dispute resolution specialist

The Plastic Surgery Center

The Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates are the largest Reconstructive Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing superior patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees&mdash;whether caring for patients directly or working in a support role.We are seeking a Claims Dispute Specialist.The Claims Dispute Coordinator manages and resolves complex medical claim disputes and appeals with a focus on compliance with the Federal No Surprises Act (NSA) and similar state surprise billing laws. This role requires strong written communication skills, analytical skills and attention to detail. The ideal candidate brings the ability to efficiently prepare strong written arguments based on complex medical claims while effectively managing dispute process deadlines.Key Responsibilities <ul><li>Review and analyze medical claims to ensure accuracy, compliance, and eligibility for appeal or dispute under the NSA or state law</li><li>Investigate claim payments and denials by reviewing clinical documentation, insurance payer contracts, and claim history</li><li>Initiate and manage disputes under the NSA or state law</li><li>Prepare clear and effective written arguments as part of claims dispute processes</li><li>Analyze data and identify insights to support negotiations and dispute arguments</li><li>Collaborate with various teams within ARSA to ensure timely and successful dispute resolution</li></ul>Qualifications and Experience <ul><li>1&ndash;3 years in healthcare claims processing preferred</li><li>Experience with No Surprises Act dispute resolution highly preferred</li><li>Bachelor&rsquo;s degree relevant field preferred</li></ul>Skills <ul><li>Strong analytical and problem-solving abilities</li><li>Strong written and verbal communication skills</li><li>Strong organization skills</li><li>Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li><li>Proficiency in Microsoft Office suite and healthcare practice management systems</li></ul>Compensation &amp; Benefits:<ul><li>&middot; Pay Range: $55,000- $60,000annually</li><li>the starting rate within this range for this role varies depending on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies, experience, and location.</li><li>&middot; Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance</li><li>&middot; 401k and Profit sharing</li><li>&middot; Paid Time Off</li><li>&middot; Contribution to Health Benefits</li><li>Company Discounts on Products &amp; Services</li></ul>IND2Job Type: Full-timePay: $55,000.00 - $60,000.00 per yearExperience:<ul><li>Medical claims processinfg: 2 years (Required)</li><li>No Surprises Act: 2 years (Required)</li></ul>Ability to Commute:<ul><li>Red Bank, NJ 07701 (Required)</li></ul>Work Location: In person

Claims Dispute Specialist

iMPROve Health

<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div>About iMPROve Health
Come join the iMPROve Health team!
iMPROve Health is Michigan&rsquo;s Medicare-designated Quality Improvement Organization, and we&rsquo;re proud to be recognized as both a Cool Place to Work by Crain&rsquo;s Detroit Business (four years running) and one of Modern Healthcare&rsquo;s Best Places to Work in Healthcare.
As a nonprofit with more than 40 years of experience, we&rsquo;re dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better.
This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees&rsquo; growth through professional development and continuing education opportunities. Our benefit package includes medical, dental, vision, life insurance, short- and long-term disability, and a generous 401(k) match.
At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals&mdash;including physicians, nurses, and experienced consultants&mdash;partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.
Join us in making a meaningful impact on healthcare&mdash;one improvement at a time.
SUMMARY:
The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR/IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of all necessary review documentation.
DUTIES AND RESPONSIBILITIES:<ul><li>
Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.</li><li>
Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.</li><li>
Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness.</li><li>
Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.</li><li>
Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.</li><li>
Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.</li><li>
Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.</li><li>
Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.</li><li>
Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.</li><li>
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare &amp; Medicaid Services, Federal Acquisition Regulation (FAR)).</li><li>
Complete other duties as assigned</li></ul>
EDUCATION AND/OR EXPERIENCE:<ul><li>
Associate&rsquo;s degree or five (5) years of related experience required; Bachelor&rsquo;s degree preferred (healthcare specialty preferred).</li><li>
Minimum two (2) years of project support experience in a corporate or professional environment required.</li><li>
Experience in IDR or claims, appeal, and denial processes preferred.</li><li>
Project management skills required.</li><li>
Strong communication skills, both verbal and written, required.</li><li>
Strong multi-tasking skills with attention to detail and deadlines required.</li></ul>
CORE COMPETENCIES:
Attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving.
This is a fully remote opportunity. 
EOE/VET/Disability</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div> 
Monday - Friday 8 am to 5 pm EST</div>

PROJECT SPECIALIST - HEALTHCARE - REMOTE

Cydecor, Inc.

