Role Description As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. - Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature - Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) - Alert Supervisor and Special Investigations Unit to potentially suspect claims - Ensure timely denial or payment of benefits in accordance with jurisdictional requirements - Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure - Negotiate claims settlements with client approval - Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition - Work collaboratively with Lodestar nurse professionals to develop and execute return to work strategies - Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome - Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced - Demonstrate technical proficiency through timely, consistent execution of best claim practices - Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues - Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions - Authorize treatment based on the practiced protocols established by statute or the Lodestar Managed Care department - Assist Lodestar clients by suggesting panel provider information in accordance with applicable state statutes - Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work Qualifications - CA License and SIP designation required - Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry - At least 3-5 years' experience handling lost time workers compensation claims required; past experience with CA jurisdiction is required - Associate in Claims (AIC) Designation or similar professional designation desired - Active license required or ability to obtain license within 90 days of employment in mandated states - Familiarity with medical terminology and/or Workers' Compensation - Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously - Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details - Strong verbal, written communication skills and customer service skills - Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint - Ability to travel for business purposes, approximately less than 10% Requirements - Lodestar is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $75,000 to $101,000. - Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.

Role Description Metro Vein Centers is seeking a detail-oriented Medical Claims Resolution Specialist to support our billing and revenue cycle operations. This role is responsible for resolving denied, underpaid, and aging insurance claims while helping ensure accurate reimbursement and timely account resolution. You’ll work directly with insurance payers, payer portals, billing systems, and internal operational teams to investigate claim issues, submit appeals, and reduce revenue delays across our growing national clinic network. The ideal candidate has prior experience in medical billing, insurance follow-up, denial resolution, or accounts receivable within a healthcare environment. Success in this role requires strong problem-solving skills, attention to detail, urgency, and the ability to manage high claim volumes while navigating complex payer guidelines. This is a fully remote role supporting Metro Vein Centers’ growing national operations. The ideal candidate is highly organized, detail-oriented, and comfortable working independently in a fast-paced, high-volume claims environment. What Your Day Looks Like - Investigating denied or underpaid medical claims - Following up with insurance payers through portals and phone communication - Reviewing payer guidelines and submitting claim appeals - Managing aging reports and prioritizing time-sensitive accounts - Reprocessing claims and updating billing information within the EMR system - Collaborating with billing, coding, and operational teams to resolve claim issues - Managing multiple claims simultaneously while maintaining productivity and accuracy standards What You’ll Do - Investigate and resolve denied, unpaid, or underpaid insurance claims - Submit timely and accurate appeals based on payer-specific guidelines and supporting documentation - Follow up on aging claims through payer portals, phone calls, and billing systems - Review claim edits, rejections, and payment discrepancies to determine resolution steps - Perform insurance re-verification and reprocess claims as needed - Post adjustments, payments, and account updates accurately within the EMR system - Maintain detailed documentation regarding claim follow-up activity and payer communication - Collaborate with internal billing, coding, and operational teams to reduce recurring denials and reimbursement delays - Support departmental productivity, quality, and turnaround time expectations What You’ll Bring - Ability to work independently and maintain productivity in a fully remote environment - Strong understanding of medical billing, claims follow-up, denial management, and insurance workflows - Knowledge of CPT, ICD-10, EOBs, payer guidelines, and medical billing terminology - Comfortable navigating payer portals, EMR systems, and healthcare billing platforms - Strong analytical and problem-solving skills with attention to detail - Ability to manage multiple claims and deadlines within a fast-paced environment - Clear written and verbal communication skills when working with payers and internal teams - Organized, self-motivated, and accountable work style Education & Experience - High school diploma or equivalent required - 2+ years of experience in medical billing, insurance follow-up, denial resolution, claims management, or healthcare revenue cycle operations required - Prior experience with surgical, specialty practice, outpatient, or procedural billing strongly preferred - Familiarity with Centricity / Athena EMR preferred - Experience reviewing appeals, denials, EOBs, and payer correspondence strongly preferred Schedule & Location - Fully remote position - Standard business hours Monday–Friday - Candidates must have reliable internet access and a distraction-free remote work environment Benefits - Medical, Dental, and Vision Insurance - 401(k) with Company Match - Paid Time Off (PTO) + Paid Company Holidays - Company-Paid Life Insurance - Short-Term Disability Insurance - Employee Assistance Program (EAP) - Career Growth & Development Opportunities Compensation Starting at $20/hour and up to $25/hour based on experience.

Credentialing Specialist Location: Pearland, TX, United States Job Description: Requisition number: 2350427 Job category: Network Management Primary location: Pearland, TX Overtime status: Non-exempt Travel: No Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Credentialing Specialist will be responsible for the credentialing and recredentialing of all employed Kelsey-Seybold physicians and contracted affiliated providers. The functions include but are not limited to initial and recredentialing applications, mailing and tracking of all applications, primary source verifications, file production and maintenance, presentation at Credentialing Committee, internal and external communication of outcome reporting, liaison with designated payors regarding the delegation of credentialing/recredentialing to Kelsey-Seybold (initial assessments, onsite audits, corrective action plans and submission of monthly reports), hospital privileges, assist with credentialing subdelegations and tracking of licensure/certification expirations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - High school diploma or equivalent - 2+ years of Credentialing experience with hospital application experience or managed care experience - Proficient: Microsoft Access, Word and Excel - Capable of sitting for extended periods of time Preferred Qualifications: - College Degree, Certification - Knowledge of AAAHC, NCQA and TDI credentialing standards, MD Staff - Academic Credentialing or Coordinator experience - Proven self starter who can work independently with minimal supervision Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Title: Auto Claims Representative Locations: Duluth, GA Kennesaw, GA Albany, GA Macon, GA Newnan, GA time type Full time job requisition id R_5330 A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims representative to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company’s claims training program for the assigned line of insurance and requires the person to: - Investigate, evaluate, and settle entry-level insurance claims - Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products - Learn and comply with Company claim handling procedures - Develop entry-level claim negotiation and settlement skills - Build skills to effectively serve the needs of agents, insureds, and others - Meet and communicate with claimants, legal counsel, and third-parties - Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment - Study, obtain, and maintain an adjuster’s license(s), if required by statute within the timeline established by the Company or legal requirements Desired Skills & Experience - Bachelor’s degree or direct equivalent experience with property/casualty claims handling - Ability to organize data, multi-task and make decisions independently - Above average communication skills (written and verbal) - Ability to write reports and compose correspondence - Ability to resolve complex issues - Ability to maintain confidentially and data security - Ability to effectively deal with a diverse group individuals - Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) - Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company’s underwriting guidelines for coverage - Continually develop product knowledge through participation in approved educational programs Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-Hybrid #IN-DNI