Claims Examiner Jobs

Job Title: Commercial Auto Claims Examiner Company: Location: Golden, CO Description: Safeco is a Fortune 500, Washington State corporation with headquarters in Seattle. We have over 8,000 employees and have been in business since 1923 serving the insurance needs of drivers, homeowners and small to mid-sized businesses. Our business helps people protect what they value and deal with the unexpected. Responsibilities: Handles inside claims requiring substantial investigation to determine coverage, liability and extent of physical damage claims. Negotiates resolution of claim based on facts and legal climate where claims occurred. Documents correspondence on claim and prepares agenda for resolving issues. Qualifications: BA/BS Degree or equivalent work experience handling liability claims. Excellent interpersonal, customer service skills. Effective written and verbal communication skills. Prior experience with personal computers, knowledge of MS Office software. Prior experience in a fast-paced, multiple priority, customer-focused environment is preferred. Prior management experience a plus. No relocation assistance provided. Position is open to Golden-CO, Richardson-TX, St. Louis-MO, Indianapolis-IN and Atlanta-GA office. To Apply for this position, please CLICK HERE

Job Title: Traveling Medical Insurance Claims Examiners & Customer Service Reps Wanted Company: Location: Los Angeles , CA Description: Begin your Journey to the Lifestyle you always wanted at Perot Systems Business Process Solutions, Inc. We provide claims solutions to the giants of the Healthcare Industry. Perot Systems (you knew us as CSRG) has immediate openings for local (in state) and traveling (out of state) Medical Claims Examiners and Customer Service Representatives. Qualified candidates must possess a minimum of two years experience processing medical health insurance claims within an Insurance company, Managed Care company, Call Center or TPA environment. Knowledge of CPT, HCPC and ICD-9 codes and Medical Terminology is required. All traveling positions require a commitment to be away from home for a minimum of 6 weeks at a time. Join our team and enjoy the World-Class Benefits only an Industry Leader can provide. We offer an improved set of benefits, which include paid time off (vacation, personal and sick time) plus excellent health insurance options and employee investment plans. All out of state traveling positions offer paid lodging and expenses plus an additional daily per diem to cover meals and incidentals. After 6-8 weeks on a travel project, you will be granted a 1 week rotation to fly home - all expenses paid. All candidates must be legally entitled to work in the United States and immediately available to begin work in the location specified. Perot Systems is proud to be an Equal Opportunity Employer. For immediate consideration, please e-mail your resume to PSC- Register to View or fax your resume to Register to View . Visit our website at http://www.perotsystems

Job Title: Claims Examiner Company: UnitedHealth Group Location: Plano, TX Description: Job Category: Claims Reference Code: PLTAPlano Position Type: Claims Examiner Job Description: UnitedHealth Group At UnitedHealth Group, we are a healthy business in more ways than one. We are a Fortune 100 company identified as the first or second most admired company in the health care industry by rankings published in Fortune magazine since 1995. We also have the privilege each day " directly or indirectly " to make a significant difference in someone's life. Sound like a rare combination? It is. Join us and you'll be inspired to discover your own mix of professional advantages and personal rewards. Job Requirements: Primary Responsibilities: Adjudicate claims for specified account(s) as assigned by Claims Management based on appropriate goals for an Examiner Level 1. Authorizes the appropriate payment or refers claims to investigators for further review. Maintains production and quality within assigned limits as indicated by College Claims Team Lead and College Claims Supervisor. Responsible for maintaining the appropriate follow up and closure of all pended claims for assigned schools. Review, signoff and return audit errors within 24 hours Complete claims issue queue for each assigned school in 24 hours. Moderate work experience within own function. Some work is completed without established procedures. Basic tasks are completed without review by others. Supervision/guidance is required for higher level tasks. Other duties as assigned by management. Job Skills: Qualifications: High school education or equivalent experience required. 1+ years experience in claims adjudication is required. Strong knowledge of medical terminology, CPT codes and ICD-9 codes. Previous healthcare experience working for an insurance company is required. Strong understanding of medical claims processing (adjudication) using a windows-based system. Ability to read and interpret health insurance policies and answer coverage questions. Computer proficiency in a windows-based environment. Strong computer keyboarding skills, minimum typing speed of 40 wpm. 10 key by touch. Excellent oral and written communication skills. Strong interpersonal skills. Strong problem solving, including organizational and prioritization skills. Ability to work independently as well as part of a team. Ability to work in a fast paced environment and manage multiple priorities. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.

