insurance claims processor

Moda Health

<div>
 <strong>
  Let&rsquo;s do great things, together!
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  <br/>
 </strong>
 <strong>
  About Moda
  <br/>
  <br/>
 </strong>
 Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let&rsquo;s be better together.
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 <br/>
 <strong>
  Position Summary
  <br/>
  <br/>
 </strong>
 Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company.
 <strong>
  This is a FT WFH role.
  <br/>
  <br/>
 </strong>
 <strong>
  Pay Range
  <br/>
  <br/>
 </strong>
 $17.34 - $19.41 hourly, DOE.
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 <br/>
 <ul>
  <li>
   Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Please fill out an application on our company page, linked below, to be considered for this position.
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  <br/>
 </strong>
 https://j.brt.mv/jb.do?reqGK=27774713&amp;refresh=true
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 <strong>
  Benefits
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Medical, Dental, Vision, Pharmacy, Life, &amp; Disability
  </li>
  <li>
   401K- Matching
  </li>
  <li>
   FSA
  </li>
  <li>
   Employee Assistance Program
  </li>
  <li>
   PTO and Company Paid Holidays
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Skills, Experience &amp; Education
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High School diploma or equivalent
  </li>
  <li>
   6-12 months data entry or medical office experience preferred
  </li>
  <li>
   10-key proficiency of 135 spm
  </li>
  <li>
   Type a minimum of 35 wpm
  </li>
  <li>
   Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred
  </li>
  <li>
   Demonstrates work habits that include punctuality, organization, and flexibility
  </li>
  <li>
   Ability to maintain balanced performance in areas of production and quality
  </li>
  <li>
   Analytical reasoning and flexibility
  </li>
  <li>
   Professional and effective written and verbal communication skills
  </li>
  <li>
   Experience with Facets platform a plus
  </li>
  <li>
   Identify all the duties and responsibilities
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Primary Functions
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
  </li>
  <li>
   Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
  </li>
  <li>
   Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
  </li>
  <li>
   Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
  </li>
  <li>
   Adjudication of claims to achieve quality and production standards applicable to this position.
  </li>
  <li>
   Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
  </li>
  <li>
   Reviews Policies and Procedures (P&amp;P&rsquo;S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
  </li>
  <li>
   Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
  </li>
  <li>
   Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
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   <br/>
  </li>
 </ul>
 <strong>
  Working Conditions &amp; Contact With Others
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  <br/>
 </strong>
 <ul>
  <li>
   Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
  </li>
  <li>
   Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Together, we can be more. We can be better.
  <br/>
  <br/>
 </strong>
 Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
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 <br/>
 For more information regarding accommodations, please direct your questions to Kristy Nehler &amp; Danielle Baker via our humanresources@modahealth.com email.
</div>


Medical Claims Processor I

Forest River, Inc.

Forest River, Inc., the Nation's largest manufacturer of Recreational Vehicles, Cargo Trailers, Transit Buses and Boats has an immediate opening.
<br><br>
Responsibilities
<br><br>
<ul>
<li>Process Warranty Claims submitted by our dealer base.</li>
<li>Answer questions regarding claims via phone/email.</li>
<li>Record retention and reporting.</li>
<li>Scanning documents.</li>
<li>Miscellaneous office duties.</li>
</ul>
Qualifications
<br><br>
<ul>
<li>Attention to detail and accuracy</li>
<li>Excellent computer skills, able to work in Microsoft Office programs efficiently</li>
<li>Must have good written and verbal communication skills</li>
<li>A desire to provide extraordinary customer service to the dealer/customer network</li>
<li>Able to work within a group and transition between responsibilities given</li>
<li>Willingness to learn many different components of a RV</li>
</ul>
Forest River offers a stable work environment that is fast paced. Our employees enjoy a highly competitive Wage and Benefit Package. We are looking for dedicated individuals with experience in the Industry as well as other Manufacturing Processes.

