claims representative

GAINSCO

<div>Are You Driven?&reg; We Are.

We are a company of driven, enthusiastic and determined people. We celebrate achievement and success. We foster innovation, determination and recognition. Because of that, our employees feel recognized and rewarded for the contributions they make on a daily basis. At GAINSCO, It is our people that set us apart.

If you are looking for a place where you can make a difference, perceive how your work impacts the company, and be recognized for your efforts and passion, then GAINSCO is the company for you.

Why Join GAINSCO?

GAINSCO&rsquo;s work environment rewards engaged individuals who have a desire to contribute and succeed. That&rsquo;s because our culture encourages individuals to grow their skills as they build their careers. Come join us and become a champion with GAINSCO.

GAINSCO is looking to hire a Bilingual Claims Representative. This individual should be looking to build a career within the industry, as our company will be growing, giving plenty of potential to make advancements. This role is intended to develop skills for investigating, evaluating, negotiating, resolving claims on losses of lesser complexity, and providing exceptional customer service with no prior insurance or claims handling experience required.

What does a Bilingual Claims Representative do at GAINSCO?
<ul>
<li>Learns insurance terminology, knowledge and skills required to document and begin processing claims.</li>
<li>Learns initial claims processing from the first notice of loss.</li>
<li>Learns the fundamentals of proper claims handling practices, including how to resolve coverage issues and determining liability through the investigation process.</li>
<li>Learn how to set vehicle inspections and assist in managing the repair process.</li>
<li>Uses GAINSCO claims systems and other technologies to document reports of loss and transfer claims as necessary for resolution.</li>
<li>Serves as the first point of contact for claims resulting from accidents involving GAINSCO policyholders.</li>
<li>Provides exceptional customer service while obtaining detailed information regarding the facts of loss.</li>
<li>Answers general claims related questions from customers and agents regarding losses.</li>
</ul>
What is required?

Education:
<ul>
<li>High School Diploma or Equivalent.</li>
</ul>
Licenses/ Certifications:
<ul>
<li>To perform the essential functions of this job an active Adjuster License will be required to comply with state and GAINSCO requirements.</li>
<li><ul><li>Upon hire, additional license(s) may be required. If that is the case, license(s) must be obtained.</li>
<li>All licenses must be maintained in accordance with state requirements.</li>
</ul></li>
</ul>Training:
<ul>
<li>12 weeks of training.
<ul><li>Week 1-8 Working in the office 7:30AM-4:30PM.</li>
<li>Weeks 9-12 M-Th in office; Friday work from home</li>
</ul>
</li><li>After training, the first 90-day schedule may vary based on business needs between 8AM- 6PM.
</li>
</ul>Schedule:
<ul>
<li> M-F (8am-5pm), (8:30am-5:30pm), (9:00am - 6:00pm)</li>
</ul>Experience:
<ul>
<li>Demonstrated success in customer service capacity.</li>
<li>Comfortable working in a fast-paced, high-volume call center.</li>
<li>Bilingual (English/Spanish) preferred</li>
</ul>
Other skills and abilities:
<ul>
<li>Ability to learn and apply claims practices.</li>
<li>Excellent verbal, written communication and listening skills.</li>
<li>Ability to manage time while prioritizing multiple tasks.</li>
<li>Have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism.</li>
</ul>
<div></div>What else do you need to know?
<ul>
<li>Hybrid</li>
<li>Excellent benefits package: medical &amp; dental, vision insurance, life insurance, short-term and long-term disability insurance.</li>
<li>Parental Leave Policy</li>
<li>401K + Company Match</li>
<li>PTO Plan + Paid Company determined Holidays.</li>
</ul>
**Applicants are required to be eligible to lawfully work in the U.S. immediately; employer will not sponsor applicants for U.S. work authorization (e.g. H-1B visa) for this opportunity**

All offers are contingent upon a successful background investigation (including employment, education, criminal and DMV verification- when applicable) and a pre-employment drug test with results satisfactory to GAINSCO.