Job Title: Sr. Field Property Claims Examiner Company: Safeco Insurance Location: Baltimore, MD Description: Safeco Insurance , headquartered in Seattle, WA is an industry leader in Property and Casualty products. We employ approximately 7,000 people in several locations across the country. Safeco is a Fortune 500 company traded on the NYSE (SAF). We pride ourselves on our unparalleled commitment to providing outstanding claims service to our customers. Safeco is dedicated to community and values a diverse workforce. Position: Sr. Property Claims Examiner Location: Baltimore, MD As a Sr. Claims Examiner, you will: Use your strong decision-making skills to investigate and maintain Personal Lines Homeowner claims Showcase your analytical skills to determine coverage, investigate and estimate property damage and settle claims from start to finish Use your strong communication skills to secure information and educate the customer Strengthen your multi-tasking skills in a fast-paced environment If you are an individual with a BA/BS degree, then we are especially interested in speaking with you! Are you experienced in handling field property claims? If you are ready to let your excellent interpersonal and customer service skills move you forward in a great career, then we would like to speak with you. We seek an individual with effective written and verbal communication skills, and prior experience with personal computers, including knowledge of MS Office software. We seek an individual with at least 2 years prior Xactimate and estimate experience, and prior Commercial Claims experience is a plus. If you are an individual who can work independently and has the skills as stated to be a successful Field-Property Claims Examiner, apply now! This is a telecommuter position; however, you must reside within the territory. The territory covers the Baltimore Metro area plus an area that extends south to the Upper Marlboro, Maryland area. The individual must live in the Baltimore Metro area. No relocation assistance is provided.

Job Title: Healthcare Claims Examiner/CSR reps needed! Company: Location: Uniontown, OH Description: A growing healthcare plan company is seeking claims examiners and customer service representatives. CLAIMS EXAMINER: Will accurately process claims according to plan provisions and corporate policies and procedures. Initiates requests for additional information needed to make a benefit determination. Follow standards for file notation. Comply with all regulatory prompt payment regulations. Bring issues to the supervisor's attention. Provide backup in other areas, based on business needs. Follow HIPAA Guidelines, Rules, and Regulations. Hours are M-F, 8:00AM-4:30PM. $12/hr with great benefits! Must have at least 1 year experience in this role. ----------------------------------------------------------------------------------------------------------------------------- CUSTOMER SERVICE REPRESENTATIVE: Provide quality customer service to assigned membership and providers. Respond to all communications received in a timely and professional manner. Educate members about their healthcare benefits and problem resolution processes as needed. Resolve claim issues or concerns that may arise, including the following: *Initiate requests for stop payments, re-issues, and/or check forgery *Initiate recalculation requests after verifying that benefits were mis-paid *Forward additional information to supervisors for distribution to the staff Bring issues to the supervisor's attention Provide backup in other areas, based on business needs. Follow HIPAA Guidelines, Rules, and Regulations. Other duties as assigned. Hours are M-F, 8:00-4:30. $10/hr with great benefits! Must have at least 6 months prior experience in this role.

Job Title: Inside Catastrophe Claims Examiner Company: Location: Richardson, TX Description: Safeco Insurance, headquartered in Seattle, WA is an industry leader in Property and Casualty products. We employ approximately 7,000 people in several locations across the country. Safeco is a Fortune 500 company traded on the NYSE (SAF). We pride ourselves on our unparalleled commitment to providing outstanding claims service to our customers. Safeco is dedicated to community and values a diverse workforce. We have several inside desk claims examiner opportunities in our National Catastrophe Claims team. We are looking for both experienced property claims examiners and entry-level candidates with 1-2 yrs of customer service experience looking for their first great career! As an Inside Catastrophe Claims Examiner, you will be responsible for investigating and adjusting home property losses and non-structural damage claims. Other responsibilities include: Identify coverage issues and policy revisions Correctly interpret and apply the principles of replacement cost value versus actual cash value Coordinate field investigation and outside resources and partner with field examiners in investigating, documenting, and assessing damage. Identify and document subrogation issues Identify and document origin and cause of loss Understand and evaluate estimates within the scope of the damages If you have a desire to help others, have a positive and enthusiastic attitude, and possess strong decision making skills, come be a part of our growth! Qualifications Bachelors Degree plus 1-2 yrs customer service experience; or equivalent work experience handling liability claims. Proficient in file management of moderate auto and property claims from a desk. Experience with multi-line losses involving moderate dwelling damages, SIU issues, etc. Capable of handling moderate structural losses (fire, weather claims with structural damage, etc.) contents, stock and inland marine. Knowledge of HVAC, electrical, plumbing and building codes preferred. Ability to interpret reports from business alliances to determine whether items can be repaired or need replacing Excellent time management and communication skills Strong communication, analytical and decision making skills Strong experience with Microsoft Office software Desire to learn and develop professionally Prior experience in a fast-paced, multiple priority, customer-focused environment Overtime is expected in this position, given the nature of a catastrophe operation, roughly 25% We offer a fully paid 3 week training program during which you will receive a variety of computer based and classroom training focused on developing core skills and knowledge in liability investigation, analysis, and evaluation. To apply, please visit our web-site at www.safeco.com and job #3765. To Apply for this position, please CLICK HERE

