insurance claims manager

AMERICAN FREEDOM INSURANCE

<div>Description:
<p>
 <b>What You'll Be Doing</b></p><p>
As our Claims Manager, you will lead and shape the success of our claims department, focusing on efficiency, cost control, and exceptional service. Experience handling Private Passenger Auto (PPA) claims in Indiana and Pennsylvania is preferred, while overall claims workload management covers IL, IN, TN, PA, and TX:</p><ul><li><b>
Lead &amp; Empower Your Team:</b> Manage and motivate claims staff with focus on IN and PA claims teams, ensuring workflow, workload, and service levels are met efficiently.</li><li><b>
Optimize Processes:</b> Develop strategies to reduce loss costs and ensure efficient claim processing</li><li><b>
Drive Performance:</b> Set and measure performance indicators to ensure accountability and team success.</li><li><b>
Regulatory Excellence:</b> Monitor and ensure regulatory compliance and minimize complaints.</li><li><b>
Hands-On Claims Management:</b> Oversee, evaluate, and authorize claims, keeping high priority <b>IN and PA PPA cases</b> closely monitored.</li><li><b>
Guidance &amp; Training:</b> Coach adjusters handling <b>IN and PA PPA claims</b> to meet or exceed service objectives and regulatory standards.</li><li><b>
Negotiation &amp; Resolution:</b> Negotiate claims, achieve favorable outcomes, and minimize expenses.</li><li><b>
Build Relationships:</b> Foster collaboration within the Claims Department, working closely with staff, supervisors, and managers.</li><li><b>
Continuous Improvement:</b> Identify opportunities to improve processes and ensure operational excellence.</li></ul>
Requirements:
<p>
 <b>What We're Looking For:</b></p><ul><li>
Bachelor&rsquo;s degree or higher</li><li>
Minimum 3 years of relevant claims management experience</li><li>
IL, TN, or TX experience preferred and IN and/or PA experience strongly preferred</li><li>
Nonstandard auto insurance experience a plus</li><li>
Strong customer service skills and fast-track claim processing expertise</li><li>
Skilled at negotiating with attorneys and pro se litigants</li><li>
Knowledge of claims practices in IL, IN, TN, PA, or TX preferred</li><li>
Exceptional written and verbal communication skills</li><li>
Proficient with technology and coverage/liability analysis</li><li>
High level of responsibility, problem-solving, and organizational skills</li><li>
Bilingual Spanish preferred</li></ul><p><b>
Benefits: </b>AFIC offers a competitive salary and a comprehensive benefits package to support you</p><ul><li><b>
Competitive Salary:</b> Rewarding your expertise and experience</li><li><b>
Financial Security:</b> 401K with up to a 6% company match</li><li><b>
Health &amp; Wellness:</b> Choice of Blue Cross Blue Shield PPO, HMO, or HSA plans, Dental and vision coverage, Access to telemedicine services</li><li><b>
Growth/Stability:</b> Over 12 consecutive years of profitable growth, confirmed by A+ Superior rating by A.M. Best</li><li><b>
Work-Life Balance:</b> Monday-Friday, 8 am-5 pm CST</li><li><b>
Holidays: </b>At Least 6 Paid Holidays</li><li><b>
Paid Time Off (PTO):</b> PTO that can be used for vacation, personal, or sick time</li><li><b>
Personal Days:</b> Separate personal days for sickness, family needs, appointments or personal matters</li><li><b>
Employee Recognition:</b> We celebrate work milestones to show appreciation for your contributions</li><li><b>
Professional Growth:</b> Paid training, state licensing reimbursement, and opportunities for advancement</li><li><b>
Positive Culture:</b> Enjoy our inclusive holiday events, employee referral bonuses, virtual team meetings, and more</li></ul></div>

