claims director

Alight Solutions

<div>Do you have advanced experience in absence management leadership within appeals?
Amazing Opportunity and Great Place to Work!
Our story
At Alight, we believe a company&rsquo;s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to &ldquo;Be Alight.&rdquo; We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.
Our Benefits
With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities &ndash; all within a thriving global organization.
Flexible Working
So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and &ldquo;Top 100 Company for Remote Jobs&rdquo; 6 years in a row.
Great Place to Work
Thanks to the work of every colleague, Alight has received multiple awards of recognition including &ldquo;Great Place to Work&rdquo; for the past 7 years and Fortune&rsquo;s &ldquo;Best Companies to Work For.&rdquo; To learn more about our company culture and awards Click Here.
If you, Champion People, seek to Grow with Purpose, and embody the meaning of Be Alight &ndash; We invite you to join our team! Learn more at careers.alight.com.
Responsibilities<ul><li>
Leading LOA, STD, ADA, and/or LTD Appeals service teams.</li><li>
Developing strategy and business plans to deliver market-centric capabilities and processes.</li><li>
Working with broader organization and external parties to identify and gaps and develop a plan to address. Anticipating future trends and challenges, developing and implementing strategies to address opportunities.</li><li>
Assessing and evaluated business/technology partners to integrate products on various platforms. Developing and recommended Claims and Service level strategies and tactics.</li><li>
Demonstrating expertise in accurate Appeals Claim Management.
</li><li>Collaborating with peers and senior leadership to deliver exceptional service.</li><li>
Managing Appeals departmental budget and plan effectively for responsible growth.</li><li>
Enhancing the Claims team through regular business updates to ensure alignment with organizational goals. Fostering a culture of trust within the team.</li><li>
Establishing performance metrics with clear systems of measures and accountabilities that drive results.</li><li>
Ensuring that an effective system of regulatory compliance and internal controls have been maintained. Complying with applicable laws and regulations, and documented procedures that incorporated preventive and defective controls. Partnering with Regulatory Compliance and Risk Committees.</li></ul>
Requirements<ul><li>
Possess advanced education, equivalent work experience, training, or DMEC certification.</li><li>
Have experience of 10 years in claims/appeals and 7 years leadership in absence management.</li><li>
Display qualifications or experience in healthcare, rehabilitation, or a medical field.</li><li>
Hold Lean Six Sigma Certification and or formal Operations Strategy training.</li><li>
Have experience in leadership of a team of Managers within Appeals. This position oversees a total organization or roughly 40 professionals.</li></ul>
Application and Interview
By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight&rsquo;s employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position.
Alight requires all virtual interviews to be conducted on video.
Our commitment to Inclusion
We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.
At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.
As part of this commitment, Alight will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact alightcareers@alight.com.
Equal Opportunity Policy Statement
Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ disabled persons, disabled veterans, and other covered veterans.
Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request reasonable accommodations/modifications by contacting their recruiter.
Authorization to work in the Employing Country
Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not, now or in the future, require sponsorship of a visa for employment authorization in the Employing Country and with Alight.
Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.
We offer you a competitive total rewards package, continuing education &amp; training, and tremendous potential with a growing worldwide organization.
Salary Pay Range
Minimum :
110,000.00 USD
Maximum :
130,000.00 USD
Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate&rsquo;s experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: Wellbeing and Benefits Selector Page - Alight 
DISCLAIMER: 
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.
Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, pregnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law. Alight Solutions is committed to a diverse workforce and is an affirmative action employer.</div>

