claims specialist

Bahri | البحري

<div>
 
 
 Job Purpose:
 
 
 
 Manage the Claims process and ensure it is communicated, followed up and settled in an efficient and timely manner as per the insurance guidelines.
 
 
 
 
 
 
 Key Accountabilities:
 
 
 
 
 
 
 Claims Process:
 
 
 Register claims with relevant stakeholders, validate the insurance against the set policies and determine the claim size. Track claims from submittal to settlement. Conduct provider negotiations for insurance claims.
 
 
 Manage and handle all insurance claims such as P&amp;I, HH&amp;M, GC, Crew, Legal&hellip;etc. Review and study contracts and reports to make effective claims management decisions. Liaise with P&amp;I Clubs, Lawyers, agents network, Surveyors and Underwriters. Act as a technical expert in the insurance claim area.
 
 
 
 
 
 Relationship Management:
 
 
 Build and maintain strong relations with legal entities P&amp;I Clubs, H&amp;M Underwriters, Loss Adjuster and Brokers to ensure seamless business support.
 
 
 
 
 
 Reconciliation:
 
 
 Reconcile claim&rsquo;s summary for the Manager&rsquo;s review in order to validate correct measures.
 
 
 
 
 
 Concepts &amp; Policies:
 
 
 Define insurance claims guidelines and procedures to mitigate risk exposure and cost of insurance claims. Adopt and apply new professional strategies and policies within the area of responsibility in accordance with management directions.
 
 
 
 
 
 Risk Management:
 
 
 Identify and mitigate risk exposure for all insurance matters and related to P&amp;I and H&amp;M Policies.
 
 
 
 
 
 
 Qualifications and Experience:
 
 
 
 Bachelor degree in Insurance Claims, Risk Management or equivalent.
 
 
 Minimum 4 years of relevant experience in Claims handling and Loss prevention.
 
 
 
 
 
 
 Professional Certificates and Licenses:
 
 
 
 Qualification from The Chartered Insurance Institute (CII) is preferred.
 
</div>

Claims Specialist

BAYEGAN

<div>
 
 
 Qualifications &amp; Requirements:
 
 
 
 
 
 <ul>
 <li>
 Bachelor's degree in Maritime Studies, Logistics, Trade, or a related field,
 </li>
 <li>
 Minimum of 2-3 years of experience in Shipping or Trading company,
 </li>
 <li>
 Technical knowledge in the laytime calculation and maritime terminology,
 </li>
 <li>
 Excellent analytical skills with attention to detail and a results-oriented approach,
 </li>
 <li>
 Solid planning, organization, time-management, coordination and multitask skills,
 </li>
 <li>
 Strong negotiation skills,
 </li>
 <li>
 Advanced proficiency in Excel and relevant software tools.(Knowledge in SAP and IMOS is an added advantage),
 </li>
 <li>
 Strong written and verbal communication skills,
 </li>
 <li>
 Advanced level of English,
 </li>
 <li>
 Experience in International trade environment.
 </li>
 </ul>
 
 
 
 
 
 
 
 
 Key Responsibilities:
 
 
 
 
 
 <ul>
 <li>
 Responsible for the timely preparation, review and finalization of laytime calculations with both internal and external counter parties,
 </li>
 <li>
 Extract from contracts, Charter Parties, Statement of Facts, and other relevant document the data pertinent to the calculation,
 </li>
 <li>
 Compare and evaluate results to show the remarkable points and/or the discrepancies with calculation presented by counterpart,
 </li>
 <li>
 Holding close communication with in-house operations and commercial departments,
 </li>
 <li>
 Handle the negotiation part and minimize recovery period,
 </li>
 <li>
 Ensuring that accounting department has all information required to process relevant payables/receivables,
 </li>
 <li>
 Maintain reports with time sheet done , amount, claimed , amount settled , date of finalization , date of receipt of funds and many other relevant details,
 </li>
 <li>
 Tracing payment of the invoices.
 </li>
 </ul>
</div>