<div>
 
 Cydecor is a premier Federal Government solutions provider, delivering differentiated innovations in mission systems and business platforms. We leverage leading-edge secure systems and software development, backed by industry-leading subject matter expertise, and business intelligence to enable decision-support and remain ahead of ever-evolving national security challenges. Our success rests squarely on three bedrock principles: People, our center of gravity; Mission, what inspires us; and an unyielding commitment to Excellence, what separates us.
 
 
 
 
 
 
 Job Description:
 
 
 
 Cydecor is seeking an Alternative Dispute Resolution (ADR) Deputy Program Manager to support Naval Sea Systems Command (NAVSEA), Total Force &amp; Corporate Operations Directorate (SEA 10) in Washington, DC.
 
 
 The ADR Deputy Program Manager will play a vital role in managing, analyzing, and optimizing data, as well as overseeing the ADR and Ombudsman programs within the NAVSEA EEO Office.
 
 
 Ideal candidates will have experience in establishing and/or re-energizing a challenged ADR program, be proficient in data analysis and possess above average interpersonal communication skills. Knowledge of federal-sector EEO regulations and associated compliance frameworks is also imperative.
 
 
 
 
 
 
 Responsibilities:
 
 
 
 
 Data Analytics and Reporting
 
 :
 
 <ul>
 <li>
 Develop, implement, and maintain data analysis models, systems, and dashboards to monitor EEO program effectiveness and performance metrics.
 </li>
 <li>
 Collect, analyze, and interpret complex datasets related to EEO compliance, ADR cases, and workforce diversity trends.
 </li>
 <li>
 Produce comprehensive reports for senior leadership, outlining insights and recommendations to improve EEO and ADR program outcomes.
 </li>
 <li>
 Ensure accuracy, integrity, and confidentiality of all data in compliance with federal regulations and NAVSEA policies.
 </li>
 </ul>
 
 
 ADR/Ombudsman Program Management
 
 :
 
 <ul>
 <li>
 Manage and oversee the operations of the NAVSEA ADR/Ombudsman programs, ensuring timely and effective conflict resolution.
 </li>
 <li>
 Coordinate ADR processes, including mediation sessions, facilitation, and consultations, ensuring compliance with established guidelines.
 </li>
 <li>
 Serve as a point of contact for program stakeholders, including mediators, facilitators, and employees utilizing ADR services.
 </li>
 <li>
 Implement strategies to promote awareness and accessibility of the ADR/Ombudsman programs throughout NAVSEA.
 </li>
 </ul>
 
 
 Policy and Compliance
 
 :
 
 <ul>
 <li>
 Ensure adherence to all federal and NAVSEA policies, procedures, and regulations related to EEO, ADR, and Ombudsman activities.
 </li>
 <li>
 Identify and address gaps in EEO program compliance, recommending corrective actions as necessary.
 </li>
 <li>
 Stay up to date with changes in EEO laws, ADR best practices, and industry standards, incorporating them into program management efforts.
 </li>
 </ul>
 
 
 Program Development and Improvement
 
 :
 
 <ul>
 <li>
 Identify opportunities for enhancing data analytics capabilities and ADR/Ombudsman program effectiveness within the NAVSEA EEO Office.
 </li>
 <li>
 Design and implement initiatives to improve employee engagement and satisfaction with conflict resolution services.
 </li>
 <li>
 Collaborate with stakeholders to establish goals, priorities, and benchmarks for program success.
 </li>
 </ul>
 
 
 Communication and Stakeholder Collaboration
 
 :
 
 <ul>
 <li>
 Act as a liaison between the NAVSEA EEO Office and internal/external stakeholders, fostering collaboration and trust.
 </li>
 <li>
 Facilitate open communication to address concerns and provide program updates.
 </li>
 <li>
 Develop and deliver presentations to stakeholders, leadership, and employees to report progress and raise awareness.
 </li>
 </ul>
 
 
 
 
 
 Here&rsquo;s what you need:
 
