• Determine compensability and/or coverage issues for loss time workers' compensation claims • Effectively manage a caseload of loss time claims from numerous jurisdictions • Negotiate and direct settlements under management's review • Gather medical and factual evidence to determine compensability • Direct outside investigation and handle litigation files within given authority • Coordinate and maintain contact with claimants and/or their attorneys, outside investigators, and rehabilitation personnel as well as routine contact with insureds, account liaisons and medical providers

• Determine compensability and/or coverage issues for loss time workers' compensation claims • Effectively manage a caseload of loss time claims from numerous jurisdictions • Negotiate and direct settlements under management's review • Gather medical and factual evidence to determine compensability • Direct outside investigation and handle litigation files within given authority • Coordinate and maintain contact with claimants and/or their attorneys, outside investigators, and rehabilitation personnel as well as routine contact with insureds, account liaisons and medical providers

Role Description We seek a meticulous and customer-focused individual to join our team as a Claims Processor. This role requires a combination of research acumen, attention to detail, and exceptional customer service skills. As a key member of our organization, you will be responsible for: - Processing medical claims accurately. - Conducting thorough audits to ensure compliance with regulations and policies. - Providing excellent service to our clients and healthcare providers. Key Responsibilities - Review and process medical claims submitted by members or providers promptly and accurately. - Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. - Ensure compliance with insurance policies and industry standards. - Investigate and resolve any discrepancies or issues related to claim submissions. - Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. - Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. - Research complex medical billing and coding issues to support claims processing and audit activities. - Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. - Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. - Serve as members' primary point of contact regarding claims inquiries and resolution. - Respond promptly to customer inquiries and concerns with professionalism and empathy. - Collaborate with cross-functional teams to address customer issues and ensure timely resolution. Qualifications - Strong knowledge of medical terminology, medical coding, and insurance billing practices. - Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines. - Exceptional attention to detail and accuracy in data entry and documentation. - Effective verbal and written communication skills with a customer-centric approach. - Ability to work independently and collaboratively in a fast-paced, deadline-driven environment. - Excellent verbal, written and interpersonal communication skills. - Must be a self-motivator and self-starter. - Exceptional listening and analytical skills. - Solid time management skills. - Ability to multitask and successfully operate in a fast-paced, team environment. - Must adapt well to change and successfully set and adjust priorities as needed. Education/Experience - High School Diploma or equivalent. - Proven experience in medical claims processing and healthcare reimbursement. Technical Knowledge - SalesForce Experience. - Google Suite Experience. - Claims Management Software experience. Benefits - Competitive salary and benefits package. - Dynamic and innovative work environment. - Opportunities for professional growth and development. - Remote work.

Role Description The VA Claims Specialist will investigate 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 essential for success Qualifications - 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 - Organizational skills while multi-tasking - Critical thinking and problem-solving skills - Clear communication skills, both verbally and in writing - Investigative mindset - Experience in a professional office environment - General understanding of insurance billing (a plus, but not required) - Experience with billing and appealing denied health claims (a plus, but not required) Requirements - A private, distraction-free environment to work within your home - On-Camera Presence: Being on camera is essential for building trust and collaboration - A secure internet connection - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads - Workspace must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset) - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check Benefits - Paid training and incentive plans - Medical, dental, vision, and life insurance benefits available on day 1 - 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