Job Closed
This listing is no longer active.
At ScionHealth, we empower our caregivers to do what they do best — provide compassionate, high-quality patient care. We are committed to fostering a culture of service excellence, teamwork, and continuous improvement. Our employees are supported, valued, and given opportunities to grow while making a meaningful impact in the communities we serve.
Eligibility and Benefits Specialist
Location
United States
Posted
94 days ago
Salary
$21 - $31 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Eligibility and Benefits Specialist
Kindred Healthcare
Role Description The Eligibility & Benefits Specialist plays a crucial role in ensuring patients can access the care they need by verifying insurance benefits and eligibility before admission. This role demands accuracy, strong organizational skills, and a commitment to operational excellence. As a key member of the Central Access and Authorizations Team (CAAT), the Eligibility & Benefits Specialist actively contributes to quality improvement, problem solving, and productivity initiatives within an interdisciplinary model. - Serves as key team member of the new Central Access and Authorizations Team (CAAT), focused exclusively on eligibility and benefit verification. - Actively works a queue of patient referrals and references multiple sites to conduct E&B checks, Medicare status and entitlement, citizenship status, and any worker’s compensation details. - Accesses Medicare Common Working files and calculates Medicare days. - Accesses other insurance verification portals to determine benefits and eligibility coverage. - Verifies patient insurance coverage and eligibility for admission services with primary and secondary payors. - May assist in calling hospital (i.e., case management, nursing, etc.) for admissions dates and SNF dates. - May assist with the coordination of benefits, including outreach to patient and/or family to obtain and verify benefits information. - Obtains revocation letters where needed and appropriate to secure proper funding and reimbursement. - Review return to acute patients / interrupted stay patients prior to admission and apply the interrupted stay rules where applicable. - Reviews and documents benefit details, including deductibles, co-pays, co-insurance, and out-of-pocket maximums. - Identifies coverage limits, restrictions, benefit caps, and authorization requirements. - Confirms policy effective dates, termination dates, and coordination of benefits when applicable. - Accurately enters benefits data into the appropriate systems in a timely manner. - Communicates benefit details and potential patient responsibility to appropriate team members. - Participates in continuing education/ professional development activities. - Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them. - Learns and has a full understanding of scheduling and pre-register routines in Meditech and any other referral platform utilized by the CAAT team (i.e., Referral Manager). - And ad hoc duties as assigned that fall within scope of the CAAT team. Qualifications - High School Diploma or GED required, Associates or Bachelors Degree preferred. - Preference towards a healthcare related area of concentration or be a licensed health care provider or equivalent experience. - Certified Benefits Specialist, preferred. - In lieu of a healthcare related field certificate, 2+ years of experience performing the functions of the role will be accepted. Requirements - Team player, able to communicate and demonstrate a professional image/attitude. - Excellent oral and written communication and interpersonal skills. - Strong computer skills with both standard and proprietary applications. - Data entry with attention to detail. - Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. - Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others. - Adheres to policies and practices of ScionHealth. - Must read, write, and speak fluent English. - Must have good and regular attendance. Benefits - Comprehensive benefits package for benefit-eligible employees that includes: - Medical - Dental - Vision - 401(k) - FSA/HSA - Life Insurance - Paid Time Off - Wellness Experience - Experience in a healthcare-related area is strongly preferred. - Ideal candidates will be highly detail oriented, have benefits, medical terminology, revenue cycle management, knowledge of post-acute care industry, and long-term acute care hospital experience.
Job Requirements
- High School Diploma or GED required, Associates or Bachelors Degree preferred.
- Preference towards a healthcare related area of concentration or be a licensed health care provider or equivalent experience.
- Certified Benefits Specialist, preferred.
- In lieu of a healthcare related field certificate, 2+ years of experience performing the functions of the role will be accepted.
- Team player, able to communicate and demonstrate a professional image/attitude.
- Excellent oral and written communication and interpersonal skills.
- Strong computer skills with both standard and proprietary applications.
- Data entry with attention to detail.
- Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
- Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others.
- Adheres to policies and practices of ScionHealth.
- Must read, write, and speak fluent English.
- Must have good and regular attendance.
Benefits
- Comprehensive benefits package for benefit-eligible employees that includes:
- Medical
- Dental
- Vision
- 401(k)
- FSA/HSA
- Life Insurance
- Paid Time Off
- Wellness
- Experience
- Experience in a healthcare-related area is strongly preferred.
- Ideal candidates will be highly detail oriented, have benefits, medical terminology, revenue cycle management, knowledge of post-acute care industry, and long-term acute care hospital experience.
