insurance claims specialist

State of Montana

<div><div><b>Insurance Claims Specialist</b> <b>-</b> <b>(</b><b>26140779</b><b>)</b></div><p></p><div><div><b><br>
Why should you keep reading and consider working here?</b></div><div>
We know you have other work options, but we ask you to consider working with us at the State of Montana Department of Administration. Our foundation of success is having effective working relationships, built on mutual trust and respect. We will challenge you to be the best you can be and will work hard to provide a work environment that allows you to succeed. (You can learn more about us here.)</div><p><b>
What is this career opportunity?</b><br>
The Risk Management and Tort Defense Division is looking for a detail oriented, problem solving individual who is ready to begin or continue a career in risk management, claims, and the insurance industry. The Risk Management and Tort Defense Division is comprised of 19 positions including finance, loss prevention, claims staff, and attorneys. This position will work closely with and learn from our expert and renowned claims team. The incumbent will investigate, evaluate, and resolve claims involving auto, aviation, boiler and machinery, cyber, fine arts, general liability, professional liability, and property claims to name a few. We are looking for a candidate who is passionate about learning and growing with our business. (You can learn more about the division/section here.)</p></div><div></div><div><p><b><br>
What are we looking for?</b></p><p><b>
Education and Experience:</b></p><ul><li><p>
Bachelor&rsquo;s degree in business or closely related field; OR</p></li><li><p>
Associates degree in business or closely related field, and two years of applicable experience; OR</p></li><li><p>
Alternate combinations of education and experience will be considered on a case-by-case basis.</p></li></ul><p><i>
Ability to:</i></p><ul><li><p>
Learn the ins and outs of the insurance and claims industry and the State of Montana&rsquo;s comprehensive insurance plan;</p></li><li><p>
Understand and follow insurance policies and claims adjusting principles;</p></li><li><p>
Provide effective and professional customer service;</p></li><li><p>
Plan, organize, gather information and conduct research;</p></li><li><p>
Demonstrate a strong attention to detail;</p></li><li><p>
Troubleshoot, research techniques and problem determination;</p></li><li><p>
Examine and interpret data prior to processing work assignments;</p></li><li><p>
Communicate clearly and concisely both orally and in writing;</p></li><li><p>
Set priorities and manage time effectively;</p></li><li><p>
Establish and maintain effective working relationships with others.</p></li></ul><div><b>
Does this sound like you?</b></div><div>
Please tell us how and why by submitting your <b>resume,</b> <b>cover letter, and three professional business references.</b> <i>(Please Note: You do not need to complete the &ldquo;work experience&rdquo; or the &ldquo;education &amp; certifications&rdquo; portion of the application process in our recruiting system.</i><i> </i><i>You only need to upload the requested documentation.)</i></div><p><b>
Other important information to be aware of:</b></p><ul><li><p>
Only online applications are accepted. By applying online, you are able to receive updates and monitor the status of your application.</p></li></ul><p><b>
What can you expect from us in return for your hard work?</b></p><p>
&Oslash; Look here to see the additional benefits! They include:</p><p>
o Work/life Balance</p><p>
o Health Coverage</p><p>
o Retirement plans</p><p>
o Paid Vacation and Sick Leave and Holidays</p><p>
o And more&hellip;</p><p>
&Oslash; <b>Public Service Loan Forgiveness (PSLF) &ndash; </b>Employment with the State of Montana may qualify you to receive student loan forgiveness under the PSLF. Look here to learn more and see if you may qualify!</p><div><br>
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Applicant Pool Statement</b><b>:</b> If another department vacancy occurs in this job title within six months, the same applicant pool may be used for the selection.<div>
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Training Assignment</b><b>:</b> Not Applicable<div></div><div><br>
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Salary: $</b> 60,000.00 - 66,000.00 Yearly<div></div><div><br>
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Telework Eligibility</b><b>:</b> Telework Eligible (Full-time telework is not available. Telework schedule must be supervisor approved.)<div>
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Benefits Package Eligibility</b><b>:</b> Health Insurance, Paid Leave &amp; Holidays, Retirement Plan<div></div><div><br>
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Number of Openings</b><b>:</b> 1<div>
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Employee Status</b><b>:</b> Regular<div>
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Schedule</b><b>:</b> Full-Time<div>
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Job Type</b><b>:</b> Standard<div>
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Shift</b><b>:</b> Day Job<div>
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Travel</b><b>:</b> Yes, 5 % of the Time<div></div><div><br>
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Primary Location</b><b>:</b> Helena<div></div><div><br>
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Agency</b><b>:</b> Department of Administration<div>
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Union</b><b>:</b> 000 - None<div></div><div><br>
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Posting Date</b><b>:</b> Mar 17, 2026, 9:09:09 AM<div>
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Closing Date (based on your computer's timezone)</b>: Apr 1, 2026, 12:59:00 AM<div>
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Required Application Materials</b><b>:</b> Cover Letter, Resume<div></div><div><br>
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Contact Name</b><b>:</b> Natasha Cook | <b>Contact Email</b><b>:</b> nacook@mt.gov | <b>Contact Phone</b><b>:</b> 4064443103</div></div><p></p>

