ul><li><div>
A Juris Doctor from top-ranked law school, required.</div></li><li><div>
2-5 years of trusts and estates experience, including drafting estate planning documents.</div></li><li><div>
Experience preparing federal and state (Massachusetts preferred) estate tax returns.</div></li><li><div>
Knowledge of Massachusetts probate laws and procedures.</div></li><li><div>
Strong analytical skills and excellent attention to detail.</div></li><li><div>
Outstanding written and verbal communication skills.</div></li><li><div>
Ability to manage competing deadlines and adapt to quickly evolving client needs.</div></li><li><div>
Demonstrated alignment with Rimon&rsquo;s values of excellence, innovation, and teamwork.</div></li><li><div>
Massachusetts bar license required.</div></li></ul></div>

ASSOCIATE

The Hartford

<div>General Adjuster - CL08AE
Assoc General Adjuster - CL08EE<p>
We&rsquo;re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals &ndash; and to help others accomplish theirs, too. Join our team as we help shape the future.
</p><p>We are hiring for both Associate General Adjuster and General Adjuster - Texas and surrounding Regions</p><p>
Associate General Adjuster: $85,200 - $127,800</p><p>
The successful Associate General Adjuster candidate will plan, recommend, reserve and execute the investigation, valuation, disposition and settlement of large personal insurance property claims in a manner consistent with corporate claim settlement policies and procedures and statutory, regulatory and ethics requirements throughout the United States as appropriate.</p><p>
The individual in this position will work to achieve fair, equitable and timely claim dispositions and properly assess the indemnity and expense exposure of assigned claims. They will report to a Property Major Case Manager and operate in a team environment that will develop and share business knowledge and claim handling expertise with team members and business partners. Primary territory to include Texas, Oklahoma, New Mexico and Louisiana. Additional regional support may be assigned as needed.</p><p>
Qualifications:</p><ul><li>Must have 3+ years' experience as a full file Claim Property Adjuster</li></ul>
 managing moderately severe property claims.<br>
<ul><li>Strong functional knowledge of residential claims and be able to</li></ul>
 appropriately interpret and apply insurance coverage.<br>
<ul><li>College degree or equivalent experience.</li><li>Consistent high level of performance and achievement over career span</li><li>Cost estimation preferably using Xactimate and computer</li></ul>
 competencies required.<br>
<ul><li>Good working knowledge of regional jurisdictional issues.</li><li>Disciplined time management and organizational skills and ability to</li></ul>
 function in a self-reliant manner.<br>
<ul><li>Availability for nationwide catastrophe operations as necessary.</li><li>Must have MS Office knowledge (i.e. Excel).</li><li>The ideal candidate should reside in Texas. (Houston, Austin, San</li></ul>
 Antonio or Dallas preferred).<p>
General Adjuster: $108,000 &ndash; 162,000</p><p>
The successful General Adjuster candidate will plan, recommend, reserve and execute the investigation, valuation, disposition and settlement of large Personal Insurance property claims in a manner consistent with corporate claim settlement policies and procedures and statutory, regulatory and ethics requirements throughout the United States as appropriate.</p><p>
The individual in this position will work to achieve fair, equitable and timely claim dispositions and properly assess the indemnity and expense exposure of assigned claims. They will report to a Property Major Case Manager and operate in a team environment that will develop and share business knowledge and claim handling expertise with team members and business partners. This position will also mentor Associate General Adjusters and Property Damage Adjusters .Primary territory to include Texas, Oklahoma, New Mexico and Louisiana. Additional regional support may be assigned as needed.</p><div>
Qualifications:<br>
<ul><li>Must have 5+ years of experience as a full file Claim Adjuster for</li></ul>
 complex property losses in excess of $300,000 in value.<br>
<ul><li>Strong functional knowledge of residential claims and be able to</li></ul>
 appropriately interpret and apply insurance coverage.<br>
<ul><li>College degree or equivalent experience.</li><li>Consistent high level of performance and achievement over career</li></ul></div><div>
span.<br>
<ul><li>Cost estimation preferably using Xactimate and computer</li></ul>
 competencies required.<br>
<ul><li>Good working knowledge of regional jurisdictional issues.</li><li>Disciplined time management and organizational skills and ability to</li></ul>
 function in a self-reliant manner.<br>
<ul><li>Availability for nationwide catastrophe operations as necessary.</li><li>Must have MS Office knowledge (i.e. Excel).</li><li>The ideal candidate should reside in Texas. (Houston, Austin, San</li></ul>
 Antonio or Dallas preferred).</div><p><b>
Compensation</b></p><p>
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford&rsquo;s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:</p>
$85,200 - $162,000<p>
The posted salary range reflects our ability to hire at different position titles and levels depending on background and experience.</p><p>
Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age</p></div>

