insurance claims processor

90 Degree Benefits

<p>90 Degree Benefits, a Third Party Administrator (TPA) with offices across the country, is seeking a detail-oriented Medical Claims Processor to join our team. The ideal candidate will have a background in processing medical claims for self-funded clients and possess knowledge of medical terminology.</p><p><b>Responsibilities:</b></p><ul><li>Review and process medical, dental, and vision claims accurately and efficiently</li><li>Interpret and understand Plan Document provisions</li><li>Maintain financial, procedural, and payment standards</li><li>Maintain established production standards</li></ul><p><b>Skills:</b></p><ul><li>Familiarity with medical terminology</li><li>Strong attention to detail and accuracy</li><li>Strong computer keyboard and navigational skills</li><li>Ability to prioritize and manage multiple tasks</li><li>Ability to work independently and in a team environment</li><li>Proficiency in MS Office</li></ul><p><b>Benefits:</b></p><ul><li>Health, dental, vision</li><li>Life and disability</li><li>401(k)</li><li>Paid time off</li><li>11 Holidays</li><li>Online training library</li><li>Defined career path</li><li>Work from home</li></ul><p><b>This position is Full time/Remote</b></p><p>Job Type: Full-time</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Education:</p><ul><li>High school or equivalent (Required)</li></ul><p>Language:</p><ul><li>English (Required)</li></ul><p>Work Location: Remote</p>

Medical Claims Processor

APCO Holdings

<div><p>APCO Holdings partners with dealerships across North America to deliver innovative vehicle protection products and services that enhance the ownership experience for customers and drive growth for our partners. Through our family of brands, we bring together industry expertise, technology, and data-driven insights to help dealers strengthen their finance and insurance performance and build lasting relationships with their customers.</p>
<p>
Our teams work collaboratively across operations, technology, risk, finance, marketing, and sales to deliver solutions that create measurable value and support the continued growth of APCO and the partners we serve.</p>
<p>
We are looking for a <b>Manager, Claims Payment Processing </b>to lead our claims payment operations team. In this role, you will oversee payment accuracy, team performance, and operational efficiency&mdash;ensuring claims are processed promptly while maintaining strong quality and financial controls.</p><div><br>
</div>
<h3 class="jobSectionHeader"><b>What You'll Do</b></h3><div>
<ul><li>Lead and manage a team of Claims Payment Processors, including coaching, development, and performance management</li>
<li>Oversee claims payment processing to ensure accuracy, timeliness, and compliance</li>
<li>Conduct quality audits on paid claims and identify areas for improvement</li>
<li>Monitor and report on key performance indicators (KPIs) and team productivity</li>
<li>Support monthly reconciliation of claims and vendor disbursement accounts</li>
<li>Investigate and resolve discrepancies, including initiating and managing payment disputes</li>
<li>Handle escalated issues related to payment processing and customer concerns</li>
<li>Allocate work and manage workflow to ensure efficient turnaround times</li>
<li>Serve as a subject matter expert for departmental processes, including timekeeping and operational procedures</li>
<li>Drive process improvements to enhance efficiency, accuracy, and overall performance</li>
</ul></div><h3 class="jobSectionHeader"><b>What Makes You Successful</b></h3><div>
