claims management specialist

ariika

<div>
 
 Job Description
 
 
 
 We are looking for a detail-oriented Back Office Agent to manage customer claims and ensure smooth coordination across internal teams. This role is critical in maintaining service quality and operational efficiency.
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Claims Processing &amp; Validation: Review claims escalated by the Call Center, verify supporting evidence (photos/videos), check warranty status, and identify root causes.
 </li>
 <li>
 Operational Coordination: Act as the main point of contact between departments: Warehouse (check replacement availability), Logistics (arrange deliveries/pickups), Technical/Repair Team (schedule inspections and validate reports)
 </li>
 <li>
 Resolution Decision-Making: Apply company policies to determine claim outcomes (replacement, repair, or rejection).
 </li>
 <li>
 Case Tracking: Manage and update all cases on CRM systems, ensuring adherence to SLAs.
 </li>
 <li>
 Root Cause Reporting: Analyze recurring issues and prepare weekly reports for Quality and Procurement teams.
 </li>
 <li>
 Resolution Closure: Finalize all documentation for replacements/refunds and ensure customer satisfaction.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Experience: 1&ndash;3 years in Back Office Operations, Claims Management, or Logistics
 </li>
 <li>
 Industry Requirement: Must have experience in the furniture industry
 </li>
 <li>
 Education: Bachelor&rsquo;s degree in Business Administration, Logistics, Supply Chain, or related field is preferred
 </li>
 <li>
 Technical Skills:
 </li>
 <li>
 Advanced Excel (Pivot Tables, VLOOKUP, tracking sheets)
 </li>
 <li>
 Experience using CRM systems
 </li>
 <li>
 Key Competencies:
 </li>
 <li>
 Strong analytical skills and attention to detail
 </li>
 <li>
 Process-oriented mindset with ability to follow SOPs
 </li>
 <li>
 Effective coordination and communication across departments
 </li>
 <li>
 Ability to handle multiple cases and meet deadlines
 </li>
 </ul>
</div>

Back Office Agent (Furniture Industry)

Unilever

<div>JOB PURPOSE
This role exists to ensure operational excellence in the end-to-end cash collection and claims management cycle. Corresponding with customers to close open invoices, settle claims, resolve disputes, and reconcile balances. Coordinating with colleagues in logistics and sales for open actions and to highlight risks or manage bad debts.. You&rsquo;ll be part of a team that believes in doing work that matters &mdash; for people and the planet.
Because here, we don&rsquo;t just hire for jobs. We invite you to be part of something bigger.
KEY RESPONSIBILITIES<ul><li>
Accurate and timely claims analysis and settlement with customers</li><li>
Ensure compliant and reconciled customer accounts</li><li>
Managing open items and aged balances to tackle disputes or risks to collection</li><li>
Cross-functional interactions with sales and logistics teams</li><li>
Monthly meeting with the cash &amp; claims team and leadership to update on open actions, opportunities, or risks</li></ul>
REQUIRED QUALIFICATIONS<ul><li>
Bachelor&rsquo;s Degree, preferably in business/accounting/finance or supply chain</li><li>
Minimum 4 years of work experience, ideally in accounts receivables, collections, or claims management</li><li>
Experience of working with key information systems (Excel, SAP)</li><li>
Excellent communication skills - Impactful and flexible communication</li></ul>
PREFERRED QUALIFICATIONS<ul><li>
Experience in working across cross-functional teams and with external stakeholders</li><li>
Multitasking and ability to work with different ad hoc issues.</li><li>
Strong business acumen, passion for high performance</li></ul>
Unilever is an organisation committed to equity, inclusion and diversity to drive our business results and create a better future, every day, for our diverse employees, global consumers, partners, and communities. We believe a diverse workforce allows us to match our growth ambitions and drive inclusion across the business. At Unilever we are interested in every individual bringing their &lsquo;Whole Self&rsquo; to work and this includes you! Thus if you require any support or access requirements, we encourage you to advise us at the time of your application so that we can support you through your recruitment journey.</div>