Insurance Claims Specialist

Certus Healthcare Management

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

Kokosing Construction

<div><div><div><div><div><div><div><div><p>Kokosing (www.kokosing.biz) is one of America's 40 largest General Contractors and services a broad spectrum of clients in both the private and public business sectors. Kokosing's services include heavy civil/industrial construction such as highways, bridges, underground utilities, water/wastewater facilities, and marine construction. For over 70 years, Kokosing has successfully attracted the most qualified technical personnel in the construction industry by offering visible challenges, superior quality, and attractive rewards. With over $2.8 billion in annual sales and a commitment to its workforce, Kokosing is the winning team.</p></div></div></div></div></div></div></div><p></p><p><b>
Job Description:</b></p><p>
Support the claims administrative process as part of the Risk Department. Perform the day-to-day activities of claims reporting, work to resolve claim within a certain threshold and prepare regularly scheduled reports. This is an entry level position with an opportunity for development and growth.
</p><p></p><p><b>Essential Functions and Responsibilities:</b></p><ul><li>
Answer calls and record reported incidents and distribute appropriately</li><li>
Prepare claim releases, denials, etc. as appropriate</li><li>
Prepare and distribute weekly safety call agendas &amp; scorecards</li><li>
Participate in Claim Reviews</li><li>
Assist with tracking and issuance of Certificates of Insurance</li><li>
File documents and information within SharePoint</li><li>
Prepare and track collection packets and submissions</li><li>
Gather information and respond to Ohio Court of Claims inquiries</li><li>
Verify and code insurance and claim related invoices</li><li>
Prepare check requests for submission to Accounts Payable</li><li>
Other tasks as assigned</li></ul><p></p><p><b>
Education and Experience:</b></p><ul><li>
1-2 years of risk, claims, insurance, or business experience</li><li>
Claims Handling Experience</li><li>
Insurance or a business background is preferred</li></ul><p></p><p><b>
Knowledge, Skills and Abilities:</b></p><ul><li>
Strong communication/customer service skills, both oral and written</li><li>
Proficient with MS Office applications (Word, Excel, Outlook, etc.)</li><li>
Multi-task and work in a fast-paced environment</li><li>
Strong attention to detail required</li><li>
Work with other team members as well as the general public</li><li>
General knowledge or interest in the construction industry</li></ul><p></p><p><b>
Benefits:</b><br>
Kokosing offers a competitive compensation and benefits package including medical, life, and disability insurance, paid time off and a 401K plan.</p><p></p><p>
Kokosing is an equal employment opportunity/affirmative action federal and state contractor. The company does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected class.</p><p></p><div><div><div><div><div><div><div><p>
Kokosing is an equal employment opportunity/affirmative action federal and state contractor. The company does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected class.</p></div></div></div></div></div></div></div></div>