GAINSCO is an Equal Employment Opportunity Employer</div>

Claims Representative

The RTA Store Inc

Pay: $17.00 - $19.00 per hourJob description:Claims RepresentativeLocation: Remote (Available in FL, GA, IL, MI, MA, NY, PA, TX, WI)You belong here!We&rsquo;re looking for enthusiastic Claims Representatives to join our growing team. Ideal candidates will have a strong background in inspecting customer order errors, have excellent problem solving skills, and have prior experience with customer resolution centric responsibilities. Customer service, verbal communication, written communication, and analytical skills are also essential.If you&rsquo;re passionate about customer satisfaction and problem solving , we&rsquo;d love to hear from you!What&rsquo;s Expected in the role:Key Responsibilities<ul><li>Serve as the primary liaison between customers, manufacturers, and carriers to resolve issues related to defective, damaged, or missing products</li></ul><ul><li>Communicate with customers via phone and email to assess issues and determine replacement needs</li></ul><ul><li>Collect and verify all required documentation and information to support customer claims</li></ul><ul><li>Process replacement orders accurately and efficiently</li></ul><ul><li>Track and follow up on claims to ensure timely submission and resolution</li></ul><ul><li>Maintain detailed records of cases and communications in internal systems</li></ul><ul><li>Collaborate cross-functionally with Operations, Customer Service, and Logistics teams</li></ul>Required Skills &amp; Qualifications<ul><li>Strong customer service orientation with a commitment to fast, thorough, and informative support</li></ul><ul><li>Excellent organization and multitasking abilities</li></ul><ul><li>Calm, professional demeanor when handling high-stress situations</li></ul><ul><li>Strong verbal and written communication skills</li></ul><ul><li>Proficiency in basic email and computer applications</li></ul><ul><li>Highly reliable, dedicated, and team-oriented mindset</li></ul><ul><li>Ability to manage multiple cases while maintaining attention to detail</li></ul>The ability to quickly learn and effectively manage the claims process, along with strong de-escalation skills, is essential for this role. Claims are often received at a point when customers may already be frustrated, making excellent customer service, clear communication, and strong problem-solving abilities critical to success. Candidates who can meet these expectations are encouraged to submit their resume for consideration in the interview process.What we&rsquo;re offering:● Comprehensive Benefits: Health, dental, and vision insurance, plus a 401(k).● Health &amp; Wellness: Weekly meditation sessions to recharge and stay balanced.● Remote Flexibility: Work from home while staying connected with a supportive team.● Work-Life Balance: Paid time off and flexible scheduling options. We are a remote-first company with no plans&mdash;unlike many e-commerce and tech companies&mdash;to go back to the office.● Growth &amp; Training: Ongoing development and coaching to sharpen your skills and expand your knowledge.Job Type: Full-timeBenefits:<ul><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: RemotePay: $17.00 - $19.00 per hourBenefits:<ul><li>401(k)</li><li>Health insurance</li><li>Paid time off</li><li>Parental leave</li><li>Vision insurance</li></ul>Work Location: Remote

Berkley

<div>Company Details:<div></div><div> 
BerkleyNet is an innovative workers compensation insurance provider that does all our business online. Our Goal? To make doing business &ldquo;Ridiculously Fast. Amazingly Easy.&rdquo;</div> 
<div></div>
Responsibilities:
<div>
As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers&rsquo; compensation claims of moderate complexity in multiple jurisdictions.</div><ul><li>
Investigate workers&rsquo; compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due</li><li>
Calculate and set timely financial reserves and proactively manages reserve adequacy throughout claim lifecycle</li><li>
Record and code injured worker demographics, job information and accident information in company&rsquo;s claims management system and files necessary forms with state regulatory agencies</li><li>
Issue timely payments to injured workers, medical providers and service vendors</li><li>
Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation</li><li>
Negotiate settlements of claims within designated authority with injured workers and attorneys</li><li>
Demonstrate a working knowledge of the Workers&rsquo; Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions</li><li>
Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities</li><li>
Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner</li><li>
Respond in a timely manner to communications from policyholders, injured workers, and other interested parties</li><li>
Notify management and develops reports for large exposure claims and complies with reinsurance reporting requirements</li><li>
Manage the claims litigation process to ensure timely and cost-effective claims resolution</li><li>
Monitor the expenses and effectiveness of managed care and investigation vendors</li><li>
Actively participate in special projects as assigned by management</li><li>
Periodically travel to attend hearings, conferences and training sessions</li><li>
Attend and participates in claim file reviews with management and defense attorneys</li><li>
Continuously strives to improve our product and business results through innovation</li><li>
Obtain and maintain adjuster licenses in assigned jurisdictions where required</li></ul>
Qualifications:
<ul><li>Excellent written and verbal communication skills</li><li>
Strong interpersonal and relationship building skills</li><li>
Exceptional time management and organization skills</li><li>
Strong analytical and critical thinking skills</li><li>
Ability to work independently and strategically problem solve</li><li>
Ability to diplomatically manage conflict</li><li>
Ability to develop relationships within the organization and work effectively across departments</li><li>
Strong discretion and integrity in dealing with highly confidential and sensitive information</li><li>
Detail oriented</li></ul><div>
Education</div><ul><li>
Bachelors&rsquo; degree or equivalent insurance industry work experience</li></ul>
Additional Company Details: The Company is an equal employment opportunity employer. We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. Base salary &amp; Benefits include Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Additional Requirements: &bull;Low level of domestic U.S. travel required (up to 5% - 10% of time)</div>