Claims Operations Director- Appeals-Alight Leave Solutions

AmTrust Financial

<div>Overview:
<div>
AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Construction Defect Claims Director. This position requires previous supervisory experience. This position will supervise a team of adjusters. Supervision duties include the technical development of the adjusters and their claim files which includes, coverage, liability investigation, development and evaluation of damages, settlement strategy and litigation management. These claims arise in various jurisdictions throughout the country and, as such, experience and adjusters&rsquo; license in multiple jurisdictions is required. This position will also have personnel administration responsibilities for the adjusters under their supervision. This position will assist on various special projects as needed.</div><div></div><div> 
This role follows a hybrid work model, requiring 4 days per week on‑site and 1 day remote.</div><div> 
To support team collaboration and business needs, preference will be given to candidates who can work in a hybrid capacity from one of our approved office locations listed below.</div><h3 class="jobSectionHeader">
Eligible Office Locations</h3><ul><li>
Ohio: Cleveland, Seven Hills</li><li>
Texas: Dallas</li><li>
Georgia: Alpharetta</li><li>
Illinois: Chicago</li><li>
Florida: Boca Raton, Maitland</li><li>
Connecticut: Southington</li><li>
California: Concord, Irvine, Woodland Hills</li><li>
New Jersey: Jersey City, Princeton</li><li>
Arizona: Scottsdale</li><li>
New York: New York City, Melville, Latham</li><li>
Utah: South Jordan</li><li>
New Hampshire: Nashua</li><li>
Massachusetts: Boston</li><li>
Kansas: Overland Park</li><li>
Washington: Seattle</li><li>
Missouri: St. Louis</li></ul>
Responsibilities:
<ul><li>Ensures new claims are assigned to unit members based on complexity and skill level of staff.</li><li>
Oversees the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, litigation management, evaluation, negotiation and settlement.</li><li>
Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications.</li><li>
Ensures claim processing is consistent with applicable policies, procedures and department guidelines.</li><li>
Supervises maintenance of all claim records.</li><li>
Reviews issues adjusters are unable to resolve and prepares formal response to consumer complaints.</li><li>
Analyzes and approves insurance claim payments.</li><li>
Provides file authority as appropriate to staff members.</li><li>
Completes regular quality audits of staff&rsquo;s work, records results and counsels staff to bring work to or above standards.</li><li>
Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards.</li><li>
Completes special projects as assigned.</li><li>
Assures that all customers receive quality service.</li><li>
Establishes and executes controls to assure that the quality of the work meets or exceeds standards.</li><li>
Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency.</li><li>
May recruit, hire and recommend or initiate promotions, transfers and disciplinary action.</li><li>
Manages personnel administration including employee evaluations and salary administration.</li><li>
Participate in the specialized training and handling of complex claim matters and projects requiring advanced claim knowledge and experience.</li><li>
Manages the development and training of their team, including monitoring and relaying information to the staff regarding changes in coverage and laws</li></ul>
Qualifications:
<ul><li>Thorough understanding of laws, principles of coverage, liability and insurance industry in general.</li><li>
Analytical and human relations skills are critical.</li><li>
Leadership skills; ability to plan, organize, delegate and develop staff.</li><li>
Effective communication skills; ability to obtain and deliver information to others orally and in written form.</li><li>
Ability to carry out detailed written and verbal instructions.</li><li>
Ability to work with little supervision and direction.</li><li>
Sound command of the English language.</li><li>
Ability to operate business technology.</li><li>
College degree or 10 years equivalent experience and skills required.</li><li>
Valid adjuster&rsquo;s license in appropriate jurisdictions or ability to obtain such.</li></ul><div>
The expected salary range for this role is $125,000-165,000 annual.</div><div></div><div> 
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations</div>
What We Offer:
<div>
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical &amp; Dental Plans, Life Insurance, including eligible spouses &amp; children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.</div><div></div><div> 
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.</div><div></div><div> 
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.</div></div>

Director, Construction Defect Claims

Return Assets Division- Lauth Investigations International, Inc.

<div>
 Position Summary
 
 
 The Director of Case Management is a strategic and operational leader responsible for overseeing the full lifecycle of claims from post-signature through approval and payout. This role ensures that all cases are processed accurately, efficiently, and in compliance with state requirements while meeting monthly filing and approval goals.
 
 
 This position combines hands-on claim processing expertise, team leadership, and process optimization, serving as the central authority for claim execution, quality control, and continuous improvement within RAD.
 
 
 This role carries direct accountability for converting signed claims into filed claims and ensuring that monthly Filing to State Fee targets are consistently achieved.
 
