insurance claims specialist

Hueman PE Talent Solutions

<div><p><b>Valcourt Building Services has partnered with Hueman to find a Paralegal for their corporate contract team in Morgan Hill, California.</b></p><p><br>
We are seeking a highly organized and detail-oriented <b>In-House Paralegal</b> to support our legal department in a variety of legal and administrative tasks. The ideal candidate will have experience working in a corporate legal environment and a solid understanding of litigation management, insurance, corporate law, contracts, and regulatory compliance. This position plays a key role in helping the company manage claims, legal risks and litigation and ensure adherence to applicable laws and regulations.</p><p>
Valcourt is a premier provider of a variety of building services, such as waterproofing, window cleaning, and restoration services. Valcourt works with building owners and property managers to provide preventative maintenance, repairs, safety consulting, and comprehensive building envelope restorations to extend the life of a structure and protect property value.<br>
<br>
<b>Key Responsibilities:</b></p><ul><li>
Manage and administer claims and litigation from inception through resolution, under the supervision of internal counsel</li><li>
Manage insurance claims and monitor insurance carrier handling</li><li>
Maintain claims and litigation matrices and records</li><li>
Draft, review, and manage a wide range of legal documents, including NDAs, contracts, corporate resolutions, and internal policies.</li><li>
Serve as the primary point of contact for contract review requests from internal branches and departments.</li><li>
Manage the contract lifecycle process, including contract routing, approvals, signatures, renewals, and terminations.</li><li>
Maintain organized electronic and physical contract files using a contract management system (CMS).</li><li>
Monitor contract deadlines, obligations, renewal dates, and compliance requirements.</li><li>
Ensure and monitor subcontractor and vendor insurance compliance</li><li>
Assist in corporate governance activities, including preparing board materials, maintaining corporate records, and managing entity registrations.</li><li>
Support compliance programs by tracking legal and regulatory obligations and assisting in audits or internal reviews.</li><li>
Coordinate with outside counsel on litigation, IP filings, and other legal matters.</li><li>
Conduct legal research and summarize findings for internal stakeholders.</li><li>
Maintain and organize legal files, contract management systems, and databases.</li><li>
Support M&amp;A activities, due diligence, and post-acquisition integration efforts when necessary.</li><li>
Assist with the preparation of intellectual property filings</li><li>
Monitor and report on legal developments relevant to the business.</li><li>
Draft internal and external correspondence relating to areas of responsibility</li></ul><div></div><p><br>
Qualifications:</p><ul><li>
Bachelor's degree required; Paralegal Certificate from an ABA-approved program preferred.</li><li>
5+ years of experience as a paralegal, preferably in an in-house legal department or corporate or litigation focused law firm.</li><li>
Strong knowledge of claims, insurance, corporate and contract law.</li><li>
Excellent organizational and communication skills.</li><li>
Proficiency with legal research tools (e.g., LexisNexis, Westlaw) and document management systems.</li><li>
High level of discretion and ability to handle confidential information.</li><li>
Demonstrated proficiency using MS Office (Outlook, Word, Excel) with the ability to learn and use new software and systems</li><li>
Knowledge of legal terminology and concepts</li><li>
Excellent time management skills and attention to detail, with a high degree of accuracy and success in delivering to key deadlines</li><li>
Understanding of and experience with insurance claims and litigation processes.</li></ul><p></p><p><b><br>
Preferred Skills:</b></p><ul><li>
Ability to work independently and manage multiple priorities in a fast-paced environment.</li><li>
Litigation Management experience preferred
</li><li>Demonstrated success working in a team environment</li><li>
Flexible hours from time to time to be able to support East Coast and West Coast time zones.</li></ul><p></p><p><br>
For 35 years, Valcourt Building Services has grown from a small window cleaning company serving the Washington DC area into one of the largest exterior maintenance companies in the country. We proudly serve clients from our offices in New Jersey, Pennsylvania, Maryland, Virginia, Georgia, Florida, and Texas. If you are looking to join a dynamic team with a growing company, this opportunity is for you.</p><p><br>
Hueman is proud to partner with Valcourt Building Services as the exclusive recruitment partner for this role. If you are interested in learning more about a career with Valcourt as a Paralegal, apply today!</p><p>
#INDPE2023</p></div>

