insurance claims specialist

City of Mission Tx

JOB SUMMARY:This position requires knowledge of clerical/ secretarial procedures. The individual has no supervisory responsibilities. Individual is responsible for assisting the Risk Manager in ordering, maintaining inventory and dispensing of safety supplies. Individual is responsible for processing all claims the Risk Management Division receives. Individual will be assigned other duties as needed by Risk Manager and/or department director.II. EDUCATION &amp; EXPERIENCE REQUIREMENTS:High School Diploma or GED required.One (1) year experience in Workers&rsquo; Compensation, Liability Claims or related work preferred.Individual must be able to type 50 wpm, and have good filing skills.Knowledge of intermediate legal and medical terminology.Proficient in Microsoft Word, Excel, Publisher, Power Point, Internet, and E-mail.III. EMPLOYMENT REQUIREMENTS:Applicant will be subject to a complete background investigation. Incomplete, inaccurate and/or failure to report information will cause the applicant rejection from consideration.Applicant must take and pass pre-employment screenings administered by the City of Mission doctor at the City&rsquo;s expense.Applicant must have a current valid class &ldquo;C&rdquo; driver&rsquo;s license from the department of Public Safety with no more than two (2) moving traffic violations within the past two (2) years.Applicant will be asked to sign a confidentiality agreement with regard to the sensitive nature of the information being handled.IV. SKILL ABILITY REQUIREMENT:Ability to use computer programs such as Window OS and Microsoft Office Suite.Ability to follow procedures for keeping records.Ability to compute, maintain and prepare complex records correctly, insuring confidentiality.Ability to demonstrate good organizational skills.Ability to use eyes, hands and fingers at the same time to enter figures in computer and forms or to operate and compute.Ability to think logically to analyze written materials, organize facts and interpret a wide variety of subject matter.Ability to communicate orally and in writing in the English and Spanish language.Ability to follow set or routine procedures.Ability to use basic arithmetic in computing data.Ability to type memos and forms.Ability to follow instructions orally or in written form and perform tasks with little or no supervision.Ability to perform a wide variety of different types of tasks without the variety itself causing a loss of efficiency.Ability to make decisions based on available data/criteria, laws and regulations, or city policy.Ability to handle special projects of diverse nature as assigned.Ability to read and interpret documents such as safety rules and city policy and procedures.V. EQUIPMENT/MATERIALS: General office and safety equipment/materials toinclude but not limited to the following:Personal Computer, Printer, CD ROM, USB Drives, Keyboard, Mouse, City VehicleFaxed Machine, Software Programs, Digital Camera, Telephone, Pens, rulers, highlighters, Typewriter, Safety equipment, Measuring tape, Copy machine, Video Camera, Paper cutterBinding machine, Postage meter, Stapler, Scissors, First Aid supplies, Pain medicine, Copy machine paperPersonnel Policy Manual, Safety ManualVI. ESSENTIAL JOB FUNCTIONS:Answer telephone with clear, courteous, and business voice, and directs the calls to the appropriate destination to expedite response.Receive visitors, answer questions and inquiries to resolve issues at hand or direct to appropriate destination.Analyze and interpret financial data from computer.Type purchase orders in computer for printing by the Purchasing division.Make all necessary travel arrangements for departmental staff.Process accounts payable invoices and submit to Finance for processing.Enter or post data into computer as directed.Process every element of a Workers&rsquo; Compensation claim.Update departments on Work Status Reports.Process Liability and Property claims.Request information from departments to process all claims.Use proper forms for submitting claims and reporting incidents.Order safety supplies and distribute among the different departments when needed.Copy documents, utilizing office equipment, as directed.Prepare letters and packages for processing utilizing postage meter machine for mailing.Compose letters and other documents as requested and within the time frame.Receive and sort incoming correspondence, mail and packages within the office.Undertake assignments/projects assigned.Sort and file letters and other documentation.Order and maintain inventory of office and safety supplies.Fax/Email information to Workers&rsquo; Compensation office, clinics/hospitals, city departments and vendors.Maintain good communication with all City departments.Perform all job functions with special attention placed on good public relations, safety, and proper office procedures in compliance with city policies.Perform accident field investigations; interview, claimants, potential witnesses, physicians, city employees, and others necessary to document fact in order to make a proper report. Make recommendations as to disposition of small claims. Write and maintain reports detailing initial investigations.Create safety newsletters and bulletins.Review and comply with recommendations of the TML local representative.Monitor compliance with federal and state regulations.Coordinate and participate in Safety Meetings with the safety representatives of each department.Process the TML Insurance bill.The above duties describe the chief functions of the job and are not to be considered a detailed description of every duty of the job.VII. NON-ESSENTIAL JOB FUNCTIONS:Organize meeting room setups and making coffee when necessary.Pay: $16.15 per hourBenefits:<ul><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: In person