Personal Insurance Associate General Adjuster / General Adjuster - Texas Region

Zenith Associates

<p><b>Company:</b> NextGen Capital Solution / Zenith Business Solution<br/><b>Location:</b> Lahore<br/><b>Job Type:</b> Full-Time<br/><b>Shift:</b> Night Shift (7 PM-3AM PST)</p><p>About the Role</p><p>NextGen Capital Solution / Zenith Business Solution is hiring a <b>motivated and results-driven Sales Associate &ndash; Lead Generation</b> to join our growing team.</p><p>If you have strong English communication skills and want to build a long-term career in <b>international sales, lead generation, and outbound calling</b>, this opportunity is for you.</p><p><b>Fresh candidates are highly encouraged to apply &mdash; paid training will be provided.</b></p><p>Key Responsibilities</p><ul><li>Make outbound calls to international prospects (B2B)</li><li>Generate and qualify leads for the sales team</li><li>Introduce and explain company services professionally</li><li>Build interest and rapport with potential clients</li><li>Schedule appointments or follow-ups for closers</li><li>Maintain accurate records in CRM software</li><li>Meet daily, weekly, and monthly lead generation targets</li><li>Follow call scripts while keeping conversations natural and engaging</li></ul><p>Requirements</p><ul><li>Excellent English communication skills (spoken &amp; listening)</li><li>Confident, persuasive, and target-driven personality</li><li>Strong interpersonal and negotiation skills</li><li>Basic computer knowledge (CRM, MS Office, Email)</li><li>Willingness to work night shift</li><li>Previous experience in sales, cold calling, or call center is a plus (not mandatory)</li></ul><p>What We Offer</p><ul><li>Competitive salary package</li><li>Performance-based incentives &amp; bonuses</li><li>Professional sales training</li><li>Career growth opportunities</li><li>Supportive and growth-focused work environment</li></ul><p><b>Apply now and start your career in international sales and lead generation!</b></p><p>Job Type: Full-time</p><p>Pay: Rs50,000.00 - Rs75,000.00 per month</p><p>Work Location: In person</p>

Calling Associate -US Based

Zurich Insurance

<div><div>Zurich is seeking an experienced Workers&rsquo; Compensation Claims Specialist to join our team! This will be a hybrid role based out of our Las Vegas, NV office, or remote in the U.S for those with expertise in handling Jurisdiction of NV.</div><div></div><div><br>
The Sr. Workers&rsquo; Compensation Claims Specialist will handle multi-party personal or commercial line Workers&rsquo; Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.</div><div></div><div><br>
In this role you will be responsible for:</div><br>
<div></div><ul><li>
Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.</li><li>
Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.</li><li>
Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.</li><li>
Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.</li><li>
Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.</li><li>
Assess damages by calculating applicable damages or range of damages allowed by law.</li><li>
Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.</li><li>
Meet quality standards by following best practices</li></ul><div></div><div><br>
Basic Qualifications:</div><br>
<div></div><ul><li>
Bachelor&rsquo;s Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.<br>
AND</li><li>
Must obtain and maintain required adjuster license(s)</li><li>
Microsoft Office experience</li><li>
Knowledge of insurance regulations, markets and products</li></ul><div></div><div><br>
Preferred Qualifications:</div><br>
<div></div><ul><li>
6+ experience handling high severity Workers Compensation claims
</li><li>6+ years of experience in litigation management</li><li>
Must have Jurisdiction expertise handling state of Nevada</li><li>
Effective verbal and written communication skills</li><li>
Strong analytical, critical thinking and problem-solving skills</li><li>
Strong multi-tasking and prioritization skills</li><li>
Experience collaborating in a team environment and building cross functional working relationships</li><li>
Proactively shares and promotes sharing of insights</li><li>
Ability to gather unique perspectives from other teams/functions to optimize outcomes.</li><li>
Understands, analyzes, and applies the component parts of an insurance policy for complex claims</li><li>
Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims</li><li>
Ability to determine the scope and exposure for complex claims</li><li>
Ability to leverage trend and relationships to provide high-quality customer service</li><li>
Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.</li><li>
Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims</li><li>
Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies</li></ul><p></p><p><br>
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply&mdash;your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $72,100.00 - $117,900.00, with short-term incentive bonus eligibility set at 15%.</p><p></p><p><br>
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]</p><p></p><p><b><br>
Why Zurich?</b></p><p>
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment&mdash;so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500&reg;.</p><p></p><p><br>
Join us for a brighter future&mdash;for yourself and our customers.</p><p></p><p><br>
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.</p><p></p><p><br>
Zurich complies with 18 U.S. Code &sect; 1033.</p><p></p><p><b><br>
Please note:</b> Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.</p><p>
Location(s): AM - Nevada Virtual Office<br>
Remote Working: No<br>
Schedule: Full Time<br>
Employment Sponsorship Offered: No<br>
<br>
Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID</p></div>