 
 <ul>
 <li>
 Proven experience in ADR program establishment, development and management, as well as case management.
 </li>
 <li>
 Strong knowledge of EEO laws and regulations.
 </li>
 <li>
 Proven experience in ADR case management, program development and management.
 </li>
 <li>
 Proficiency using the MS Office suite of applications, to include Word, Excel, Outlook, PowerPoint, and Teams.
 </li>
 <li>
 Experience in managing data gathering sessions to achieve desired outcomes preferred.
 </li>
 <li>
 Familiarity with the formatting and protocols used to compose official Department of Navy correspondence.
 </li>
 <li>
 Familiarity with procedures needed for compliance with applicable Records Management policies.
 </li>
 <li>
 Excellent written and verbal communication.
 </li>
 <li>
 Stellar customer service.
 </li>
 <li>
 Proven ability to thrive in a collaborative team environment.
 </li>
 <li>
 5+ years of experience collecting, analyzing, and professionally presenting data and trends is preferred.
 </li>
 <li>
 Experience in developing PowerPoint briefings and communicating with wide variety of audiences at all levels is preferred.
 </li>
 </ul>
 
 
 
 
 
 Security Clearance:
 
 Secret
 
 
 
 
 
 
 Education:
 
 Highschool diploma. Bachelor's degree preferred.
 
 
 
 
 
 
 Work Schedule:
 
 Onsite five days per week, 7:30 am - 4:00 pm EST
 
 
 
 
 
 
 Compensation and Benefits:
 
 
 
 The projected compensation range for this position is $100-105,000, annually. There are numerous factors that can impact a final salary/hourly rate including, but not limited to, relevant work experience, skills and competencies that align to the role, work location, education/certifications, and a contract's Labor Categories.
 
 
 Cydecor offers a comprehensive compensation package including Health and Dental Insurance, Vision and Life Insurance, Short-Term &amp; Long-Term Disability, 401(K) + company match, Paid Time Off (PTO), Paid Company Holidays, Tuition and Professional Development Assistance and more.
 
 
 
 
 
 
 What We Believe
 
 
 
 We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Cydecor has the responsibility to create and sustain an inclusive environment.
 
 
 
 
 
 
 
 Equal Employment Opportunity Statement
 
 
 
 
 
 Cydecor is an Equal Employment Opportunity/Affirmative Action Employer (EEO/AA). All employment and hiring decisions are based on qualifications, merit, and business needs without regard to race, religion, color, sexual orientation, nationality, gender, ethnic origin, disability, age, sex, gender identity &amp; expression, veteran status, marital status, or any other characteristic protected by applicable law.
 
 
 
 
 If you are a qualified individual with a disability and/or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site because of your disability. You can request assistance by contacting HR@cydecor.com or calling 703-884-2105.
 
 
 <ul>
 <li>
 Alternative Dispute Resolution (ADR)
 </li>
 <li>
 Program Management
 </li>
 <li>
 Ombudsman Programs
 </li>
 <li>
 EEO (Equal Employment Opportunity)
 </li>
 <li>
 Federal Sector EEO
 </li>
 <li>
 NAVSEA / Department of Navy
 </li>
 <li>
 Government / Federal Compliance
 </li>
 </ul>
 
 
</div>

Alternative Dispute Resolution (ADR) Deputy Program Manager - Clearance Required

Legal Aid Society - Pakistan

<div>
 
 
 Company Description
 
 
 
 The Legal Aid Society (LAS) is a not-for-profit NGO established in 2013 under the Societies Registration Act, 1860, by Justice Nasir Aslam Zahid, former Chief Justice of Sindh and former Supreme Court Judge. Dedicated to serving marginalized and underprivileged communities, LAS aims to reduce barriers to accessing justice. The organization combines the principles of equity, fairness, and inclusion to address challenges within the legal ecosystem. With its head office in Karachi and six district offices across Sindh, LAS focuses on both direct legal aid services and systemic change through legal empowerment. Recognized locally and internationally, LAS continues to support vulnerable communities throughout its 13 judicial districts in Sindh.
 
 
 
 
 
 
 Position summary
 
 
 
 The Associate Director will lead
 
 Musaliha International Center for Arbitration and Dispute Resolution
 
 MICADR&rsquo;s transition towards financial sustainability by building its commercial infrastructure, driving revenue growth, and strengthening institutional partnerships. This is a senior leadership role with full authority to set commercial direction, build and manage the team, and ensure financial independence within a three-year horizon. The role reports directly to the Chief Executive Officer and is responsible for transforming MICADR into a self-sustaining institution.
 
