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insurance claims specialist

NTT DATA

<div>Company Overview:<br>
Req ID: 360808<br>
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.<br>
<br>
We are currently seeking a Claims Specialist to join our team and REMOTE. The position is for 6 months and pay rate is $19.25/hour W2<br>
<br>
Job Description:<br>
Claims Specialist<br>
Job Description<br>
The claims Specialist will Identify primary vs. secondary coverage when a member has more than one health plan. Reviewing and updating claims to reflect correct COB rules Applying COB primacy rules (subscriber status, effective dates, plan type, Medicare coordination, etc.) Communicating with members, providers, and other insurers to verify coverage details Correcting overpayments, initiating refunds or reprocessing, and maintaining accurate claim records Working within claims systems and following regulatory and compliance requirements (e.g., HIPAA)<br>
<br>
Job Duties<br>
Duties may include the following responsibilities or functions required to support the claims unit.
<ul><li>Reviews, research, and make necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction.</li>
<li>Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) to process both coordinated and non-coordinated claims correctly. Requesting medical records may be required.</li>
<li>Communicates, both orally and in writing, with internal and external contacts to provide necessary and accurate information for the establishment of sound claims records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc.</li>
<li>Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.</li>
<li>Research, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to ***</li>
<li>Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews of all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability.</li>
<li>Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability.</li>
<li>Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation). May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction.</li>
</ul>Required Skills
<ul><li>2 years in medical claims processing required &bull; Coordination of Benefits (COB) processing experience preferred</li>
<li>Strong analytical ability, that includes strong logical, systemic, and investigates thinking.</li>
<li>Strong oral and written communication skills and human relations skills are necessary.</li>
<li>Working knowledge of relevant PC software.</li>
<li>Ability to prioritize multiple streams of work effectively.</li>
</ul>Education
<ul><li>High School Diploma or equivalent required Work Experience</li>
</ul>
<br>
About NTT DATA:<br>
<br>
NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&amp;D to help organizations and society move confidently and sustainably into the digital future. Visit us at us.nttdata.com<br>
<br>
NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.<br>
<br>
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $19.25/hour<b>.</b> This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.<br>
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&amp;D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits<i>.</i><br>
<i>#indist</i><br>
<i>#li-northamerica</i></div>

Healthcare Claims Specialist

GEICO

<div><p><b>At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.</b></p><p><b>
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers&rsquo; expectations while making a real impact for our company through our shared purpose.</b></p><p></p><p><b>
When you join our company, we want you to feel valued, supported and proud to work here. That&rsquo;s why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.</b></p><p></p><p>
Claims Specialist &ndash; Tampa, Florida<br>
Salary: $28.29 - $34.24 per hour / $57,000 - $69,000 annually</p><p><br>
Claim your career growth as a Claims Service Specialist at GEICO&rsquo;s Tampa, Florida office and be a part of one of the fastest-growing auto insurers in the United States! If you are motivated, all about solutions, and empathetic to the needs of customers, come grow a fulfilling career with us!<br>
<br>
Through our paid, industry-leading training, you will learn the ins and outs of the claims process and be ready to assist our policyholders when they need us the most &ndash; during an accident. As a Claims Service Specialist, you will collect facts about the accident, investigate claim details, and collect statements from involved parties. Our policyholders will count on your patience, support, and attention to detail to get them back on the road as quickly as possible. GEICO will also give you the space and grace to explore your abilities and learn new ones. So if you are ready to start growing your career, let&rsquo;s talk!<br>
<br>
Many associates see a base salary increase of 10% within their first year as a Claims Specialist. Top associates can see increases up to 15%!<br>
<br>
Qualifications &amp; Skills:</p><ul><li><p>
Experience providing outstanding customer service by showcasing expertise, fostering trust and growing customer satisfaction</p></li><li><p>
Solid computer multitasking skills</p></li><li><p>
Ability to effectively communicate, verbally and in writing, and willingness to expand on these abilities</p></li><li><p>
Ability to work comfortably and grow in a fast-paced, high-volume call center environment</p></li><li><p>
Minimum of high school diploma or equivalent, college degree or currently pursuing preferred</p></li><li><p>
Eagerness to explore new skills and openness to different career paths</p></li></ul><p></p><p>
#geico300</p><br>
<p></p>
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.<p></p><p><b><br>
The GEICO Pledge:</b></p><p></p><p><b>
Great Company:</b> At GEICO, we help our customers through life&rsquo;s twists and turns. Our mission is to protect people when they need it most and we&rsquo;re constantly evolving to stay ahead of their needs.</p><p>
We&rsquo;re an iconic brand that thrives on innovation, exceeding our customers&rsquo; expectations and enabling our collective success. From day one, you&rsquo;ll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people&rsquo;s lives.</p><p></p><p><b>
Great Careers:</b> We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career &ndash; and your potential &ndash; in mind. You&rsquo;ll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.</p><p></p><p><b>
Great Culture:</b> We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.</p><p>
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.</p><p></p><p><b>
Great Rewards:</b> We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.</p><ul><li>
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family&rsquo;s overall well-being.</li><li>
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.</li><li>
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.</li><li>
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.</li></ul><p></p><p>
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.</p><p></p><p>
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.</p></div>

