claims specialist

WEX Inc.

<div>The Claims Specialist is responsible for properly reviewing and processing claims for various Employer benefit plans according to IRS regulations and specific employer plan rules. A Claims Specialist should be prepared to work in a detail oriented and fast paced environment with a high level of accuracy.
Essential Duties:
<ul><li>Daily claim processing.
</li></ul><ul><li>Accurately process all FSA claim types.
</li><li>Determine eligibility by utilizing available resources.
</li><li>Ensure priority of workload is followed and turnaround times are met.
</li><li>Properly process claim appeals.
</li><li>Troubleshoot software issues accordingly.
</li></ul><ul><li>Assist with other operational functions.
</li></ul><ul><li>Coordinate with other departments when appropriate.
</li><li>Assist Claims Supervisors with projects as assigned.
</li></ul><ul><li>Work with Claims Supervisors to develop new processes and procedures.
</li></ul><ul><li>Continuous improvement approach to work.
</li><li>Communicate changes needed for processes.
</li><li>Develop and update procedures as needed.
</li></ul><ul><li>Promote continuous learning and sharing of knowledge.
</li></ul>The base pay range represents the anticipated low and high end of the pay range for this position. Actual pay rates will vary and will be based on various factors, such as your qualifications, skills, competencies, and proficiency for the role. Base pay is one component of WEX's total compensation package. Most sales positions are eligible for commission under the terms of an applicable plan. Non-sales roles are typically eligible for a quarterly or annual bonus based on their role and applicable plan. WEX's comprehensive and market competitive benefits are designed to support your personal and professional well-being. Benefits include health, dental and vision insurances, retirement savings plan, paid time off, health savings account, flexible spending accounts, life insurance, disability insurance, tuition reimbursement, and more. For more information, check out the &quot;About Us&quot; section.
Pay Range: $17.00 - $22.50</div>

Claims Specialist

Spectrum Automotive Holdings

Position Title: Claims Specialist Location: Schertz, TX (On-Site Monday-Friday) Position Status: Full-time non-exempt Compensation: $20.00 per hour Position Purpose: Responsible for coordinating and supporting initiatives related to the evaluation, processing, and handling of claims. Acts as a liaison between CalTex, claimants, vendors, agents and dealerships regarding the status and eligibility for coverage for all relevant claims. Responsible for the claim adjudication process that includes the interpretation of warranty and service contracts, rendering coverage decisions, managing claim resolutions/issues, and ensuring work and payments are completed successfully. Essential Job Functions: The Claims Specialist must be able to perform all of the following duties and responsibilities with or without a reasonable accommodation. Claims Processing: Review warranties to determine coverage of claim, and approve, authorize payment or deny accordingly. Responsible for high quality customer interactions via inbound and outbound calls. Order and review inspection reports when needed to assist in making claims determination. Make sure all documents are attached to the claim prior to submitting for processing. Work with dealerships to ensure the proper paperwork is received for calculations on theft product claims. Process vendor assignments to ensure payments are sent correctly. Assist consumers in obtaining the necessary documentation from the dealership to get warranty registered and submitted for claim processing. Interact with customers, vendors, and internal staff via inbound/outbound calls and email. Answer general questions about products and services. Return voicemail and reply to emails within required service levels. Assist customers and vendors with opening a new claim and giving status on existing claims. Maintain work queue to ensure claims are processed timely and effectively making follow up calls as needed for missing documents. Make determination on transfer/renewal requests, communicate with customers on needed documents, audit documents for the request, and make final approval/denial decisions. Process invoices and submit settlement payments. Process, communicate and mail checks for paid claims. Work with various departments to receive and communicate the status of warranty claims. Manage time effectively, complete tasks and projects quickly with little to no guidance, think and plan ahead. React with appropriate urgency to situations that require a quick turnaround and take effective action without having to know the total picture. Possess and exhibit an exemplary level of integrity and discretion in handling confidential information. Maintain a strong focus on continuous process improvement. Work collaboratively in a team environment and build effective working relationships inside and outside of the group. Demonstrate sound judgment and problem-solving skills. Perform other duties that may reasonably be assigned. Education/Experience: The minimum educational background of an applicant to this position is a high school degree or GED required. College preferred although not required. Must have at least 2 &ndash; 3 years of warranty, claims, call center and customer service experience. In addition, a qualified applicant will have: Automotive insurance claims adjudication experience is preferred. Experience with Vehicle Service Contracts (VSC) is preferred. Strong verbal and written communication skills with the ability to communicate effectively with others at all levels of the organization. Good problem solving and time management skills. Ability to work in a team environment and engage with peers and management as well as working independently. Strong organizational skills and the ability to multitask while producing quality results. Ability to adapt to changing organizational and operational needs. Must be comfortable working in a fast-paced, high-volume call center. Detail oriented, can work under the pressure of deadlines and multi-task. Some analytical ability is required to gather and interpret data where activities are routine in nature. Basic knowledge of Word, Excel, and Outlook databased related applications as well as phone and claims management systems. Supervisory Responsibility: This position does not have any supervisory responsibilities. Work Environment: The majority of job responsibilities are performed while seated indoors with little exposure to hazards. Some flex hours may be required (must be able to work nights and weekends on a non-routine basis). Contacts: Interaction will occur with various departments, employees and management, and customers in the performance of the job duties as they relate to the Claims Specialist. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Brookings Health System