Auto Insurance Claims Manager

Certus Healthcare Management

<div><p><b>Company Overview:</b></p>
<p>
Certus Healthcare Management proudly owns and operates a network of 17 communities across Ohio and Michigan, serving both rural and urban populations. Our mission is to deliver personalized, family-focused care that enhances the quality of life for our residents and their families, fostering an environment where everyone&rsquo;s voice is heard and valued.</p>
<p><b>
Overview:</b></p>
<p>
 We are seeking an energetic and detail-oriented Insurance Claims Specialist to lead our claims processing team. In this pivotal role, you will oversee the entire claims lifecycle, ensuring accurate, efficient handling of insurance claims related to health, auto, workers' compensation, and property damage. Your expertise will drive fraud prevention, risk analysis, and effective negotiation strategies to optimize claim outcomes while maintaining exceptional service standards.</p>
<p>
This position will work out of our corporate office located in Mayfield Heights, Ohio. Typical schedule for this position is 9am to 5pm.</p>
<p><b>
Duties</b>:</p>
<ul><li>
Manage and coordinate all aspects of insurance claims processing, including auto estimating, medical documentation review, and construction inspection reports.</li><li>
Lead investigations into potential fraud cases by utilizing fraud detection tools and analysis skills to identify suspicious claims.</li><li>
Oversee risk management procedures by analyzing claim data to identify trends and implement preventative measures.</li><li>
Collaborate with underwriters, medical professionals, auto repair shops, and legal teams to facilitate accurate claim assessments.</li><li>
Ensure compliance with industry standards such as ICD-9/10 coding, CPT coding, HCPCS codes, and Medicare/Medicaid regulations.</li><li>
Develop and implement service writing strategies that enhance customer satisfaction while safeguarding company interests.</li><li>
Provide training and mentorship to claims staff on best practices in negotiation, auto service management, water damage restoration procedures, and clerical processes.</li></ul><p></p><p><b><br>
Qualifications:</b></p>
<ul><li>
Proven experience in insurance claims management with a strong understanding of workers' compensation, auto insurance, medical billing, and construction inspection processes.</li><li>
Demonstrated expertise in negotiation skills and risk analysis techniques.</li><li>
Knowledge of medical terminology, ICD coding (ICD-9/10), CPT coding, HCPCS codes, and medical documentation standards.</li><li>
Familiarity with auto estimating software, auto body repair procedures, automotive repair processes, and auto restoration practices.</li><li>
Strong organizational skills with the ability to manage multiple claims efficiently under tight deadlines.</li><li>
Analytical mindset with proficiency in financial software and insurance verification systems.</li><li>
Mechanical knowledge related to automotive service management or water damage restoration is a plus.</li><li>
Excellent communication skills to liaise effectively with internal teams and external partners.</li></ul><p>
Join us as an Insurance Claims Manager where your expertise will shape a seamless claims experience for our residents while advancing your career in a dynamic environment committed to excellence!</p></div>