 
 Core Responsibilities
 
 
 <ul>
 <li>
 Case Management &amp; Execution (Hands-On)
 </li>
 <li>
 Perform Claim Processor duties as needed, especially for complex or escalated cases
 </li>
 <li>
 Oversee cases from onboarding &rarr; documentation &rarr; filing &rarr; approval &rarr; payout
 </li>
 <li>
 Ensure all submissions to state agencies are complete, accurate, and compliant
 </li>
 <li>
 Resolve stalled, rejected, or high-risk claims
 </li>
 <li>
 Team Leadership, Oversight &amp; Training
 </li>
 <li>
 Manage Claim Processors and oversee caseload distribution
 </li>
 <li>
 Ensure cases progress according to timeline, quality, and compliance standards
 </li>
 <li>
 Conduct case audits and performance reviews
 </li>
 <li>
 Train, onboard, and coach Claim Processors to improve accuracy and efficiency
 </li>
 <li>
 Maintain and evolve Claim Processing training systems and documentation
 </li>
 <li>
 Pipeline Management, Revenue Execution &amp; Accountability
 </li>
 <li>
 Own and be fully accountable for achieving monthly Filing to State Fee targets
 </li>
 <li>
 Ensure all signed and viable cases are moved efficiently to filing
 </li>
 <li>
 Monitor pipeline health to prevent revenue leakage between Signed &rarr; Filed
 </li>
 <li>
 Identify risks early and take corrective action to close performance gaps
 </li>
 <li>
 Escalate proactively to COO when additional resources, leads, or support are required
 </li>
 <li>
 Process Optimization &amp; Continuous Improvement
 </li>
 <li>
 Analyze pipeline data to identify bottlenecks and inefficiencies
 </li>
 <li>
 Implement process improvements, SOPs, and workflow enhancements
 </li>
 <li>
 Continuously improve claim lifecycle performance (speed, accuracy, approval rate)
 </li>
 <li>
 Drive operational efficiency to reduce cycle time and increase throughput
 </li>
 <li>
 Client &amp; Conflict Management
 </li>
 <li>
 Serve as the first line of escalation for claimant concerns and complaints
 </li>
 <li>
 Handle complex situations including claimant skepticism, heir disputes, and sensitive communications
 </li>
 <li>
 Resolve issues professionally before escalation to executive leadership
 </li>
 <li>
 Technology &amp; Operational Enablement
 </li>
 <li>
 Identify and implement technology solutions to improve processing efficiency and accuracy
 </li>
 <li>
 Ensure effective use of CRM, automation tools, and document systems
 </li>
 <li>
 Drive adoption of systems that enhance scalability, visibility, and client experience
 </li>
 <li>
 Key Performance Indicators (KPIs)
 </li>
 <li>
 Monthly Filing to State Fee vs. target
 </li>
 <li>
 Claim approval rate
 </li>
 <li>
 Average processing cycle time
 </li>
 <li>
 Case accuracy / rejection rate
 </li>
 <li>
 Pipeline movement (Signed &rarr; Filed &rarr; Approved)
 </li>
 <li>
 Client satisfaction / complaint resolution time
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 Experience in claim processing, case management, operations, legal support, probate/estate matters, unclaimed property, investigations, or regulated administrative processes preferred. Prior leadership or team oversight experience strongly preferred.
 </li>
 <li>
 Strategic and analytical thinker with strong operational judgment
 </li>
 <li>
 High ownership mindset with accountability for outcomes, not just activity
 </li>
 <li>
 Strong leadership and team development capability
 </li>
 <li>
 Skilled in conflict resolution and high-stakes communication
 </li>
 <li>
 Process-driven with continuous improvement mindset
 </li>
 <li>
 Comfortable leveraging technology to drive efficiency and scale
 </li>
 <li>
 Experience with unclaimed property claims, probate/heirship documentation, state agency correspondence, Salesforce/CRM tools, Microsoft 365, workflow automation, SOP creation, and leading small operations teams.
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 Performance based incentives
 </li>
 <li>
 Medical, Dental, Vision, FSA, HSA (60 day waiting period applies)
 </li>
 <li>
 Life Insurance, Short Term/Long Term Disability (60 day waiting period
 