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
Anticipated End Date: 2026-03-18 Position Title: Benefits Investigator - Specialty Pharmacy Job Description: Pharmacy Customer Associate II BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey. LOCATION: This is a virtual position (after training). You must be within a commutable distance of one of our offices (for training and meetings). HOURS: To be determined, but in the area of 10:30am-7:00pm PST (11:30am-8:00pm MST; 12:30pm-9:00pm CST; 1:30pm-10:00pm EST). TRAINING: 5 Weeks, training will be conducted during regular business hours, 8:00am-5:00pm or 9:00am-6:00pm. Onsite: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in-person interaction, communication, and immediate support. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Pharmacy Techs welcome! The Pharmacy Customer Associate II is responsible for responding to basic customer questions via telephone and written correspondence regarding pharmacy retail and mail order prescriptions. Primary responsibilities include, but are not limited to: - Develops and maintains positive customer relations and coordinates with functions within the company to ensure customer requests are handled and resolved appropriately and in a timely manner. - Interacts with internal and external customers (could include subscribers, providers, group or benefit administrators, physician offices, third party representatives, and other Blue Cross Plans) to provide claims, customer service, and/or membership support. - Completes necessary research to provide proactive, thorough solutions. - Displays ownership of service requests ensuring high quality resolution and follow-thru. - Supports and guides the customer with their personal options and decisions and helps the customer become knowledgeable and confident about using technology, tools and resources available to them. Required Qualifications - Requires a HS diploma or equivalent and previous experience in an automated customer service environment; or any combination of education and experience which would provide an equivalent background. Preferred Qualifications - 2+ years of Specialty Pharmacy experience strongly preferred. - Certified or Registered Pharmacy Technician strongly preferred. - Benefits investigation experience preferred. - Experience processing and interpreting pharmacy claims preferred. - Experience working with a variety of therapy types is very helpful. - Strong critical thinking skills are a must for this position. *For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $18.66-27.98/hr. Location(s): Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CUS > Care Reps Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
What’s Under the Hood DriveTime Family of Brands includes SilverRock, which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative services encompassing everything from GAP coverage to vehicle theft and GPS tracking to dealership fleet management. Our ancillary product expertise is proven with over 1 million service contracts, products, and warranties, and over $300 million in claims. That’s Nice, But What’s the Job? In short, the Ancillary Specialist will review and adjudicate claims for our GAP product. This includes verifying multiple documents to ensure the correct amount is applied to the loan or returned to the customer.So What Kind of Folks Are We Looking for? - Passionate and goal-oriented. We are looking for someone that is enthusiastic about their career and is passionate about meeting and exceeding their goals. - Excellent verbal and written communication skills. The ability to talk and write with confidence, charisma, and competence to a wide variety of audiences. - Agile in a fast-paced environment. We move, and we move quickly. Thriving in and contributing to an environment that never stops is a must. - Plays well with others. You will be working in a high-functioning team environment. We work together and we win together. - Works well in a time crunch. There will be multiple time-sensitive requirements and you will need the ability to meet deliverable due dates. - Fantastic problem solver! Some calls will be challenging. Your goal is not only to find the problem but more importantly, find the solution. - Positive emotional resilience. This is an environment where you will be faced with challenging calls on a daily basis. We want to make sure you have the ability to rise past them while maintaining an optimistic attitude. The Specifics. - High School diploma required, Bachelor or Associate degree is preferred. - Knowledge of GAP and/or Insurance Claims background preferred. So What About the Perks? Perks matter - Work From Home. Feel free to rock the casual wear while still being camera ready. You will be working from your home office (in an approved city & state) and make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet. - Medical, dental, and vision, oh my! DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage. - But Wait, There’s More. 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few. - Growth Opportunities. You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year. - Tuition Reimbursement. We’re as passionate about your professional development as you are. With that, we’ll put our money where our mouth is. - Wellness Program. Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities! - Gratitude is Green. We offer competitive pay across the organization, because, well… money matters! - Consistent Work Schedule. You’ll get a set schedule Monday through Friday, with rotating Saturdays! With that, we do ask for some flexibility and overtime as needed. - Game Room. Gimme a break – no, not a Kit Kat ad but we do have a ping-pong table, a pool table and other games if you ever need a break in your day. - In-House Gym. We want our employees to be the best versions of themselves. So come early, take a break in your day, or finish strong with a workout! - Enjoy Social Events? Bring it on. Rally with your team for festive gatherings, team competitions or just to hang out! - We Care and Value YOU! Feel the love and let us treat you to company outings, personal rewards, amazing prizes & much more! - Paid Time Off. Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn! Anything Else? Absolutely. DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we’ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don’t forget Phoenix Business Journal Healthiest Employers (okay, we’ll stop there)! Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer. And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!