Warranty Representative/Claims Processor

Tata Consultancy Services (TCS)

<div></div><div><div><div><div><div>Responsibilities:</div><br>
<div><br>
</div><div>To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
</div><div>Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
</div><div>Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
</div><div>Approval or denial on FMLA claims as per Insurance carrier, and employer&rsquo;s guidelines
</div><div>Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
</div><div>Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
</div><div>Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
</div><div>Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
</div><div>Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
</div><div>Refers cases as appropriate to team lead and clinical case management
</div><div>Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
</div><div>Provide ideas to management on continuous improvement and service level management
</div><div>Performs other duties or participates in special projects as assigned</div><br>
<div><br>
</div><div>Requirements:</div><br>
<div><br>
</div><div>1+ year of Disability/FMLA/PFL claims or insurance claims experience
</div><div>Experience working with FINEOS
</div><div>Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
</div><div>Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
</div><div>Excellent oral and written communication, including presentation skills
</div><div>Strong Analytical, decision making, problem solving, and people management skills
</div><div>Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
</div><div>Willingness to embrace change in a fast paced work environment
</div><div>A strong desire to continuously learn and improve
</div><div>Identify escalated cases and work with Team Leader to develop a plan to address key issues.</div><div><br>
</div>
<div></div><br>
<div>TCS Employee Benefits Summary:
</div><ul><li> Discretionary Annual Incentive.
</li></ul><ul><li> Comprehensive Medical Coverage: Medical &amp; Health, Dental &amp; Vision, Disability Planning &amp; Insurance, Pet Insurance Plans.
</li></ul><ul><li> Family Support: Maternal &amp; Parental Leaves.
</li></ul><ul><li> Insurance Options: Auto &amp; Home Insurance, Identity Theft Protection.
</li></ul><ul><li> Convenience &amp; Professional Growth: Commuter Benefits &amp; Certification &amp; Training Reimbursement.
</li></ul><ul><li> Time Off: Vacation, Time Off, Sick Leave &amp; Holidays.
</li></ul><ul><li> Legal &amp; Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.</li></ul><br>
<div><br>
</div><div>Salary Range: $43,000 - $51,000 per year
</div></div></div></div><div><div><div><b>Location</b></div>
<div>Austin, TX</div>
</div><div><div><b>Job Function</b></div>
<div>BUSINESS PROCESS SERVICES</div>
</div><div><div><b>Role</b></div>
<div>Workflow Specialist</div>
</div><div><div><b>Job Id</b></div>
<div>405783</div>
</div><div><div><b>Desired Skills</b></div>
<div>Insurance</div>
</div><div><div><b>Salary Range</b></div>
<div>$43,000-$51,000 a year</div>
</div></div><p>Desired Candidate Profile
</p><div><div><b>Qualifications</b> : Diploma</div></div></div><div></div>

Claims Specialist

AAA Auto Club Enterprises

Job Summary
<br><br>
This entry-level position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, and claims resolution and negotiation strategies of lower complexity claims in compliance with established company technical and customer service best practices. Under moderate supervision, works within specific limits and authority to resolve claims with well-defined procedures.
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Job Duties
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Communicate and interact with a variety of individuals including insureds and claimants. Verify and explain benefits, coverages, fault, and claims process either verbally or in writing which complies with regulatory and statutory requirements.
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Conduct investigations to determine liability and damages and differentiate between allegations and facts. Identify and obtain statements from insureds, claimants, and witnesses.
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Evaluate and negotiate within settlement authority with insureds and claimants to resolve first and third-party claims in multiple markets. Demonstrate proficiency with estimate review, material damage, liability, analysis of claims, claims technology, and tool usage.
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Coordinate with internal and external departments as required.
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Respond quickly to customer needs and inquiries.
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Overtime and holiday hours may be required.
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Qualifications
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Bachelors Equivalent combination of education and experience Preferred
<br><br>
No prior claims experience.
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Knowledge of Microsoft Office suite and general computer software.
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Organization and planning recognition skills required.
<br><br>
Oral and written communication skills required.
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Interpersonal skills required.
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Property and Casualty Insurance License, valid in selling state - Issued by State
<br><br>
May be required to obtain an Adjuster license as applicable in accordance with state law. within 60 Days
<br><br>
The starting pay range for this position is $25.48 – $28.03 per hour. Additionally, you will be eligible to participate in our incentive program based upon your team and individual performance.
<br><br>
<b>Remarkable benefits:</b><br>
<ul>
<li>Health coverage for medical, dental, vision</li>
<li>401(K) saving plans with company match AND Pension</li>
<li>Tuition assistance</li>
<li>Floating holidays and PTO for community volunteer programs</li>
<li>Paid parental leave</li>
<li>Wellness programs</li>
<li>Employee discounts (membership, insurance,</li>
</ul>
travel, entertainment, services and more!)
<br><br>
Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
<br><br>
“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
<br><br>
AAA is an Equal Opportunity Employer
<br><br>
Our organization participates in E-Verify
<br><br>
The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

Claims Auto Adjuster

AltuMed (Cube Healthcare Systems Pvt Ltd)