Paralegal - Insurance Claims - Hybrid

Prime Therapeutics

<div><div>Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.</div><div>
Job Posting Title</div><div></div>
Claims Specialist Sr<div>
Job Description</div><div></div>
The Claims Specialist is responsible for assisting in the ongoing operational support of Prime key service offerings. This position is responsible for responding to inquires from internal and external partners for the research of and resolution of claim issues. Additionally, this position serves as a subject matter expert resource for coworkers and other departments.<div></div><div>
Responsibilities</div><ul><li>
Work in Medicare, Commercial and Health Insurance Marketplace (HIM) integrity lines of business to ensure strict adherence to unique guidelines and regulations for each</li><li>
Monitor and respond appropriately to incoming inquiries related to specific process or support systems (e.g. claim adjudication system) Escalate issues when appropriate</li><li>
Partner with Prime's clients to produce and execute corrective measures found in key service offerings</li><li>
Process authorizations to meet HIPAA/privacy and CMS requirements</li><li>
Sorts, researches and processes daily internal and external documents received by the mailroom.</li><li>
Assist with RxClaim Release user acceptance testing and reporting</li><li>
Serve as a subject matter expert (SME) resource for other departments</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
High school diploma from accredited institution or equivalent GED</li></ul><ul><li>
1 year of claims experience</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li>
Experience with Microsoft Office products</li><li>
Strong written and verbal communication skills</li><li>
Strong organizational skills</li><li>
Ability to work independently</li><li>
Strong attention to detail with ability to perform with high degree of accuracy</li><li>
Ability to prioritize and handle multiple tasks simultaneously</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
2+ years of experience in claims, insurance, or healthcare</li><li>
Extensive experience using Excel spreadsheets</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div><br>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Claims Specialist Sr

The Cincinnati Insurance Companies

<div></div><div><div>US-OH-Fairfield<div>
</div></div><div><b>
Description</b><div></div><p><b><br>
Make a difference with a career in insurance</b></p><p>
At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we&rsquo;re looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that <i>Actions Speak Louder in Person</i>&reg;.</p><p>
If you&rsquo;re ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow.</p><p><b>
Build your future with us</b></p><p>
Our Headquarters Claims Department is currently seeking a Casualty Litigation Specialist to handle and oversee the processing of large and complex casualty claims. This position is located in Fairfield, OH. We currently provide a hybrid work environment between in-office and remote.</p><p><b>
Starting Salary: </b>$95,000 to $125,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance.</p><p><b>
Be ready to:</b></p><ul><li>
manage litigation and defense strategies in assigned states and assigned claims</li><li>
evaluate claims and set reserves in excess of $100,000</li><li>
participate in coverage analysis for the assigned claims</li><li>
provide technical direction and support to field claims associates</li><li>
prepare reports and other written correspondence for internal and external stakeholders</li><li>
participate in mediations, seminars, field unit meetings and complete other tasks as needed</li><li>
travel as required</li></ul><p><b>
Be equipped with:</b></p><ul><li><p>
preferred 5 years prior casualty claim handling experience</p></li><li>
demonstrated proficiency in coverage analysis</li><li>
experience in detailed analysis of facts relevant to an evaluation of coverage, liability and damages</li><li>
ability to multitask and maintain positive demeanor</li></ul><p><b>
Bring education and experience:</b></p><ul><li>
a bachelor&rsquo;s degree or equivalent preferred</li><li><p>
CPCU, AIC, AIM designations, or other relevant education preferred</p><p></p><p><b><br>
Enhance your talents</b></p><p></p><p><br>
Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you&rsquo;re new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional &ndash; all while enjoying a meaningful career.</p><p></p><p><b><br>
Enjoy benefits and amenities</b></p><p></p><p><br>
Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated.<b> </b>To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities.</p><p></p><p><b><br>
Embrace a diverse team</b></p><p></p><p><br>
As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation; religion; national origin; age; disability; or any other basis prohibited by law. about the Federal Employment Notices</p></li></ul></div></div><p></p>

Claims - Casualty Litigation Spec III - IV (HQ Based)