Claims Service Specialist

Chubb Insurance

<div><p>Responsibilities include, but are not limited to:
</p><ul><li>Receives assignments and reviews claim and policy information to provide background for investigations. May determine the extent of the policy&rsquo;s obligation to the insured, depending on the line of business.
</li><li>Contacts, interviews, and obtains statements (recorded or in person) from insured individuals, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant parties to gather necessary claim information.
</li><li>Depending on the line of business, may inspect and appraise damage for property losses or arrange for such appraisal.
</li><li>Evaluates facts obtained during investigations to determine the extent of liability and the company&rsquo;s obligation under the policy contract.
</li><li>Prepares reports on investigations, settlements, claim denials, and evaluations of involved parties.
</li><li>Sets reserves within authority limits and recommends reserve changes to the Team Leader.
</li><li>Reviews the progress and status of claims with the Team Leader, discussing challenges and recommending solutions.
</li><li>Prepares and submits to the Team Leader any unusual or potentially undesirable exposures.
</li><li>Assists the Team Leader in developing methods and improvements for handling claims.
</li><li>Resolves claims promptly and fairly.
</li><li>Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.
</li><li>Communicates claim denials to claimants, insureds/customers, or attorneys as applicable.
</li><li>Manages litigation as required.</li></ul></div><p></p>
<br><div><ul><li>Minimum of 5 years of technical claims handling experience in Auto and General Liability lines, demonstrating a high level of knowledge and competence.
</li><li>Experience working in a Third-Party Administrator (TPA) environment is strongly preferred.
</li><li>Must obtain and maintain required state licenses.
</li><li>Strong knowledge of insurance coverages and a solid understanding of applicable legal principles.
</li><li>Familiarity with auto liability cost containment programs and proven account management skills.
</li><li>Excellent communication, negotiation, and interpersonal skills for effective interaction with all levels of internal and external stakeholders.
</li><li>Strong analytical and problem-solving abilities.
</li><li>Demonstrated commitment to providing consistently superior customer service.
</li></ul><p>An applicable resident or designated home state adjuster&rsquo;s license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS&rsquo;s employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.</p></div>
<br><div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.<br>
</div><div></div><br>
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