SVP, Claims – Commercial and E&S/Specialty
Nationwide InsuranceNationwide Insurance, founded in 1926, is one of the oldest and most well-respected insurance agencies in the United States. Headquartered in Columbus, Ohio, where more than 10,000
If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Please Note: This position is open to working remotely in the United States. #LI-RR1 Job Description Summary Do you enjoy making an impact on the Claims and Customer Experience strategy of a Fortune 100 insurance company? Are you an expert in P&C Commercial and Excess & Surplus Claims? If you thrive in an environment where you can interface with executive leaders, associates, and industry partners to achieve financial goals, strategic vision and build industry expertise, then we want to hear from you! You will be the senior executive responsible for all Claims functions supporting the Commercial and Excess/Surplus & Specialty lines of business at Nationwide Insurance. Functional areas include Casualty Claims, Property Claims, Financial Lines Claims, Farm & Agribusiness Claims, Indemnity Claims, and Claims Operations. These areas partner closely with P&C Commercial and E&S/S divisions accountable for profitable management of an $8.7B book of diversified business. You’ll be reporting to the President of Nationwide P&C Commercial and Excess Surplus & Specialty, and working with Planning Unit, Operations and Corporate Support functional areas (Technology, Actuarial, Finance, Reserving, Legal, Compliance, etc). Your primary goal is developing claims execution and transformation strategy. Job Description Key Responsibilities: - Strategic thought leader of overall Standard Commercial & E&S/Specialty Claims, including accountability for identifying and developing plans to achieve long-term goals of the company. - Oversees the organization’s Standard Commercial and E&S/Specialty Claims and Indemnity functions. Serves as the Chief Claims Officer with highest level approval authority and accountable for delivering industry leading risk management and claims expertise. - Drive increased effectiveness of servicing and process operations, including developing new procedures and systems, and enhancing existing processes to achieve optimal efficiency while minimizing operational risk. Serve as the champion of the “Voice of the Customer” and influence the design of products and services that delight our members value. - Responsible for the key areas of: strategic contingency planning; organizing the way the claims organization allocates resources, assigns tasks, and goes about accomplishing goals; establishing claims and indemnity policies, programs and annual business goals; continually monitoring performance and correcting situations in which the goals and objectives are not being met. - Oversees executive and associate management functions. Including performance management, salary planning and administration, assessing and development of talent to ensure associates are appropriately skilled for future business state model, hiring and placement, and ensuring a strong performance driven culture. May perform other responsibilities as assigned. Reporting Relationships: Reports to President, E&S Specialty and Commercial Lines Typical Skills and Experiences: Education: Undergraduate degree required in Business, Finance, Insurance, Economics, Statistics, or related field; graduate degree preferred. Licenses/Certifications/Designations: CPCU and E&S/S industry specific designations are strongly preferred. Experience: 20+ Years of property & casualty claims, business operations, regulatory, analytics, and budget management is preferred. Knowledge, Abilities and Skills: Expert knowledge of specialty lines insurance underwriting, risk and regulatory environment. Technical underwriting, product and insurance carrier value chain expertise. Advanced analytics, modeling and data fluency. Strategic agility and vision management. Executive presence, communication and command. Strong written and verbal communication, negotiation, influencing and interpersonal skills. Exercise independent judgment and effectively make sound business decisions. Creatively resolve unique and challenging business problems. Other criteria, including leadership skills, competencies and experiences may take precedence. Staffing exceptions to the above must be approved by the hiring manager’s leader and Human Resource Business Partner. Values: Regularly and consistently demonstrates the Nationwide Values. Job Conditions: Overtime Eligibility: Exempt (Not Eligible) Working Conditions: Normal office environment; light travel also required. ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. We currently anticipate accepting applications until 04/17/2026. However, we encourage early submissions, as the posting may close sooner if a strong candidate slate is identified before the deadline. Benefits We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here. Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law. This position could be filled within any of the lower 48 U.S. states. #claims Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247. For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf NOTE TO EMPLOYMENT AGENCIES: We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means. Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule. The national salary range for SVP, Claims - Commercial and E&S/Specialty : $275,250.00-$458,750.00 The expected starting salary range for SVP, Claims - Commercial and E&S/Specialty : $275,250.00-$458,750.00
• To analyze complex or technically difficult general liability claims to determine benefits due. • To work with high exposure claims involving litigation and rehabilitation. • To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements. • To identify subrogation of claims and negotiate settlements. • Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.