Insurance Claims Specialist

Openkyber

<div><p>Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for an Risk Manager/Claims Specialist .</p>
<b>Job Description:</b>
<p>Job Title: Risk Manager/Claims Specialist<br>
Job Type: Contract<br>
Job Location: York PA<br>
Work Schedule: Hybrid<br>
Pay Rate: $ 93 Based on experience.</p>
<b>Description:</b>
<p>General Summary Provides risk management services to System entities. Evaluates the risk of financial or property losses and arranges for appropriate insurance coverage for such losses. Oversee the claims process, including managing activities, documents, and files related to handling and settling claims, as well as ensuring that each claim is handled promptly, appropriately, and in accordance with company policy. Manages day-to-day operations of claims function and provide general oversight and direction of all litigation and claims activity. Assumes the duties and responsibilities of the Risk Manager in their absence.</p>
<b>Responsibilities for Internal Candidates Duties and Responsibilities Essential Functions :</b>
<ul><li>Responds to questions concerning risk management and claims that may arise.</li>
<li>Conducts and participates in Root Cause Analyses and risk assessments such as PRAs, FMEAs, etc. upon request and as needed.</li>
<li>Participates in the Accreditation/Risk Management on-call rotation.</li>
<li>Reviews event reports daily.</li>
<li>As requested, assists the entity patient safety officer in the event of investigation and in decisions concerning regulatory reporting issues.</li>
<li>Conducts educational sessions on risk issues for the various entities as necessary.</li>
<li>Investigates allegations of inappropriate treatment/care which results in injury (or alleged injury) to a patient/visitor and determines next steps.</li>
<li>Drives proficiencies in claims processes and investigations to reduce litigation costs by tracking, reviewing, and analyzing newly litigated cases.</li>
<li>Determines the complexity and value of litigated claims for possible resolution, attending trial as needed.</li>
<li>Reviews and analyzes initial case assessment and legal strategy and assists in the development of litigation strategy.</li>
<li>Collaborates with leadership to develop reporting metrics (for example, reporting metrics packet) and develops reports and communicates results of current and potential litigation trends to leadership, including, but not limited to, communicating updates such as pre-trial reminders, daily trial updates, and summaries of cases where an increase in indemnity reserves is being requested, as well as any other critical updates.</li>
<li>Identifies, gathers, and preserves discovery items, or items requested by defense counsel that will assist with an investigation, related to existing or potential litigation.</li>
<li>Manages and overseas outside counsel on litigation, discovery matters, litigation costs, negotiations, and settlement agreements by identifying and assigning counsel to handle claims.</li>
<li>Reviews and approves outside counsel invoices to ensure billable hours are appropriate for each case and rejects incorrect invoices and follows up with outside counsel when there are questions with respect to such invoices.</li>
<li>Directs the preparation and maintenance of department reports.</li>
<li>Prepares periodic reports for top management, as required.</li>
<li>Provides management services to the Company s reciprocal Risk Retention Group, and coordinates activities of governing board, attorneys, and consultants.</li>
</ul><b>Common Expectations:</b>
<ul><li>Maintains established policies and procedures, objectives, quality assessment, and safety standards.</li>
<li>Maintains appropriate records, reports, and files as required.</li>
<li>Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.</li>
<li>Works collaboratively with Risk Management, Accreditation and Licensure, and key stakeholders to address organization risks.</li>
</ul><b>Required for All Jobs:</b>
<ul><li>Performs other related duties as identified.</li>
<li>Company has adopted and implemented a compliance program to support Company s values and standards for professionalism, integrity, and ethics.</li>
<li>Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.</li>
<li>Company has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization.</li>
<li>Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.</li>
</ul><p>The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.</p>
<b>Physical Demands:</b>
<ul><li>Standing - Occasionally</li>
<li>Walking - Occasionally</li>
<li>Sitting - Frequently</li>
<li>Reaching - Rarely</li>
<li>Talking - Frequently</li>
<li>Hearing - Frequently</li>
<li>Repetitive Motions - Occasionally</li>
<li>Eye/Hand/Foot Coordination - Occasionally</li>
</ul><b>Travel Requirements:</b>
<p>Estimated Amount: - Some travel required within Company s geographic service area.</p>
<b>Qualifications for Internal Candidates Qualifications Minimum Education:</b>
<p>Master s Degree Required or Work Experience: 5 years Health care or insurance related experience. Required Claims management or paralegal background experience. Preferred</p>
<b>About Maxonic:</b>
<p>Since 2002 Maxonic has been at the forefront of connecting candidate strengths to client challenges. Our award winning, dedicated team of recruiting professionals are specialized by technology, are great listeners, and will seek to find a position that meets the long-term career needs of our candidates. We take pride in the over 10,000 candidates that we have placed, and the repeat business that we earn from our satisfied clients. Interested in Applying? Please apply with your most current resume. Feel free to contact OpenKyber for more details.</p>
<p><b>For applications and inquiries, contact:</b> hirings@openkyber.com</p></div>