Job Title: Claims Examiner Company: HealthPlan Services Location: Dallas, TX Description: CLAIMS ADJUSTER Job Title Level 1 (Trainee) Level 2 Primary Function Investigates, analyzes, and determines extent of plan's liability concerning medical, dental, vision, pharmacy, and/or disability claims. Calculates benefit payments and approves payment of claims. Responsibilities include: Understanding of claims processing guidelines, benefit structure, system procedures, and miscellaneous guidelines. Calculate benefits and approve payment of claims. Refer questionable claims to team lead. Ability to work in ABPA's ETK system or comparable system by creating, updating and resolving logs. Identify potential problems/trends in processes to be escalated for management review. Identify potential problems and possible solutions for process improvement. Create, update and resolve logs in ABPA Encounter Tracking Systems or comparable system or its counterpart. Must meet the departments’ quality and production standards for this job, as provided on the work standards grid. In addition to level 1 responsibilities: Calculates overpayments and underpayments and approves payment of adjustments. Has strong understanding of claims processing guidelines, benefit structure, system procedures and miscellaneous guidelines. Adjudication of complicated claims and approves payment of claims. Must meet the departments’ quality and production standards for this job, as provided on the work standards grid. Minimum Education & Experience HS or GED. Healthcare background/previous experience preferred. Must have worked in Level 1 position for a minimum of 12 months. Must meet all level 2 qualifications, on average, during the previous 12 month period. Mental/Visual concentration or Manual Dexterity Requires normal concentration easily learned simple movements. Computer Operations Must be PC literate. Working knowledge of HCFA, CPT, ICD9, HCPCS and other medical coding protocols. Data entry and 10-key skills required. Proficient in claims systems. Testing Requirements ABPA’s Pre-employment test for new hires to ABPA Typing 10-key. Claims Test. Physical Work Environment Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements. May be subject to interruptions. May be required to lift a maximum of 25 lbs. Must be able to have flexible work schedule when workflow requires. Meets established attendance and punctuality guidelines. COMPETENCIES Customer Focus Understand customer needs, both internal and external, and looks for opportunities to provide the highest quality service Quality Focus Maintains appropriate documentation Works with other employees/departments to ensure timely and quality service Must meet the department’s quality and production standards for this job. Analysis Average analytical/problem solving skills Average research skills Mathematical proficiency required. Planning Solid organizational skills Ability to prioritize and multi-task. Communication Solid written, verbal and presentation skills Listens actively Communicates effectively with participants, co-workers, and vendors. Interpersonal Relations Assists participants, co-workers, and vendors in a friendly, courteous, and professional manner. Uses courtesy in communication and working with others. Works with other employees/departments to ensure timely and quality service Patience and rapport with others required. Teamwork Works well in a team environment with minimal supervision Contributes to team tactics to meet defined goals. Supports a work environment that is conducive to team productivity. Accepts team decisions and works toward implementation. Positive Attitude Highly motivated Demonstrates flexibility and resilience when faced with multiple demands, shifting priorities, ambiguity and rapid change Integrity Approaches all business decisions and actions guided by sound personal and professional beliefs. High level of credibility and confidentiality. Earns trust by dealing honestly and following through on commitments Core Values To be the most respected and sought after benefits administrator We value relationships Understand customer needs, both internal and external. Actively seeks opportunities to strengthen work relations, both internal and external. We meet our commitments Earn trust by dealing honestly and following through on commitments Performs routine follow-up with co-workers to ensure commitments are being met. We expect and deliver quality Looks for opportunities to improve the reliability and quality of our services. Takes time to ensure that expectations are clearly defined. Works with other employees/departments to ensure timely and quality service are delivered, taking ownership for the end product. We treat people with fairness and respect Assists participants, co-workers, clients, employers and vendors in a friendly, courteous, and professional manner. Uses courtesy in communication with others. Demonstrates patience and rapport with others. Assists customers and co-workers willingly. We conduct our selves with discipline and integrity Approaches all business decisions and actions guided by sound personal and professional beliefs and ethics. Maintains confidentiality when necessary. Takes personal responsibility for communications and actions, even when confronted with difficult challenges. Takes appropriate care in the custody and use of customer and company assets We provide an environment that promotes growth and success · Assists coworkers by providing positive feedback, encouragement and coaching. · Openly shares knowledge that would help co-workers in their jobs or personal development. · Supports team success above personal success.