GluCare

<div><p><b>Job Summary:</b></p><p>
GluCare Integrated Diabetes Center is seeking a highly organized and detail-oriented Insurance Coordinator to join our team. The Insurance Coordinator will be responsible for managing the insurance processes, including pre-approvals, claims submissions, resubmissions, and reconciliations. The role requires a thorough understanding of insurance policies, regulations, and healthcare billing systems. The ideal candidate will work closely with healthcare providers, patients, and insurance companies to ensure the smooth processing of claims and maximize revenue recovery.</p><p></p><p><b>
Key Responsibilities:</b></p><ul>
<li>Pre-Approval Coordination: Ensure all required pre-approvals for treatments and procedures are obtained from insurance providers in a timely manner.</li>
<li>Claims Submission: Prepare and submit insurance claims in compliance with payer policies and regulations, ensuring accuracy and completeness.</li>
<li>Resubmissions &amp; Appeals: Handle rejected or denied claims by identifying errors or missing information and resubmitting or appealing claims as necessary.</li>
<li>Invoicing: Generate accurate invoices for patients and insurance companies, ensuring alignment with policy coverage and patient treatment plans.</li>
<li>Verification of Insurance Coverage: Check and verify patient insurance coverage and eligibility before services are provided, ensuring that the required services are covered under the patient's policy.</li>
<li>Reconciliation of Accounts: Work with the finance department to reconcile patient accounts, ensure payments are posted correctly, and identify any outstanding balances.</li>
<li>Patient Support: Provide clear communication and support to patients regarding insurance coverage, claims status, and any financial obligations they may have.</li>
<li>Maintaining Records: Keep detailed and organized records of all insurance-related documents, claims submissions, payments, and correspondence.</li>
<li>Liaison with Insurance Providers: Maintain strong working relationships with insurance companies, ensuring quick resolution of issues related to claims or approvals.</li>
<li>Compliance: Ensure that all insurance activities are in compliance with DHA (Dubai Health Authority) regulations and other relevant healthcare insurance standards in the UAE.</li>
<li>Regular Reporting: Provide regular reports on claim submissions, approvals, denials, and reimbursements to management for review and action.</li>
</ul><p>Understand, follow and support all hospital infection control programs</p><p></p><p><b>
Requirements</b></p><ul>
<li>A Bachelor's degree in healthcare administration, business administration, or a related field is preferred.</li>
<li>Certified Professional Coder (CPC) Certified</li>
<li>Minimum of 2 years of experience in medical insurance coordination, claims processing, or healthcare billing within a healthcare facility or insurance company.</li>
<li>Experience in an endocrinology clinic will be an added advantage</li>
<li>Familiarity with UAE healthcare insurance regulations, insurance provider policies, and DHA standards. In-depth knowledge of coding systems such as ICD-10 and CPT codes is highly desirable.</li>
<li>Strong expertise in:</li>
<li><ul><li><ul><li>Approvals</li>
<li>Invoicing</li>
<li>Submissions and resubmissions</li>
<li>Eclaimlink and DHA regulations</li>
</ul></li></ul></li><li>Solid understanding of medical terminology and clinical justifications</li>
<li>Excellent communication skills, both verbal and written, to interact with insurance companies, patients, and healthcare providers.</li>
<li>Proficiency in healthcare billing software and systems.</li>
<li>Ability to analyze, prioritize, and solve issues related to insurance claims and denials.</li>
<li>Time management skills to handle multiple tasks and meet deadlines.</li>
<li>Language: Fluency in English is required. Proficiency in Arabic is an advantage.</li></ul></div>

Insurance Coordinator

Link K Insurance TPA P Ltd

<p>Greetings From Link - K Insurance TPA</p><p>We are hiring <b>Claims Senior Executive</b> for our claims Department at our Chennai Corporate office.</p><p><b>Year of Experience :</b> 1 to 3 Years</p><p><b>Qualification:</b> Any Degree</p><p><b>Industry:</b> TPA \ Health Insurance (Indian Based Claims )</p><p><b>Roles and Responsibility </b></p><ul><li>Accurate and efficient processing of claims, including verifying policy coverage, assessing claim validity, and calculating the appropriate payable amount.</li><li>Get fully trained in claims software and complete understanding of features and validations in the system</li><li>Get good understanding of process flow, movement of claim and stakeholders expectations w r t claims services</li><li>Accurate data entry of bills into appropriate columns/fields</li><li>Verify the accuracy of details entered at inward level and correcting wherever required.</li><li>Adhere to SoPs defined</li><li>Processing the number of claims allocated. Prioritizing claims as required.</li><li>Be aware of all insurers SoPs and application of relevant protocols.</li><li>Be updated about the new products and features in health policies</li><li>Interaction with customer service team and help with any clarifications in billing</li><li>Ensure clarity in communication to customers.</li><li>Identify and report potential fraudulent claims, following established procedures and guidelines.</li><li>Coordinate with doctors and CRMs to aid in assessing claims accurately.</li><li>Maintain daily report of claims processed and report to team lead.</li><li>Actively participate in training sessions and workshops to enhance knowledge of insurance products, claims processing techniques, and industry developments.</li><li>Assist medical officers in responding to audit queries of insurers.</li></ul><p>Important Note:</p><ul><li>Health Insurance / TPA profile only eligible</li><li>Interested candidate can share your updated resume to <b>careers@linkktpa.com</b></li></ul><p>Job Types: Full-time, Permanent</p><p>Pay: &#8377;25,000.00 - &#8377;30,000.00 per month</p><p>Benefits:</p><ul><li>Provident Fund</li></ul><p>Experience:</p><ul><li>Cashless and Reimbursement: 1 year (Required)</li></ul><p>Work Location: In person</p>

