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associate clinical account specialist (atlanta, ga) - johnson & johnson medtech, electrophysiology Jobs in Atlanta

claims specialist

Amerit Consulting

<div>
 
 
 
 OVERVIEW:
 
 
 
 
 
 Our client, a US Fortune 50 organization and a leading provider of Healthcare and Health Insurance services
 
 , seeks an accomplished
 
 Medical Claims Specialist
 
 .
 
 
 
 
 
 
 
 IMPORTANT NOTES: REMOTE / WORK-FROM-HOME RELATED:
 
 
 
 <ul>
 <li>
 
 This will be a Remote role.
 
 </li>
 <li>
 
 Equipment's will be provided.
 
 </li>
 <li>
 MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections are not allowed.
 </li>
 <li>
 MUST have a reliable home-office environment.
 </li>
 <li>
 
 Payrate would be $18.15 per hour. The worker must also receive an additional $5.55 per hour payment in lieu of benefits. Total hourly Pay rate would be $23.70 per hour.
 
 </li>
 <li>
 
 Training Shift Hours: 40 hours per week | 08:00am to 4:30pm (Eastern Time).
 
 </li>
 <li>
 
 Training will be 5-6 weeks.
 
 </li>
 <li>
 
 After training, the candidates may choose to flex start time of 6:00 AM to 10:00 AM (Eastern Time).
 
 </li>
 </ul>
 
 
 
 
 
 
 Client will be considering candidates MUST sit within 50 miles of below location (Please apply accordingly):
 
 
 
 <ul>
 <li>
 Dennison, TX
 </li>
 <li>
 Atlanta, GA
 </li>
 <li>
 Midland/Columbus, GA
 </li>
 <li>
 Indianapolis, INDIANA
 </li>
 <li>
 Louisville, KY
 </li>
 <li>
 Gilbert, MN
 </li>
 <li>
 St Louis, MO
 </li>
 <li>
 Winston-Salem, NC
 </li>
 <li>
 Cincinnati, OH
 </li>
 <li>
 Columbus, OH
 </li>
 <li>
 Mason, OH
 </li>
 <li>
 Nashville, TN
 </li>
 <li>
 Norfolk, VA
 </li>
 <li>
 Richmond, VA
 </li>
 <li>
 Roanoke, VA
 </li>
 <li>
 Baltimore, MD
 </li>
 </ul>
 
 
 
 
 
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 This is an entry level position in the NGS Appeals Department that reviews, analyzes and
 
 processes non-complex pre-service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A &amp; B)
 
 related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
 </li>
 <li>
 Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
 </li>
 <li>
 Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
 </li>
 <li>
 The grievance and appeal work are subject to applicable accreditation and regulatory standards and requirements.
 </li>
 <li>
 As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
 </li>
 <li>
 Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
 </li>
 <li>
 Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
 </li>
 <li>
 The analyst may serve as a liaison between grievances &amp; appeals and /or medical management, legal, and/or service operations and other internal departments.
 </li>
 </ul>
 
 
 
 
 
 
 Required Qualifications:
 
 
 
 <ul>
 <li>
 
 Must have High School Diploma or GED.
 
 </li>
 <li>
 
 Must have 3-4 years&rsquo; experience working with Medical Claims, grievances and appeals, Medicare, Part A OR PART B.
 
 </li>
 <li>
 
 Familiarity with medical terminology, demonstrated business writing proficiency.
 
 </li>
 <li>
 Must have strong understanding of provider networks, the
 
 medical management process
 
 ,
 
 claims processing
 
 .
 </li>
 <li>
 Must be proficient handling
 
 high volume
 
 
 inbound calls
 
 .
 </li>
 <li>
 Must have background in
 
 following up with insurance providers
 
 .
 </li>
 </ul>
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 
 
 
 
 Recruiter Contact Info
 
 
 
 Jatin Rattan
 
 
 E-mail: jatin.rattan@ameritconsulting.com
 
 
 www.ameritconsulting.com
 
 
 
 
 
 
 I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
 
 
 
 
 
 
 
 Company Overview:
 
 
 
 Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local &amp; regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients&rsquo; businesses forward.
 
 
 
 
 
 Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
 
 
 
 
 
 This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.
 