<p>Work Location: Abbottabad (On Site)</p><p>Shift timings: 8:00 AM - 5:00 PM</p><p>5:30 PM - 2:30 AM</p><p>We are seeking a detail-oriented and experienced <b>Medical Billing Executive</b> to join our team. The ideal candidate will have a strong understanding of medical billing processes, insurance claims, and coding standards, along with the ability to manage multiple tasks efficiently.</p><p><b>Education &amp; Experience</b></p><ul><li>Bachelor&rsquo;s degree from a recognized institution (required)</li><li>Minimum of 2 years of relevant experience in medical billing or insurance claims processing</li><li>Proficiency in Microsoft Office applications, particularly MS Word and MS Excel</li></ul><p><b>Key Skills</b></p><ul><li>Strong command of English (both written and verbal)</li><li>Excellent attention to detail and organizational skills</li><li>Basic understanding of ICD and CPT coding standards</li><li>Ability to manage multiple tasks and meet deadlines</li></ul><p><b>Key Responsibilities</b></p><ul><li>Verify patient insurance eligibility and coverage</li><li>Prepare, submit, and monitor insurance claims to ensure timely processing</li><li>Ensure compliance with ICD and CPT coding standards for accurate billing</li><li>Follow up on denied or unpaid claims to ensure resolution and payment</li><li>Generate and analyze financial reports related to billing and claims</li><li>Collaborate with internal departments to resolve billing discrepancies</li></ul><p><b>Compensation &amp; Benefits</b></p><ul><li>Market-leading salary</li><li>Medical insurance</li><li>Provident Fund and EOBI</li><li>Paid leaves</li><li>Cash advance facility</li><li>Performance-based bonuses</li><li>Annual increments</li><li>Allowances (Accommodation, OPD, Travel, Night, Utilities, Technical)</li><li>Parental leaves</li><li>Annual dinners and company trips</li></ul><p><b>Additional Information</b></p><p>Preference will be given to candidates from the Hazara Division, Khyber Pakhtunkhwa. However, candidates from across Pakistan are encouraged to apply.</p><p>Pay: Rs40,000.00 - Rs60,000.00 per month</p><p>Work Location: In person</p>

RCM Executive

Amerisure Insurance

<div>
 <strong>
  Amerisure creates exceptional value for its partners, policyholders, and employees.
 </strong>
 As a property and casualty insurance company, Amerisure&rsquo;s promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. With an A.M. Best &ldquo;A&rdquo; (Excellent) rating, Amerisure serves mid-sized commercial enterprises focused in construction, manufacturing and healthcare. Ranked as one of the top 100 Property &amp; Casualty companies in the United States, we proudly manage nearly $1 Billion of Direct Written Premium and maintain $1.21 billion in surplus.
 <br/>
 <br/>
 <strong>
  Amerisure
 </strong>
 is hiring for a
 <strong>
  Claims Adjuster Associate
 </strong>
 to help support the claims department. This role will assist adjusters with all phases of the claim lifecycle. This role will specifically align to support two of our Workers&rsquo; Compensation teams. This is a hybrid role with 2 days being onsite. The ideal candidate will also possess the following skill set.
 <br/>
 <br/>
 <strong>
  Summary Statement
  <br/>
  <br/>
 </strong>
 The Claims Associate provides quality assistance to adjusters at all phases of the claim lifecycle to drive the claim to timely conclusion. Supports the success of the organization through interactions with agencies, policyholders, and employees. This individual will handle incoming calls and mail for the claims department and facilitate tasks and processes to aid the adjuster to process claims accurately and efficiently.
 <br/>
 <br/>
 <strong>
  Essential Tasks/Major Duties
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Respond to inquiries from policyholders, claimants, injured workers, and other stakeholders regarding claim status, receipt of payment or bills, and other claim-related questions.
  </li>
  <li>
   Obtain and verify information by gathering missing or incomplete details from relevant parties, including policyholders, claimants, witnesses, and external vendors, to support accurate claim processing.
  </li>
  <li>
   Assist with claim documentation by preparing and submitting require state filings, closing documents, and other administrative support requests on behalf of adjusters.
  </li>
  <li>
   Draft and distribute correspondence to policyholders, claimants, injured workers, or agents in accordance with company standards and regulatory requirements.
  </li>
  <li>
   Maintain accurate claim records by entering data into the claims management system and ensuring all documentation is complete and up to date.
  </li>
  <li>
   Coordinate external vendors by engaging appraisers, attorneys, and contractors, to support the claims process.
  </li>
  <li>
   Process payments and invoices by reviewing and issuing payments in accordance with company policies and adjuster direction.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Knowledge, Skills &amp; Abilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate's degree or equivalent combination of education and experience.
  </li>
  <li>
   1 year of experience in insurance, claims, or customer service is preferred.
  </li>
  <li>
   Ability to obtain appropriate state licensing as required.
  </li>
  <li>
   Proficiency in Microsoft Office Suite.
  </li>
  <li>
   Familiarity with claims management software preferred.
  </li>
  <li>
   Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
  </li>
  <li>
   Excellent verbal and written communication skills with the ability to interact with internal and external customers.
  </li>
  <li>
   Demonstrated ability to organize and prioritize work to ensure timely deadlines.
  </li>
  <li>
   Demonstrated ability to input data with a high accuracy rating, and strong attention to detail.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Just as we are committed to creating exceptional value for our Partners For Success&reg; agencies and policyholders, Amerisure also remains committed to being an employer of choice.
 </strong>
 We reinforce this commitment by adhering to an Employee Value Proposition that, in part, is provided through a competitive total rewards package. This package includes competitive base pay, performance-based incentive pay, comprehensive health and welfare benefits, a 401(k) savings plan with profit sharing, and generous paid time off programs. We also offer flexible work arrangements to promote work-life balance. Recognized as one of the
 <em>
  Best and Brightest&reg; Companies to Work For in the Nation
 </em>
 and one of Business Insurance magazine&rsquo;s
 <em>
  Best Places to Work in Insurance
 </em>
 , we provide a workplace that fosters excellence and professional growth. If you are looking for a collaborative and rewarding career, Amerisure is looking for you.
 <br/>
 <br/>
 Amerisure Mutual Insurance Company is an Equal Employment Opportunity employer. Amerisure provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (to include sexual orientation and gender identity), national origin, age, disability, genetic information, veteran status, or any other protected characteristic under applicable federal, state, or local laws. Amerisure complies with all applicable laws governing nondiscrimination in employment in all locations where the company operates. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Amerisure prohibits harassment or discrimination of any kind and is committed to maintaining a workplace free from unlawful harassment or discrimination. Amerisure prohibits retaliation against anyone who reports discrimination, participates in an investigation, or opposes unlawful practices. Any improper interference with an employee&rsquo;s ability to perform their job duties may result in disciplinary action, up to and including termination.
</div>


