This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Role: VA Claims Specialist involves investigating health insurance claims and bills to ensure claims resolution. Responsibilities include: - Following up on unresolved claims - Facilitating payment of claims for Veterans' Affairs and its affiliates Training: - Comprehensive training begins on your first day and lasts 8-10 business days - Led by instructors with interactive discussions and hands-on activities - Participation is required to be fully present each day and remain on camera Is this role for you? Revecore encourages our employees to be driven and highly motivated to be successful. Consider this role if you: - Want to grow a career - Have a working knowledge of Microsoft Office (Word, Excel, Outlook) - Possess technical proficiency to work on multiple computer screens and software applications simultaneously - Can maintain strong performance in a fast-paced environment with productivity metrics - Remain organized while multi-tasking - Use critical thinking and problem-solving skills to find effective and efficient solutions - Communicate clearly, both verbally and in writing - Have at least one year of experience in a professional office environment; experience in health insurance billing preferred - Have experience with Coordination of Benefits and a general understanding of insurance billing (a plus, but not required) - Have experience with billing and appealing denied health claims (a plus, but not required) Requirements - A private, distraction-free environment to work from in your home - On-Camera Presence: Being on camera is essential for building trust and collaboration - A secure internet connection is required - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads - The workspace area accommodates all workstation equipment and provides adequate surface area to be productive - Must reside in the United States within specified states Benefits - Paid training and incentive plans - Medical, dental, vision, and life insurance benefits available from the first day of employment - Excellent work/life balance - Employee Resource Groups build community and foster a culture of belonging and inclusion - 401(k) contributions matched - Career growth opportunities - 12 paid holidays and generous paid time off - Pay: $15/hr

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role is responsible for conducting Workers Compensation virtual premium audits. The individual will work directly with insureds to collect the payroll information necessary for premium audits. The individual will complete all virtual audits in a timely fashion with an emphasis on quality and will provide status updates to management as requested. This role will be responsible for resolving audit disputes and audit related inquiries as it relates to virtual audits. - Conduct Workers Compensation virtual premium audits - Collect payroll information necessary for premium audits - Complete all virtual audits in a timely fashion with an emphasis on quality - Provide status updates to management as requested - Resolve audit disputes and audit related inquiries - Track, research, and resolve all audit final disputes and communicate to shareholders as necessary - Manage class code inquiries with the rating bureau and make changes to classification as appropriate - Respond to audit specific questions including risk classification, class code application, state rules and other audit related inquiries from policyholders, brokers, and internal staff - Provide status updates and submit completed audits in a timely manner - Contact policyholders to obtain various payroll and financial records to complete the premium audit - Properly schedule audits to maximize time service and production - Assist with vendor audit reviews as needed Qualifications - High School Diploma - 3 years of customer service experience required - 1 year of current Workers Comp Premium Audit experience required - Pennsylvania Workers Comp experience strongly preferred - Understanding of PCRB regulations - Basic knowledge of accounting principles and financial documents beneficial - Familiarity with NCCI and individual state rating bureau regulations - Ability to cultivate and maintain a strong relationship with policyholders, brokers, and internal staff - Effective and professional verbal and written communication skills - Customer service driven - Ability to handle multiple tasks and prioritize work - Strong judgement, critical thinking, and decision-making skills - Solid organizational skills including time management, prioritization, and attention to detail - Knowledge of administrative procedures - Experience with audit software applications as well as Microsoft Word and Excel Licensure, Certifications, and Clearances - UPMC is an Equal Opportunity Employer/Disability/Veteran

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The purpose of this position is to lead a claims litigation team to help achieve Selective’s loss and claims expense objectives, as well as deliver excellent claims service to customers. Claims supervised are those in litigation and may involve complex and large monetary exposures. This claims leader must provide continuous training, coaching, and feedback to the members of their claims team. Must foster business partnerships with other company departments, including field agency management and inside underwriting teams. Responsibilities include fostering good relationships with independent agents. Must have expertise in commercial and personal lines, including coverage, contractual, and legal issues. Members of the team may handle both commercial and personal lines, and multiple lines of business, with large geographic territories, including multiple different states. These duties are performed consistent with company claims policies and procedures, prescribed authority, and standards of performance. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Responsibilities - Supervises, coordinates, and monitors activities of a claims litigation unit to ensure an accurate, quality product while maintaining high production standards and performance standards. - Schedules, prioritizes, and distributes workflow of litigation unit to ensure work is done in a timely fashion and all deadlines are met. - Audits procedures and controls to ensure compliance with company and statutory requirements; provides statistical data to management to ensure adherence to company policies, procedures, and state regulations. - Provides technical assistance to staff and assists them with the disposition of litigated claims with attorneys, insureds, and claimants. - Reviews completed adjustments for corrections and authorizes payments when required. - Establishes and adjusts claims reserves. - Recognizes fraudulent claims activity that would be subject to SIU referral in accordance with company guidelines and subsequent referral to law enforcement or regulatory agencies. - Reviews and implements claims audit recommendations on a continuous basis. - Reviews consumer/agency complaints; maintains a direct diary on litigated claims and an override diary on other selected claims. - Must be able to drive an automobile to travel within territory; car travel represents approximately 0-10% of employee’s time and requires a valid driver’s license. Qualifications - Excellent customer service skills. - Excellent leadership, communication, organizational, and interpersonal skills. - Must have valid state-issued driver’s license in good standing and be able to drive an automobile. - College degree preferred. - 3-5 years litigated claims experience. - 3+ years supervisory experience of technical level staff. - Prior auto claims experience preferred. Benefits - Competitive base salary. - Incentive plan eligibility at all levels. - Comprehensive health care plans. - Retirement savings plan with company match. - Discounted Employee Stock Purchase Program. - Tuition assistance and reimbursement programs. - 20 days of paid time off. Pay Range USD $108,000.00 - USD $163,000.00 /Yr. Additional Information Selective is an Equal Employment Opportunity employer. We respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions. For Massachusetts Applicants: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Health Claims Specialist at Revecore, you will bill and investigate health insurance claims to ensure maximum payment from insurance companies on behalf of our clients (hospitals and medical providers). - Investigate and research health insurance claims - Follow up on unresolved claims to facilitate payment for commercial health, Medicare, and Medicaid - Ensure maximized payments to our clients (medical providers) - Contribute to your team with various denial reports, audits, and overall support Qualifications - Experience researching and resolving claims for commercial health, Medicare, and Medicaid - Knowledge of filing correct UB04's and 1500 HCFA's with subrogation information to payers - Familiarity with billing health insurance as part of auto accidents - Experience working in EPIC - Working knowledge of Microsoft Office (Word, Excel, Outlook) - Technical proficiency to work on multiple computer screens and software applications simultaneously - Ability to maintain strong performance in a fast-paced environment with productivity metrics Requirements - A quiet, distraction-free environment to work from in your home - A secure internet connection is required - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads - Workspace area accommodates all workstation equipment and related materials - Must reside in the United States within specified states Benefits - Paid training and incentive plans - Medical, dental, vision, and life insurance benefits available from the first day of employment - Excellent work/life balance - Employee Resource Groups build community and foster a culture of belonging and inclusion - 401(k) contributions matched - Career growth opportunities - 12 paid holidays and generous paid time off