</div>

Medical Claims Specialist

Zurich Insurance

<div>At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected. The candidate selected for this opportunity should be able to report into the following North American Claims offices: Addison, Texas. 
Position Available: Senior Claims Specialist 
Location: Addison, Texas 
Zurich is currently seeking a Senior Claims Specialist to join our team in Addison, Texas, on a hybrid work schedule. In this role, you will be responsible for handling Workers Compensation claims primarily in Texas, with additional cases in Arkansas and Oklahoma. The position focuses on high exposure and complex claims, ensuring prompt and equitable resolutions. 
Key Responsibilities: 
<ul><li>
Investigate Workers Compensation claims to determine applicable coverage and liability.</li><li>
Document claim files thoroughly to support payment decisions.</li><li>
Set appropriate reserves within authority levels and comply with special handling requirements.</li><li>
Develop and maintain positive customer relationships, anticipating needs, and recommending changes as necessary.</li></ul> 
Basic Qualifications: 
<ul><li>
Bachelor&rsquo;s Degree and 6 plus years of experience in Claims and/or Litigation Management 
OR</li><li>
Juris Doctor and 2+ years of experience in Claims and/or Litigation Management 
OR</li><li>
Zurich Certified Insurance Apprentice with an Associate Degree and 6 plus years of experience in Claims and/or Litigation Management 
OR</li><li>
Completion of Zurich Claims Training Program and 6 plus years of experience in Claims and/or Litigation Management 
OR</li></ul><ul><li>
High School Diploma Equivalent and 8 plus years of experience in Claims and/or Litigation Management</li><li>
Must obtain and maintain required adjuster license(s)</li><li>
Proficiency in Microsoft Office</li><li>
Knowledge of insurance regulations, markets, and products</li></ul> 
Preferred Qualifications: 
<ul><li>
6+ years of experience handling Worker Compensation claims of high exposure</li><li>
6+ years of experience with litigation management</li><li>
Required expertise in handling claims in Texas, with preferred experience in Arkansas and Oklahoma.</li><li>
Property &amp; Casualty Insurance Experience</li><li>
Effective verbal and written communication skills</li><li>
Strong analytical, critical thinking, and problem-solving skills</li><li>
Strong multitasking and prioritization abilities</li><li>
Experience collaborating in a team environment and building cross-functional working relationships</li><li>
Proactive sharing of insights and gathering unique perspectives from other teams/functions</li><li>
Understanding, analysis, and application of insurance policy components for complex claims</li><li>
Ability to follow reserving process for indemnity and expense in analyzing potential exposure of complex claims</li><li>
Ability to determine scope and exposure for complex claims</li><li>
Leveraging trends and relationships to provide high-quality customer service</li><li>
Identification, understanding, and explanation of complex financial and/or actuarial trends/concepts</li><li>
Effective communication of coverage determinations to customers/clients/brokers for complex claims</li><li>
Directing counsel on an ongoing basis to guide the course of complex litigation and settlement strategies</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 pay range shown is a national average and may vary by location. The proposed Salary range for this position is $75,800.00 - $124,100.00, with short-term incentive bonus eligibility set at 15%. 
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 - Atlanta 
Remote Working: Hybrid 
Schedule: Full Time 
Employment Sponsorship Offered: No 
 
Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID</div>

Sr. Claims Specialist, Workers Compensation

Zurich North America

<div>
 Zurich North America is currently hiring an Auto Litigation Claims Specialist to join our Auto Rental Liability team.
 
 
 At Zurich North America Claims, we prioritize work-life balance and flexibility to support your career and personal goals. Our hybrid work model is thoughtfully designed to offer employees flexibility in choosing their preferred work location while fostering meaningful in-person connections and collaborative opportunities. While this model emphasizes autonomy, occasional in-office attendance may be required.
 
 
 The selected candidate should be able to report to one of our major claims hub offices on a hybrid work schedule: Atlanta, GA; Addison, TX; Omaha, NE; Overland Park, KS; Schaumburg, IL; Gold River, CA.
 
 
 
 Job Responsibilities:
 
 
 
 Under moderate supervision, the Auto Litigation Claims Specialist will manage multi-party commercial line rental liability claims of low to moderate complexity and exposure within specific authority limits. This role adheres to established claims-handling protocols, delivering efficient, customer-focused service.
 