 
 </li>
 </ul>
 applies)
 
 
 <ul>
 <li>
 Employee Assistance Program (EAP)
 </li>
 <li>
 10 days Paid Time Off (PTO - 90 day waiting period applies)
 </li>
 <li>
 12 hours Volunteer Time Off (VTO)
 </li>
 <li>
 401
 </li>
 </ul>
</div>

Director of Case Management - Case Manager

Reserv

<div>About Reserv
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you. 
About the role<ul><li>
As a Claims Manager at Reserv, you will be a working leader providing support to a Claims Director with leadership and claim technical responsibilities. Leadership responsibilities will include overseeing work done within the Commercial Auto Claims adjusting staff. We want your background and experience to deliver operational effectiveness, particularly in leveraging technology and analytics to drive better efficiencies and performance. You will serve a critical role with the team, the customers, and the client. This role will balance management responsibilities and individual contributor responsibilities when volume dictates the need for assistance with a claim.</li></ul>
Who you are<ul><li>
Highly motivated and growth-oriented, impactful and influential</li><li>
Claims professional - you are knowledgeable and have a track record of success in commercial auto claims adjudication.</li><li>
Strong leader - through formal management experience or a proven track record of peer and project leadership, you have demonstrated the ability to motivate, support, and teach a team to help them excel in their roles.</li><li>
Tech-oriented - You are excited by the prospect of building a tech-driven claims organization while delivering an excellent service and have proven results leveraging technology and analytics.</li><li>
Passionate - Claims professional who cares about their team, the customer, and their experience</li><li>
Empathetic leader - You exercise empathy and patience towards everyone you interact with</li><li>
Sense of urgency - at all times. That does not mean working at all hours</li><li>
Creative - You challenge existing assumptions and find ways of leveraging technology and the talents of your team to address problems</li><li>
Curious - You want to know the whole story so you can make the right decisions early and be decisive when it counts.</li><li>
Problem solver - You have the ability to take a &lsquo;deep dive&rsquo; into the details of the business while staying focused on the big picture.</li><li>
Anti-status quo - You don&rsquo;t just wish things were done differently; you act on it</li><li>
Communicative - You are comfortable with and understand the importance of phone communications throughout the claims process.</li><li>
And did we mention a sense of humor? Claims are hard enough as it is!</li></ul>
What we need
We need you to do all the things typical to the role:<ul><li>
Flexibility - you will need to be able to switch from claims handling to coaching and feedback</li><li>
Agility- you must have an agile mindset and the ability to pivot from focus to focus in a moment&rsquo;s notice</li><li>
Be consistently dependable in achieving or exceeding goals and overcoming obstacles</li><li>
Implement and maintain best practices for claims handling, including claim intake, investigation, evaluation, settlement, and recovery</li><li>
Align team with client and customer expectations of the claims process</li><li>
Serve as a resource for escalated claims</li><li>
Foster a positive work environment, promote teamwork, and encourage professional growth and development</li><li>
Attract, hire, retain, and provide a high level of training with the support of the rest of the leadership team</li><li>
Prepare and present comprehensive claims reports, metrics, and analyses to clients and customers; advise clients on claim trends and loss mitigation</li></ul>
Job Duties:<ul><li>
Responsible for having direct reports</li><li>
Responsible for initial onboarding tasks / access and new hire cultural immersion</li><li>
SME for first-line questions, escalations, roundtable discussions</li><li>
Increased reserve and payment authority with the ability to assist with moderate reviews</li><li>
Identify topics and trends to discuss in team Huddles and Elevated Claims Experience Workshops lead/ co-lead by Team Leads, Managers, and other Reserv employees</li><li>
Customer Obsession Champions - Active advocates who help leadership cultivate a customer-centric mindset</li></ul>
Requirements<ul><li>
10+ years of insurance claims experience in multiple lines of business, preference for an auto with some bodily injury experience</li><li>
5+ years of leadership experience with a preference for experience managing in a remote environment</li><li>
Comfortable with technology and the ability to evolve the claims systems and processes to drive better efficiencies and outcomes</li><li>
Demonstrated commitment to quality, accuracy, and attention to detail</li><li>
Integrity, ethics, and a strong sense of accountability in handling confidential and sensitive information</li><li>
Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license</li></ul> 
Benefits<ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul> 
Additionally, we will<ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul> 
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</div>