<div>Location:
Brookings, SD
Worker Type:
Regular
Work Shift:
Day Shift (United States of America)
Position Highlights
Consider joining an Award Winning Health Care System - Brookings Health System is a nationally awarded rural community health system, recognized for delivering high-quality care and personalized service.
Brookings Health System is seeking a Claims Specialist to join our team!
Compensation range for this position is $19.48 to $28.84, depending on experience.
This position will have full benefits that include, but is not limited to, South Dakota Retirement, Employee discounts on services, gym membership reimbursement (and on-site fitness center), eligible for public service loan forgiveness, cafeteria discounts, life insurance and so much more. We also have comprehensive medical benefits, dental and vision insurance, flexible reimbursement plans and more!
As a Claims Specialist, you&rsquo;ll play a vital role in submitting and following up on insurance claims across all service lines. More than just processing claims, our specialists provide compassionate guidance to support patients in navigating the complexities of medical billing with clarity, empathy, and expertise. If you haven't worked in Medical Billing specifically, we will provide the training and support you need to succeed.
RESPONSIBILITIES:
<ul><li>Complete all claim edits to ensure claim submissions are compliant with federal and state regulations
</li><li>Research and resolve requests from insurance companies, patients, and third-party payors.
</li><li>Assist co-workers with problem resolution and completing team projects.
</li><li>Assist patients with insurance-related questions.
</li><li>Resolve billing problems and assists interdepartmentally with billing issues
</li></ul>JOB TYPE:
<ul><li>Full time, benefit eligible
</li><li>Day position
</li><li>On-site position located in Brookings, SD</li></ul></div>

CorVel Corporation

<div>The Workers&rsquo; Compensation Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers&rsquo; compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.

 This is a hybrid role.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives Workers&rsquo; Compensation claims, confirms policy coverage and acknowledgment of the claim</li>
<li>Determines validity and compensability of the claim</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Manages non-complex lost-time workers&rsquo; compensation claims under close supervision</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Assists other claims professionals with more complex or problematic claims as necessary</li>
<li>Additional projects and duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management and organizational skills</li>
<li>Ability to meet or exceed performance competencies</li>
<li>Ability to work both independently and within a team environment</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 1 year of industry experience and claims management preferred</li>
<li>Current license or certification in Workers&rsquo; Compensation must be maintained throughout employment with CorVel</li></ul> 


PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $52,999 &ndash; $85,473

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management (https://www.corvel.com/company/careers/)

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Hybrid
Equal Opportunity Employer 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</div>

First Chicago Insurance Company

<div>At First Chicago Insurance Company, our employees are our biggest asset! It is our mission to attract and retain intelligent, motivated, ethical employees who strive for excellence and growth, and to keep those employees happy and engaged. We provide the tools and the support our employees need to grow both professionally and personally. We encourage self-improvement and celebrate success by rewarding ideas and results. We realize the strength of teamwork and its ability to join individuals together and push and pull each other, with a synergy that can only be found in groups of good people sharing ideas. Join in on the excitement and become part of our thriving organization!
We are seeking an experienced Casualty Claims Specialist! 
The Casualty Claims Specialist will be responsible for investigating and settlement of automobile bodily injury claims. They will settle complex liability claims which require greater investigation and verification, as well as casualty claims including severe injuries which may result in extended disability or bodily injury as well as coverage related litigation.
The Casualty Claims Specialist will have the following duties and responsibilities:<ul><li>
Review &amp; determine course of action on each file assigned, utilizing technical knowledge &amp; experience for the purpose of supporting final disposition of a loss.</li><li>
Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage, liability status, and damages that are applicable for each claim.</li><li>
Process Bodily Injury, and coverage claims in accordance with established office procedures.</li><li>
Work closely with Third Parties, plaintiff counsel, Claim Director and Chief Operating Officer to determine necessary injury and coverage investigation.</li><li>
Research case and statutory law in order to conduct proper claim investigation.</li><li>
Document policy status, coverage, liability and damages on all claims and notify re-insurer on qualifying claims.</li><li>
Prepare and present claim evaluations for the appropriate settlement authority.</li><li>
Maintain reasonable expense factors.</li><li>
Handle other duties as assigned</li></ul>
QUALIFICATIONS REQUIRED:<ul><li>
3-5 years in Casualty claims experience a MUST!</li><li>
Knowledge of legal and medical terminology.</li><li>
Excellent negotiation, communication, written, organizational and interpersonal skills.</li><li>
Ability to pass written examinations where required by state statutes to become a licensed claims adjuster.</li><li>
Proficiency in Microsoft Office products.</li></ul>
First Chicago Insurance Company provides a competitive benefits package to all full- time employees. Following are some of the perks First Chicago employees receive:<ul><li>
Competitive Salaries</li><li>
Commitment to your Training &amp; Development</li><li>
Medical and Dental</li><li>
Telemedicine Benefit</li><li>
401k with a generous company match</li><li>
Paid Time Off and Paid Holidays</li><li>
Tuition Reimbursement Training Programs</li><li>
Wellness Program</li><li>
Fun company sponsored events</li><li>
And so much more!</li></ul>
Visit our company website at firstchicagoinsurance.com</div>

Casualty Claims Specialist

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