Collection & Claims Specialist

Munich Re

<div><div>Location Dubai, United Arab Emirates Job type Full-Time Work mode Hybrid Job level Professional Job ID 12761 Company Munich Re Employment type Regular Area of expertise Claims &amp; Underwriting</div></div>
 <div><div>The Medical Claims Analyst provides specialized support to the Munich Re Health Team across the Middle East Region, conducting comprehensive analysis of health insurance claims through both prospective and retrospective review methodologies. This position is essential to upholding clinical quality standards, enhancing operational cost-efficiency, and maintaining the integrity of billing and claims processes across all claim categories.
Your role:<ul><li>
Monitor and review pre-approvals in coordination with the insurance team, ensuring timely and clinically appropriate feedback on case management interventions.</li><li>
Conduct comprehensive coding reviews on all inpatient approvals to ensure compliance with ICD, CPT, and DRG standards.</li><li>
Implement evidence-based cost containment strategies, including provider negotiations, second medical opinions, and home country referral facilitation in collaboration with the insurance team.</li><li>
Periodically analyze outpatient claims to identify utilization trends, provider performance patterns, and document suspected fraud, waste, and abuse for escalation.</li><li>
Establish and maintain approval thresholds for different Third-Party Administrators (TPAs) in collaboration with insurance partners to ensure alignment with clinical quality and cost efficiency objectives.</li><li>
Provide clinical expertise and assistance in health insurance medical underwriting processes as required</li><li>
Review medical evidence and recommend appropriate coverage determinations</li><li>
Support risk assessment activities in collaboration with the underwriting team</li></ul>
Your Profile:<ul><li>
Bachelor's degree in Medicine (MD/MBBS) or equivalent medical qualification</li><li>
Current Certification in Medical Coding and Billing (e.g., AAPC, ICD-10, or equivalent regional certification)</li><li>
Minimum 3 years of hands-on experience in health insurance claims management in the UAE market</li><li>
Additional insurance qualifications (e.g., AICL, RPA) are highly desirable.</li><li>
Excellent problem-solving and time management skills</li><li>
Good interpersonal and communicational skills</li><li>
Team player, motivated, dependable, and open-minded</li><li>
Assertive, reliable and business-minded with good negotiation skills.</li></ul><ul><li>Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.</li></ul></div></div>
 <div><div><div><h2 class="jobSectionHeader">Your Benefits</h2>
With us, you get more than just an exciting job. Enjoy a wide range of employee benefits tailored to your wellbeing and development. Please note that regional differences may apply.
</div><div><div>Competitive Salary
We provide fair and competitive compensation that reflects your performance and commitment.
</div><div>Company performance-based Incentives
In addition to your salary, our variable compensation approach allows you to share in Munich Re's success.
</div><div>Recognition and Special Rewards
We recognise outstanding individual contributions through a variety of targeted rewards and incentives.
</div><div>Retirement Planning
We support your long-term financial wellbeing with retirement solutions aligned with local regulations.
</div><div>Inclusive Workplace Culture
We foster a respectful, inclusive, and values-driven environment.
</div><div>Learning &amp; Development
We offer tailored learning opportunities with a strong focus on core skills and business-critical knowledge.
</div><div>Work-Life-Balance
Supporting your ability to balance family, leisure, and your career.
</div><div>Health &amp; Wellbeing
We support your physical and mental health through a range of programs and activities in each location.</div></div></div></div>

Medical Claims Analyst

NYU Langone Health

<div>Position Summary: 
We have an exciting opportunity to join our team as a Billing Representative III (A/R) - Florida.
 
 
In this role, the successful candidate performs advanced billing and financial clearance functions including claims management, complex denial resolution, insurance authorizations, precertifications, and patient cost estimates. This role provides support to staff with escalated issues and participates in training and process improvement efforts.