ESIS Senior Claims Representative, AGL

Amerisure

<div><div>Amerisure creates exceptional value for its partners, policyholders, and employees. 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.</div><div></div><div>
Amerisure is currently recruiting for a Specialty Adjuster &ndash; TPA that can do a hybrid approach onsite in one of our offices. The ideal candidate will possess the following skill set.</div><div></div><div>
Summary Statement</div><div>
In collaboration with our Third Party Administrator (TPA), monitor claims of low to medium severity, including litigated files, to proper resolution. Promotes the success of the organization through development and advancement of relationships with agencies, policyholders and employees.</div><div></div><div>
Essential Tasks/Major Duties</div><ul><li>
Monitoring claims managed by TPA, to ensure appropriate handling of claims.</li><li>
Coordinate the setup of new claims handled by the TPA by completing all required data points and providing the appropriate supporting documentation.</li><li>
Leverage prior experience to review and analyze relevant documentation.</li><li>
Monitor open claims to ensure action plans are completed in a timely and accurate manner.</li><li>
Review monthly exception reports and correct identified errors as needed.</li><li>
Process and submit bills for bill review in accordance with established procedures</li><li>
Provide claim details and status to internal and external business partners.</li><li>
Collaborate across functional teams to identify and resolve issues.</li><li>
Ensure proper reserves are established and maintained to accurately reflect financial exposure.</li><li>
Perform special projects that may be assigned in support of the Claims department.</li></ul><div></div><div>
Knowledge, Skills &amp; Abilities</div><ul><li>
Bachelor&rsquo;s degree or equivalent combination of education and experience.</li><li>
1 year of experience handling Workers Compensation claims.</li><li>
Proficient computer skills required, including Microsoft Office Suite.</li><li>
Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.</li><li>
Strong analytical skills and attention to detail.</li><li>
Excellent verbal and written communication skills with the ability to interact with internal and external customers.</li></ul><div>
#LI-BR1</div><div></div><div>
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. 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<i> Best and Brightest&reg; Companies to Work For in the Nation</i> and one of Business Insurance magazine&rsquo;s <i>Best Places to Work in Insurance</i>, 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.</div><div></div><div>
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></div>

Specialty Adjuster-TPA

Safepoint MGA, LLC

<div><p><b>Safepoint Insurance is an admitted Property and Casualty Insurance carrier. We are based in Temple Terrace, FL. </b>Our Claims Department is growing and we are looking for self-motivated professionals ready to support our organization.</p><p></p><p><b>
Job Title: Claims Service Representative - Bilingual Preferred</b></p><p><b>
Job Location</b>: Office in Tampa (on Gunn Hwy)</p><p><br>
The Claims Service Representative provides prompt, effective and courteous handling of all inquiries to policy holders and claimants with special emphasis on complying with appropriate guidelines. Complete assigned administrative tasks related to the claims process function.</p><p><b><br>
Duties and responsibilities</b></p><ul><li>
Direct customer and vendor inquiry calls</li><li>
Conduct First Notice of Loss calls and corresponding documentation</li><li>
Monitor Phone Queue for proper coverage and escalate calls when needed</li><li>
Obtain police and fire reports and other reports subject to public information requests</li><li>
Responsible for dispatching examiner assignment to IA or expert</li><li>
Responsible for organizing, scanning and dispatch of incoming and outgoing correspondence such as mail, fax, and emails</li><li>
Responsible for claims projects as assigned</li><li>
Maintain accurate and complete files, updating the claims system daily</li><li>
Print, verify, and mail checks and letters daily</li><li>
Monitor claims inbox for Incoming e-mails, and distribute and file as appropriate</li><li>
Monitor new incoming claims and assign them to appropriate desk or field adjuster</li><li>
Pay invoices and update spreadsheets and claims system</li><li>
Other tasks and projects as may be assigned</li></ul><p><b><br>
Essential Functions</b></p><ul><li>
Use telephone and computer systems to communicate with and service customers</li><li>
Use computer system to update claim files daily</li><li>
Ability to take and direct at least 30 &ndash; 50 phone calls per day</li><li>
Ability to print and physically mail correspondence</li><li>
Ability to work independently in a fast-paced office environment; meet deadlines and manage changing priorities effectively</li></ul><p><b><br>
Qualifications</b></p><ul><li>
College degree or related experience</li><li>
2 years of customer service experience analyzing and solving customer problems</li><li>
Florida All-Lines Adjuster's license (6-20) strongly preferred; ability to obtain license required</li><li>
Proficiency with Microsoft Office products required</li><li>
Ability to use systems such as Policy Port, CMS, Unisoft.</li><li>
Bilingual in English and Spanish preferred</li><li>
Excellent communication skills and ability to interact on a professional level with internal and external personnel and partners</li></ul><p><b><br>
Licensing requirements</b></p><p>
Please note that most organizations overseeing Property and Casualty licensure requirements, including the Florida Department of Financial Services, require individuals to answer background questions about criminal history and undergo fingerprinting as part of the licensing process. Obtaining applicable licensure is a requirement for this position.<br>
<br>
<b>Physical requirements</b></p><p>
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to type, handle or feel; and reach with hands and arms.</p><p><b><br>
Working conditions</b></p><p>
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, copiers, filing cabinets and fax machines.</p><p><b><br>
Compensation and Benefits</b></p><p>
We recognize that talented professionals are attracted to companies that provide a great place to work, combined with a comprehensive and competitive pay and benefits package, along with opportunities for personal growth and job advancement. For this reason we are pleased to provide:</p><ul><li>
Market Competitive Wages commensurate with experience</li><li>
Prof. Development and Educational Assistance Programs</li><li>
Safe Harbor 401K Plan with Immediate Vesting and an Automatic Company Contribution</li><li>
Paid Time-Off (Discretionary, PTO, Parental Leave, and others)</li><li>
Company Paid Holidays</li><li>
Health Insurance</li><li>
Dental Insurance</li><li>
Vision Insurance</li><li>
Short and Long Term Disability Insurance (company paid)</li><li>
Flexible Spending Accounts with Company Contribution</li><li>
Health Savings Accounts with Company Contribution</li><li>
Employee Life and AD&amp;D Insurance</li><li>
Dependent Life and AD&amp;D Insurance</li><li>
Company paid AAA Membership</li><li>
Company paid Identity Theft Protection</li><li>
Other Ancillary Insurance Benefit Programs</li><li>
And more&hellip;</li></ul><p>
Safepoint Insurance is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Safepoint depends solely on your qualifications.<br>
</p><p>
</p><p>vl8nGKXJNa</p></div>