 
 
 Basic Qualifications:
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s Degree with 3 or more years of experience in Claims or Insurance OR
 </li>
 <li>
 Zurich Certified Insurance Apprentice (including an Associate Degree) with 3 or more years of experience in Claims or Insurance OR
 </li>
 <li>
 Completion of the Zurich Claims Training Program with 2 or more years of experience in Claims or Insurance OR
 </li>
 <li>
 High School Diploma (or equivalent) with 5+ years of experience in Claims or Insurance
 </li>
 <li>
 Must obtain and maintain required adjuster license(s)
 </li>
 <li>
 Knowledge of insurance regulations, markets, and products
 </li>
 <li>
 Proficiency in Microsoft Office
 
 
 </li>
 </ul>
 
 Preferred Qualifications:
 
 
 
 <ul>
 <li>
 3 or more years of experience managing commercial auto claims, with a focus on litigated files
 </li>
 <li>
 Expertise in handling rental liability Claims
 </li>
 <li>
 Strong background in handling bodily injury claims
 </li>
 <li>
 In-depth knowledge of uninsured and underinsured motorist (UM/UIM) coverage
 </li>
 <li>
 Exceptional verbal and written communication skills, with the ability to convey complex information clearly
 </li>
 <li>
 Demonstrated strength in analytical thinking, critical problem-solving, and sound decision-making
 </li>
 <li>
 Proven ability to manage time effectively, prioritize tasks, and handle multiple assignments in a fast-paced environment
 </li>
 <li>
 Collaborative team player with experience building effective cross-functional relationships
 </li>
 <li>
 Skilled at articulating complex financial and actuarial concepts to both technical and non-technical stakeholders
 </li>
 <li>
 Adept at evaluating claim scope and exposure, particularly for moderately complex cases
 </li>
 <li>
 Solid understanding of indemnity and expense reserving processes to support accurate exposure analysis
 </li>
 <li>
 Expertise in developing and executing strategic negotiation approaches for efficient claim resolution
 
 
 </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 pay range shown is a national average and may vary by location. The proposed Salary range for this position is $59,900.00 - $98,200.00, 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
 
 
 <ul>
 <li>
 1033.
 
 
 </li>
 </ul>
 
 Please note:
 
 Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.
 
 
 Location(s): AM - Omaha, AM - Addison, AM - Atlanta, AM - Gold River, AM - Overland Park, AM - Schaumburg
 
 
 Remote Working: Hybrid
 
 
 Schedule: Full Time
 
 
 Employment Sponsorship Offered: No
 
 
 Linkedin Recruiter Tag:
 
 
</div>

Auto Rental Liability Litigation Claims Specialist

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview 
About the INVEST Program
Are you a recent college graduate looking for a long-term, stable, innovative and exciting career that helps make a meaningful difference and supports people through challenges? 
The Emerging Talent INVEST Program (ETIP) &ndash; Guardian Pathway is a 6-month paid, fully remote, entry-level immersive learning experience, designed for recent college graduates to gain real-world exposure, personalized coaching and mentorship and a clear, long-term career path in one of U.S. best industries. 
Program Highlights<ul><li>
6-months, paid, fully remote learning track</li><li>
Virtual classroom, peer shadowing, simulations, case studies, and hands-on experience</li><li>
Fully remote (candidates must physically reside in states specified although the role is remote)</li><li>
Interactive sessions, one-on-one mentorship, collaborative projects, exposure to wide variety of industries, clients, and knowledge material</li><li>
Fully paid licensing and advance education opportunities</li><li>
Career progression post-graduation into claims resolution manager roles and beyond</li></ul>
 