Nationwide Mutual Insurance Company

<div>If you&rsquo;re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide&rsquo;s Property and Casualty team could be the place for you! At Nationwide&reg;, &ldquo;on your side&rdquo; goes beyond just words. Our customers are at the center of everything we do and we&rsquo;re looking for associates who are passionate about delivering extraordinary care.
Job Description Summary
If you can put your keen legal mind to work analyzing, managing and resolving insurance coverage and claims, we want to know more about you! Working on our team offers the opportunity to be involved in settling litigated and non-litigated claims of low to moderate complexity and severity in terms of exposure and coverage. 
 
As a Claims Specialist, you'll investigate, evaluate and negotiate claims to successful resolution. This role supports the management liability and specialty lines of business, including errors and omissions, directors and officers and employment practices liability. You will have low monetary authority and work under limited direct supervision and monitoring. We will count on you to collaborate and provide insight to our business partners on claims and policy wording questions and maintain, develop and influence relationships with customers and business partners.
Job Description<h2 class="jobSectionHeader">
Key Responsibilities:</h2><ul><li>
Investigates and evaluates coverage, liability and damages to set an appropriate claim strategy, settlement and file reserves within approved claims authority.</li><li>
Provides timely and appropriate evaluation of claims to identify and manage reserves in compliance with company standards.</li><li>
Analyze coverage and provide comprehensive coverage analysis and claim resolution strategies.</li><li>
Provide feedback on claim trends and development. Provide input to underwriters on review of potential and existing insured&rsquo;s claim experience.</li><li>
Delivers outstanding customer service and satisfaction through effective interactions with insured, agents, and legal counsel.</li><li>
Maintains current knowledge of applicable lines of insurance, insurance regulations, court decisions which may impact the claims function, current guidelines and policy changes and modifications. This may require attending various seminars and training sessions.</li><li>
Contributes to a collaborative environment by consistently demonstrating teamwork, motivation, positive behavior and effort to achieve goals and objectives.</li></ul>
May perform other responsibilities as assigned.
Reporting Relationships: Reports to Claims Director, Freedom Specialty<h2 class="jobSectionHeader">
Typical Skills and Experiences:</h2>
Education: College degree preferred. Juris Doctorate desired.
License/Certification/Designation: Associates must acquire the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to acquire required licenses/registrations within the designated time period, the associate will be ineligible to continue in the position.
Experience: Typically, two to four years of claims handling experience. Prior experience in directing defense counsel required. Specific experience in a specific line of business may be required by the hiring business unit.
Knowledge, Abilities and Skills: Specific knowledge in a particular line of business and/or additional education may be required. Familiarity with various types of insurance policies preferred. The ability to evaluate and interpret information, strong written and verbal communication skills, the ability to multi-task, strong time management and organizational skills, the ability to effectively and efficiently manage all responsibilities.
Other criteria, including leadership skills, competencies and experiences may take precedence.
Staffing exceptions to the above must be approved by the hiring manager&rsquo;s leader and HR Business Partner.
Values: Regularly and consistently demonstrates the Nationwide Values.<h2 class="jobSectionHeader">
Job Conditions:</h2>
Overtime Eligibility: Not Eligible (Exempt)
Working Conditions: Normal office environment
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
Benefits
We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer.
Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.
#claims 

For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf
NOTE TO EMPLOYMENT AGENCIES:
We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.
Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.
The national salary range for Claims Specialist II - Management Specialty Lines : $61,000.00-$126,500.00
The expected starting salary range for Claims Specialist II - Management Specialty Lines : $67,500.00 - $101,500.00</div>