Claims Senior Executive

Healthcare Risk Advisors

<p></p><div><p>Healthcare Risk Advisors is seeking a medical malpractice Claims Specialist to join our claims team. This is a hybrid opportunity based out of New York City.</p>
<p>
This position is responsible for performing investigations, evaluations, negotiations, and settlements to equitably resolve claims. Position conducts business with policyholders and others in a manner that achieves economy and upholds the company&rsquo;s reputation for quality service. This position has contacts with employees, vendors, lawyers, and policyholders. This position works under immediate supervision.</p>
<p><b>
Qualifications:</b></p>
<ul>
<li>Bachelor&rsquo;s degree required.</li>
<li>Minimum of 2-5 years as a claims adjuster, paralegal, attorney, or related experience.</li>
<li>Adjusters license required, or JD in lieu of requirement.</li>
<li>Excellent interpersonal and organizational skills.</li>
<li>Strong knowledge of medical malpractice law.</li>
<li>Strong listening skills.</li>
<li>Strong negotiating skills.</li>
<li>Strong Microsoft Office Suite skills.</li></ul><br>
<p></p>
<p><b>
Responsibilities:</b></p>
<p>
Service / Support Delivery</p>
<ul>
<li>Provides clear communication to client and follows up as necessary based on expectations agreed to with the client.</li>
<li>Maintains awareness of client&rsquo;s needs and context of their communication in order to provide proper support.</li>
<li>Elevates concerns expressed by the insured client to management as necessary.</li>
<li>Provides excellent service to team members who submit requests to the team.</li>
<li>Provides high-quality, comprehensive work product that facilitates efficient/effective downstream workflow.</li>
<li>Identify and elevate ERM exposure.</li></ul><br>
<p></p>
<p>
Claim Guidelines</p>
<ul>
<li>Adhere to best practices.</li>
<li>Understands the venues, applicable law and reserving philosophy of HRA to properly evaluate the exposures contained within the assigned caseload.</li>
<li>Ensures effective documentation of established reserves.</li></ul><br>
<p></p>
<p>
Claims Investigation / Analysis</p>
<ul>
<li>Provides timely analysis of cases to establish appropriate reserves.</li>
<li>Escalate cases that are unique or unusual to leadership for evaluation, escalation, and communication as necessary.</li>
<li>Determines the proper course of resolution based on the directed investigation by assigned staff and makes recommendations to leadership accordingly.</li>
<li>Gives appropriate insight and advice to clients, staff and defense counsel on the best possible outcome for both the insured client and the company.</li>
<li>Completes coverage analysis and requests coverage review as appropriate.</li>
<li>Makes appropriate and decisive decisions to establish a plan of action on all cases assigned to the team.</li>
<li>Directs all reporting to High Exposure Committee and Reinsurers as necessary.</li></ul><br>
<p></p>
<p>
Litigation Management &amp; Claims Resolution</p>
<ul>
<li>Makes recommendation for assignment of litigated matters to appropriate defense panel members based on ability and experience.</li>
<li>Partners with defense counsel for optimum outcome on all assigned cases.</li>
<li>Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.</li>
<li>Attends and monitors (directly or indirectly) settlement conferences, mediations and trials, reports out timely and insightfully, and escalates as needed.</li>
<li>Evaluates attorney work product/performance and advises supervisor of any need for corrective action or improvement.</li>
<li>Recommends the proper course of resolution timely to leadership and/or client based on the investigation and discovery.</li></ul><br>
<p></p>
<p>
Technical Knowledge and Professional Development</p>
<ul>
<li>Maintain technical knowledge and skills to efficiently and effectively support and advance the department strategic plan and goals.</li>
<li>Completes any training required to maintain or advance the skills set necessary to reach department and company goals.</li></ul><br>
<p></p>
<p>
Other Duties as Assigned</p>
<ul>
<li>Makes oneself available for any and all duties.</li>
<li>Accepts delegated tasks readily and completes assigned duties as directed.</li></ul><br>
<p></p>
<p><b>
Salary Range: $115,123 - $151,099</b></p>
<p>
Compensation varies based on skills, knowledge, and education. We consider factors such as specialized skills, depth of knowledge in the field, and educational background to ensure fair and competitive pay.</p><br>
<p></p>
<p><b>
Benefits:</b></p>
<p>
Healthcare Risk Advisors offers competitive compensation, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program. There's more:</p>
<ul>
<li>Health, dental, and vision insurance</li>
<li>Health and dependent care tax-free spending accounts with a company match</li>
<li>401(k) and Roth IRA with company match, as well as catch-up plans for both</li>
<li>Paid vacation, sick days, and personal days each calendar year (with vacation increases based on length of service)</li>
<li>11 paid holidays each calendar year</li>
<li>Life and travel insurance</li>
<li>Tax-free commuter benefits</li>
<li>In-person and online learning opportunities</li>
<li>Cross-function career opportunities</li>
<li>Business casual work environment</li>
<li>Time off to volunteer</li>
<li>Matching donations to qualifying nonprofit organizations</li>
<li>Company-sponsored participation at non-profit events</li></ul><p></p><p><br>
Equal Opportunity Employer<br>
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</p></div>