Insurance Claims Systems Architect

Berkley

<div>Company Details:<div></div><div><br>
Vela Insurance Services provides specialized Excess and Surplus Lines Casualty and Professional Liability insurance solutions in the following market segments: Construction, Specialty Casualty, &amp; Professional Liability. We offer national service and local knowledge to our exclusive wholesale broker network and the businesses they serve.</div><br>
<div></div>
Responsibilities:
<div>
Join a dynamic, fast‑paced team in the E&amp;S space and lead a team of talented claim professionals handling a broad range of <b>General Liability and Products Liability</b> claims involving property damage and bodily injury.</div><div><br>
</div><div>As Claims Manager, you will guide and inspire your team to deliver best‑in‑class claim outcomes, ensuring alignment with company and industry standards.</div><div><br>
</div><div>You will play a pivotal role in driving quality, efficiency, and strong financial results across our portfolio&mdash;while fostering a positive, collaborative, and growth‑focused team culture. Among your responsibilities will be:</div><ul><li>
Provide clear technical guidance, coaching, and mentorship to claim professionals at varying experience levels.</li><li>
Serve as a key decisionmaker regarding claim valuation, reserves, negotiation approaches, and resolution strategies.</li><li>
Maintain an active diary on all claim files within your direct team, ensuring accuracy, consistency, and timeliness.</li><li>
Conduct comprehensive performance evaluations and support team members with meaningful feedback, development opportunities, and career progression.</li><li>
Partner closely with claim professionals on matters within and above their authority to ensure exceptional claim handling across the board.</li><li>
Support preparation of reports and presentations for senior leadership and internal business partners.</li><li>
Drive profitability by ensuring strict adherence to Best Practices and high‑quality claim file execution.</li><li>
Promote an engaged, collaborative, and supportive team environment centered on accountability, innovation, and success.</li><li>
Build and maintain strong relationships with internal stakeholders, customers, and external partners while delivering excellent customer service.</li><li>
Collaborate effectively with other claim teams and cross‑functional departments throughout the company.</li><li>
Act as a mentor and resource for claims knowledge, professional development, and skill advancement.</li><li>
Identify process, training, or performance opportunities and recommend solutions that elevate team performance.</li><li>
Leverage data and analytics to identify trends, improve outcomes, and enhance strategic decision‑making.</li><li>
Conduct monthly file audits to ensure accuracy, quality, and consistency in claim handling.</li><li>
Maintain all required state adjuster licenses at all times (see qualifications below).</li><li>
Ensure compliance with statutory regulations, Unfair Claims Practices laws, and corporate standards.</li><li>
Perform additional duties or special projects as assigned.</li><li>
Regular and predictable attendance</li></ul>
Qualifications:
<ul><li>Four (4) year College Degree or equivalent industry experience</li><li>
Industry designations preferred (CRIS, AIC, SCLA, etc.)</li><li>
Eight (8) plus years claims handling experience or equivalent experience.</li><li>
Strong knowledge of the insurance industry, including legal and regulatory environments.</li><li>
Specific knowledge and expertise in General Liability and Products Liability (BI &amp; PD) claims.</li><li>
3 &ndash; 5 years of managerial or leadership experience preferred.</li><li>
Proven ability to lead and develop remote or virtual teams.</li><li>
Applicable adjusters license(s) to include - CA, CT, DE, FL, KY, LA, NH, NM, NC, OK, RI, SC, TX, VT, WV, WY</li></ul><br>
<div></div>
Sponsorship Details: Sponsorship not Offered for this Role</div>