Job Title: Medicare Claims Examiner Company: Phoenix Health Plan and Abrazo Advantage Health Plan Location: Phoenix, AZ Description: Department: Claims Processing Schedule: Full-time Shift: Day Shift Hours: 8-5 M-F Job Description: High School/GED Position Summary: Support the Claims Department by processing Medicare claims for Abrazo Advantage Health Plan (AAHP). This position will entail processing, adjusting, and reviewing all claim types for payment at the production, quality and timeliness levels determined appropriate. In addition, this position will answer provider calls and assist Member Services with claims related issues from Membership inquiries. Primary Duties: Accurately and efficiently processes, adjusts, edits and refunds all assigned claim types for payment in accordance with AAHP standards. Accurately and efficiently pends provider claims for later resolution in accordance with AAHP. Monitors the number of outstanding pended claims and adjudicates correctly within timeframes established by department policies and procedures. Correctly denies payment of provider claims that do not meet submission guidelines as established in AAHP policies and operating procedures. Correctly explains denials on all claims not submitted in the correct format or without required documentation. Researches, investigates, and adjusts complex claims identified from telephone calls, correspondence submitted by providers and other parties, and those associated with the formal grievance process. Proficiently adjusts any claim processed by self or other analysts. Seeks technical assistance and guidance in a timely fashion from management as necessary after first consulting the Processing Manual or other claim processing reference material. Prepares for and participates in audits and reviews performed by CMS. Responds to telephone customer inquiries within the standards set by AAHP. Consistently keeps commitments to providers by returning telephone calls and making adjustments as promised. Works with Member Services on claims related issues from membership inquiries. Identifies and brings to the attention of management those claims considered to be unusual in terms of dollar amount, provider/service type, dates and/or location of service, member eligibility or that do not meet or appropriately addressed by department policies and procedures. Other duties as assigned Minimum Education: High School Diploma or GED Preferred Education: 2 year associates degree preferred Minimum Experience: 3 years processing Medicare claims Preferred Experience: 5 years processing Medicare claims with some experience in customer service _______________ We are located on the corner of 16th St & Northern Ave in North Phoenix. You must apply online. Feel free to visit our benefits website at: www.abrazo.benergy.com User id = abrazo Password = benefits

Job Title: Claims Examiner Company: Chubb Group of Insurance Location: Simsbury, CT Description: For more than 125 years, the Chubb Group of Insurance Companies has been delivering exceptional property and casualty insurance products and services to businesses and individuals around the world. Today, we are the 11th largest property and casualty insurer in the United States and have a worldwide network of some 120 offices in 28 countries staffed by 10,600 employees. The Chubb Corporation reported $50.6 billion in assets and $14.1 billion in revenues in 2007. According to Fortune magazine, Chubb is the 176th largest U.S.-based corporation. The magazine also includes Chubb in its list of “America’s Most Admired Companies.” Forbes listed Chubb as one of America’s 400 Best Big Companies. The Chubb Personal Insurance (CPI) segment offers products for individuals with large homes and valuable possessions. Check out our references! We insure 258 of the top 500 CEO's (52%) in the U.S. as rated in Forbes.com by compensation.* We insure more than 60% of the Forbes 400 wealthiest people in the U.S.** We insure 60% of the U.S. collectors listed in ArtNews' Top 200 World Collectors.*** We insure approximately 1,500 homes in the U.S. with values over $5,000,000.** Chubb has maintained its reputation and financial stability with underwriting expertise, unparalleled customer service, unique industry-specific specialization and a deep respect for all of our employees. Currently, Chubb is seeking a Claims Examiner for the Simsbury, CT office. JOB DESCRIPTION: The job responsibilities include the following: • Deliver superior customer service and satisfaction through effective interactions with insureds, agents and internal business partners. • Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives. • Provide accurate and timely loss assessments. • Make decisions regarding payment amounts and claim settlements. • Timely and appropriately communicate with internal and external customers relative to account trends, service issues and large losses. • Consistently demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage, loss assessment, and case management. • Ensure the establishment, documentation, and execution of appropriate strategies to bring early resolution to assigned claims. • Recognize and properly address coverage issues, potential fraud, and subrogation; follow guidelines relative to completion of reporting forms. • Keep all files on a current diary system in order to timely monitor new developments, follow up on outstanding requests, update management, and respond to all other diary activities.

Job Title: Claims Examiner / Adjuster Workers' Compensation Company: Insurance Recruiting Specialists (IRS) Location: Dallas , TX Description: Claims Examiner / Adjuster Workers' Compensation Insurance Recruiting Specialists (IRS) is the premier staffing organization dedicated to the insurance professional. We work with the insurance industry's top companies. Our organization has exclusive access to the highest paying direct hire, temporary and temporary to permanent Claims Adjuster and Examiner jobs in Dallas, Ft. Worth and Texas. Our client is looking for a SENIOR Examiner with 5+ years of LOST TIME experience, including LITIGATION background in the jurisdictions of TX, OK and LA. The candidate will work on a pending of 100 to 120 pending files that include heavy catastrophic injuries. Our Client is looking to pay YOU $55,000 - $75,000!!!