This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Claims Analyst is responsible for managing a portfolio of complex commercial insurance claims from initial investigation through resolution. This role requires strong analytical skills, sound judgment, and the ability to collaborate effectively with internal partners, external counsel, insureds, and claimants. The ideal candidate has experience handling commercial claims—such as general liability, auto liability, or professional liability—and excels in a fast‑paced, detail‑driven environment. Key Responsibilities - Claim Management & Investigation - Manage a caseload of complex commercial claims with significant exposure, ensuring each claim is handled efficiently and in accordance with company guidelines. - Conduct thorough investigations by gathering statements, reviewing contracts and documentation, interviewing involved parties, and coordinating with experts as needed. - Verify policy coverage, interpret policy language, and establish accurate and timely reserves. - Identify compensability, liability, and damages to determine claim validity and develop effective strategies for resolution. - Customer Service & Communication - Deliver exceptional customer service by maintaining proactive communication with insureds, claimants, attorneys, and internal stakeholders. - Provide timely updates, respond to inquiries promptly, and ensure all parties remain informed throughout the claim lifecycle. - Resolution & Negotiation - Develop and execute strategic claim resolution plans, collaborating with coverage experts, legal partners, and internal teams. - Negotiate settlements, manage complex litigation when needed, and authorize payments within designated authority levels. - Identify potential subrogation or fraud opportunities and refer to appropriate internal departments. - Compliance & Documentation - Ensure claims are handled in alignment with regulatory requirements and internal protocols. - Maintain accurate, well‑documented claim files that meet quality and compliance standards. - Prepare summaries for leadership regarding high‑risk claims or significant exposures. - Financial Management - Establish and manage claim budgets, oversee expenses, and ensure resources are used efficiently. - Support timely and accurate billing, expense approval, and closure of claims. Qualifications - Minimum 1–3 years of commercial claims experience - Must have medical malpractice experience - Strong understanding of policy interpretation, liability assessment, and claim negotiation. - Excellent communication, analytical, and organizational skills. Requirements - Intermediate Level - This is a Contract position based out of Chicago, IL. Benefits - The pay range for this position is $24.00 - $28.84/hr. - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Application Deadline This position is anticipated to close on Mar 24, 2026.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are currently seeking a Medical Claims Processor to join our team in Plano, Texas (US-TX), United States (US). In this role, the candidate will be responsible for: - Processing of Professional claim forms files by provider - Reviewing the policies and benefits - Complying with company regulations regarding HIPAA, confidentiality, and PHI - Abiding by the timelines to complete compliance training of NTT Data/Client - Working independently to research, review and act on the claims - Prioritizing work and adjudicating claims as per turnaround time/SLAs - Ensuring claims are adjudicated as per clients defined workflows, guidelines - Sustaining and meeting the client productivity/quality targets to avoid penalties - Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA - Timely response and resolution of claims received via emails as priority work - Correctly calculating claims payable amount using applicable methodology/fee schedule Qualifications - 3 year(s) hands-on experience in Healthcare Claims Processing - 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools - High school diploma or GED - Previously performing – in P&Q work environment; work from queue; remotely - Key board skills and computer familiarity - Toggling back and forth between screens/can you navigate multiple systems - Working knowledge of MS office products – Outlook, MS Word and MS-Excel Requirements - Amisys - Ability to communicate (oral/written) effectively in a professional office setting - Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities - Time management with the ability to cope in a complex, changing environment Company Description NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Sentara Health Plans is hiring a Member Appeals and Grievances Coordinator- Remote in Virginia! - Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. - Works closely with the Plan's Medical Directors who are responsible for all decisions regarding clinical appeals/grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances. Qualifications - HS - High School Grad or Equivalent (REQUIRED) - Managed Care - 3 years (REQUIRED) - Previous member appeals and grievances experience preferred Requirements - None required for Certification/Licensure Benefits - Medical, Dental, Vision plans - Adoption, Fertility and Surrogacy Reimbursement up to $10,000 - Paid Time Off and Sick Leave - Paid Parental & Family Caregiver Leave - Emergency Backup Care - Long-Term, Short-Term Disability, and Critical Illness plans - Life Insurance - 401k/403B with Employer Match - Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education - Student Debt Pay Down – $10,000 - Reimbursement for certifications and free access to complete CEUs and professional development - Pet Insurance - Legal Resources Plan - Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Prior Authorization Referrals & Notifications Representative with Banner Plans & Networks, you will call upon your medical office and/or medical prior authorizations experience to help members and work as part of a larger team. You will perform data entry, review regulatory guidelines, and answer a phone queue on a rotating basis. Your work shifts will be Monday-Friday with a Saturday rotation every 4 weeks. Your work location will be remote. For compliance, for this role, you must live within 30 minutes of driving distance to Banner Mesa Corporate Center in Mesa, Arizona or Banner Corporate Center in Tucson, Arizona. Under the direction of the Prior Authorization leader, the primary purpose of this position is to perform non-clinical functions related to Prior Authorization requests and notifications. Core Functions - Review all requests for authorization for eligibility, expiration date, accuracy and completeness. - Data enters all member information in documentation database using approved notification templates to meet regulatory requirements. - Enters all approvals, extensions, downgrades, denials/partial denials/service reductions into the computer systems. - Performs other related duties, consistent with the goals and qualifications of this position. - Works cooperatively with both internal and external customers in assisting members and providers with referral related issues. - Performs other related duties as assigned, which are consistent with the goals and qualifications of this position. - This position performs all related duties in a manner that is consistent with and in support of the organization's mission, vision, values and goals. - This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization. Qualifications - Strong knowledge of medical terminology. - Knowledge of HMO systems. - Experience working with the medical referral/denial process (normally gained through two years of experience in a medical office or clinical environment). - Ability to work independently. - Ability to work with database systems. - Good working knowledge of PC applications. Preferred Qualifications - Additional related education and/or experience preferred. EEO Statement EEO/Disabled/Veterans. Our organization supports a drug-free work environment. Privacy Policy Privacy Policy