Nodak Insurance Company

<div><div><div>Summary: We are seeking a detail-oriented Inside Liability Claims Representative to investigate, evaluate, negotiate, and settle complex liability claims within assigned authority. This position plays a key role in providing prompt, professional claim service while maintaining strong relationships with policyholders, agents, attorneys, and others involved in the claim process. 
 
Essential Duties and Responsibilities:</div></div><ul><li><div>
Conduct thorough investigations, gathering statements, medical records, police reports, photographs, and expert testimony as needed.</div></li><li><div>
Analyze coverage and liability issues, interpreting policy language and legal precedent to determine appropriate claim outcomes.</div></li><li><div>
Prepare clear and well-documented claim files, including worksheets, forms, and supporting materials for accurate tracking and follow-up.</div></li><li><div>
Review bills, estimates, and other documentation to ensure accuracy and compliance with policy provisions.</div></li><li><div>
Negotiate fair and timely settlements within authority limits; prepare and present settlement recommendations when additional authority is needed.</div></li><li><div>
Communicate claim decisions and coverage determinations effectively and professionally, including preparing denial documentation when warranted.</div></li><li><div>
Engage external specialists or vendors when necessary to support cost-effective and efficient claim resolution.</div></li></ul><div><div>
Authority: Operate within established company policies and claim-handling procedures, exercising sound judgment, initiative, and independence in decision-making.</div> 
</div><div><div>Education &amp; Experience: Bachelor's Degree or equivalent work experience required. Prior insurance claims handling experience strongly preferred. 
Promotional potential and organizational progressions: Senior Claim Representative. 
 
Required Knowledge and Skills:</div></div><ul><li>
Communication: Excellent verbal and written communication skills; able to explain complex information clearly and handle sensitive interactions with professionalism and empathy.</li><li>
Technical: Proficient in computer systems, data entry, and claims software; strong organizational, time management, and multitasking abilities.</li><li>
Analytical: Ability to interpret policy language, legal principles, and medical documentation accurately.</li><li>
Decision-Making: Strong problem-solving and judgment skills; comfortable interpreting contracts and applying company policy.</li><li>
Mathematical: Competent in basic math concepts for accurate claim calculations.</li>
Reliability: Consistent attendance, punctuality, and accountability. 
<li>
</li></ul><div><div>Special Relationships (to other people, internally and externally, cost control, etc.): Has broader personal settlement authority subject to normal supervisory review. Generally, can work independently with normal supervision and accountability for results. Has considerable contact by telephone or in person with claimants, insureds, agents, attorneys, Company personnel, and the general public. Must continually be aware of being a Company representative and 
projecting a favorable image. Must have the ability to communicate effectively with upset, angry individuals to resolve disputes and disagreements.</div> 
</div><div><div>Physical Requirements: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand, walk, sit, use hands to finger, handle, or feel, reach with hands and arms, climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee must may occasionally lift and/or move up to 25 pounds. The noise level in the work environment is usually moderate.</div></div><div><div>
Nodak Insurance Company complies fully with all federal, state, and local employment laws and shall provide equal employment and advancement opportunities for all persons regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, the presence of any mental or physical disability, status with regard to public assistance or marriage, or any other category protected by local, state or federal law.</div></div></div>

Inside Claims Representative

Risk Theory

<div>
 
 Auto Claims Representative - Dealer Open Lot
 
 
 
 We are an industry claims service leader, providing custom-tailored Third-Party Administration (TPA) programs to clients. We are a national program that is fast-paced and growing. This position handles 1st party Damages to the auto dealer&rsquo;s Inventory and other first-party auto damage claims. As the adjuster in this role, you will handle the claim from the first notice of loss through resolution/settlement and the payment process.
 
