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Claims Examiner I Jobs

Pl Claims Examiner - Medical Claims
By JCW At Florida, United States
Manage healthcare professional liability claims from start to finish
Minimum of two years of specialized experience in legal or medical field, preferably in professional liability
Strong interpersonal, negotiation, and analytical skills
Excellent communication, writing, and organizational skills
Conduct investigation, coverage analysis, and work with defense counsel
Control legal expenses and provide technical expertise throughout the claim process
Claims Examiner (Employee Benefits)
By Transamerica At United States
Strong preference for prior Transamerica experience and/or knowledge of Transamerica Operations
Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
Associate’s degree in a business field or equivalent experience
Excellent communication and customer service skills
Organizational, problem-solving and analytical skills
Review claims and outside sources used in the review.
Claims Analyst/Claims Consultant I, Ii, Or Sr.
By National General At Washington, United States
Time management skills from a global case management and pending perspective (vs. transactional)
Identifies customer needs and works to meet those needs using appropriate customer service skills
Bachelor’s degree preferred or equivalent experience
0-2 years of related experience
Effective verbal and written communication skills
Problem solving and analytical skills; ability to detect differences and issue recognition from multiple sources
Claims Examiner Jobs
By Blue Cross and Blue Shield of Kansas At Topeka, KS, United States

Upon completion of training, extensive knowledge of business-related skills and trained product lines required.

High School graduate or equivalent required.

Claims Examiner I - Evicore - Remote
By The Cigna Group At United States
Experience with Plexus Claims Management (PCM), Truist and Cigna Portal preferred
1+ years of experience with eviCore delegated plans with working knowledge of horizon Health plan preferred
1+ years of experience in medical claims processing required
Utilize expertise to appropriately apply claim concepts, rules and departmental practices, ensuring accuracy, and timeliness of claims payment
Confirm member eligibility, claim pricing and verify authorization and service appropriateness.
Follow appropriate workflows to confirm necessary information such as member eligibility and claim pricing
Mpl Claims Examiner Jobs
By JCW At United States
Pursuit of additional certifications such as CPCU, ARMS, or AINS designation is also valued.
The role involves driving litigation by managing the deployment and utilization of defense counsel and identifying suspected fraudulent claims.
Participation in Claims Projects, reserving roundtables, and pre-trial roundtables is required.
Please apply here, or email your resume to [email protected] for further consideration!
Claims I Clerk Jobs
By BlueCross BlueShield of South Carolina At Greenville, SC, United States
Strong organizational and analytical skills
Strong verbal and written communication skills
Correct keying errors as noted by system edits
Accurately use medical review forms and all available reference materials
High School Diploma or equivalent
Ability to handle confidential or sensitive information with discretion
Facets Claims Examiner - Remote
By NTT DATA Services At Philadelphia, PA, United States
Confirm to the required regulatory and compliance requirements such as the HIPAA.
Confirm to the organizational and client training requirements
Demonstrate knowledge of internal operations and develops relationships to facilitate workflow.
Knowledge of related regulations and standards.
3+ years of full cycle claims processing experience in a Health Plan setting (Pay, Pend, Deny)
1+ year of experience processing claims in Facets
Driver's License Examiner I, Service Oklahoma (Sok)
By State of Oklahoma At Ada, OK, United States
Knowledge, Skills, Abilities And Competencies
Establishes driver’s license records while maintaining the confidentiality and security of information in compliance with state and federal laws.
Provides assistance in preparing legal cases regarding fraudulent applications.
Job Posting End Date (Continuous if Blank)
Estimated Appointment End Date (Continuous if Blank)
License Examiner Ii / License Examiner I - 151392
By South Carolina Department of Motor Vehicles At Williamsburg County, SC, United States
Thorough knowledge of driver licensing eligibility requirements. Application of DMV organizational competencies.
Answers customer inquiries pertaining to driver, vehicle, and registration, titling, and insurance requirements by phone in person.
Must have a valid South Carolina driver's license and be at least 21 years of age with one year driving experience.
A high school diploma or equivalent and related work experience.
Ability to communicate in a professional and effective manner with internal and external customers. Excellent customer service skills.
Responsibilities Of a License Examiner I
Claims - Express Claims Examiner
By The Cincinnati Insurance Companies At Fairfield, OH, United States
Customer service experience or prior management or leadership experience beneficial.
Knowledge or experience with Microsoft® Office and Excel preferred.
Deliver an excellent customer service experience through telephone and e-mail communication.
Accurate and efficient keyboarding skills.
Excellent written and verbal communication skills.
Prior experience in an office setting either fully in-office or hybrid helpful.
Claims Examiner Jobs
By Paramount Health Care At Toledo, OH, United States
Responsible for providing workers’ compensation third party administration claims management to Stated-Funded and self-insured employers.
·Participates in other departmental activities as directed by the department manager/director.
1. Previous workers’ compensation experience.
2. Knowledge of medical and legal terminology.
·Assist legal counsel in preparation of Workers’ Compensation cases and attendance at Workers’ Compensation Hearings if necessary.
·Participate in monthly/quarterly claim review with Employers providing detailed reports and claim reviews.
License Examiner Ii/ License Examiner I - 151350
By South Carolina Department of Motor Vehicles At Darlington County, SC, United States
Thorough knowledge of driver licensing eligibility requirements. Application of DMV organizational competencies.
Answers customer inquiries pertaining to driver, vehicle, and registration, titling, and insurance requirements by phone in person.
Must have a valid South Carolina driver's license and be at least 21 years of age with one year driving experience.
Ability to communicate in a professional and effective manner with internal and external customers. Excellent customer service skills.
Responsibilities Of a License Examiner I
Minimum Qualifications & State Qualifications
Medical Claims Examiner Jobs
By Flex Employee Services At United States
Title: Medical Claim Examiners-Long Term Care - 100% Remote
Pay Rate: $32-$40 per hour (based on experience)
Minimum 2 years previous experience in long term care or disability claims experience or equivalent.
Hours: M-F 8:00 am – 5:00 pm
# of Positions Needed: 15
Claims Examiner - Fully Remote Position
By Lowe's Companies, Inc. At Mooresville, NC, United States
Maintains a functional knowledge of the relevant laws and legal principles in order to resolve claims
Gathers appropriate information, evaluates alleged damages, determining liability and compensability and negotiating settlements and reporting obtained information
Controls claim costs, provides excellent customer service and resolves complaints to the satisfaction of the customer
Complies with federal and state regulations and service standards
NC Adjuster's Property & Casualty Adjuster's License
License Examiner Ii/ License Examiner I - 151150
By South Carolina Department of Motor Vehicles At Marlboro County, SC, United States
Thorough knowledge of driver licensing eligibility requirements. Application of DMV organizational competencies.
Answers customer inquiries pertaining to driver, vehicle, and registration, titling, and insurance requirements by phone in person.
Must have a valid South Carolina driver's license and be at least 21 years of age with one year driving experience.
Ability to communicate in a professional and effective manner with internal and external customers. Excellent customer service skills.
Responsibilities Of a License Examiner II
Minimum Qualifications & State Qualifications
Claims Examiner I Jobs
By Western Growers At Irvine, CA, United States
A minimum of one (1)year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims
Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination
Basic knowledge of medical terminology. Familiar with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes.
Good verbal and written communication skills.
Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.
Ensure compliance with all appropriate policies and practices, local, State, Federal regulations and requirements regarding claims and contract administration.
Claims Dispute Examiner I - Evicore - Remote
By The Cigna Group At United States
1+ years of experience with eviCore delegated plans with working knowledge of horizon Health plan preferred
1+ years of experience in medical claims processing required
Experience with MC400, ICE, NASCO ImageOne preferred
Utilize expertise to appropriately apply claim concepts, rules and departmental practices, ensuring accuracy, and timeliness of claims payment
Confirm member eligibility and claim pricing. Verify authorization and service appropriateness.
Follow appropriate workflows to confirm necessary information to process disputes (i.e. member eligibility and claim pricing).
Claims Representative I Jobs
By Elevance Health At United States
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Learning the activities/tasks associated with his/her role. Works under direct supervision.
Relies on others for instruction, guidance, and direction.
Work is reviewed for technical accuracy and soundness.
Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
Researches and analyzes claims issues.
Litigation Claims Examiner - Professional Liability
By Reserv At Atlanta, GA, United States
Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment
Maintaining adjuster licenses and continuing education requirements
Manage litigation cases related to professional lines claims disputes
Passionate adjuster who cares about the customer and their experience.
12+ years of claim handling experience, with 7+ of those years handling a pending of >60% in litigation
You have strong medical knowledge