How you'll make an impact 
What will you do?
Over the course of this 6-month program you will be partnered with a team of peers and experienced Training Specialists that will create a supportive learning environment designed to position you for successful program completion. You will alternate between self-study modules, virtual classroom-style learning, guided training modules, and hands-on application of the knowledge gained. Over the course of the program, you will progressively increase your hands-on experience to immerse yourself into the world of claims management and client service excellence under the mentorship of the program mentors and training leaders. The program is designed to offer consistent and repeated opportunities to develop, grow and practice your knowledge, advance your education via licensing studies, and help you gain confidence in the unique and highly specialized field of commercial claims handling for world&rsquo;s largest employers and insurance carriers. 
What can you expect?<ul><li>
Participate in Structured Learning: Actively engage in the first phase of the INVEST Program, which includes instructor-led sessions, online modules, job shadowing, and mentorship focused on foundational insurance knowledge, claims operations, and state-specific workers&rsquo; compensation regulations.</li><li>
Shadow Claims Experts: Observe experienced claims professionals and learn best practices in managing lost time (indemnity) workers&rsquo; compensation claims.</li><li>
Practice in a Simulated Environment (&quot;Sandbox&quot;): Apply newly learned concepts in a controlled, simulated claims environment designed to mimic real-world scenarios. The sandbox allows colleagues to practice making decisions, inputting data, and managing mock claims without risk, helping build confidence before handling actual cases.</li><li>
Complete Program Milestones: Achieve key learning objectives and performance checkpoints as you build technical knowledge and professional skills essential for a successful claims career.</li><li>
Collaborate and Network: Engage with peers, mentors, and cross-functional teams to deepen understanding of the claims process and build professional relationships within the organization.</li><li>
Gradual Claim Ownership: Begin handling new workers&rsquo; compensation claims starting in Week 3 of the program. Claim assignments will begin at an incremental, supportive pace, with inventory gradually increasing as confidence and competency develop.</li><li>
Support Claims Management: Take ownership of an evolving portfolio of indemnity claims under close supervision. Begin applying program training to real-world scenarios, including benefit calculations, wage loss evaluations, and return-to-work considerations.</li><li>
Claims Analysis and Learning: Continue developing skills in analyzing medical documentation, regulatory guidelines, state-specific regulations, and supplemental case materials to determine claim strategy, financial exposure and potential next steps.</li><li>
Stakeholder Communication: Engage in professional communication and strategy development with clients; provide support and empathy to the injured employees; secure key details from medical providers and other key stakeholders to support collaborative, outcome-focused, and empathetic claims handling.</li><li>
Client Service Instructions &amp; Carrier Guidelines: 
Learn how to interpret and apply client service instructions and carrier guidelines to ensure claims are handled in compliance with expectations. This includes understanding unique requirements for documentation, communication, and jurisdictional standards across our diverse client base.</li><li>
Reserving Acumen: 
Build core skills in setting and adjusting reserves by analyzing claim details, medical data, and potential outcomes. You&rsquo;ll learn how accurate reserving supports financial stewardship and impacts overall claim strategy.</li></ul>
 
About You<div> 
Education: Bachelor&rsquo;s degree or 4-year degree from an accredited institution preferred.</div><div>
Candidates possessing a Bachelor&rsquo;s degree will receive preferential treatment. Others with proven experience will be considered.</div><div></div><div> 
Attributes:</div><ul><li>
Active listening skills
</li><li>Problem-solving mindset</li><li>
Adaptable to changes in procedures and technology</li><li>
Computer literacy, including strong familiarity with M365 products (e.g. Outlook, Word, and basic Excel and PPT)</li><li>
Strong verbal and written communication skills</li><li>
Strong time management and ability to multi-task</li><li>
Detail-oriented</li><li>
Curious, learning-focused mindset</li></ul><div>
#GBTopJob</div><div>
#remote</div><div>
#INVEST</div> 
 
Compensation and benefits 
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you&rsquo;ll get, depending on your job level these benefits may improve:
<ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div>
Other benefits include:</div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</div><div></div><div> 
We value inclusion and diversity</div>
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</div>