Job Responsibilities:
<ul>
<li>Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow-up, or other related responsibilities.
</li><li>Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.</li>
<li>Perform daily tasks in assigned work queues and according to manager assignments.</li>
<li>Identify payer, provider credentialing, and/or coding issues and address them with management.
</li><li>Follow workflows provided in training classes and request additional training as needed.
</li><li>Utilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe.</li>
<li>Review reports to identify revenue opportunities, unpaid claims, delays in obtaining authorizations/financial clearance.</li>
<li>Adhere to general practices and departmental guidelines on compliance issues and patient confidentiality.
</li><li>Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.</li>
<li>Work following operational policies and procedures, and regulatory requirements.</li>
<li>Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality.</li>
<li>Read and apply policies and procedures to make appropriate decisions.</li>
<li>Coordinate functions and work cooperatively with others.</li>
<li>Responsible for assisting other billing representatives with difficult and escalated issues.
</li><li>Assist department supervisor with special projects and staff training.</li>
<li>Appeal complex denials through review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.</li>
<li>Cross cover other areas in the office as assigned by management including Accounts Receivable/Denials, Customer Service or Authorizations.
</li><li>Other related duties as assigned.</li>
</ul>
Patient Experience and Access
<ul>
<li>Drives consistency in every patient and colleague encounter by embodying the core principles of our Billing Department Service Strategy CARES (Connect, Align, Respond, Ensure, and Sign-Off)</li>
<li>Greets patients warmly and professionally, stating name and role, and clearly communicates each step of the care/interaction as appropriate</li>
<li>Works collaboratively with colleagues and site management to ensure a positive experience and timely resolution for all patient interactions and inquiries whether in person, by phone or via electronic messaging.</li>
<li>Proactively anticipates patient needs, and participates in service recovery by applying the LEARN model (Listen, Empathize, Apologize, Resolve, Notify), and escalates to leadership as appropriate.</li>
<li>Shares ideas or any observed areas of opportunity, to improve patient experience and patient access, with appropriate leadership. (i.e. ways to optimize provider schedules, how to minimize delays, increase employee engagement, etc.)</li>
<li>Partners with internal and external team members to support collaboration and promote a positive patient experience.</li>
<li>Takes a proactive approach in ensuring that practice staff are fully versed in the Access Agreement gold standard principles.</li></ul> 


Minimum Qualifications: 
To qualify you must have a High School Diploma or GED. Experience in medical billing, accounts receivable, insurance, or related duties; Knowledge of CPT and ICD10; medical billing software; English usage, grammar and spelling; basic math; 3 years experience in a similar role. Light, accurate keyboarding skills required. Prefer that candidates type 35 words per minute (wpm) or greater on the typing assessment that will be administered prior to onboarding.
 
Personal Characteristics: 
Strong verbal and written communication skills, with the ability to collaborate across departments. 
Strong critical thinking and effective listening skills 
Professional demeanor and positive attitude required
 
Time management skills required 
Ability to develop and maintain effective working relationships with peers, other staff and leadership

Qualified candidates must be able to effectively communicate with all levels of the organization.
 
 
NYU Langone Florida provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.
 
 
NYU Langone Florida is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.
 
 
View Know Your Rights: Workplace discrimination is illegal.&quot;</div>

Billing Representative III (A/R) - Boynton Beach, Florida

Moreland OBGYN Associates, S.C.

MORELAND OB-GYNMedical Payment Poster/Financial Counseling Representative (on-site)This key role supports our patients through high quality medical claims management with a kind and compassionate approach. This is a full time, on-site, Monday - Friday, 40-hour day position. This on-site position is located at our Waukesha Clinic.Milwaukee Journal Sentinel Top Workplace 8-years in a row. Come be a part of our team of professionals!KEY JOB FUNCTIONS:<ul><li>Medical payment posting from insurance payer remittances electronically and on paper, for government and commercial payers</li><li>Work with patients to make payment arrangements, review benefits, and process refunds</li><li>Communicate with medical insurance companies regarding claims denials, remittances (EOB's) from payers, follow up authorizations, and insurance verification</li></ul>KNOWLEDGE, SILLKS &amp; ABILITIES:<ul><li>Knowledge of patient account transactions. Prior medical billing and payment posting experience required.</li><li>Exceptional organization skills, the ability to multi-task, and work independently</li><li>Strong computer skills in Excel and Word along with basic math knowledge</li><li>Proficient with electronic health records (EHR) and billing software (Epic) preferred</li><li>Strong attention to detail and accuracy with data entry</li></ul>WHO WE ARE:The providers at Moreland OB-GYN are dedicated to providing women with compassionate OB-GYN care throughout life. This includes complete obstetrical care, gynecology, gynecologic and obstetric surgery, infertility services, preventative health care, and more!We are dedicated to the needs of the community by promoting overall excellence in the delivery of women&rsquo;s health care. Through a continued tradition of caring, our staff of professionals will provide the latest medical knowledge and treatment.Our philosophy encourages patient education and personal involvement in pursuing the ultimate goal of physical well-being.We ensure an environment of compassion and confidentiality, as we recognize the rights and dignity of all individuals. We are an Equal Opportunity EmployJob Type: Full-timeBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul>Work Location: In person