Claims Adjuster Associate - WC

<p>Work Location: Abbottabad (On Site)</p><p>Shift timings: 8:00 AM - 5:00 PM</p><p>We are seeking a detail-oriented and experienced <b>Medical Billing Executive (Females)</b> to join our team. The ideal candidate will have a strong understanding of medical billing processes, insurance claims, and coding standards, along with the ability to manage multiple tasks efficiently.</p><p><b>Education &amp; Experience</b></p><ul><li>Only female candidates can apply.</li><li>Bachelor&rsquo;s degree from a recognized institution (required)</li><li>Minimum of 2 years of relevant experience in medical billing or insurance claims processing</li><li>Proficiency in Microsoft Office applications, particularly MS Word and MS Excel</li></ul><p><b>Key Skills</b></p><ul><li>Strong command of English (both written and verbal)</li><li>Excellent attention to detail and organizational skills</li><li>Basic understanding of ICD and CPT coding standards</li><li>Ability to manage multiple tasks and meet deadlines</li></ul><p><b>Key Responsibilities</b></p><ul><li>Verify patient insurance eligibility and coverage</li><li>Prepare, submit, and monitor insurance claims to ensure timely processing</li><li>Ensure compliance with ICD and CPT coding standards for accurate billing</li><li>Follow up on denied or unpaid claims to ensure resolution and payment</li><li>Generate and analyze financial reports related to billing and claims</li><li>Collaborate with internal departments to resolve billing discrepancies</li></ul><p><b>Compensation &amp; Benefits</b></p><ul><li>Market-leading salary</li><li>Medical insurance</li><li>Provident Fund and EOBI</li><li>Paid leaves</li><li>Cash advance facility</li><li>Performance-based bonuses</li><li>Annual increments</li><li>Allowances (Accommodation, OPD, Travel, Night, Utilities, Technical)</li><li>Parental leaves</li><li>Annual dinners and company trips</li></ul><p><b>Additional Information</b></p><p>Preference will be given to candidates from the Hazara Division, Khyber Pakhtunkhwa. However, candidates from across Pakistan are encouraged to apply.</p><p>Pay: Rs40,000.00 - Rs60,000.00 per month</p><p>Work Location: In person</p>

RCM Executive (Female)

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