Risk Insurance Claims Specialist

Prosper Infusion

<div><p><b>Delivering personalized, in-home care to patients with rare diseases across Florida.</b></p><h3 class="jobSectionHeader"><b>
About Prosper Infusion</b></h3><p>
Prosper Infusion is a specialized home infusion pharmacy focused on bringing high-quality therapies directly to patients&mdash;removing the burden of traveling to infusion centers and elevating the standard of care through a concierge-level experience.</p><p></p><h3 class="jobSectionHeader"><b>
Role: Health Insurance Claims Specialist</b></h3><p>
This position reports to the Billing Manager and is essential to ensuring our services are reimbursed accurately. Insurance companies frequently deny or underpay claims&mdash;your role is to dig into the details, challenge discrepancies, and drive appropriate payment.</p><p></p><h3 class="jobSectionHeader"><b>
Location: Largo Satellite Office</b></h3><ul><li><p><b>
On-site only</b> (Monday&ndash;Friday, 8:30 AM &ndash; 5:00 PM)</p></li><li><p>
Must be comfortable working independently, including times when you may be the only team member in the office</p></li><li><p>
If you&rsquo;re seeking a remote role, this position will not be a fit</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
What You&rsquo;ll Do</b></h3><ul><li><p>
Contact insurance companies to investigate denied or underpaid claims and work toward resolution</p></li><li><p>
Track and manage a pipeline of claims, ensuring all required documentation is complete and up to date</p></li><li><p>
Partner with internal teams to support patient care and resolve billing issues efficiently</p></li><li><p>
Communicate professionally and confidently with insurance representatives and team members</p></li><li><p>
Take ownership of claim outcomes, including escalating issues when needed</p></li><li><p>
Ask questions and think critically to uncover the root cause of payment issues</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
Qualifications</b></h3><ul><li><p>
Bachelor&rsquo;s degree preferred, but not required</p></li><li><p>
At least 1 year of experience in healthcare or an office-based role</p></li><li><p>
Strong verbal and written communication skills</p></li><li><p>
Excellent organizational and time-management abilities</p></li><li><p>
Detail-oriented with strong problem-solving skills</p></li><li><p>
Ability to manage multiple priorities and follow up consistently</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
Who You Are</b></h3><p>
You&rsquo;re persistent, resourceful, and comfortable pushing for answers. You don&rsquo;t accept vague responses, and you&rsquo;re confident navigating conversations with insurance companies to get results. You take ownership of your work and thrive in a role where follow-through and accountability matter.</p><p>
</p><p>SMGQmuEcvT</p></div>

Health Insurance Claims Specialist - Largo

Renown Health

<div><div><div><div><div><div><div><div><div><p><b>Position Purpose</b></p><br>
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<div><div><div><div><div><div><div><div><div><div><p>The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.</p><br>
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</div></div><p></p><div><div><div><div><p><b>Nature and Scope</b></p><br>
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<div><div><div><div><div><div><div><div><div><div><p>The Insurance and Claims Specialist is responsible for:</p><br>
<p></p><ul><li>Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.</li></ul>
<ul><li>Audit denials and payment variances to determine root cause and correction as required.
</li></ul><ul><li>Auditing payment variances ensuring appropriate reimbursement.</li></ul>
<ul><li>Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.</li></ul>
<ul><li>Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.
</li></ul><ul><li>Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.</li></ul>
<ul><li>Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.</li></ul><br>
<p></p><p>This position is required to operate within policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with Renown Health goals and objectives.</p><br>
<p></p><p>This position does not provide patient care.<br>
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<div><div><div><div><div><div><p><b>Disclaimer</b></p><br>
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<div><div><div><div><div><div><p>The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.</p><br>
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</div></div><p></p><div><div><div><div><p><b>Minimum Qualifications</b><br>
Requirements - Required and/or Preferred</p><br>
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<div><div><div><div><div><div><div><div><div><div><p><b>Name</b></p><br>
</div><div><p><b>Description</b></p><br>
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<div><div><p>Education:</p><br>
</div><div><p>Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.</p><br>
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<div><div><p>Experience:</p><br>
</div><div><p>One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.</p><br>
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<div><div><p>License(s):</p><br>
</div><div><p>None.</p><br>
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<div><div><p>Certification(s):</p><br>
</div><div><p>None.</p><br>
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<div><div><p>Computer / Typing:</p><br>
</div><div><p>Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.</p><br>
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<p></p>Location: Renown Health &middot; 100620 Hospital Billing Services<br>
Schedule: Full Time - Eligible for Benefits, Day, 8am-4:30pm</div>