Medical Payment Poster/Financial Counseling Representative (on-site)

Zurich Insurance

<div>Zurich is currently looking for a to join our Rural Community Insurance Services (RCIS) team. RCIS is one of the leading crop insurance providers in the U.S. RCIS offers insurance protection in all 50 states through a national network of about 3,600 licensed agents. RCIS offers a wide range of private product coverages, including a diverse selection of named-peril options, supplemental and stand-alone insurance products as well as federal crop insurance plans through the United States Department of Agriculture&rsquo;s Risk Management Agency. Together with RCIS agents, we protect America&rsquo;s farmers and ranchers. 
 
Zurich North America is hiring an RCIS Crop Claims Specialist or Claims Crop Field Adjuster I to join our team! 
 
We are open to hiring talent in one of the following locations within- Noble, Garfield, Payne, Kay, Grant County area in Oklahoma. You must live within 50 miles of these locations to be successful. 
 
If you are ready for a career move, consider working for a company with a global footprint that offers terrific benefits including a bonus plan, 401K match and a second 401K company contribution, flexible work options, summer hours, an excellent work/life balance and a great culture. 
 
Additional responsibilities will include: 
<ul><li>
Exercise judgement to determine liability by gathering and analyzing relevant facts, utilizing applicable procedures.</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>
Participates in Risk Management Agency initiated reviews and referrals for sake of operations integrity and quality assurance.</li><li>
Protect Zurich&rsquo;s reputation by keeping claims information confidential.</li><li>
Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks. And participating in professional societies.</li></ul> 
This role will be filled at either the Crop Claims Specialist or Crop Claims Specialist II Level. The hiring manager will determine the appropriate level based upon the selected applicant&rsquo;s experience and skill set relative to the qualifications listed for this position. 
 
Crop Claims Specialist Basic Qualifications: 
<ul><li>
High School Diploma or Equivalent and 6 or more months of experience in the agricultural area</li><li>
Crop Adjuster Proficiency Program Certification (CAPP) must be obtained with 180 days of hire date.</li><li>
Reliable personal transportation and travel within territory</li><li>
RCIS Crop Adjuster Physical Requirements: walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs to 50 lbs, work outdoors in varying temperatures/weather conditions.</li></ul> 
OR 
 
Crop Claims Specialist II: 
<ul><li>
High School Diploma or Equivalent and 4 or more years of experience in the agricultural or the crop insurance industry 
AND</li><li>
Crop Adjuster Proficiency Program (CAPP) Certification must be obtained within 180 days of hire date</li><li>
Personal transportation and travel within assigned territory and travel outside of assigned are to assist with workload(s) , participate on CAT team and/or provide remote assistance for the CROP Claims Care Center calls and/or CCP Claims</li><li>
RCIS Crop Adjuster Physical Requirements; walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs to 50 lbs, work outdoors in varying temperatures/weather conditions</li></ul> 
Preferred Qualifications for both levels: 
<ul><li>
Strong verbal, written and interpersonal skills.</li><li>
Strong organization, multi-tasking and prioritization skills.</li><li>
Intermediate Microsoft office skills</li></ul> 
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 combined salary range for this position is $41,900.00 - $72,900.00. The proposed hourly rate for the Claims Crop Field Adjuster I is $20.14 - 27.79, with short-term incentive bonus eligibility set at 5%. The proposed salary range for the Crop Claims Specialist is $44,600.00 - $72,900.00, with short-term incentive bonus eligibility set at 10%. 
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.] 
Why Zurich?
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;. 
Join us for a brighter future&mdash;for yourself and our customers. 
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. 
Zurich complies with 18 U.S. Code &sect; 1033. 
Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal. 
Location(s): AM - Oklahoma Virtual Office 
Remote Working: Hybrid 
Schedule: Full Time 
Employment Sponsorship Offered: No 
 
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE</div>

RCIS Crop Claims Specialist or Claims Crop Field Adjuster, OK

Ecology Auto Parts Inc

<div>Description:

