Role Description Join the new Bakinaw-Karna Joint Venture Team as a Temporary, Full-Time Medical Claims Processor. Become an integral part of a team dedicated to servicing the World Trade Center Health Program. In this role, you will leverage your meticulous attention to detail and commitment to accuracy in processing complex medical claims. If you’re eager to make a positive impact in our community through your administrative skills, we encourage you to apply! - Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims. Job Responsibilities - Claims Review and Processing: - Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. - Critical Analysis: - Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios. - Timely Processing: - Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers. - Issue Resolution: - Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions. - Confidentiality Maintenance: - Uphold the confidentiality of patient records and company information as per HIPAA regulations. - Detailed Record Keeping: - Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability. - Trend Monitoring: - Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting. - Audit Participation: - Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes. - Mentoring: - Mentors and trains new claims processors as needed. Qualifications - High school diploma or equivalent. - Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims. - Familiarity with ICD-10, CPT, and HCPCS coding systems. - Understanding of medical terminology, healthcare services, and insurance procedures (worker’s compensation experience is a plus). - Strong attention to detail and accuracy. - Ability to interpret and apply insurance program policies and government regulations effectively. - Excellent written and verbal communication skills. - Proficient in Microsoft Office Suite (Word, Excel, Outlook). - Capacity to work independently as well as collaboratively within a team. - Commitment to ongoing education and training in industry standards and technology advancements. - Experience with claim denial resolution and the appeals process. - Ability to efficiently manage a high volume of claims. - Customer service-oriented with strong problem-solving capabilities. - Must be flexible and have the ability to adjust to the needs of the client and changes in the program. Remote Work - Position is remote.

Role Description At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. Qualifications - High School Diploma. - Minimum of 3 years related claims experience. - Appropriate licensing and/or certification in all states in which claims are being handled. - Knowledge of accepted industry standards and practices. - Computer experience with related claims and business software. Requirements - Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims. - Interact extensively with various parties involved in the claim process to ensure effective communication and resolution. - Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process. - Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements. - Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file. - Investigate, evaluate, and resolve Auto Liability claims, applying your claims experience and analytical skills to make informed decisions and bring claims to resolution. - Work in partnership with our clients to deliver innovative solutions and enhance the claims management process. - Think critically, solve problems, plan, and prioritize activities to optimally serve clients. Benefits - Medical/dental/vision plans, which start from day one! - Life and accident insurance. - 401(K) and Roth options. - Tax-advantaged accounts (HSA, FSA). - Educational expense reimbursement. - Paid parental leave. - Digital mental health services (Talkspace). - Flexible work hours (availability varies by office and job function). - Training programs. - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing. - Charitable matching gift program. - And more...

• To analyze and process low to mid-level auto and transportation claims. • Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. • Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution. • Identifies and pursues subrogation opportunities; secures and disposes of salvage. • Communicates claim action/processing with insured, client, and agent or broker when appropriate. • Maintains professional client relations. • Performs coverage, liability, and damage analysis on all claims assignments. • Performs other duties as assigned. • Supports the organization's quality program(s).

• To analyze complex or technically difficult 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 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.