 
 
 
 
 
 Key responsibilities
 
 
 
 
 
 
 
 1. Financial Leadership &amp; Revenue Growth
 
 
 <ul>
 <li>
 Own MICADR&rsquo;s financial performance across training, cases, and corporate membership streams.
 </li>
 <li>
 Set annual revenue targets and monitor monthly performance.
 </li>
 <li>
 Hold pillar leads accountable for financial and operational outcomes.
 </li>
 <li>
 Develop innovative strategies to strengthen and diversify revenue generation.
 </li>
 </ul>
 
 
 
 
 
 2. Business Development &amp; Institutional Partnerships
 
 
 <ul>
 <li>
 Lead senior-level business development initiatives.
 </li>
 <li>
 Build and maintain relationships with corporates, law firms, chambers of commerce, judicial institutions, and government bodies.
 </li>
 <li>
 Convert institutional credibility into sustainable revenue pipelines and partnerships.
 </li>
 </ul>
 
 
 
 
 
 3. Team Leadership &amp; Organizational Development
 
 
 <ul>
 <li>
 Recruit, onboard, and manage key team members including Training Manager, Cases Manager, BD &amp; Membership Manager, and Operations Officer.
 </li>
 <li>
 Establish a high-performance culture with clear accountability structures.
 </li>
 <li>
 Provide strategic leadership across all operational pillars.
 </li>
 </ul>
 
 
 
 
 
 4. External Representation &amp; Stakeholder Engagement
 
 
 <ul>
 <li>
 Represent MICADR at conferences, regulatory forums, judicial engagements, media appearances, and stakeholder events.
 </li>
 <li>
 Serve as a credible institutional face capable of engaging senior-level audiences.
 </li>
 </ul>
 
 
 
 
 
 5. Governance &amp; Board Reporting
 
 
 <ul>
 <li>
 Prepare and present quarterly P&amp;L and performance reports to the Board.
 </li>
 <li>
 Provide clear analysis of revenue performance, pipeline status, and forward projections.
 </li>
 <li>
 Ensure execution aligns with Board-approved strategy.
 </li>
 </ul>
 
 
 
 
 
 Requirements
 
 
 <ul>
 <li>
 Minimum 10 years of leadership experience in professional services, ADR, institutional management, legal sector, or related fields.
 </li>
 <li>
 Proven track record of owning revenue targets and delivering measurable financial results.
 </li>
 <li>
 Strong credibility in the corporate or legal market with an active senior network.
 </li>
 <li>
 Demonstrated ability to build and lead high-performing teams without micromanagement.
 </li>
 <li>
 LL.B. or equivalent degree preferred. IMI accreditation or ADR certification is an advantage but not mandatory; commercial credibility is prioritized.
 </li>
 <li>
 Consistent year-on-year revenue growth across all three revenue pillars: training, cases, and corporate membership.
 </li>
 <li>
 Minimum 80% KPI achievement across all operational pillars each quarter.
 </li>
 <li>
 At least 6 senior-level business development engagements per quarter at C-suite or board level.
 </li>
 <li>
 Timely submission of all quarterly Board reports.
 </li>
 <li>
 Achievement of financial independence within three years through reduction of institutional subsidy.
 </li>
 </ul>
 
 
 
 
 
 Core responsibilities
 
 
 <ul>
 <li>
 Ensure consistent year-on-year revenue growth across training, cases, and corporate membership.
 </li>
 <li>
 Achieve a minimum of 80% KPI performance across all operational pillars each quarter.
 </li>
 <li>
 Maintain institutional partnerships with at least six senior-level engagements per quarter.
 </li>
 <li>
 Ensure timely submission of quarterly Board reports.
 </li>
 <li>
 Drive MICADR towards financial independence within three years.
 </li>
 </ul>
 
 
 
 
 
 
 
 EEO &amp; Non-Discrimination Statement:
 
 
 Integrated into our shared values is LAS&rsquo;s commitment to diversity and equal employment opportunity. All qualified applicants will receive consideration for employment regardless of sex, age, race, colour, creed, religion, disability, sexual orientation, gender identity, or any other characteristics or conduct protected by law. LAS is committed to being an inclusive organization where all people are treated fairly, recognized for their individuality, promoted based on performance and encouraged to strive to reach their full potential. We believe in understanding and respecting differences among all people. Every individual at LAS has an ongoing responsibility to respect and support a diverse environment.
 