<p>
You&rsquo;ll be successful in this role if you&rsquo;re a detail-oriented leader who thrives in a fast-paced, high-volume environment. You&rsquo;re comfortable managing both people and processes, ensuring that work is completed accurately and efficiently.</p>
<p>
You&rsquo;re also a strong coach and communicator who can develop team members while holding them accountable to performance standards. You bring a problem-solving mindset, proactively identifying issues and implementing improvements to drive better outcomes.</p>
</div><h3 class="jobSectionHeader"><b>
Basic Qualifications</b></h3><div>
<ul><li>Bachelor&rsquo;s degree or equivalent work experience</li>
<li>4+ years of experience in a claims or payment processing environment</li>
<li>Experience leading or supervising a team</li>
<li>Strong organizational and time management skills</li>
<li>Strong communication skills, both written and verbal</li>
</ul></div><h3 class="jobSectionHeader"><b>Preferred Qualifications</b></h3><div>
<ul><li>Experience in claims payment processing or financial operations</li>
<li>Experience with reconciliation and audit processes</li>
<li>Georgia Property &amp; Casualty Adjuster license (or ability to obtain)</li>
<li>Experience working in a high-volume, service-oriented environment</li>
</ul></div><h3 class="jobSectionHeader"><b>This Role Might Be a Great Fit If You&hellip;</b></h3><div>
<ul><li>Enjoy leading teams and improving operational performance</li>
<li>Thrive in environments that require accuracy, urgency, and accountability</li>
<li>Like balancing people leadership with process improvement</li>
<li>Take pride in delivering high-quality, efficient outcomes</li>
</ul></div><h3 class="jobSectionHeader"><b>What We Offer</b></h3><div>
<ul><li>Competitive salary</li>
<li>Comprehensive medical, dental, and vision benefits</li>
<li>401(k) with company match</li>
<li>Paid time off and company holidays</li>
<li>Opportunities for leadership growth and development</li>
<li>A collaborative and performance-driven work environment</li>
</ul></div><div>At APCO, the way we work matters just as much as the results we deliver. Our values guide how we work, how we partner, and how we deliver results.</div>
<div></div>
<div>We C.A.R.E.</div>
<div><b><i>C</i></b><i>ommitted</i> &ndash; We build strong, high-trust relationships with our partners and each other.</div>
<div><b><i>A</i></b><i>ccountable</i> &ndash; We take ownership of outcomes and hold ourselves to the highest standards of performance and integrity.</div>
<div><b><i>R</i></b><i>esults-Driven</i> &ndash; We focus on delivering measurable outcomes that create value for our partners and our business.</div>
<div><b><i>E</i></b><i>xcellent</i> &ndash; We strive for excellence in everything we do while balancing short-term performance with long-term success.</div>
<div></div>
<div>If you're excited about joining a team that values collaboration, accountability, and continuous improvement, we'd love to hear from you.</div><br>
<div></div>
<div></div>
<div><i>By submitting your application, you acknowledge that you have read and understand our </i><i>Privacy Policy</i><i>. APCO Holdings may collect personal information (such as name, contact details, and employment history) to evaluate your candidacy. We may share this data with our subsidiaries, affiliates, and service providers. We retain applicant data only as long as necessary for the hiring process or as required by law.</i></div>
<p>
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.</p></div>

