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<h3>Job Description</h3>
Job Description

Claims Examiner II
Location: Birmingham, AL
Job Description
The Claims Examiner II will administer all claims adjudication processes in accordance with contractual agreements along with VIVA HEALTH guidelines. This position will assist with additional duties such as reports and following up with departments on routed claims. Must be available to work during the core hours of operation, 8am to 5pm Monday through Friday, and overtime as required.
Key Responsibilities
<ul>
<li>Adjudicate claims submitted by providers and members assigned via claims workflow.</li>
<li>Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.</li>
<li>Correctly match authorizations to ensure claims are processing appropriately based on established guidelines.</li>
<li>Work with internal departments to resolve issues preventing claims from processing or enhancing processing capabilities.</li>
<li>Meet and maintain performance and quality measurements as required by the department to meet regulatory compliance standards.</li>
</ul>
REQUIRED:
<ul>
<li>At least 1–2 years of experience with claims processing</li>
<li>2 years of college or equivalent claims adjudication experience</li>
<li>Ability to thrive in a production environment where quality and quantity are highly measured, including recognizing and correcting quality errors</li>
<li>Demonstrate excellent customer service skills through written and verbal communication</li>
<li>Organized, detail oriented, and skilled at prioritizing and multitasking</li>
<li>Ability to work in a team environment, remain flexible to changes, and recognize responsibilities, actively participate with others to accomplish assignments and achieve desired goals</li>
<li>Knowledge of medical terminology, ICD, CPT, and HPCS</li>
<li>Basic computer skills including Microsoft Word, Excel, and Outlook</li>
<li>Understanding of Claims Payment System in order to process claims, prepare reports and correspondence</li>
</ul>
PREFERRED:
<ul>
<li>Professional and/or hospital claims adjudication experience, preferably in the healthcare/medical field</li>
<li>CRT data entry experience</li>
</ul>

Claims Examiner II

<h3>Job Description</h3>
Job Description
This position is posted by Jobgether on behalf of TRISTAR Insurance Group. We are currently looking for a Claims Examiner III in Rancho Cordova, CA.
This is a hybrid opportunity for a seasoned claims professional to manage complex and litigated indemnity claims from start to resolution. You'll play a vital role in ensuring timely and accurate benefits administration, effective case resolution, and strong client relationships. The environment combines high responsibility with strong collaboration across legal, medical, and vocational stakeholders. Ideal for candidates with SIP certification and a proactive mindset, this role offers a chance to make a direct impact while advancing within a supportive and experienced team.
Accountabilities
<ul>
<li>Manage a caseload of complex and litigated indemnity claims in compliance with regulatory and internal standards.</li>
<li>Investigate claims promptly and determine compensability based on applicable laws and best practices.</li>
<li>Oversee medical treatment plans and billing, authorizing procedures as appropriate.</li>
<li>Interface with attorneys, claimants, providers, and internal departments for optimal case outcomes.</li>
<li>Set and adjust reserves within authority and guidelines; pursue claim settlements and finalize cases.</li>
<li>Maintain detailed documentation and proactive case planning in diary systems.</li>
<li>Identify and pursue subrogation and excess reporting opportunities.</li>
<li>Conduct exit interviews and participate in client file reviews and audits.</li>
<li>Mentor less experienced examiners and contribute to overall team development.</li>
</ul>
Support state reporting, audit responses, and multi-jurisdictional claims as needed.
Requirements
<ul>
<li>Minimum of 5 years of relevant experience in workers’ compensation claims management.</li>
<li>SIP certification required.</li>
<li>Solid knowledge of medical and legal terminology, and regulatory requirements.</li>
<li>Strong analytical skills with attention to detail in claims evaluation and documentation.</li>
<li>Excellent verbal and written communication skills for interaction with diverse stakeholders.</li>
<li>Ability to work both independently and collaboratively in a fast-paced, hybrid setting.</li>
<li>Proficiency in Microsoft Word and Excel preferred.</li>
<li>Jurisdictional licenses as required.</li>
</ul>
Benefits
<ul>
<li>Competitive salary based on experience.</li>
<li>Hybrid work model based in Rancho Cordova, CA.</li>
<li>Medical, dental, and vision insurance coverage.</li>
<li>Life and disability insurance.</li>
<li>401(k) retirement plan.</li>
<li>Paid holidays and paid time off (PTO).</li>
<li>Employee referral bonus program.</li>
<li>Supportive work environment with mentorship opportunities.</li>
</ul>
Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI‑driven job matching.
When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly.