Are you looking for a challenging and rewarding career as a Claims Examiner I? We are looking for an experienced professional to join our team and help us process and review insurance claims. You will be responsible for ensuring accuracy and timeliness of claims processing, as well as providing excellent customer service. If you have a passion for helping people and a commitment to accuracy, then this is the job for you!

Overview Claims Examiner I is responsible for reviewing and processing insurance claims. They must ensure that all claims are handled in accordance with company policies and procedures. They must also ensure that all claims are paid in a timely manner. Detailed Job Description Claims Examiner I is responsible for reviewing and processing insurance claims. They must review all claims for accuracy and completeness and ensure that all claims are handled in accordance with company policies and procedures. They must also ensure that all claims are paid in a timely manner. They must also investigate and resolve any discrepancies or disputes that may arise. They must also maintain accurate records of all claims and provide customer service to claimants. Job Skills Required
• Knowledge of insurance policies and procedures
• Excellent customer service skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to handle multiple tasks simultaneously
• Attention to detail
• Ability to work in a fast-paced environment
• Computer proficiency
Job Qualifications
• Bachelor’s degree in business, finance, or a related field
• At least two years of experience in claims processing
• Knowledge of insurance policies and procedures
• Ability to work independently and as part of a team
• Computer proficiency
Job Knowledge
• Knowledge of insurance policies and procedures
• Knowledge of claims processing procedures
• Knowledge of customer service principles
• Knowledge of legal and regulatory requirements
Job Experience
• At least two years of experience in claims processing
• Experience in customer service
• Experience in problem-solving
Job Responsibilities
• Review and process insurance claims
• Ensure that all claims are handled in accordance with company policies and procedures
• Investigate and resolve any discrepancies or disputes that may arise
• Maintain accurate records of all claims
• Provide customer service to claimants
• Monitor claims to ensure timely payment
• Communicate with claimants and other parties involved in the claims process