Claims Specialist II - Management Specialty Lines

UNITE HERE HEALTH

<div><div>UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!</div><div></div><div> 
The Workers Compensation Specialist will coordinate the workers&rsquo; compensation program that allows potential work-related claims to be paid while the Participant follows the state workers&rsquo; compensation process. Recovery dollars are then deemed to be work-related from providers when the workers compensation process in complete. This position requires patient and participant communication skills to explain and support participant enrollment in the program, TPA system knowledge and accurate record keeping, follow up with staff, participants, provider offices, TPA and vendors, and union communication requests.</div><div></div><div> 
ESSENTIAL JOB FUNCTIONS AND DUTIES</div> 
<ul><li>
Receive, review, and take appropriate action on claims related to work related injury claims received from the TPA, Fund, Union, NHS, or Workers&rsquo; Compensation Attorney</li><li>
Communicate with the employees and/or their Attorney, provide guidance during the appeal process (1st and 2nd level appeal), follow up with letters and phone calls, and document process and steps for each case</li><li>
Obtain and distribute accordingly the medical records and document needed to proceed with the case</li><li>
Provide directives to the TPA on next steps &ndash; pay claims or recover on paid claims according to Worker&rsquo;s Compensation final Case determination</li><li>
Assist employees with continuity of care access-related inquiries during the two levels of the appeal process</li><li>
Track and submit necessary reports on workers&rsquo; compensation cases to the Fund&rsquo;s Leadership</li><li>
Manage the mail process in a timely manner to ensure patient is not disenfranchised by a missed workers compensation mandated deadline</li><li>
Maintain a sense of timeliness in the handling of priority cases and reduction requests such as completing case follow ups within timeline guidelines</li><li>
Manage difficult calls and return follow-up calls within 24 hours</li><li>
Treat referral of settled cases as priority and refer to the TPA within Fund guidelines (usually 24 hours)</li><li>
Comply with Federal/States mandates as applied to Workers&rsquo; Compensation Cases</li><li>
Exemplifies the Fund&rsquo;s values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement</li></ul> 
ESSENTIAL QUALIFICATIONS<ul><li>
 4 ~ 6 years of related experience within Nevada state workers&rsquo; compensation claims cases</li><li>
Associate&rsquo;s degree or equivalent work experience, preferred</li><li>
Experience with interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits</li><li>
Working knowledge and experience in medical claims adjudication, preferably in a multi-employer environment</li><li>
Understanding of Medicare, Medicaid, ACA, DOL regulations, ERISA and HIPAA</li><li>
Intermediate level MS Office and MS Excel skills</li><li>
Manage competing deadlines and multiple projects in a fast-paced environment</li><li>
Excellent communication skills, with the ability to communicate effectively with vendors, state agencies, participants, union staff, and Fund staff and leadership</li><li>
Ability to demonstrate good judgment and have excellent critical thinking and problem-solving skills</li><li>
Ability to work independently with minimal supervision in a fast-paced environment</li></ul><div></div> 
Salary range for this position: Salary $58,300 - $72,900. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid employee, 8 &ndash; 4pm (PT).
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- &amp; Long-term Disability, Pension, Life, AD&amp;D, Flexible Spending Accounts (healthcare &amp; dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
 #LI-Hybrid</div>