Claims Examiner III

<h3>Job Description</h3>
Job Description
Position Purpose:&nbsp; The Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims and other duties as necessary.
Key Responsibilities: 
<ul>
<li>Review, research, analyze and process &nbsp;professional claims by navigating multiple applications and platforms accurately.</li>
<li>Ensure that the proper benefits are applied to the claim using the appropriate tools (e.g. CMS guidelines)</li>
<li>Communicate with internal departments using clear, simple language to ensure understanding.</li>
<li>Keep up via training with system updates and new applications.</li>
<li>Meet and maintain the performance goals as established for the position in the area of quality and production</li>
</ul>
Qualifications:
<ul>
<li>High School Diploma or GED</li>
<li>Excellent oral and written communication skills</li>
<li>1 – 3 years of Health claims processing experience</li>
<li>Working knowledge of COB and MSP preferably </li>
<li>Medical terminology</li>
<li>Computer literacy </li>
<li>Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.</li>
<li>Excellent organizational skills</li>
<li>Ability to work well under pressure and difficult situations</li>
</ul>
Note:&nbsp; This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).&nbsp; Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.&nbsp;&nbsp;&nbsp;
 No Third Party Agencies or Submissions Will Be Accepted.&nbsp;&nbsp;&nbsp; Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP&nbsp;&nbsp;&nbsp; Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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<h3>Job Description</h3>
Job Description
Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway’s insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.
We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty, and specialty lines insurance company in the world?
Learn more about our unique culture and history.
 
Job Opportunity: 
Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for an experienced Multi-Line Claims Examiner to join our dynamic Claims team. The Examiner will be responsible for handling of specialty lines claims and management oversight of TPA claims as well as some handling of individual claim files, collaborating with underwriters throughout the claims process and marketing BHSI Claim Service to customers. We are seeking candidates with a high level of technical skill, as well as excellent communication and interpersonal skills. The position will be based in either our New York, Boston or Atlanta office. 
 
Duties &amp; Responsibilities:
<ul>
<li>Responsible for oversight, managing and adjusting of primary and TPA claims to include; commercial auto, general casualty, errors &amp; omission, accident &amp; health, homeowner and commercial property claims. Ensure high level of customer service and technical claim file quality.</li>
<li>Duties include proactive handling of claims from first notice of loss through ultimate resolution, working and advising internal partners on claims, developing a plan of action for ultimate resolution, obtaining budgets and meeting with clients and brokers. Audit and oversite of TPA claims.</li>
<li>Provides outstanding customer service and works well with the insured, broker and TPA in the handling and adjudication of claims.</li>
<li>Analyze and draft coverage letters as appropriate and communicates coverage positions effectively.</li>
<li>Conducts, coordinates, and proactively directs investigation, defense and settlement of claims.</li>
<li>Directs and closely monitors assignments to experts and defense counsel.</li>
<li>Evaluates information on coverage, liability, and damages to determine the extent of exposure to the insured and the company.</li>
<li>Drafts reports, sets reserves within authority or make claim recommendations concerning reserve changes.</li>
<li>Travels to audits, conferences, mediations, and trials as necessary</li>
</ul>

 Qualifications, Skills, and Experience:
<ul>
<li>Should have a high degree of specialized and technical competence in the handling multi line claims.</li>
<li>Minimum of 3 -5 years multi line claim handling experience.</li>
<li>College degree preferred.</li>
<li>Ability to work independently and assimilate learning materials on many different subjects from various sources.</li>
<li>Excellent interpersonal communications and negotiation skills.</li>
<li>Ability to work in a team environment.</li>
<li>Should have technical competence in all aspects of multi-line claims with particular emphasis on customer service.</li>
<li>Experience in handling and adjusting claims in all 50 states and possess required licenses.</li>
</ul>
 
BHSI Offers:
<ul>
<li>A competitive package and exciting growth opportunities for career-oriented teammates.</li>
<li>A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates, and our other stakeholders.</li>
<li>A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework.</li>
<li>Benefits that support your life and well-being, which include:</li>
</ul>
<ul>
<ul>
<li>Comprehensive Health, Dental and Vision benefits</li>
<li>Disability Insurance (both short-term and long-term)</li>
<li>Life Insurance (for you and your family)</li>
<li>Accidental Death &amp; Dismemberment Insurance (for you and your family)</li>
<li>Flexible Spending Accounts</li>
<li>Health Reimbursement Account</li>
<li>Employee Assistance Program</li>
<li>Retirement Savings 401(k) Plan with Company Match</li>
<li>Generous holiday and Paid Time Off</li>
<li>Tuition Reimbursement</li>
<li>Paid Parental Leave</li>
</ul>
</ul>

The base salary range for this position is $60,000 to $80,000, along with annual bonus eligibility. Total compensation for a candidate is determined by their relevant skills, location, and experience. We value our teammates – both their capabilities and character – as demonstrated by our amazing culture.
NOTE: Compensation will be commensurate with experience. This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization.