Claims Manager - Early Resolution

AmTrust Financial

<div>Overview:
<div>In this role, you will handle first‑ and third‑party cyber claims, manage relationships with outside counsel and vendors, and provide timely claim trend insights to support underwriting and actuarial teams. Our portfolio includes admitted and surplus lines, primary and excess accounts, and insureds ranging from small businesses to Fortune 500 companies.</div>
Responsibilities:
<ul><li>Directly managing claims including the investigation, analysis and evaluation of coverage liability and damages</li><li>
Formulating claims and litigation strategies</li><li>
Supporting and coordinating with outside counsel and third-party vendors, and helping track associated costs</li><li>
Identifying liability and coverage trends and issues with both individual and portfolio impact and formulating the processes and strategies for handling
</li><li>such claims as well as ensuring accurate and consistent claims management across impacted underwriting segments and lines of business</li><li>
Facilitating the collection and analysis of claims-related data for analytic purposes</li><li>
Reviewing and updating third party vendor panel on an ongoing basis</li><li>
Disseminating information on claim trends to senior management and underwriting teams</li><li>
Supporting underwriting inquiries and information requests</li><li>
Communicating with senior executives, brokers, reinsurers, actuaries, insureds, and auditors (both external and internal)</li></ul>
Qualifications:
<ul><li>5+ years of claims experience handling primary and excess cyber claims <b>and/or</b> JD with insurance coverage litigation experience (ideally related to cyber/data privacy)</li><li>
Demonstrated ability and experience handling both first- and third-party (cyber) claims involving a wide variety of loss scenarios as well as reporting and presenting about same to senior management</li><li>
In-depth knowledge of claims, litigation, arbitration, and trial processes as well as excellent analytical, investigative, and negotiating skills</li><li>
Strong organizational and collaborative skills</li><li>
Analytical thinker that can drive results using all facets of the legal and claims processes</li><li>
Understanding of and ability to balance both the immediate claim issues as well as the broader portfolio impact and customer service impact of coverage disputes and issues</li><li>
Excellent oral and written communication skills with the ability to deal effectively with people with conflicting expectations, differing opinions, and multiple viewpoints</li></ul><div><i>
The expected salary range for this role is $120.5K-$155K/year.</i></div><div></div><div><i><br>
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.</i></div><div></div><div><br>
#LI-BL1</div><br>
<div></div>
What We Offer:
<div>
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical &amp; Dental Plans, Life Insurance, including eligible spouses &amp; children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.</div><div></div><div><br>
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.</div><div></div><div><br>
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.</div></div>