Insurance Claims Specialist

Epic Home Solutions

Job Summary: We are seeking a skilled and experienced Roofing Specialist(s) to join our team. As a Roofing Specialist, you will be responsible to prospect, qualify, identify, and close new sales opportunities (targeted canvassing, referrals, preset leads, networking, social media).Qualifications:-Excellent Communication, time management and organizational skills-Self Sufficient; Must be able to work in an independent environment-Dedication to personal career development by reaching your set goals-Must have a valid Driver's License-21 years of age or older preferred (for insurance purposes)-2+ years proven full cycle sales experience (preferred)-Must have reliable working vehicle with insurance coverageResponsibilities:-Conduct exterior property inspection identifying for wind and hail damage-Convert inspection to claim filed and contract signed.-Meet the insurance adjuster on property-Collect funds and insurance deductible from homeowner-Obtain referrals from customers on approved sales/networking-Build relationships by earning trust with homeowners-Maintain constant communication with Sales Leadership and homeownersThis is a 1099 position.Job Types: Full-time, Part-time, ContractPay: $50,000.00 - $100,000.00 per yearWork Location: In person

Roofing Insurance Claims Specialist

Medical Foot Care Center

Established physician office seeking an experienced Medical Claims Follow-Up Specialist to manage insurance accounts receivable, denials, and appeals. This role is ideal for someone who enjoys problem-solving, working accounts, and ensuring accurate reimbursement from commercial and government payers.Small, team-oriented office with a supportive work environment and long-term stability.Key Responsibilities<ul><li>Review and follow up on insurance denials and unpaid claims</li><li>Submit corrected claims and appeals as needed</li><li>Work with payers including UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield</li><li>Analyze EOBs and ensure accurate payment posting and adjustments</li><li>Identify trends in denials and recommend solutions</li><li>Correct errors related to demographics, coding, and charge entry</li><li>Communicate with insurance companies regarding claim status</li><li>Assist front office with patient account questions as needed</li></ul>Qualifications<ul><li>Minimum 1&ndash;2 years experience in medical claims follow-up / AR</li><li>Strong understanding of insurance guidelines and billing processes</li><li>Experience with denials, appeals, and payment posting</li><li>Familiarity with CMS and commercial payer rules</li><li>Strong analytical and organizational skills</li><li>Ability to manage multiple accounts in a fast-paced environment</li></ul>Additional Requirements<ul><li>Proficient in Microsoft Word, Excel, and practice management systems</li><li>High school diploma or equivalent required</li><li>Ability to sit/stand and work at a computer for extended periods</li></ul>Compensation &amp; Schedule<ul><li>Full-time, Monday&ndash;Friday (9 AM &ndash; 5 PM)</li><li>Compensation: Based on experience</li></ul>Additional Information<ul><li>This is an in-office position</li><li>Benefits: Not offered at this time</li></ul>Job Type: Full-timeExperience:<ul><li>Insurance specialist: 1 year (Required)</li><li>Claim Follow Up: 1 year (Required)</li></ul>Work Location: In personPay: $18.00 - $23.00 per hourBenefits:<ul><li>Paid time off</li></ul>Work Location: In person

Medical Claims Follow up Specialist

Blue Star Claims - Auto Physical Damage Claims Specialist

Philadelphia Insurance Companies

<div>Description
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We a re looking for a Claims Specialist - Auto to join our team!
JOB SUMMARY 
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES 
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. 
Communicates with all relevant parties and documents communication as well as results of investigation. 
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. 
Travel is required to attend customer service calls, mediations, and other legal proceedings. 
JOB REQUIREMENTS 
High School Diploma; Bachelor's degree from a four-year college or university preferred. 
10 plus years related experience and/or training; or equivalent combination of education and experience.<ul><li>National Range : $82,800.00 - $97,300.00</li><li>Ultimate salary offered will be based on factors such as applicant experience and geographic location.</li></ul>
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. 
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at https://www.phly.com/Careers/default.aspx</div>

