medical claims manager

TPAC Underwriters

A CAREER AT CAPTRUE BENEFITSWorking at Captrue Benefits, you&rsquo;ll experience a culture that is made up of a group of people who are supportive, innovative, collaborative, and caring towards each other and the customers we serve. Captrue Benefits is looking for a Claims Auditor/Stop Loss Specialist to join our team. This is a full-time remote position. Join our team and help us change the way healthcare is financed, disclosed and delivered.OUR VISION FOR THIS KEY ROLEThe Claims Manager oversees the Claims Department, ensuring timely, accurate, and compliant processing of healthcare claims and stop loss coordination. This role provides daily leadership, technical expertise, and cross-functional collaboration while driving continuous improvements in efficiency, quality, workflows, and cost management. The manager develops staff, creates and maintains department policies/procedures, supports regulatory compliance, manages high-cost claims and appeals, analyzes performance trends, and partners with internal and external stakeholders to advance operational goals.A SAMPLE OF WHAT YOU'LL GET TO DO IN THIS JOB<ul><li>Lead, coach, train and manage claims staff; oversee workload distribution and performance.</li><li>Resolve complex and escalated claim issues.</li><li>Oversee adjudication, research, appeals, disputes, and escalations.</li><li>Serve as SME for complex claims and coverage interpretation.</li><li>Develop and execute strategies to optimize auto-adjudication in partnership with Plan Building team.</li><li>Ensure compliance with ERISA, HIPAA, other applicable state/federal rules, and plan requirements.</li><li>Review, analyze and process appeals in accordance with regulatory guidelines and benefit plan requirements.</li><li>Analyze trends, errors, and system issues; identify root causes and improvement opportunities.</li><li>Participate in system updates, UAT, and defect resolution with IT and vendors.</li><li>Work with providers, members, and internal teams to resolve claim and reimbursement issues.</li><li>Support staff education, benefit interpretation, and cross-functional coordination.</li></ul>WHAT YOU'LL BRING TO THE JOB&middot; Bachelor&rsquo;s degree preferred; associate degree or equivalent experience accepted.&middot; 5-7 years of healthcare claim processing experience is required including thorough knowledge of coding structures (CPT, HCPCS, Revenue codes, ICD 9/10 etc.); as well as COB payments and distribution of funds.&middot; Understanding all types of claims pricing (Network, Medicare, UCR, etc.)&middot; Stop loss experience including understanding of contract types, reimbursement features/terms and claims filing requirements.&middot; 2&ndash;5+ years of supervisory/leadership experience.&middot; Familiarity with VBA Software claims systems strongly preferred but not required.&middot; Strong analytical, communication, and problem-solving skills; ability to manage high-volume priorities.WHO WE ARECaptrue Benefits is a third-party administrator located in Minneapolis, Minnesota. Captrue Benefit&rsquo;s mission is to change the way healthcare is financed, disclosed and delivered. We need people who value honesty and transparency; people who take ownership and responsibility of whatever they are doing. We seek individuals who value all people and interact with humility and respect; people who like to dig deep into issues, who are curious and who understand life is about more than work. If you believe in our mission and share our Core Values, then we would like to talk about how we can make a positive impact together.To apply directly with employer: https://recruiting.paylocity.com/recruiting/jobs/Details/3908270/TPAC-Underwriters/Claims-ManagerPay: $80,000.00 - $110,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Paid training</li><li>Parental leave</li><li>Prescription drug insurance</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul>Work Location: Remote

Claims Manager - Captrue Benefits

Copper Claims Services, Inc.