Emerging Talent INVEST Program - Guardian Associate

Empowerment Resource Center

<div><div>Job Classification: Billing &amp; Coding Specialist</div><div>
Reports To: Client Services Supervisor</div><div>
FLSA Status: Part -Time not to Exceed 29 Hours week</div><div></div><div> 
Summary: Reports to the Client Services Supervisor. The Billing &amp; Coding Specialist is responsible for managing the end-to-end medical billing process, including claim submission, payment posting, denial resolution, and reconciliation across EMR and QuickBooks systems and payer compliance to ensure timely and accurate revenue collection for the organization. . This position ensures compliance with payer contracts and coding standards, promotes accurate reimbursements, and supports financial transparency. The role plays a vital part in maintaining the organization&rsquo;s financial health, improving cash flow, and ensuring alignment with private insurance carrier agreements.</div><div></div><div> 
The Billing &amp; Coding Specialist must have a strong understating of CPT, ICD-10 and insurance billing codes, as well as, working knowledge of payer contracts, private carrier reimbursement methodologies, and compliance requirements, The incumbent ensures that all claims are processed correctly, reimbursement are maximized, and revenue is maintained through careful monitoring, auditing, and collaboration with internal departments and payers. The role supports and enhances the insurance billing function through diligent claim management, payer communication, and reconciliation activities that promote accurate reimbursement and financial transparency.</div><div></div><div> 
Essential Duties and Responsibilities:</div><div></div><h1 class="jobSectionHeader"> 
Insurance Claims Management</h1><div><ul><li>
Verify CPT codes prior to claim submission in the EMR system to ensure compliance and maximize reimbursement.</li><li>
Collaborate with coding and revenue cycle teams to resolve complex CPT coding issues beyond standard expertise.</li><li>
Prepare, review, and submit insurance claims through the EMR system, ensuring compliance with payer-specific and contractual requirements.</li><li>
Monitor and manage claim submissions to ensure accuracy, timely filing, and proper follow-up on rejections or denials.</li><li>
Research claim denials and rejections, determine root causes, and take corrective actions to resolve issues promptly.</li><li>
Revise and resubmit corrected claims with necessary documentation and coding updates to secure proper reimbursement.</li><li>
Participate in weekly meetings with clinic leadership to analyze denials, rejections, and claim status for continuous improvement.</li><li>
Monitor the adjudication of submitted claims to verify timely processing, accuracy, and alignment with contracted reimbursement rates.</li><li>
Represent and advocate for corrected or underpaid claims during follow-up with insurance carriers.</li><li>
Ensure all billing activities comply with payer contracts, including fee schedules, covered services, and filing deadlines established by private carriers.</li></ul>
Payment Processing<div><ul><li>
Post all insurance payments&mdash;checks, ACH, and virtual card payments&mdash;into the EMR system, ensuring proper allocation to patient accounts.</li><li>
Collaborate with Accounts Receivable (A/R) to review outstanding claims, address aged accounts (91+ and 121+ days), and ensure all posted payments are reflected accurately.</li><li>
Track unpaid claims, follow up with insurance companies, and execute collection procedures on delinquent accounts to minimize write-offs.</li><li>
Pull and review A/R reports regularly to identify trends, payment delays, or discrepancies</li></ul></div>
Contract Compliance and Payer Relations<div><ul><li>
Maintain up-to-date knowledge of payer contracts, reimbursement terms, and policy changes for private carriers.  Verify that all claims, payments, and adjustments adhere to negotiated fee schedules and contractual obligations.</li><li>
Identify and report patterns of underpayment or contract violations by payers to management.</li><li>
Assist leadership with payer audits, renegotiations, and periodic reviews to ensure continued compliance and optimal reimbursement.</li><li>
Serve as a liaison between the organization and private insurance carriers to promote positive working relationships and resolve contract-related billing concerns.</li><li>
Participate in regular meetings with A/R and billing support teams to align on claim status, outdated accounts, and reconciliation needs.</li><li>