Sr. Claims Specialist (Workers Compensation)

Accenture in India

<div>
 <strong>
  Skill required:
 </strong>
 Claims Appeals - Claims Administration
 <br/>
 <br/>
 <strong>
  Designation:
 </strong>
 Health Admin Services Associate
 <br/>
 <br/>
 <strong>
  Qualifications:
 </strong>
 Any Graduation
 <br/>
 <br/>
 <strong>
  Years of Experience:
 </strong>
 1-3 Yrs
 <br/>
 <br/>
 <strong>
  About Accenture
  <br/>
  <br/>
 </strong>
 Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song&mdash; all powered by the world&rsquo;s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
 <br/>
 <br/>
 <strong>
  What would you do?
 </strong>
 Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowClaims Appeals involves reviewing and processing appeals for denied insurance claims. This includes evaluating the reasons for denial, gathering additional information, and making decisions on the appeal. The goal is to ensure fair and accurate resolution of claims. Responsibilities include communicating with claimants, analyzing documentation, and adhering to regulatory guidelines. This role is essential for maintaining trust and satisfaction in the claims process.Includes the administration of health, life, and property &amp; causality claims. Includes activities involved in core claim processing such as registering claims, editing &amp; verification, claims evaluation, and examination &amp; litigation.
 <br/>
 <br/>
 <strong>
  What are we looking for?
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests. Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  </li>
  <li>
   Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve, request for additional clinical information or summarize and route to Client s nursing reviewer and/or Client s medical staff for review.
  </li>
  <li>
   Accurately routes cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefit criteria.
  </li>
  <li>
   Responsible for conducting medical management review activities which require the review of clinical information against client specific criteria as noted above but excludes denial determinations.
  </li>
  <li>
   Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract. Consult with clinical reviewers and/or U.S.-licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
  </li>
  <li>
   Graduate of any college degree or High School Diploma with 6 months&rsquo; BPO work experience.
  </li>
  <li>
   Excellent written and verbal communication skills in English.
  </li>
  <li>
   Must pass American English and alternate language fluency test (&ldquo;Test&rdquo;) upon hire (non-US resident). For voice accounts, must pass US Berlitz B2 level or Versant score of 58 or any language proficiency equivalence.
  </li>
  <li>
   Proficiency in basic computer knowledge with the ability to learn additional computer programs
  </li>
  <li>
   Holds current and unrestricted local Registered Nurse license.
  </li>
  <li>
   Bachelor of Science Nursing (BSN) degree or General Nursing &amp; Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
  </li>
  <li>
   A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required.
  </li>
  <li>
   Three months is equivalent to 480 hours of working experience as an RN.
  </li>
  <li>
   Work experience as a Registered Nurse means holding an active RN license and providing direct patient care. Roles and Responsibilities:
  </li>
  <li>
   In this role you are required to solve routine problems, largely through precedent and referral to general guidelines
  </li>
  <li>
   Your primary interaction is within your own team and your direct supervisor
  </li>
  <li>
   In this role you will be given detailed instructions on all tasks
  </li>
  <li>
   The decisions that you make impact your own work and are closely supervised
  </li>
  <li>
   You will be an individual contributor as a part of a team with a predetermined, narrow scope of work
  </li>
  <li>
   Please note that this role may require you to work in rotational shifts, Any Graduation
   <br/>
  </li>
 </ul>
</div>


Health Admin Services Associate

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