Job descriptionCopper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA.Copper Claims Services excels in providing custom claims solutions for Property and Casualty, Transportation, Agriculture and Public Entity clients, with an emphasis on Specialized Programs. Our extensive and diverse background allows our staff to fully understand the needs of our customers and how evaluations should be presented. We pride ourselves in being a trusted resource for specialty programs.We are currently looking for career-minded individuals to join our team as a Technical Claims Manager for virtual US liability claims. In this role, you will manage, investigate and resolve general liability and auto liability claims with moderate to severe complexity, with minimal oversight. You will work with both direct employees and independent contractors to support our clients by providing fair and accurate estimates, thorough investigations, and detailed written and oral status reports. You will oversee quality delivery, timeliness of claim resolution and assure positive customer experiences of the team.This role suits someone with strong technical expertise in general liability disciplines, excellent communication skills, leadership skills and ability to multitask.The skills required for success are:&middot; Experience in managing both general liability bodily injury and property damage claims. Construction defect experience is a plus.&middot; Maintain continuous and professional communication with our clients to ensure their needs are met.&middot; Analyze and evaluate damages including bodily injury, and property damage claims.&middot; Ability to conduct and oversee liability investigations to include taking recorded statements, gathering medical injury documentation and evaluating losses to negotiate and settle.&middot; Litigation claims expertise required.&middot; Prepare clear, concise, and timely narrative reports for our clients&middot; Ability to review contracts required to determine contractual liability obligations&middot; Skilled at writing tender, demand and coverage letters&middot; Xactimate and CCC estimating experience a plus.&middot; Conscientious, hard-working, and flexible during high volumes, with the ability to cope with a fast-changing working environment.&middot; Enthusiastic, professional, and work with a positive attitude.&middot; Desire to embrace innovative working practices and make suggestions to improve company process.&middot; Ability to guide and support team members and contractors, by providing constructive feedback to ensure the final product is done timely and with quality.&middot; Organized, diligent, and able to run tasks through to completion.Qualifications:&middot; 8-10 years of commercial general liability to include bodily injury or property damage claim evaluation experience required.&middot; 5 years of leadership/supervisor experience preferred.&middot; Prior experience training and overseeing staff a plus&middot; Proficient in Microsoft Office (Word, Excel, and Outlook)&middot; Proven ability to provide exceptional customer service&middot; Strong written and verbal communication skills&middot; Understands and displays a sense of urgency in claims handling&middot; Exceptional organization and time management skills&middot; CPCU or other Insurance Designation like AIC or CLA desiredJob Type: Full-timePay: $90,000 - $125,000 per yearBenefits:&middot; 401(k)&middot; 401(k) matching&middot; Dental insurance&middot; Health insurance&middot; Paid time off&middot; Vision insurance&middot; Work from homeSchedule:&middot; 8 hour shift&middot; Monday to FridayExperience:&middot; General Liability claims handling 8- 10 years (Required)&middot; Litigation experience (Required)Location:Work Location: RemotePay: $90,000.00 - $125,000.00 per yearBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li><li>Work from home</li></ul>Work Location: Remote

General Liability Claims Manager

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview<div> 
Salary: Salary can go up to $165,000 per year, dependent upon experience</div><div><div>
Jurisdictions: Open to any</div><div>
Licenses: Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
Location: This role is eligible for fully remote work</div><div></div><div> 
The Senior Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims, with a primary focus on Physician Medical Malpractice exposures. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div></div> 
 
How you'll make an impact 
<ul><li>
Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability focusing on Physician Claims (Medical Malpractice).</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
 
About You<div> 
Required:
</div><ul><li>Bachelor's Degree and 5+ years related claims experience required.
</li><li>Prior experience working within the applicable specialty claims area or demonstrated ability to handle unique/challenging claims issues.</li><li>
Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
</li><li>Knowledge of accepted industry standards and practices.
</li><li>Computer experience with related claims and business software.</li></ul><div>
Preferred:
</div><ul><li>JD Highly Preferred</li><li>
Licensed Attorney highly preferred.</li><li>
2+ years of prior experience adjusting claims in Healthcare professional Liability</li></ul><div>
Behaviors:
</div><ul><li>Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
</li><li>Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.
</li><li>Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div>