Communicate professionally with insurance representatives, patients, and internal teams to facilitate timely resolutions and optimize reimbursement workflows.</li></ul></div>
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<div><ul><li>
Education and/or Experience: High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in Healthcare Administration, Accounting, or related field preferred. 2+ years of experience in medical billing, insurance claims, or accounts receivable management required. Proficiency in EMR systems. Strong understanding of CPT, ICD-10, and insurance billing codes (certified coder preferred but not required). Working knowledge of payer contracts, private carrier reimbursement methodologies, and compliance requirements. Excellent organizational, analytical, and problem-solving skills. Strong communication skills and attention to detail.</li><li>
Certifications, Licenses, Registrations: Certified coder preferred, but not required.</li><li>
Language Skills: Fluency in English and Spanish is preferred. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, participants, funders, and the general public.</li><li>
Computer Skills: Must possess extensive computer skills and experience with software use (Word, Excel, PowerPoint, Publisher, Adobe, etc.). Must be proficient in Microsoft Office Suite; Electronic mail software; Microsoft Exchange. Medical software &ndash; Electronic medical/health records software and Client management software. Helpful if you have experience in Greenway, and any Telemedicine platform. Knowledge of Quest and LabCorp systems.</li><li>
Mathematical Skills: Basic math, bookkeeping and accounting skills.</li><li>
Reasoning Ability: Effective computer skills to use bookkeeping and account management software in a timely and efficient manner. Strong communication, including writing, speaking and active listening. Must be a great communicator, meticulous, and possess excellent interpersonal skills. Great customer service skills, including interpersonal conversation, patience and empathy. Good problem-solving and critical thinking skills. Organization, time management and prioritization abilities. Ability to be discreet and maintain the security of patient or customer information. Understanding of industry-specific policies, such as HIPAA regulations for health care. Demonstrate the ability to exercise discretion, independent judgment, and business acumen. Exhibit the finesse to handle private, confidential, protected, and sensitive information. Possess a genuine empathy for clients and a willingness to help others. Possess excellent communication skills and the tact to deal effectively with clients, guests, program staff, medical and behavioral health professionals, and executive-level staff. Must have the ability to interact with professional staff and clients from diverse socioeconomic background, races, and cultures. Must have the ability to conduct Internet research. Must possess strong leadership, team-building, management, organizational, and time management skills. Must possess the ability to develop innovative action plans to improve efficiency and processes, minimize cost/waste, and meet quality standards.</li></ul></div></div><div> 
Employment Standards &amp; Conditions: Must successfully pass a pre-employment drug screen and background check.
Must be able to work flexible hours when required.
Must submit verification of completion of the following current health screenings:
Influenza immunization
Tuberculin Skin Test (TB) within the past 12 months
HBV immunization (required if position requires direct contact with clients) 
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 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 regularly required to talk and hear.
The employee is regularly required to sit, stand and walk.
The employee s regularly required to use hands to key, handle, or feel and reach with hands and arms.
The employee must occasionally lift and/or move up to 25 pounds. 
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is moderate.
Empowerment Resource Center (ERC) values a diverse, respectful, and collaborative work environment. We establish and maintain trustful relationships with our staff, partners, funders, and the communities that we are privileged to serve. ERC makes all hiring and employment decisions without regard to race, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, physical or mental disability, sexual orientation, sexual identity, immigrant status, political affiliation or belief, exoffender status (depending on the offense and position to be filled), and/or unfavorable military discharge.</div></div>