Insurance and Claims Specialist - Hybrid

Lighthouse Roofing & Exteriors LLC

<p>Job Overview</p><p>We are seeking a motivated <b>Insurance Claim Roofing Specialist</b> to join our team and help homeowners navigate the process of restoring their homes after storm damage.</p><p>This role goes beyond traditional sales. You will serve as a <b>trusted advisor to homeowners</b>, helping identify roof damage, guiding them through the insurance claim process, and managing the project from initial inspection through completion.</p><p>The ideal candidate is self-motivated, enjoys working with people, and is comfortable working in a field-based environment. This position offers <b>strong earning potential and the opportunity to build a long-term career in the roofing and restoration industry</b>.</p><p>Key Responsibilities</p><p><b>Customer Outreach &amp; Lead Generation</b></p><ul><li>Generate new opportunities through canvassing, referrals, networking, and company leads</li><li>Build relationships with homeowners and schedule property inspections</li><li>Maintain a professional and helpful presence within the community</li></ul><p><b>Roof Inspections &amp; Storm Damage Assessment</b></p><ul><li>Perform roof and exterior inspections to identify storm-related damage</li><li>Document damage with photos and inspection notes</li><li>Explain findings and recommended solutions to homeowners</li></ul><p><b>Insurance Claim Assistance</b></p><ul><li>Educate homeowners on the insurance claims process for storm damage</li><li>Assist with filing claims and reviewing insurance scopes of work</li><li>Help coordinate communication between homeowners and insurance companies</li></ul><p><b>Adjuster Meetings &amp; Claim Support</b></p><ul><li>Attend adjuster inspections with homeowners</li><li>Walk the property with the adjuster and review documented damage</li><li>Ensure the scope of work accurately reflects necessary repairs</li></ul><p><b>Customer Guidance &amp; Project Support</b></p><ul><li>Guide homeowners through the restoration process from start to finish</li><li>Serve as the primary point of contact throughout the project</li><li>Coordinate with production teams and perform final walkthroughs when projects are completed</li></ul><p>Pay: $50,000.00 - $150,000.00 per year</p><p>Benefits:</p><ul><li>Flexible schedule</li><li>On-the-job training</li><li>Opportunities for advancement</li><li>Parental leave</li><li>Professional development assistance</li><li>Referral program</li></ul><p>Experience:</p><ul><li>roofing sales : 1 year (Required)</li></ul><p>Shift availability:</p><ul><li>Day Shift (Required)</li></ul><p>Ability to Commute:</p><ul><li>Denver, CO 80280 (Required)</li></ul><p>Work Location: In person</p>

Insurance Claims Roofing Specialist

eVolve Health

<p><b>Evolve Health Medical Claims Specialist</b></p><p>Join the Evolve Health team as a Medical Claims Specialist at our Portland, Oregon administrative offices. Evolve Health provides medication management, interventional psychiatric treatments such as intranasal Spravato&trade; for treatment-resistant depression, transcranial magnetic stimulation (TMS), as well as ketamine infusions for depression, anxiety, and PTSD.</p><p>We are looking for a positive, motivated individual to support our patients and our team. This position requires strong communication skills, critical thinking, attention to detail and compassion for people with mental health struggles.</p><p>To ensure success, you should be professional with good interpersonal skills. The ability to complete duties in an environment that requires multi-tasking is essential.</p><p>We are looking for an individual with well-rounded medical billing experience in some of the following areas:</p><ul><li>Monitoring A/R aging reports.</li><li>Monitoring insurance company policy updates.</li><li>Addressing denied or underpaid claims.</li><li>Preparing/submitting insurance appeals.</li><li>Posting patient and insurance payments.</li><li>Charge entry and submission of clean claims.</li><li>Using insurance portals.</li><li>Benefits and Eligibility verification.</li><li>Prior Authorizations.</li><li>Reviewing patient accounts for accuracy and completeness.</li><li>Answering patient and insurance telephone inquiries.</li><li>In addition to these general duties, we may request that you perform other duties that fit with your training and background experience or provide further training for new duties.</li></ul><p><b>SKILLS AND APTITUDES</b></p><ul><li>Must work well in a team environment</li><li>Positive attitude</li><li>Customer-service minded</li><li>Detail oriented and willing to learn</li><li>Good follow-through and perseverance</li><li>Self-motivated with the ability to work independently</li><li>Able to work in environment with direct communication</li><li>Understanding of HIPAA regulations</li><li>Proficient with Microsoft Word, Excel and Teams</li><li>Previous experience with Advanced MD preferred</li></ul><p><i><b>Please note this is not a remote position.</b></i></p><p>Job Type: Full-time</p><p>Pay: $25.00 - $29.00 per hour</p><p>Expected hours: No more than 40 per week</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>Medical/Psych Billing: 2 years (Preferred)</li></ul><p>Ability to Commute:</p><ul><li>Portland, OR 97222 (Required)</li></ul><p>Work Location: In person</p>

Medical Claims Specialist

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