 
 
 
 
 
 
 
 Safeguarding &amp; PSEA Commitment
 
 
 Legal Aid Society (LAS) is committed to the prevention and protection from all forms of sexual exploitation and abuse (SEA). LAS explicitly prohibits its staff, associates, partners, consultants, or any other representatives associated with the delivery of its work from:
 
 <ul>
 <li>
 Engaging in any form of sexual exploitation or abuse;
 </li>
 <li>
 Sexual activity with children (persons below the age of 18) irrespective of a mistaken belief of the age of the child which shall not amount to a defense;
 </li>
 <li>
 Exchange of money, employment, goods or services for sex, including sexual favors or other forms of humiliating, degrading or exploitative behavior, is prohibited. This includes any exchange of assistance that is due to beneficiaries of assistance;
 </li>
 <li>
 Sexual relationships between LAS staff and beneficiaries of assistance, since they are based on inherently unequal power dynamics, undermine the credibility and integrity of the work of LAS and are strongly discouraged.
 </li>
 </ul>
</div>

Associate Director - Musaliha International Center for Arbitration and Dispute Resolution (MICADR)

Allstate Insurance

<div>At Allstate, great things happen when our people work together to protect families and their belongings from life&rsquo;s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers&rsquo; evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.
Job Description
As a Claims Resolution Adjuster, your main focus will be investigating automobile accidents involving bodily injury. You will have the convenience of working remotely from your home while efficiently handling your responsibilities. You will assess coverage, liability, and damages while providing exceptional customer service throughout your day. Customer communication will take place through different channels, including voice calls, email, and text messages. Through the utilization of innovative platforms and tools, you will engage in negotiation processes to reach fair injury settlements with all parties involved.
The Claims Resolution Adjuster will primarily be responsible for the liability investigation and ultimate decisions, identifying injured parties beyond who is listed at FNOL (First Notice of Loss), and recognizing impactful risk potential on claim files. They will be responsible for supporting the claimant throughout the vehicle restoration process and providing feedback on the Auto process in general. The Claims Resolution Adjuster and Casualty Adjusters will work hand-in-hand throughout the claims process.
Candidates for this role must reside in either the Central (CST), Mountain (MST), or Pacific (PST) time zone. This position is not available to residents of California, Washington, Alaska, Hawaii, or Puerto Rico.
Schedule: 8-hour shift Mon-Fri | 8:00am - 4:30pm or 9:00am - 5:30pm with potential Saturday duty rotation.
You&rsquo;ll wear a few hats to fill a few roles throughout your day that all require a level of experience:
The Customer Service Expert &ndash; you&rsquo;ll live into Allstate&rsquo;s Claims Culture by caring, empowering, and restoring, and you will accomplish that by being compassionate, clear, and a committed partner in each Casualty claim. You lead with empathy, always.
The Investigator &ndash; you&rsquo;ll confidently and independently investigate casualty (and applicable LOB (line of business)) claims by performing detailed reviews of damage and interpreting policies to determine coverage.
The Effective Communicator &ndash; you&rsquo;ll use phone, emails and sometimes even video chat with customers to help them through a fast, fair, and easy claims process. You&rsquo;ll also incorporate a specific approach to claim handling to offer the customer their preference of communication to efficiently discuss their claim needs and keep them updated on the claim progress.
The Negotiator &ndash; you will evaluate and negotiate claims settlements with customers, vendors, third party carriers and claimants, in accordance with all legal and business standard methodologies. With negotiations, you will incorporate tactics in handling challenging and complex situations.
The Problem Solver &ndash; you&rsquo;ll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills.
The Recorder &ndash; you&rsquo;ll protect the company financially by executing policies along policy agreements, and you keep a clear record of your work in a claims system that you will be trained on. You&rsquo;ll accomplish this by ensuring timely and accurate documentation is completed as you work on each claim.
Qualifications:<ul><li>
2+ years Claims experience, specifically Casualty Bodily Injury claims background.</li><li>