Complex Claim Specialist, Cyber

U.S. Marine Corps

Marine Corps Community Services (MCCS) is looking for the best and brightest to join our Team! MCCS is a comprehensive program that supports and enhances the quality of life for Marines, their families, and others in the Marine Corps Community. We offer a team oriented environment comprised of military personnel, civilian employees, contractors and volunteers who keep the organization functioning smoothly and effectively. As a service-oriented organization, we never waver in our commitment to our Corps.
<br><br>
Major Duties
<br><br>
Serves as the Senior General Insurance and Emergency Response Claims Specialist for the Human Resources Branch (MRG), Business and Support Services Division (MR), Manpower and Reserve Affairs Department, Headquarters Marine Corps. Assists the Composite Insurance Branch Head in the management of the United States Marine Corps (USMC) self-insured Nonappropriated Fund (NAF) General Insurance Program and utilizes extensive knowledge of the Longshore and Harbor Workers' Compensation Act (LSHWCA), and other pertinent laws and regulations to receive and evaluate workers' compensation claims for proper acceptance and adjudication after submission to the Third Party Administrator (TPA) in the management of the United States Marine Corps (USMC) self-insured Non-appropriated Fund (NAF) Workers' Compensation Program.
<br><br>
Based on program requirements, approves, recommends and authorizes payments made under the General Insurance Program. Maintains general insurance program financial records to validate variance reports as provided by the Resources Management Branch, to include monitoring program account balance as compared to the reserve requirement. Participates in meeting budgetary requirements for program administration. Assist in the development of the combined budgets.
<br><br>
Maintains liability claims data and commercial coverage information in claims database and working in conjunction with other Senior General Insurance Specialists, oversees claims administration. Develops reports using claims data.
<br><br>
Receives and reviews workers¿ compensation claim documentation and screens for proper completion and accuracy of information. Once lost time on a claim has been accepted, processes a Supplemental Wage Calculation Spreadsheet using data from both the TPA and PeopleSoft systems. Utilizes working knowledge of the Longshore and Harbor Workers¿ Compensation Act (LSHWCA) and other pertinent laws and regulations to provide technical advice to United States Marine Corps (USMC) Non-appropriated Fund Instrumentalities (NAFIs). Performs annual file reviews and training sessions for USMC NAF field locations.
<br><br>
Serves as POC for injured employees and TPA for Headquarters Marine Corps NAF workers¿ compensation claims. Instructs injured employees on form completion and answers questions regarding workers¿ compensation benefits.
<br><br>
Prepares for and participates in annual stewardship meetings with the commercial insurance broker. Prepares data as required for WC, GL, AL, and Property Programs for use in annual submission to commercial insurance market underwriters. Coordinates as needed with other branches of MCCS for data collection/submission.
<br><br>
Collects and monitors receipt and maintains all commercial insurance policies from the broker, to include historical policies. Reviews policies as required to ensure NAF risks are appropriately addressed. Makes recommendations for policy modifications if required.
<br><br>
Reviews risks inherent to MCCS and USMC miscellaneous NAF activities. Recommends changes to procedures/policies concerning the Composite Insurance Program to ensure compliance with USMC regulations and that adequate protection is in place for MCCS activities. Assists the Branch Head in addressing legislative issues.
<br><br>
Coordinates with the Construction Branch on development of the annual update of MCCS facilities, to include outline of new construction and improvements to existing facilities for use in submission to underwriters for commercial property coverage. Coordinates directly with command CDC¿s as necessary regarding serious incident reports.
<br><br>
Maintains logs, with assigned vehicle numbers for all NAF owned/leased vehicles entitled to registration numbers. Assists with claims adjudication, working with Navy Tort Claims Unit, JAG offices and commercial insurance adjusters as needed.
<br><br>
Travel is required to present educational workshops and contract quality control reviews, and to attend required training/education seminars, conferences and command site assistance when required if/when catastrophic loss occurs.
<br><br>
Works with the Resource Management Branch to obtain financial data pertaining to NAF property to include improvements, gross sales, and inventory for use in calculating annual composite insurance assessments for each command. Utilizes FMS and/or generates data calls to field commands as needed to ensure accurate completion of annual commercial insurance renewal data submission.
<br><br>
Under general direction of the Branch Head and Commercial Insurance Consultant, oversees the emergency preparedness program for the HQMC MR and MF Divisions, to include NAF employee emergency response procedures. Recommends emergency response goals and objectives to ensure a continually updated and responsive program and follows up to ensure implementation.
<br><br>
Qualifications
<br><br>
BACHELOR'S DEGREE from an accredited college or university in human resources, communications, marketing, or a related field appropriate to the work of position AND THREE YEARS of experience in the occupation, or a related field or work area, OR an appropriate combination of education and experience that demonstrates possession of knowledge and skill equivalent to that gained in the above, OR appropriate experience that demonstrates that the applicant has acquired the knowledge, skills, and abilities equivalent to that gained in the above.
<br><br>
Knowledge of the Federal Tort Claims Act, claims review practices, financial management, and emergency response plan development. Knowledge of ADP technology to maintain databases for program administration. Practical knowledge of the Longshore and Harbor Workers¿ Compensation Act (LSHWCA) and other related laws and regulations highly preferred. Skill to independently plan, organize and implement new or improved procedures, and work methods or objectives. Skill to communicate effectively, both orally and in writing, and to conduct presentations. Working knowledge of appropriate Naval correspondence protocols. Proficiency in Microsoft Office products. Familiarity with basic accounting principles.
<br><br>
How To Apply
<br><br>
All applications must be submitted online via the MCCS Careers website:
<br><br>
Resumes/applications emailed or mailed will not be considered for this vacancy announcement. To be considered for employment, the application or resume must be submitted online by 11:59 PM (ET) on the closing date of the announcement.
<br><br>
<b>Note:</b> To check the status of your application or return to a previous or incomplete application, log into your MCCS user account and review your application status.
<br><br>
Closing Statement
<br><br>
<b>GENERAL INFORMATION:</b> Applicants are assured of equal consideration regardless of race, age, color, religion, national origin, sex, GINA, political affiliation, membership or non-membership in an employee organization, marital status, physical handicap which has no bearing on the ability to perform the duties of the position. This agency provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please notify the agency. The decision on granting reasonable accommodation will be on a case-by-case basis.
<br><br>
It is Department of Navy (DON) policy to provide a workplace free of discrimination and retaliation. The DON No Fear Act policy link is provided for your review: https://www.donhr.navy.mil/NoFearAct.asp.
<br><br>
As part of the employment process, Human Resources Division may obtain a Criminal Record Check and/or an Investigative Consumer Report. Employment is contingent upon the successful completion of a National Agency Check and Inquiries (NACI). For all positions requiring access to firearms or ammunition, the Federal Government is prohibited from employing individuals in these positions who have ever been convicted of a misdemeanor crime of domestic violence, or a felony crime of domestic violence adjudged on or after 27 November 2002. Selectees for such positions must submit a completed DD Form 2760, Qualification to Possess Firearms or Ammunition, before a final job offer can be made.
<br><br>
Direct Deposit of total NET pay is mandatory as a condition of employment for all appointments to positions within MCCS.
<br><br>
<b>Required Documents:</b><br>
<ul>
<li>Education/certification certificate(s), if applicable.</li>
<li>If prior military, DD214 Member Copy</li>
</ul>
This activity is a Drug-free workplace. The use of illegal drugs by NAF employees, whether on or off duty, cannot and will not be tolerated. Federal employees have a right to a safe and secure workplace, and Marines, sailors, and their family members have a right to a reliable and productive Federal workforce.
<br><br>
Involuntarily separated members of the armed forces and eligible family members applying through the Transition Assistance Program must submit a written request/statement (may be obtained from the MCCS Human Resources Office) and present ID card with "TA" stamped in red on front of card.
<br><br>
INDIVIDUALS SELECTED FROM THIS ANNOUNCEMENT MAY BE CHANGED TO PART-TIME OR FULL-TIME AT MANAGEMENT'S DISCRETION WITHOUT FURTHER COMPETITION.
<br><br>
ALL ONLINE APPLICATIONS MUST BE RECEIVED BY 1159PM EASTERN TIME (ET) ON THE CLOSING DATE LISTED IN THE JOB POSTING.