SUBROGATION SPECIALIST
Department: Corporate &ndash; Safety &ndash; Claims
Location: Corporate HQ &ndash; Cerritos CA
Classification: Full-Time, Non-Exempt
Reports To
Claims Manager
Position Summary
Ecology Auto Parts Inc. is seeking a diligent and detail-oriented Subrogation Specialist to join our Claims Department. Reporting directly to the Claims Manager, the Subrogation Specialist will be responsible for investigating and pursuing subrogation opportunities to recover claim payments made by Ecology Auto Parts, Inc. The ideal candidate will possess prior trucking/commercial transportation claims experience and will play a vital role in minimizing financial loss and optimizing recovery efforts. This position requires strong analytical skills, attention to detail, and the ability to work collaboratively with internal and external stakeholders.
Responsibilities<ul><li>
Investigate and evaluate subrogation potential for claims involving third-party liability.</li><li>
Communicate with insurance companies, attorneys, and other involved parties to negotiate and settle subrogation claims.</li><li>
Analyze claim documents, police reports, and other relevant information to determine liability and recoverable damages.</li><li>
Prepare and submit subrogation demands and documentation in a timely and accurate manner.</li><li>
Monitor and track subrogation claims through the entire recovery process, ensuring timely follow-up and resolution.</li><li>
Collaborate with internal Claims Department staff to identify potential subrogation opportunities and strategies.</li><li>
Maintain accurate records of subrogation activities, including documentation of communications and settlement agreements.</li><li>
Provide regular updates and reports on subrogation efforts to the Claims Manager and other stakeholders as needed.</li></ul>
Requirements:

Qualifications/Knowledge/Critical Skills<ul><li>
Previous Trucking/Commercial Transportation claims/subrogation experience HIGHLY PREFERRED</li><li>
Minimum of 2 years of experience in insurance claims handling or subrogation recovery REQUIRED</li><li>
Strong understanding of insurance principles, subrogation laws, and claims processes</li><li>
Excellent negotiation and communication skills, both written and verbal REQUIRED</li><li>
Ability to analyze complex claim information and make sound decisions regarding subrogation opportunities</li><li>
Proficiency in Microsoft Office Suite, particularly Excel and Word REQUIRED</li><li>
Experience with claims management software PREFERRED</li><li>
Detail-oriented with strong organizational and time management skills REQUIRED</li></ul>
Physical Demands/Environmental Factors<ul><li>
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.</li><li>
Occasionally required to stand and walk.</li><li>
Must frequently lift and/or move up to 25 pounds.</li><li>
Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.</li><li>
Minimal travel required.</li></ul>
Compensation
The Subrogation Specialist position offers a competitive hourly wage ranging from $22 to $28 per hour, commensurate with experience. In addition to competitive pay, Ecology Auto Parts Inc. provides a comprehensive benefits package, including medical, dental, and vision insurance, a 401k plan with employer matching, generous paid time off, and life insurance coverage.
PLEASE NOTE: This job description is not exhaustive and is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.
Ecology Auto Parts Inc. is committed to providing a workplace and culture of respect, diversity, equity, inclusion, and belonging. We are dedicated to ensuring equal employment opportunity without regard to race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. Should you have a disability or specific needs requiring accommodation, please inform us.
Thank you for your interest in opportunities with Ecology Auto Parts, Inc. We appreciate the enthusiasm and professionalism demonstrated by individuals seeking to join our team.
Please be advised that Ecology Auto Parts, Inc. does not engage with or entertain solicitations from third-party recruiting firms for our hiring needs. We have a dedicated internal recruitment team managing our talent acquisition process. We kindly request that third-party recruitment firms refrain from submitting candidates for our open positions. Ecology Auto Parts, Inc. will not consider or entertain candidates represented by headhunter agencies for our current requisitions. Our commitment to fair and equitable hiring practices includes working directly with candidates who apply through our official channels. We believe in fostering a transparent and direct relationship with potential team members.
We appreciate your understanding and compliance with this policy. If you are interested in joining Ecology Auto Parts, Inc., please visit our official careers page here: EAP, Inc. | Career Center for a list of our current job opportunities and application instructions.</div>

COMMERCIAL TRUCKING CLAIMS SUBROGATION SPECIALIST

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