Workers Compensation Specialist

Arizona Heart Arrhythmia Associates

Busy Cardiology/ Electrophysiology practice in Phoenix is seeking medical billing/AR specialist.As a Medical Billing/ Collection Specialist on our team, you help ensure the accuracy and efficiency of patient claims and contribute to the flow of our clinic's revenue. This is a fast-paced environment committed to producing the highest quality of work.We are looking for a motivated performer who will deal with claims reimbursement and collection efforts for Managed Care, Medicare, Workers Comp, Commercial plans, etc.to join our Business Office team as a Billing Specialist.Our Billing Specialist should exhibit professionalism and trustworthiness. You should have excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff.You will work closely with the Billing Manager and other team members. If you are a detail-oriented person who loves to help others, we want to hear from you!What you will do:<ul><li>Obtains adequate health insurance information for patient eligibility and benefits over the phone and/or using online resources</li><li>Appropriately uses the insurance verification process to obtain necessary information to send to offices and clinics within the organization.</li><li>Precisely analyzes documents to obtain the appropriate CPT Codes (procedures) and ICD-10 Codes (diagnosis) to use when submitting claims to 3rd Party Billing companies</li><li>Accurately audit OP Notes, Clinical Notes and more to ensure all patient files/data are correct and valid. Research and update any inaccuracies.</li><li>Effectively analyze, complete, send, and track all claims submissions on multiple entities/providers.</li><li>Ensures the review, investigation, and re-submission of any pending and/or missing claims.</li><li>Performs essential office tasks such as answering phones, faxing, scanning, filing, etc. in a professional and timely manner.</li><li>Handle the follow-up of outstanding A/R all payers, including self-pay and/or the resolution of denials.</li><li>Handle all correspondence related to insurance or patient account, contacting insurance carriers' patients, and as needed to get the maximum payments on accounts and identify issues or changes to achieve the maximum profitability</li></ul>Requirements:<ul><li>Successfully operates independently with minimal supervision.</li><li>Detail oriented and highly organized.</li><li>Can multi-task effectively, prioritize and complete multiple responsibilities in a timely manner.</li><li>Consistently follows processes and procedures with accuracy.</li><li>Effectively communicates and follows-up appropriately with co-workers, patients, providers, and insurance carriers.</li><li>Maintains a positive and professional attitude in the office, over the phone, and via email.</li><li>Competent in using Windows 11 and Office 365 (Word, Excel, Adobe, EMR systems) and other technologies.</li><li>Operates with integrity and confidentiality.</li><li>Prior Billing/AR experience is must.</li></ul>We offer medical insurance, 401k and paid time off.Job Type: Full-timePay: $20.00 - $25.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Health insurance</li><li>Paid time off</li></ul>Work Location: In person

Medical Biller/AR Specialist

Alghanim INDUSTRIES

Date: 23 Sept 2025
 
Location: 
KW
 
Company: 
Alghanim Industries
 
Job Summary
 
The Sr. Claims Officer will play a pivotal role in Claims process, assessing risk, and Handling the full claims process.
 
Job Responsibilities
 
Claim Notification, registration in system and acknowledgment to customer.
 
Conduct Survey independently Applying the Policy Terms, Conditions & Deductibles on claim.
 
Control the entry and registration of claims inputting concise yet sufficient file documentation and preparing /maintaining claims payment.
 
Constantly monitor claims procedure documents as per checklist.
 
Provide update based on the information contained in the file.
 
Claims documentation requisition, review, and follow-up with customer on missing document (if any) Claims Processing & Settlement.
 
Process claims as per the guidelines and follow the claims process – Liaise with finance for any payment queries.
 
Maintain a filing tracker for closed claims and follow up with Sultan records for any archive request
 
Candidate Requirements
 
Bachelor degree in Business Administration or any related field
 
Excellent analytical skills
 
Proficiency in using software, Microsoft Office Suite, and other relevant tools.
 
Effective communication and negotiation skills, with the ability to interact confidently with clients and stakeholders.

Alghanim Academy - Sr. Claims Officer, Enaya Insurance (Full-time opportunity)

Hueman PE Talent Solutions

<div>Valcourt Building Services has partnered with Hueman to find a Paralegal for their corporate contract team in Morgan Hill, California. 
We are seeking a highly organized and detail-oriented In-House Paralegal to support our legal department in a variety of legal and administrative tasks. The ideal candidate will have experience working in a corporate legal environment and a solid understanding of litigation management, insurance, corporate law, contracts, and regulatory compliance. This position plays a key role in helping the company manage claims, legal risks and litigation and ensure adherence to applicable laws and regulations.
Valcourt is a premier provider of a variety of building services, such as waterproofing, window cleaning, and restoration services. Valcourt works with building owners and property managers to provide preventative maintenance, repairs, safety consulting, and comprehensive building envelope restorations to extend the life of a structure and protect property value. 
 