Manager, Claims Payment Processing

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.
<br><br>
Job Duties
<br><br>
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.
<br><br>
Conduct investigations to determine liability and damages and differentiate between allegations and facts. Identify and obtain statements from insureds, claimants, and witnesses.
<br><br>
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.
<br><br>
Coordinate with internal and external departments as required.
<br><br>
Respond quickly to customer needs and inquiries.
<br><br>
Overtime and holiday hours may be required.
<br><br>
Qualifications
<br><br>
Bachelors Equivalent combination of education and experience Preferred
<br><br>
No prior claims experience.
<br><br>
Knowledge of Microsoft Office suite and general computer software.
<br><br>
Organization and planning recognition skills required.
<br><br>
Oral and written communication skills required.
<br><br>
Interpersonal skills required.
<br><br>
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

BlueCross BlueShield of South Carolina

<div>
 <strong>
  Summary
  <br/>
  <br/>
 </strong>
 Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.
 <br/>
 <br/>
 <strong>
  Description
  <br/>
  <br/>
 </strong>
 <strong>
  Logistics:
 </strong>
 CGS (cgsadmin.com)
 <strong>
  &ndash;
 </strong>
 one of BlueCross BlueShield's South Carolina subsidiary companies.
 <br/>
 <br/>
 <strong>
  Location:
 </strong>
 This position is full-time (40-hours/week) Monday-Friday You will work an 8-hour shift scheduled during our normal business hours of 8:00am-4:00pm CST. This role is located at 26 Century Blvd Suite ST610 Nashville, TN 37214.
 <br/>
 <br/>
 <ul>
  <li>
   SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Do
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly.
  </li>
  <li>
   Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
  </li>
  <li>
   Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  To Qualify For This Position, You'll Need The Following
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Required Education: High School Diploma or equivalent
  </li>
  <li>
   Required Work Experience: 2 years of experience processing, researching and adjudicating claims.
  </li>
  <li>
   Required Skills and Abilities:
  </li>
  <li>
   Strong organizational, analytical and judgment skills.
  </li>
  <li>
   Strong oral and written communication skills.
  </li>
  <li>
   Proficient in spelling, punctuation and grammar.
  </li>
  <li>
   Proficient in basic business math.
  </li>
  <li>
   Ability to handle confidential or sensitive information with discretion.
  </li>
  <li>
   Required Software and Tools: Microsoft Office.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  We Prefer That You Have The Following
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Preferred Work Experience: 2 years of claims processing experience.
  </li>
  <li>
   Preferred Skills and Abilities:
  </li>
  <li>
   Strong time management skills.
  </li>
  <li>
   Strong attention to detail skills.
  </li>
  <li>
   Knowledge of mathematical and statistical concepts.
  </li>
  <li>
   Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. proficient database software skills.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Our Comprehensive Benefits Package Includes The Following
  <br/>
  <br/>
 </strong>
 We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
 <br/>
 <br/>
 <ul>
  <li>
   Subsidized health plans, dental and vision coverage
  </li>
  <li>
   401k retirement savings plan with company match
  </li>
  <li>
   Life Insurance
  </li>
  <li>
   Paid Time Off (PTO)
  </li>
  <li>
   On-site cafeterias and fitness centers in major locations
  </li>
  <li>
   Education Assistance
  </li>
  <li>
   Service Recognition
  </li>
  <li>
   National discounts to movies, theaters, zoos, theme parks and more
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What We Can Do For You
  <br/>
  <br/>
 </strong>
 We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
 <br/>
 <br/>
 <strong>
  What To Expect Next
  <br/>
  <br/>
 </strong>
 After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
 <br/>
 <br/>
 <strong>
  Equal Employment Opportunity Statement
  <br/>
  <br/>
 </strong>
 BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
 <br/>
 <br/>
 We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
 <br/>
 <br/>
 If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
 <br/>
 <br/>
 We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
 <br/>
 <br/>
 Some states have required notifications. Here's more information.
</div>


Processor, Claims II

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

Administrative Concepts, Inc

<p>Are you looking for a career with an established company who values its employees? Administrative Concepts, Inc. (ACI) is a fast-growing company that offers its employees meaningful work and a positive environment. Founded in 1997, ACI is a nationally licensed, full-service, Third-Party Administrator providing enrollment, fulfillment and claims processing services for various insurance lines in the medical claims industry.</p><p><b>GENERAL PURPOSE OF THE JOB:</b> Review and process claims in accordance with training, guidelines, carrier directives, and policy provisions.</p><p><b>ESSENTIAL DUTIES AND RESPONSIBILITIES:</b></p><ul><li>Responsible for reviewing and maintaining a working knowledge of policy and state mandated insurance requirements.</li><li>Responsible to review and process claims for assigned accounts and back up as needed.</li><li>Prepare large claim files for review and send notifications in accordance with best practices for large claims.</li><li>Meet daily/weekly production goals established by management while maintaining processing and financial accuracy standards (95% minimum accuracy required).</li><li>Request refunds, voids, and no-pay adjustments as needed.</li><li>Respond to phone and email inquiries from clients, customers, and business partners (agents, brokers) when needed.</li><li>Provide customer service assistance in responding to benefit and claim questions.</li><li>Respond to questions and specific requests and provide complete information and documentation as needed.</li><li>Responsible to complete special projects.</li><li>Request subrogation and reimbursement letters from appropriate source.</li><li>Review and monitor the suspended claims list to ensure claims are processed within appropriate time limits.</li><li>Complete training rolled out by HR and claim management throughout the year.</li><li>Attend all individual, department and organizational meetings.</li><li>Uphold all company policies, procedures, and HIPAA guidelines</li><li>Adhere to the schedule they have selected, begin work on time.</li><li>Responsible to perform in accordance with all policies and provisions outlined in the ACI handbook.</li><li>Examiners must obtain and maintain individual adjuster licenses within the first twelve months of employment.</li><li>Other claim department duties as assigned by the manager.</li></ul><p><b>DESIRABLE QUALIFICATIONS:</b></p><ul><li>Knowledge of industry and medical terminology and codes</li><li>Understanding of the adjudication process</li><li>Ability to prioritize and organize</li><li>Strong verbal and written communication skills</li><li>Strong data entry skills</li><li>Experience with MS Office</li></ul><p>Pay: $21.00 - $24.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li><li>Work from home</li></ul><p>Work Location: Remote</p>

Medical Claims Examiner (Remote)

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