Claims Specialist - Auto

The Woman's Health Pavilion

The Woman's Health Pavilion is a growing OB/GYN practice, established in 1971. We are seeking a detail-oriented and knowledgeable Medical Claims Specialist to join our healthcare team. The ideal candidate will be responsible for managing and processing medical claims efficiently, ensuring accurate coding, billing, and reimbursement. This role is vital in maintaining the financial health of our healthcare operations and providing excellent service to our patients and providers. Prior experience with medical billing, coding, and electronic health record systems is highly valued. The position offers an opportunity to work in a professional environment dedicated to accuracy, compliance, and patient care excellence.Duties<ul><li>Review and process medical claims using EMR and EHR systems to ensure timely submission and reimbursement</li><li>Apply appropriate medical coding including ICD-10 and ICD coding standards for accurate claim generation</li><li>Verify insurance coverage and patient eligibility prior to claim submission</li><li>Resolve claim denials or rejections by analyzing errors related to medical records or coding inaccuracies</li><li>Collaborate with healthcare providers to clarify documentation discrepancies</li><li>Maintain detailed records of claims processed and follow up on outstanding payments or collections</li><li>Ensure compliance with healthcare regulations and insurance policies during all claim handling activities</li><li>Assist in updating and maintaining accurate medical records related to billing and claims processing</li></ul>Skills<ul><li>Proficiency in medical billing, coding (ICD-10), and medical records management</li><li>Strong understanding of medical terminology and healthcare documentation standards</li><li>Experience working with EMR/EHR systems for claims processing and record management</li><li>Knowledge of insurance policies, medical collections, and reimbursement procedures</li><li>Ability to interpret complex medical data and accurately assign appropriate codes</li><li>Excellent organizational skills with attention to detail to minimize errors in claims processing</li><li>Effective communication skills for collaborating with healthcare providers, insurance companies, and patients</li><li>Prior experience in a medical office setting is preferred but not required; training will be provided as needed</li></ul>Qualifications<ul><li>High School Diploma/GED</li><li>Experience a plus but not required</li><li>Good verbal and written communication skills.</li><li>Basic understanding of medical ICD 9/ 10 codes and CPT medical billing codes.</li><li>Good telephone and patient relation skills.</li><li>Detail oriented and ability to prioritize work.</li><li>OB/GYN experience a plus</li></ul>This position offers a rewarding opportunity for professionals passionate about healthcare administration, coding accuracy, and efficient claims management.** This position is in-office only and does not offer remote work. **Pay: $20.00 - $25.00 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Medical Claims Specialist

Bitco Insurance Companies

<div>BITCO Corporation, headquartered in Davenport, IA, is currently seeking a Sr. Claims Specialist to join our regional office located in Atlanta GA. With 11 branch offices in 10 states, BITCO provides quality insurance services to specialized industries including construction, forest products and oil &amp; gas.
This position is eligible for a hybrid work schedule with required business travel to BITCO office locations, customer offices, and other litigation- related travel.

Position Summary:

This position provides key support in the handling of claims across multiple lines of coverage, with a focus on Liability (Commercial Auto, Commercial Property and General Liability). This includes assessing claim coverage, liability, legal and damage issues, and investigating, evaluating, and effectively resolving all assigned claims in a timely manner according to company and regulatory guidelines. Provides a high level of customer service to internal and external business partners.

Primary Responsibilities:
<ul><li>Review, analyze, and interpret policy conditions, exclusions and endorsements to resolve coverage and liability issues for assigned claims</li>
<li>Prepare reservation of rights letters, non-waiver agreements, and coverage disclaimers to address claim coverage issues</li>
<li>Review and evaluate claim reserves to ensure that the respective reserve properly reflects the potential exposure</li>
<li>Investigate claims to evaluate coverage and legal issues, which may include meeting with Insureds and witnesses, and obtaining statements, records, and other evidentiary materials</li>
<li>Provide proper documentation and reporting of investigation and claims handling activities</li>
<li>Negotiates, including through mediation, arbitration, or other court-supervised settlement efforts, settles, and resolves claims with claimants, insureds, and their lawyers; provides appropriate claims resolution documents</li>
<li>Maintain a working knowledge of regulatory and jurisdictional requirements</li>
<li>Provides direction to and management of defense counsel, independent adjusters and other third parties retained to assist in a particular claim</li>
<li>Other duties as assigned</li>
</ul>
Qualifications:
<ul><li>Minimum of 5 years of experience with the following:
<ul><li>Coverage Review &ndash; interpreting policies, agreements and disclaimers</li>
<li>Claims Investigation &ndash; Statements, authorizations, retention of qualified experts and counsel</li>
<li>Claims Administration &ndash; Reports, review reserves, compliance knowledge of laws and procedures</li>
<li>Claims Settlement &ndash; Preparation of disclaimer letters, releases, and proof of loss statements; participation in legal court proceedings when necessary</li>
</ul></li><li>Knowledge of coverage, negligence principles, investigation and negotiation techniques</li>
<li>Ability to obtain and maintain state adjusting licenses, as needed
</li><li>Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service</li>
<li>Ability to communicate clearly and effectively with our customers, claimants, opposing counsel, defense counsel, and members of the public</li>
<li>Ability to manage and organize workload of multiple tasks simultaneously
</li><li>Excellent judgement, negotiation, and decision making skills</li>
<li>Must be able to travel between different off-site locations or overnight in an expeditious manner</li>
<li>Experience in handling liability claims in one or more of the following states: FL, GA, AL, NC, SC, VA, and PA</li>
</ul>
Benefits:
<ul><li>Competitive salary and benefits</li>
<li>Paid time off and 12 paid holidays a year
</li><li>Health, dental, and vision insurance
</li><li>Company paid life insurance &ndash; 2x annual earnings
</li><li>Old Republic 401(k) Savings and Profit Sharing Plan
</li><li>Education and training opportunities
</li><li>Insurance designations encouraged with financial assistance available
</li><li>Daily two-hour flexible start and end time for 7.5-hour workday</li>
<li>Employee Fitness Program</li></ul></div>

Sr. Claims Specialist

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