Claims Manager Auto Property Damage

Confidential Careers

<div>
 
 
 Job Title:
 
 
 
 Legal Director
 
 
 
 
 
 
 Role Purpose:
 
 
 
 To lead and manage all legal matters within the organization, including contracts, claims, disputes, and regulatory compliance, particularly across operations, maintenance, and contracting projects.
 
 
 
 
 
 
 Key Responsibilities:
 
 
 <ul>
 <li>
 Lead the company&rsquo;s
 
 legal function
 
 and provide strategic legal advice to executive management
 </li>
 <li>
 Review, draft, and negotiate
 
 contracts
 
 related to operations, maintenance, and construction projects
 </li>
 <li>
 Manage
 
 claims, disputes, and litigation
 
 , including arbitration and court cases
 </li>
 <li>
 Provide legal support on
 
 government and semi-government contracts
 
 </li>
 <li>
 Ensure compliance with
 
 local laws, regulations, and contractual obligations
 
 </li>
 <li>
 Advise on
 
 risk exposure
 
 related to contracts and project execution
 </li>
 <li>
 Work closely with project teams on
 
 contract administration and claims management
 
 </li>
 <li>
 Oversee external legal advisors and law firms
 </li>
 <li>
 Support corporate governance and internal policies from a legal perspective
 </li>
 </ul>
 
 
 
 
 
 Qualifications &amp; Experience:
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in law (Master&rsquo;s preferred)
 </li>
 <li>
 Minimum
 
 12&ndash;15 years of legal experience
 
 </li>
 <li>
 Strong experience in
 
 contracting, construction, or O&amp;M sectors
 
 </li>
 <li>
 Proven experience handling
 
 contracts, claims, and disputes
 
 </li>
 <li>
 Experience with
 
 government contracts
 
 preferred
 </li>
 <li>
 Strong knowledge of
 
 Saudi laws and regulations
 
 </li>
 </ul>
 
 
 
 
 
 Skills:
 
 
 <ul>
 <li>
 Strong contract drafting and negotiation skills
 </li>
 <li>
 Expertise in dispute resolution and claims management
 </li>
 <li>
 Strategic thinking and legal risk assessment
 </li>
 <li>
 Excellent communication and stakeholder management
 </li>
 <li>
 High integrity and professionalism
 </li>
 </ul>
 
 
 
 
 
 Location:
 
 
 
 Saudi Arabia
 
</div>

Legal Director

Quest Counseling & Consulting Inc.