Medical Malpractice Claim Specialist

Alhassanain B.S.C

<p>We are seeking a highly experienced and detail-oriented <b>Senior Insurance Coordinator</b> with specialized expertise in marine. construction-related, vehicle and property insurance. The ideal candidate will have a proven track record in managing complex insurance portfolios, processing claims, and ensuring robust risk mitigation for vessels, vehicles, equipment, and construction projects.</p><p><b>Key Responsibilities:</b></p><ul><li><b>Policy Management:</b> Administer and renew <b>marine hull &amp; machinery, protection &amp; indemnity (P&amp;I),</b> and <b>cargo insurance</b> policies for vessels and fleets.</li><li><b>Claims Processing:</b> Handle end-to-end claims management for <b>marine claims</b> (collision, damage, loss), <b>vehicle &amp; equipment damage,</b> and <b>property damage.</b></li><li><b>Construction Risk:</b> Administer <b>Contractors All Risk (CAR) policies, Erection All Risk (EAR) policies,</b> and <b>Third-Party Liability (TPL)</b> insurance for ongoing projects.</li><li><b>Liability Expertise:</b> Manage claims and policies related to <b>Public Liability, Product Liability, and Employers' Liability.</b></li><li><b>Contract Review:</b> Analyze client and vendor contracts to identify insurance requirements, indemnity clauses, and ensure compliance.</li><li><b>Stakeholder Liaison:</b> Act as the primary point of contact between brokers, underwriters, surveyors, legal teams, and clients.</li><li><b>Risk Assessment:</b> Conduct risk assessments for new projects and advise on appropriate insurance coverage.</li><li><b>Documentation:</b> Maintain precise records of all policies, certificates of insurance, claims correspondence, and renewals.</li><li><b>Reporting:</b> Prepare detailed reports on claims status, loss ratios, and insurance program performance for management.</li><li>Any other insurance claims assigned by your direct manager</li></ul><p><b>Qualifications &amp; Experience:</b></p><ul><li><b>Minimum 7 years of experience</b> in an insurance coordination or brokerage role, with a <b>mandatory focus on marine and construction insurance.</b></li><li><b>In-depth knowledge</b> of:</li><li><b>Marine Insurance:</b> Hull, MACH, P&amp;I, Freight, Demurrage.</li><li><b>Property Insurance:</b> Damage, Business Interruption, Material Damage.</li><li><b>Liability Insurance:</b> Public, Product, Contractual, Professional Indemnity.</li><li><b>Construction Insurance:</b> CAR, EAR, DSU.</li><li>Proven experience in <b>claims negotiation and settlement.</b></li><li>Strong understanding of policy wordings, terms, and conditions.</li><li>Excellent communication, negotiation, and interpersonal skills.</li><li>Proficiency in insurance software and MS Office Suite.</li></ul><p>Job Type: Full-time</p>

Senior Insurance Coordinator

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