Claims investigation and negotiation experience is preferred.</li><li>
Experience with liability investigations, investigating coverage, PD coverage, set MOI, rental and resolving liability a plus.</li><li>
Proficient communication skills, especially over the phone, to establish rapport and assess claims accurately.</li><li>
Strong critical thinking and problem-solving skills to evaluate and negotiate injury claims successfully.</li></ul>
Remote Work: 
This position is a permanent remote home-based role. Your home office does not need to be near an Allstate office, but it does need to be in the United States within one of the listed time zones above.
When you work from home full time, you&rsquo;ll need:<ul><li>
A dedicated workspace in your residence that is private and free from distractions.</li><li>
A minimum internet bandwidth of 50 MB down/5 MB up.</li><li>
Appropriate work surface and seating.</li></ul> 
What will Allstate provide?<ul><li>
A technology bundle that includes all equipment needed to perform your work from home (laptop, monitors, headset, keyboard, mouse).</li><li>
Connectivity reimbursement of $80 per month to offset some of the cost of internet.</li></ul> 
Notice of Licensing Requirement<ul><li>
As a condition of employment, your office/area may require you to obtain an adjuster and/or an appraiser license which includes passing an additional background check with the Department of Labor. If applicable, you will be required to secure license(s) within 60 days of hire.</li><li>
If required, the Hiring Manager will work with you along with the Centralized Licensing team to ensure that you are properly licensed.</li></ul>
Sign-On Bonus:
You may be eligible for a $1,000 Licensing Sign-On Bonus if you have the applicable active licenses needed for this role. This could include Home Resident Property &amp; Casualty License, Designate Home State (DHS) Florida or Texas License, and/or applicable Appraiser License.
*Candidates who have previously worked for and are seeking to be rehired at Allstate and its family of companies are not eligible for this sign-on bonus.*
Allstate Benefits
Being a part of Allstate means you receive a benefits package from Day 1 of employment. This includes time off, healthcare, retirement, and more. That is why as an Allstater, you&rsquo;ll enjoy a Total Rewards package that includes:<ul><li>
Competitive pay with needed support for continuous development and career advancement.</li><li>
Flexibility in scheduling and a time off policy that helps support your work/life balance.</li><li>
Initial and ongoing training to get you proficient in your new role</li><li>
Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life. Visit www.allstategoodlife.com to learn more.</li></ul>
Please Note:<ul><li>
In our virtual environment, employees are required to engage and participate on camera during online meetings and trainings</li><li>
The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job.</li></ul>
#LI-BC1
Skills
Compensation
Compensation offered for this role is 20.77 - 32.67 per hour and is based on experience and qualifications.
The candidate(s) offered this position will be required to submit to a background investigation.
Joining our team isn&rsquo;t just a job &mdash; it&rsquo;s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger &ndash; a winning team making a meaningful impact.
Allstate generally does not sponsor individuals for employment-based visas for this position.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
For jobs in San Francisco, please click &ldquo;here&rdquo; for information regarding the San Francisco Fair Chance Ordinance. 
For jobs in Los Angeles, please click &ldquo;here&rdquo; for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.
To view the &ldquo;EEO Know Your Rights&rdquo; poster click &ldquo;here&rdquo;. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs.
To view the FMLA poster, click &ldquo;here&rdquo;. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint.
It is the Company&rsquo;s policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee&rsquo;s ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.</div>

Claims Resolution Adjuster - Remote (PST/MST/CST)

NuStart Consulting

<div>Position: Claims Resolution Representative (DME)

Overview

The Claims Resolution Representative is responsible for identifying, correcting, and resolving DME claims that were billed inaccurately due to coding errors, payer discrepancies, or incorrect insurance information. This role ensures claims are properly corrected, rerouted to the appropriate payer, and successfully reimbursed. Complex denials requiring further review are escalated to the Appeals team.