 
 Compensation: $60,000 - $90,000 yearly
</div>

Auto Claims Representative

UnitedHealthcare

<div>This position is Onsite. Our office is located at 115 W WAUSAU AVE, WAUSAU, 54401.
UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.
In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast-paced and highly diversified career.
This position is full time (40 hours / week), Monday - Friday. Employees have the flexibility to work an 8-hour shift schedule during our normal business hours of 7:00am - 8:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer 9 weeks of paid training. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted onsite. 
Primary Responsibilities:<ul><li>
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims</li><li>
Analyze and identify trends and provide reports as necessary</li><li>
Consistently meet established productivity, schedule adherence and quality standards</li></ul>
This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy, which will impact the timely processing of the member's claim. 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR older</li><li>
Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications</li><li>
This position is onsite at 115 W WAUSAU AVE, WAUSAU, 54401, candidates must be able to work full time at this role.</li><li>
Ability to work full time (40 hours / week), Monday - Friday. Employees have the flexibility to work an 8-hour shift schedule during our normal business hours of 7:00am - 8:00pm CST. It may be necessary, given the business need, to work occasional overtime.</li></ul> 
Preferred Qualifications:<ul><li>
1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools</li><li>
1+ years of experience with processing medical, dental, prescription, OR mental health claims</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #RED #RPOLinkedIn</div>

Edwards Health Care Services, Inc.

<div>GEMCORE&rsquo;s continued success has earned us national recognition with Inc. Magazine&rsquo;s list of America&rsquo;s Fastest-Growing Companies and with the Cleveland Plain Dealer as a Top Workplace six years running! GEMCORE is a rapidly growing multi-state family of companies headquartered in Hudson, OH.
Are you looking to begin or further your career in the medical supply industry where you are able to contribute to the success of the business, and build lasting relationships? All while allowing for personal time every evening, weekend, and holiday? Edwards Health Care Services (EHCS), a division of GEMCORE, is a well-established and growing national direct-to home medical supply provider. We are seeking a highly motivated Medical Claims Representative to join our high energy team. The Medical Claims Representative's primary role is to determine the root cause of denials and payment delays.<ul><li>
We are a fast-growing company with advancement opportunities!</li><li>
This position offers the ability to work unique problems and to apply complex problem solving skills.</li><li>
This is a full-time, non-exempt, position.</li><li>
Once training is complete, this position will potentially be part of a hybrid remote work schedule. This position is located in Hudson, OH.</li><li>
Schedule is 8:00 am - 4:45 pm, Monday through Friday.</li><li>
Employer paid vacation.</li><li>
Benefits available include medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan.</li></ul>
Key Responsibilities<ul><li>
Analyze reports on insurance payment differences, appeals and rebills.</li><li>
Work claim denials.</li><li>
Identify denial trends and suggest process improvements.</li><li>
Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures.</li><li>
Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes.</li></ul> 
Key requirements:<ul><li>
Self-starter with the ability to work independently to achieve desired results.</li><li>
Clinical background or medical terminology knowledge helpful but not necessary.</li><li>
Demonstrated proficiency in Microsoft Outlook and Excel with 30 WPM typing skills.</li><li>
Strong organizational skills and multitasking ability.</li><li>
Excellent telephone skills required.</li><li>
Good cognitive reasoning ability.</li><li>
Detailed and thorough work orientation.</li><li>
Minimum 1-2 years of experience in a consumer service organization or healthcare environment.</li></ul>
Education/Experience<ul><li>
High School Diploma or GED Equivalent</li></ul>
About Edwards Health Care Services, Inc.
Edwards Health Care Services, Inc. (EHCS) is a national direct-to home medical supply provider of high quality medical and diabetes products that support the needs of individuals with diabetes and other conditions. For over 25 years, EHCS have been lighting the way to better health by providing customers an easier way to have products delivered directly to their door. By partnering with healthcare professionals, product manufacturers, and a large network of government and private insurers, EHCS prides itself on personalized customer service and a simplified, seamless order process for every customer&hellip;every time! For more information, visit www.myehcs.com.
About GEMCORE
GEMCORE, a family of companies headquartered in Hudson, Ohio - Edwards Health Care Services, GEMCO Medical, GemCare Wellness, and GEM Edwards Pharmacy - offers a core set of healthcare solutions by partnering with manufacturers, providers, employer groups, insurance groups, and patients to deliver high quality healthcare products and innovative services to proactively better lives. For more information, visit www.gemcorehealth.com.</div>

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