Senior Claim Specialist - Physician Claims

Walmart

<div><h2 class="jobSectionHeader">Position Summary...</h2><h2 class="jobSectionHeader">
What you'll do...</h2>
About the Team Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers&rsquo; compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process The Claims Manager is responsible for leading a team of case managers in the management of workers' compensation or general liability claims from initial report to resolution. This role ensures timely, accurate, and compliant claims handling while driving engagement, performance, continuous improvement, and customer satisfaction. What you'll do... Team Leadership &amp; Development
<ul><li>Manage end-to-end the case manager hiring process including screening, interviewing, selection, and onboarding.
</li><li>Lead, support, train, coach, and mentor a team of workers&rsquo; compensation or general liability case managers.
</li><li>Manage team dynamics, resolving conflicts constructively and facilitating productive discussions.
</li><li>Lead by example, setting a high standard for performance, professionalism, and accountability.
</li><li>Foster a culture of belonging, collaboration, accountability, and continuous improvement.
</li><li>Promote individual and team engagement.
</li><li>Identify skill gaps and training needs and coordinate learning opportunities for team members.
</li><li>Conduct regular one-on-ones and performance check-ins to support employee growth, clarifying goals, and remove barriers for success.
</li><li>Provide timely and specific feedback to case managers through claim reviews, audits, performance metric reviews, and one-on-one discussions to enable career growth and improve claim outcomes.
</li><li>Complete root cause analysis to identify and resolve problems.
</li><li>Conduct performance evaluations and administer disciplinary actions.
</li><li>Be a champion of change; Support and effectively lead through change.
</li><li>Mentor emerging leaders, building a pipeline of future leadership within the department.
</li></ul>Operational Oversight
<ul><li>Responsible for annual claim cost spend of up to $35,000,000.
</li><li>Assign new losses based on claim complexity matching to an appropriately tenured case manager with the necessary skill set to achieve an optimal claim outcome.
</li><li>Escalate claims to leadership based on the internal escalation guidelines and ensure the claims are reported to the insurers if applicable.
</li><li>Monitor inventory and caseloads to ensure workloads are appropriate and claims are moving through the lifecycle as efficiently as possible to prevent claim aging.
</li><li>Ensure timely and accurate investigation, documentation, evaluation, and resolution of claims in compliance with jurisdictional requirements.
</li><li>Oversee day-to-day handling of claims to ensure adherence to internal standard operating procedures and regulatory requirements.
</li><li>Review complex, high-exposure, and litigated claims and provide technical guidance on claim valuation, reserving, and claim strategy to achieve optimal outcomes.
</li><li>Provide reserve authority up to $400,000 and payment authority up to $75,000
</li><li>Collaborate with legal counsel, stakeholders, and the employer to drive claim strategy.
</li><li>Resolve escalated complaints from the client, customer, or associate.
</li><li>Monitor the team&rsquo;s phone queue to ensure that customer needs are addressed timely.
</li></ul>Quality Assurance &amp; Compliance
<ul><li>Conduct claim reviews to ensure accurate coding, claim quality, accuracy, compliance with jurisdictional requirements, timeliness of benefits, and adherence to internal standard operating procedures.
</li><li>Ensure compliance with state laws, company policies, and client-specific service instructions.
</li><li>Maintain compliance with state audit and AIG requirements; provide a COE plan if results fall below acceptable requirements
</li></ul>Performance Monitoring &amp; Reporting
<ul><li>Track and analyze key claims metrics such as inventory, closure rates, attorney representation rates, litigation rates, and return-to-work outcomes.
</li><li>Leverage &ldquo;views&rdquo; within the claim system to effectively manage inventory, ensure accurate claim coding, and ensure forward movement to prevent claim aging.
</li><li>Identify gaps in performance, processes or technology and complete a root cause analysis, develop an action, execute, and resolve.
</li><li>Collaborate with leadership to develop strategies for improving claim outcomes and reducing total cost of risk.
</li><li>Support cost containment strategies.
</li><li>Provide regular reporting on team performance, compliance findings, and strategic initiatives.
</li></ul>What you'll bring...
<ul><li>Bachelor&rsquo;s degree in business, Insurance, or related field or equivalent experience
</li><li>Proven experience in claims management or a related field
</li><li>Exceptional communication, interpersonal, and organizational skills
</li><li>Professional designations, industry experience, and/or prior leadership experience preferred
</li></ul>At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see https://one.walmart.com/notices. Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
 
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.
 
For information about benefits and eligibility, see One.Walmart.
 
The annual salary range for this position is $80,000.00 - $155,000.00 Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include :
 
<ul><li>Stock</li></ul>
ㅤ
ㅤ
ㅤ
ㅤ
&lrm;<h2 class="jobSectionHeader">
Minimum Qualifications...</h2>
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor's degree and 2 years&rsquo; experience in insurance claims or relevant area OR 4 years&rsquo; experience in insurance claims or related area<h2 class="jobSectionHeader">
Preferred Qualifications...</h2>
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Customer Service, Supervising Associates<h2 class="jobSectionHeader">
Primary Location...</h2>
905 Customer Dr, Bentonville, AR 72716, United States of America
Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.</div>

Manager, Claims Management

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview<div> 
Salary: Salary can go up to $165,000 per year, dependent upon experience</div><div><div>
Jurisdictions: Open to any</div><div>
Licenses: Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
Location: This role is eligible for fully remote work</div><div></div><div><div> 
The Senior Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims, with a primary focus on Hospital and Physician Medical Malpractice exposures. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div></div></div>
 