Key Responsibilities
<ul><li>Analyze claims to determine root cause of misrouting or denial (e.g., incorrect payer, coding errors, eligibility issues)</li></ul>
<ul><li>Verify and update patient insurance information, including coordination of benefits (COB)</li></ul>
<ul><li>Review and validate coding accuracy (ICD-10, HCPCS, CPT as applicable)</li></ul>
<ul><li>Correct claim errors and ensure all required documentation is in place prior to resubmission</li></ul>
<ul><li>Resubmit corrected claims to the appropriate payer in a timely and accurate manner</li></ul>
<ul><li>Identify trends or recurring issues in claim errors and contribute to process improvement</li></ul>
<ul><li>Monitor claim status post-resubmission and follow up on pending or unresolved claims</li></ul>
<ul><li>Escalate complex denials or unresolved issues to the Appeals team as appropriate</li></ul>

Qualifications
<ul><li>Previous experience in within DME preferably with Surgical Dressings, Ostomy, Urological, Tracheostomy, etc.)</li></ul>
<ul><li>Strong understanding of Medicare guidelines, LCDs, and compliance requirements</li></ul>
<ul><li>Proficiency with medical billing systems and electronic claims submission platforms</li></ul>
<ul><li>Working knowledge of ICD-10, HCPCS, and CPT coding</li></ul>
<ul><li>Familiarity with CMS-1500 (professional claims)</li></ul>
<ul><li>Understanding of payer guidelines, claim frequency codes, and resubmission processes</li></ul>
<ul><li>High attention to detail with strong organizational and problem-solving skills</li></ul>
<ul><li>Strong communication skills and ability to work independently and within a team</li></ul>
<ul><li>Experience with Brightree is highly preferred</li></ul>
<ul><li>Minimum typing speed of 60 WPM</li></ul></div>

Claims Resolution Specialist

Liberty Mutual Insurance

<div>Description
<div>Are you looking to use your customer service skills in a role where you can see that you are making a difference in people&rsquo;s lives? Are you looking for a position that allows you to do meaningful and innovative work in a culture of continuous improvement? If so, this opportunity could be for you!
Liberty Mutual&rsquo;s Large Loss Claims Property team has an immediate opening for a Personal Property Claims Specialist. As a Claims Specialist, you will manage, investigate and resolve assigned Property Contents claims under general supervision. Responsibilities include: capturing and creating an inventory of damaged/lost contents while on site, working with various vendors and ensuring that quality customer service is provided via face to face and phone interaction. Manages, investigates and resolves assigned Property Contents claims for more complex claims under limited supervision. Compiles and values inventory of high-end damaged/lost contents associated with property claims. Provides policyholders with quality customer service. May assist Claims Representatives with in-person inspection/policyholder contact where necessary.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory.
To be successful in this role, the ideal candidate must be comfortable with travelling as he/she would be travelling 75% of the time, visiting homes and doing inspections/investigations.
Candidates who reside in Southern Illinois and Southwest Indiana are also welcome to apply for this role. 
Responsibilities:<ul><li>
Responsible for claims handling personal property losses to include large loss.</li><li>
Works in concert with large loss adjuster for scheduling, inventorying, adjustment and relocation assistance.</li><li>
Performs on-site inventory inspection and specific detail capture (50% minimum on-site) to provide to policyholder for pricing.</li><li>
Develops expert list/websites for various product categories.</li><li>
Utilizes internet VIA/Insurer's World/vendors for pricing and/or validation.</li><li>
Documents the file accordingly.</li><li>
Provides quality customer service.</li><li>
Provides insured with policy information to include coverage, limitations, replacement or ACV options.</li><li>
Works with and may coordinate a number of vendor services such as contractors, emergency repair, cleaning services and various replacement services.</li><li>
May assist on files handled by Claims Reps with in-person inspection/policyholder contact when needed.</li><li>
Attends product seminars/shows to build personal property expertise.</li><li>
May be called upon for catastrophe duty.</li></ul></div>
Qualifications<ul><li>
Strong written and oral communications skills required.</li><li>
Good interpersonal, analytical and negotiation skills required</li><li>
Customer service experience preferred</li><li>
Knowledge of coverages provided within various homeowner policies.</li><li>
Experience in interior design, electronics, appliances, antique-collectibles, clothing and furniture retail preferred.</li><li>
The capabilities, skills and knowledge required is normally acquired through a Bachelor&rsquo;s degree or equivalent experience and 3-5 years of directly related experience.</li><li>
Ability to obtain proper licensing as required.</li></ul>
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. 
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. 
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits 
 
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. 
 
Fair Chance Notices<ul><li>
California</li><li>
Los Angeles Incorporated</li><li>
Los Angeles Unincorporated</li><li>
Philadelphia</li><li>
San Francisco</li></ul></div>

Claim Resolution Specialist, Personal Property

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