Billing & Coding Specialist

AIG Claims, Inc.

<div>At AIG, we are reimagining the way we help customers to manage risk. Join us as a Complex Claims Liability Director, TPA Oversight to play your part in that transformation. It&rsquo;s an opportunity to grow your skills and experience as a valued member of the team.
Make your mark in Claims
Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.
How you will create an impact
As Complex Claims Director &ndash; TPA Oversight, you will analyze and process bodily injury and third-party property damage claims by investigating and gathering information to determine the exposure on the claim; ensure proactive claims handling aimed at the prompt and cost-effective resolution of claims through well-developed action plans. You will determine need for and direct independent adjusters to gather information to determine exposure on the claim and control their costs.<ul><li>
Identify and evaluate coverage issues; prepare comprehensive coverage letters with supervisory review and analysis; retain and provide direction to coverage counsel when necessary.</li><li>
Assess liability and resolve claim within established evaluation. Maintain diaries and complete tasks within required timeframes as set forth by department guidelines; ensure claim files are timely and properly documented with clear and concise analysis on coverage, damages, reserves, and liability including an action plan for resolution. Process and pay invoices within a timely manner.</li><li>
Coordinate vendor referrals for additional investigation and/or litigation management. Calculate and assign timely and appropriate reserves; monitor reserve accuracy throughout the life of the claim.</li><li>
Refer case as appropriate to supervisor and management. Respond to requests or directions in a professional and timely manner.</li><li>
Attend arbitrations, mediations, settlement conference and trials.</li><li>
Successfully complete required State licensing examinations and continuing education requirement.</li><li>
Communicate with all internal business partners including underwriters to make sure underwriting is aware of large losses and industry trends.</li><li>
Partner with TPA Governance and Relationship Management to help TPA&rsquo;s and Insureds comply with claim handling and reporting guidelines.</li><li>
Work with TPA Claims Financial to check the accuracy of TPA financials ensuring alignment with TTPO financials.</li></ul>
What you will need to succeed<ul><li>
7 plus years of General Liability/Auto claims experience.</li><li>
Experience with complex and high exposure General Liability Bodily Injury and Property Damage claims.</li><li>
Excellent communication skills (verbal/written) and strong negotiation skills.</li><li>
Advanced experience and capabilities in litigation claims management, including ADR and mediation processes, involving auto/GL exposures.</li><li>
Strong technical expertise interpreting insurance contracts.</li><li>
In depth knowledge of claim handling procedures, claims performance strategies, and claim best practices.</li><li>
Advanced analytical and problem solving skills.</li><li>
Should also have a demonstrated ability to initiate and champion change initiatives that leverage technology and improve skills in benchmarking.</li><li>
Creativity in resolving challenging business problems, as well as ability to achieve business goals and objectives is essential.</li></ul>
Ready to accelerate your career? We would love to hear from you.
Compensation for this position includes base salary and eligibility for a bonus in accordance with the terms of the applicable incentive plan. In addition, we&rsquo;re proud to offer a range of competitive benefits, a summary of which can be viewed here: US Benefits.
#LI-AIG #claimsprofessionals #InsuranceJobs #legalcareers #paralegaljobs #claimsexaminer #claimsadjuster #InsuranceCareers #insuranceTPA
At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike.
Enjoy benefits that take care of what matters
At AIG, our people are our greatest asset. We know how important it is to protect and invest in what&rsquo;s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security&mdash;as well as your professional development&mdash;to bring peace of mind to you and your family.
Reimagining insurance to make a bigger difference to the world
American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world&rsquo;s most far-reaching property casualty networks. It is an exciting time to join us &mdash; across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.
Welcome to a culture of inclusion
We&rsquo;re committed to creating a culture that truly respects and celebrates each other&rsquo;s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG&rsquo;s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.
AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.
AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com.
<div><div><div><div><div><div><div>Functional Area:</div></div></div></div></div></div></div>
CL - Claims
AIG Claims, Inc.</div>

Complex Claims Liability Director, TPA Oversight

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.<h3 class="jobSectionHeader"> 
About the role</h3><ul><li>
Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org.</li><li>
Passionate claims professional who cares about the customer and their experience.</li><li>
Sense of urgency - at all times. That does not mean working at all hours.</li><li>
Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational.</li><li>
Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution.</li><li>
Anti-status quo. You don&rsquo;t just wish things were done differently, you act on it.</li><li>
Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls and resolving customer requests</li><li>
Gather necessary information from customers to initiate the claim and determine the appropriate course of action</li><li>
Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim</li><li>
Coordinate the repair, if necessary, for the property damage</li><li>
Recognize requirements for potential escalation should the loss no longer meet criteria for your handling</li><li>
Communicate and coordinate with involved parties regarding negotiations and settlement</li><li>
Provide input for continuous development best practices, and process improvements</li></ul><h3 class="jobSectionHeader">
Who you are</h3><ul><li>
Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org.</li><li>
Passionate claims professional who cares about the customer and their experience.</li><li>
Empathetic. 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>
Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational.</li><li>
Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution.</li><li>
Anti-status quo. You don&rsquo;t just wish things were done differently, you act on it.</li></ul><h3 class="jobSectionHeader">
What we need</h3>
We need you to do all the things typical to the role:<ul><li>
Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls and resolving customer requests</li><li>
Gather necessary information from customers to initiate the claim and determine the appropriate course of action</li><li>
Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim</li><li>
Coordinate the repair, if necessary, for the property damage</li><li>
Recognize requirements for potential escalation should the loss no longer meet criteria for your handling</li><li>
Communicate and coordinate with involved parties regarding negotiations and settlement</li><li>
Provide input for continuous development best practices, and process improvements</li></ul><h3 class="jobSectionHeader">
Requirements</h3><ul><li>
Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)</li><li>
Experience with handling real property damage, this is not required but encouraged</li><li>
Minimum of 1 year experience with insurance claims and/or customer service</li><li>
Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license</li></ul><h3 class="jobSectionHeader">
Benefits</h3><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>

Auto Property Damage Claims Adjuster

Explore 86+ Claims specialist in Atlanta this March. Find roles across top companies and apply now to boost your career.