Key Responsibilities:<ul><li>
Manage and administer claims and litigation from inception through resolution, under the supervision of internal counsel</li><li>
Manage insurance claims and monitor insurance carrier handling</li><li>
Maintain claims and litigation matrices and records</li><li>
Draft, review, and manage a wide range of legal documents, including NDAs, contracts, corporate resolutions, and internal policies.</li><li>
Serve as the primary point of contact for contract review requests from internal branches and departments.</li><li>
Manage the contract lifecycle process, including contract routing, approvals, signatures, renewals, and terminations.</li><li>
Maintain organized electronic and physical contract files using a contract management system (CMS).</li><li>
Monitor contract deadlines, obligations, renewal dates, and compliance requirements.</li><li>
Ensure and monitor subcontractor and vendor insurance compliance</li><li>
Assist in corporate governance activities, including preparing board materials, maintaining corporate records, and managing entity registrations.</li><li>
Support compliance programs by tracking legal and regulatory obligations and assisting in audits or internal reviews.</li><li>
Coordinate with outside counsel on litigation, IP filings, and other legal matters.</li><li>
Conduct legal research and summarize findings for internal stakeholders.</li><li>
Maintain and organize legal files, contract management systems, and databases.</li><li>
Support M&amp;A activities, due diligence, and post-acquisition integration efforts when necessary.</li><li>
Assist with the preparation of intellectual property filings</li><li>
Monitor and report on legal developments relevant to the business.</li><li>
Draft internal and external correspondence relating to areas of responsibility</li></ul><div></div> 
Qualifications:<ul><li>
Bachelor's degree required; Paralegal Certificate from an ABA-approved program preferred.</li><li>
5+ years of experience as a paralegal, preferably in an in-house legal department or corporate or litigation focused law firm.</li><li>
Strong knowledge of claims, insurance, corporate and contract law.</li><li>
Excellent organizational and communication skills.</li><li>
Proficiency with legal research tools (e.g., LexisNexis, Westlaw) and document management systems.</li><li>
High level of discretion and ability to handle confidential information.</li><li>
Demonstrated proficiency using MS Office (Outlook, Word, Excel) with the ability to learn and use new software and systems</li><li>
Knowledge of legal terminology and concepts</li><li>
Excellent time management skills and attention to detail, with a high degree of accuracy and success in delivering to key deadlines</li><li>
Understanding of and experience with insurance claims and litigation processes.</li></ul> 
Preferred Skills:<ul><li>
Ability to work independently and manage multiple priorities in a fast-paced environment.</li><li>
Litigation Management experience preferred
</li><li>Demonstrated success working in a team environment</li><li>
Flexible hours from time to time to be able to support East Coast and West Coast time zones.</li></ul> 
For 35 years, Valcourt Building Services has grown from a small window cleaning company serving the Washington DC area into one of the largest exterior maintenance companies in the country. We proudly serve clients from our offices in New Jersey, Pennsylvania, Maryland, Virginia, Georgia, Florida, and Texas. If you are looking to join a dynamic team with a growing company, this opportunity is for you. 
Hueman is proud to partner with Valcourt Building Services as the exclusive recruitment partner for this role. If you are interested in learning more about a career with Valcourt as a Paralegal, apply today!
#INDPE2023</div>

Paralegal - Worker's Comp - Hybrid

Search 8327+ Claims specialist jobs near you this October. New roles added regularly across leading industries. Apply today.

8327 claims specialist jobs NEAR_ME

Claims Specialist

Claims Specialist

Claims Specialist II - Management Specialty Lines

Workers Compensation Specialist

Medical Biller/AR Specialist

Alghanim Academy - Sr. Claims Officer, Enaya Insurance (Full-time opportunity)

Paralegal - Worker's Comp - Hybrid