Claims Customer Service Representative

Allied Universal Compliance and Investigations

<div><p>SIU Investigator - Part-Time</p><h2 class="jobSectionHeader"><b>
Overview</b></h2><p>
Company Overview:
</p><p>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.</p><h2 class="jobSectionHeader"><b>
Job Description</b></h2><p>
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</p><p><br>
</p><ul><li><b>Must possess a valid driver's license with at least one year of driving experience</b></li><li><b>
Florida applicants must either hold a C Private Investigators' License or independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying</b></li></ul><br>
<p></p>
<p><b>RESPONSIBILITIES:</b>
</p><ul><li>Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability</li>
<li>Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li>
<li>Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li>
<li>Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li>
<li>Run appropriate database indices if necessary and verify the accuracy of results found</li>
<li>Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following:</li><li><ul><li>
Bachelor's degree in Criminal Justice</li>
<li>High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li>
<li>Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li>
<li>Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li>
<li>Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li>
<li>Proficient in utilizing laptop computers and cell phones.</li>
<li>Special Investigative Unit (SIU) Compliance knowledge</li>
<li>Ability to type 40+ words per minute with minimum error</li>
<li>Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><ul><li>Military experience</li>
<li>Law enforcement</li>
<li>Insurance administration experience</li>
<li>Familiarity with California SIU regulations</li>
<li>One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li>
<li>Certified Insurance Fraud Investigator (CIFI)</li>
<li>Fraud Claim Law Associate (FCLA)</li>
<li>Fraud Claim Law Specialist (FCLS)</li>
<li>Certified Protection Professional (CPP)</li>
<li>Associate in Claims (AIC)</li>
<li>Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><p><b>
BENEFITS:</b>
</p><ul><li>Medical, dental, vision, basic life, AD&amp;D, and disability insurance</li>
<li>Enrollment in our company's 401(k)plan, subject to eligibility requirements</li>
<li>Seven paid holidays annually, sick days available where required by law</li>
<li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.</li></ul><h2 class="jobSectionHeader"><b>
Closing</b></h2><p>
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</p><p>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</p><h2 class="jobSectionHeader"><b>
Requisition ID</b></h2><br>
2026-1541753</div>