SENIOR GENERAL INSURANCE SPECIALIST NF4

NMC Health plc

<div><p><b>DUTIES AND RESPONSIBILITIES :
</b></p><div><ul><li><div>Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy&rsquo;s schedule of benefits
</div></li></ul><ul><li><div>Respond to Insurance/ TPA queries and liaise with concerned department without ny delay.
</div></li></ul><ul><li><div>Responsible for receiving, evaluating and escalating second opinion cases and case management
</div></li></ul><ul><li><p>Perform night shift duty and on public holidays as per duty roster.
</p></li></ul><ul><li><p>Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
</p></li></ul><ul><li><div>Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors
</div></li></ul><ul><li><p>Attend Meetings and Presentation
</p></li></ul><ul><li><div>Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
</div></li></ul><ul><li><p>Prepare cost estimate for procedures for Cash Patient
</p></li></ul><ul><li><p>To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
</p></li></ul><ul><li><p>Managing and handling pending cases (if any) to the next shift colleagues.
</p></li></ul><ul><li><p>Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title</p></li></ul></div></div>
<br><div><ul><li><p>Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy&rsquo;s schedule of benefits.
</p></li><li><p>Respond to Insurance/TPA queries and liaise with concerned department without any delay.
</p></li><li><p>Responsible for receiving, evaluating and escalating second opinion cases and case management.
</p></li><li><p>Perform night shift duty and on public holidays as per duty roster.
</p></li><li><p>Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
</p></li><li><p>Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors.
</p></li><li><p>Attend Meetings and Presentation.
</p></li><li><p>Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
</p></li><li><p>Prepare cost estimate for procedures for Cash Patient.
</p></li><li><p>To adjust duties in case of any sudden/emergency unplanned leaves by colleagues.
</p></li><li><p>Managing and handling pending cases (if any) to the next shift colleagues.
</p></li><li><p>Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.</p></li></ul></div>
<br><div><ul><li><p><b>Qualification: </b>Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
</p></li><li><p><b>Experience: </b>Experience in Insurance Claims management/adjudication (minimum 2 years).
</p></li><li><p><b>Medical Coding: </b>Experience in Medical Coding ICD, CPT, DRG and HCPCS.
</p></li><li><p><b>Language: </b>Excellent command of oral and written English.
</p></li><li><p><b>Skills: </b>Flexible and able to work under pressure.
</p></li><li><p><b>Computer Skills: </b>Excellent knowledge of Microsoft applications.</p></li></ul></div>

Approval Officer

Search 10000+ Insurance claims manager jobs near you this March. New roles added regularly across leading industries. Apply today.