How you'll make an impact 
<ul><li>
Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability focusing on Hospital and Physician Claims (Medical Malpractice).</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
 
About You<div> 
Required:
</div><ul><li>Bachelor's Degree and 5+ years related claims experience required.
</li><li>Prior experience working within the applicable specialty claims area or demonstrated ability to handle unique/challenging claims issues.</li><li>
Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
</li><li>Knowledge of accepted industry standards and practices.
</li><li>Computer experience with related claims and business software.</li></ul><div>
Preferred:
</div><ul><li>JD Highly Preferred</li><li>
Licensed Attorney highly preferred.</li><li>
2+ years of prior experience adjusting claims in Healthcare professional Liability</li></ul><div>
Behaviors:
</div><ul><li>Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
</li><li>Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.
</li><li>Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div>

Senior Claim Specialist - Hospital / Physician Claims

AAA Life Insurance Company

<div>
 
 Overview
 
 
 
 AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them &ndash; and their families &ndash; when we&rsquo;re needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive.
 
 
 The Medical Claims Consultant is responsible for providing medical and business expertise and knowledge in support of claims decisions. This role&rsquo;s primary responsibility is to serve as a resource to the claims team including contestable claims examiners, Accident and Health examiners, claims consultants and management with respect to denials, appeals, escalations or complex medical questions that arise in the processing of claims.
 
 
 
 Responsibilities
 
 
 
 
 How You&rsquo;ll Work
 
 
 
 Work Solution: Hybrid
 
 
 Relocation Eligibility: Not Available
 
 
 <ul>
 <li>
 Serve as a resource to the contestable claims team. This includes review of contestable claims as needed by claims personnel.
 </li>
 <li>
 Review of medical documentation including physician and hospital records, accident reports or other clinical materials
 </li>
 <li>
 Review and understanding of policy language &ndash; interpret policy exclusions and endorsements in relation to medical findings
 </li>
 <li>
 Review all contestable claim denials, including those that may have potential to result in litigation
 </li>
 <li>
 Identify inconsistencies or gaps in medical documentation and recommend additional information when needed.
 </li>
 <li>
 Serve as a resource to claims consultants and management with regards to denials, appeals or escalations that involve medical decisions
 </li>
 <li>
 Resource to the entire claims team with respect to complex medical decisions that arise in the day-to-day handling of claims. Assist in determining whether a claim is eligible under policy language and with respect to any supporting medical documentation.
 </li>
 <li>
 Provide training for claims examiners on medical topics relevant to claims decision making
 </li>
 <li>
 Support claim work related to denials or appeals that require medical decision making
 </li>
 <li>
 Participate in training and round tables, providing medical expertise in support of claims decision making.
 </li>
 <li>
 Collaborates closely with claims examiners, underwriters, legal counsel and potentially third parties to ensure accurate and fair claims decisions
 </li>
 <li>
 Maintain up-to-date knowledge of relevant medical standards, diagnostic/treatment guidelines, and regulatory/industry developments that impact claim adjudication
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Doctorate or Advanced healthcare degree (MD, DO, BA-PA (Physician Assistant Bachelor&rsquo;s Degree in conjunction with PA certification, PA-C, NP, RN) with demonstrated claim-consulting or clinical review experience
 </li>
 <li>
 Clinical experience (min 5-10 years) with a strong familiarity of a broad range of medical conditions, treatments or outcomes
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience in the life insurance industry
 </li>
 <li>
 Excellent ability to interpret and synthesize complex medical records, and to translate findings into actionable claims decisions.
 
 
 </li>
 </ul>
 While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel, talk, hear and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
 
 
 This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.
 
 
 We are committed to ensuring equal employment opportunities for all job applicants and employees. Employment decisions are based upon job-related reasons regardless of an applicant's race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, marital status, genetic information, protected veteran status, or any other status protected by law.
 
 
 
 AAA Life Insurance Company does not offer immigration sponsorship for this position. This includes visa types such as H-1B, TN, and STEM OPT. Please do not apply if you currently require or may require employer-sponsored immigration support now or in the future.
 
 
 
 PM21
 
 
</div>

Medical Claims Consultant- Part Time

90 Degree Benefits

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

Medical Claims Processor

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