Quest Counseling &amp; Consulting, a private nonprofit located in Reno, Nevada, provides behavioral health services to children, adolescents and adults including substance abuse and/or mental health disorders treatment. We are currently seeking an Accounts Receivable/Billing Specialist!The Accounts Receivable / Billing Specialist is responsible for managing client and insurance billing processes to ensure timely and accurate payment collection. This position closely monitors aging accounts, manages self-pay and secondary insurance billings, reconciles payment records, resolves billing discrepancies, and provides high-quality customer service while maintaining strict client confidentiality.Essential Functions:<ul><li>Review and work aging reports in detail to ensure timely receipt of payments.</li><li>Identify, investigate, and resolve outstanding balances before they become unmanageable, including client copayments.</li><li>Monitor and ensure timely filing deadlines are met.</li><li>Maintain the self-pay aging report by formatting, reconciling individual accounts, and posting cash and credit card (VISA) payments.</li><li>Reconcile client accounts to ensure accurate balances.</li><li>Prepare and distribute monthly statements to clients with past-due balances via mail or email.</li><li>Document account notes to support front desk staff in collecting outstanding balances.</li><li>Respond to client inquiries regarding balances, payments, and refunds.</li><li>Contact clients by phone to collect past-due balances.</li><li>Review and reconcile accounts weekly and process refunds as needed.</li><li>Run client credit reports on a monthly basis.</li><li>Balance credit card receipts with the Global Payments report and provide documentation to the Bookkeeper.</li><li>Reconcile CCBHC aging for secondary insurance billing on a monthly basis.</li><li>Retrieve, review, and maintain Explanation of Benefits (EOBs) while ensuring client confidentiality.</li><li>Prepare and submit paper claims and electronic claims for secondary insurance.</li><li>Submit manual claims when required.</li><li>Assist with posting EOB payments to client accounts.</li><li>Research, correct, appeal, and reprocess rejected or denied claims as appropriate.</li><li>Perform other duties as assigned by the Executive Director, Director of Operations, Billing Manager, or Bookkeeper.</li></ul>Qualifications:<ul><li>Experience in bookkeeping, accounting, or general office procedures.</li><li>Strong mathematical skills with a high degree of accuracy.</li><li>Excellent organizational skills and strong attention to detail.</li><li>Ability to work independently and effectively prioritize multiple tasks.</li><li>Strong verbal and written communication skills.</li><li>Proficiency in Microsoft Word and Microsoft Excel.</li><li>Demonstrated ability to maintain client confidentiality at all times.</li></ul>Physical Demands The overall nature of the position is sedentary, requiring little physical effort and occasional light exertion. There is minimal exposure to environmental conditions such as heat, cold, and temperature changes.This is a 100% in-person position. Job Type: Full-timePay: $22.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Vision insurance</li></ul>Ability to Commute:<ul><li>Reno, NV 89519 (Required)</li></ul>Work Location: In person

Accounts Receivable/ Billing Specialist

DOCTORS HEALTHCARE PLANS, INC.

<div>The Claims Examiner III is a senior-level claims professional responsible for the accurate and timely adjudication of complex professional and institutional claims in accordance with regulatory requirements, contractual agreements, and internal policies. This role supports departmental workflow oversight, assists leadership with productivity and quality monitoring, and serves as a subject matter resource to team members to ensure operational excellence and compliance with CMS and organizational standards. 
 
Key Responsibilities:<div><ul><li>
Review, analyze, and adjudicate professional and institutional claims, including high-dollar and complex cases.</li><li>
Process Member Reimbursement claims in accordance with plan benefits and regulatory guidelines.</li><li>
Ensure claims are processed accurately, timely, and in compliance with CMS regulations, state guidelines, and internal policies.</li><li>
Assist the Claims Manager and/or Assistant Director in monitoring daily, weekly, and monthly workflow to meet production and quality targets.</li><li>
Generate and analyze reports to track productivity, aging inventory, and pending items.</li><li>
Provide guidance and clarification to team members regarding claims processing rules, contract interpretation, and system functionality.</li><li>
Support the implementation and enforcement of departmental policies and procedures.</li><li>
Collaborate with leadership to ensure production, accuracy, and turnaround time metrics are consistently met.</li><li>
Communicate departmental goals, workflow strategies, and performance improvement initiatives to staff.</li><li>
Promote a positive work environment that supports staff engagement, accountability, and teamwork.</li><li>
Maximize system capabilities by ensuring proper utilization of claims processing tools and platforms.</li><li>
Identify process improvement opportunities and escalate system or configuration issues as needed.</li><li>
Perform additional duties as assigned.</li></ul><div>
Qualifications:</div></div><ul><li>
High School Diploma or GED</li><li>
Minimum of 3+ years of experience as a Medical Claims Examiner.</li><li>
Experience processing Medicare Advantage and/or managed care claims preferred.</li><li>
Strong experience with contract interpretation and benefit application.</li><li>
Working knowledge of CMS guidelines, Medicare regulations, and healthcare claims processing standards.</li><li>
Strong analytical and problem-solving skills.</li><li>
Proficiency in Windows-based systems and claims processing applications. 
</li></ul><div>
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.</div>
No Third Party Agencies or Submissions Will Be Accepted. 
 
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP 
 
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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Claims Examiner III

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