SIU Investigator - Part-Time

Humanitary Medical Center, INC

<div></div><div><p>HMC Dental Services Inc. is seeking a highly experienced and detail-oriented <b>Dental Billing Specialist</b> to join our elite, technology-driven dental practice. The ideal candidate will have a strong background in dental billing, ADA coding, insurance verification, and account reconciliation. This role is pivotal to maintaining an efficient revenue cycle and providing an outstanding patient experience through accurate and transparent billing practices.</p><h3 class="jobSectionHeader"><b>
Key Responsibilities</b></h3><h4 class="jobSectionHeader"><b>
Insurance Claims Management</b></h4><ul><li>
Prepare and submit dental claims accurately and timely (electronic and manual).</li><li>
Verify dental insurance eligibility and benefits (PPO &amp; Medicare Advantage).</li><li>
Attach necessary documentation (e.g., x-rays, perio charting, narratives) through platforms,</li><li>
Follow up on unpaid, denied, or underpaid claims to ensure maximum reimbursement.</li><li>
File appeals and corrections for denied claims, including submission of supplemental information.</li><li>
Submit pre-authorizations and predeterminations as required.</li></ul><h4 class="jobSectionHeader"><b>
Patient Account Management</b></h4><ul><li>
Post insurance and patient payments (EFT, checks, and patient payments).</li><li>
Reconcile and manage accounts receivable, ensuring accurate and timely follow-up.</li><li>
Generate and send monthly patient statements, particularly for balances following insurance denials.</li><li>
Respond to billing inquiries and resolve patient account issues professionally and promptly.</li><li>
Assign overdue balances to collections when necessary, following internal protocols.</li></ul><h4 class="jobSectionHeader"><b>
Billing Accuracy &amp; Compliance</b></h4><ul><li>
Ensure accurate use of ADA procedure codes.</li><li>
Identify and correct account errors, such as inaccurate demographics or insurance setup.</li><li>
Stay current with dental insurance billing policies and coding updates.</li><li>
Maintain compliance with federal, state, and payer-specific regulations.</li></ul><h4 class="jobSectionHeader"><b>
Reporting &amp; Collaboration</b></h4><ul><li>
Prepare daily, weekly, and monthly billing and production reports.</li><li>
Collaborate with front desk, dental assistants, and providers to ensure accurate documentation and timely billing.</li><li>
Support credentialing and re-credentialing processes for providers as needed.</li><li>
Assist Financial Coordinator with cost estimates and patient financial responsibility reviews.</li><li>
Maintain the cleanliness and confidentiality of all billing-related documentation.</li></ul><p></p><h3 class="jobSectionHeader"><b><br>
Qualifications &amp; Skills</b></h3><ul><li>
Minimum 2 years of dental billing experience required.</li><li>
Strong knowledge of ADA coding, PPO and Medicare Advantage plans.</li><li>
Experience with dental software Open Dental.</li><li>
High attention to detail and ability to multitask in a fast-paced environment.</li><li>
Excellent communication, organizational, and analytical skills.</li><li>
Strong customer service orientation with a problem-solving mindset.</li><li>
Must work on-site; remote work is not available for this position.</li><li>
Bilingual in English and Spanish is a plus.</li><li>
Knowledge of HIPAA and dental billing compliance standards</li></ul><p>
You will be eligible for a generous benefits package that includes:</p><ul><li>Paid time off (PTO)</li><li>Paid Holidays</li><li>401K</li><li>Voluntary Life Insurance</li><li>Employee Assistance Program (EAP)</li><li>Medical, Dental and Vision Benefits</li></ul><p><b>
Work Location:</b></p><div>
4200 W Cypress St. Suite 690</div><div></div><div><i><br>
Humanitary Medical Center Inc. complies with all federal, state, and local laws prohibiting employment discrimination of any kind. Humanitary Medical Center Inc. is an at-will employer and can terminate its employment relationship at any time, with or without cause, and without notice.</i></div></div>

Billing Dental

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