Claims Examiner, Programs

<h3>Job Description</h3>
Job Description
Swoon is currently looking for a Claims Specialist for a major company in the US
<ul>
<li>Location:&nbsp;Allentown, PA</li>
<li>Duration: 6 Months</li>
<li>Pay Rate: $22/h</li>
</ul>
Responsibilities: • Assist in determining liability for damage claims • Ensure compliance with state regulations and Company tariff • Analyze claims to ensure losses to be paid are appropriate for event • Process claims by accepting or rejecting claimant’s documentation • Maintain tracking records of all accepted and denied claims • Ensure confidentiality of claims decisions and rationale • Provide quality customer service • Handle escalated calls or route to appropriate work groups • All other duties and projects as assigned &nbsp;
Company DescriptionFull-service utility contractor specializing in construction for the telecommunications, broadband, and underground utility industries. Our team is committed to employee success and growth, with leadership that prioritizes mentorship and career development. 
<h3>Company Description</h3>
Full-service utility contractor specializing in construction for the telecommunications, broadband, and underground utility industries. Our team is committed to employee success and growth, with leadership that prioritizes mentorship and career development.

Claims Specialist

<h3>Job Description</h3>
Job Description
Job Description: Overall Position Summary/Purpose:
Position is Temp to Hire and is onsite 4 days a week.
This position is responsible for providing claims administrative support.&nbsp; The individual should possess exceptionally strong administrative servicing skills, specifically in customer service by fostering strong partnership with both internal and external stakeholders. Follows appropriate policies and procedures using various systems. The individual should approach their daily duties with a sense of urgency and accuracy when performing their role. The individual will be accountable for managing their time effectively to ensure the provision of claim support aligns with the attributes and values of our firm and our valued customers.&nbsp;
Key Functions/Duties of Position: Describe the overall job responsibilities: 
Claim File Handling:&nbsp;&nbsp;&nbsp;
<ul>
<li>Manage the setup and finalization of new losses in the system, ensuring all the necessary fields are accurately completed during the new claim setup process.&nbsp;&nbsp;</li>
<li>Input loss details into the designated system and ensure all information is recorded correctly.&nbsp;</li>
</ul>
<ul>
<li>Communicate with brokers or producers to obtain insurance policies when applicable.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Notify claims once the loss has been set up.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Ensure acknowledgment letters are sent out promptly.&nbsp; &nbsp;</li>
</ul>
Billing Processing:&nbsp;
<ul>
<li>Review invoices for accuracy and pay approved invoices.&nbsp;</li>
</ul>
<ul>
<li>Ensure proper documentation is provided to support payments.&nbsp;</li>
</ul>
<ul>
<li>Request W-9’s for new vendors and ensure accuracy/completeness of information received.&nbsp;</li>
</ul>
<ul>
<li>Review payments to ensure duplicate payments are not processed.&nbsp;</li>
</ul>
<ul>
<li>Monitor deductible amounts &amp; communicate same with brokers, insureds &amp; claim handlers.&nbsp;</li>
</ul>
<ul>
<li>Confirm adequacy of reserves for payment of invoices and communicate with claim handlers regarding same.&nbsp;</li>
</ul>
<ul>
<li>Collaborate with adjusters to address and resolve any outstanding payment issues.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Monitor check status and ensure prompt delivery of payments.&nbsp;</li>
</ul>
<ul>
<li>Communicating with adjuster to confirm payment details regard to settlements and reimbursements or request additional information as needed.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Conduct thorough investigations into payment discrepancies, non-clearing checks, and vendor disputes to facilitate timely resolutions.&nbsp;</li>
</ul>
<ul>
<li>Maintain requests for wire payments and track check status.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Request W-9 forms from vendor, verify information by cross-reference with IRS database before processing payments.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Generate and send invoices to customers for outstanding deductibles.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Ensure proper accounting entries are made to accurately reflect deductible payments in the system.&nbsp;&nbsp;</li>
</ul>
Administrative and Technical Oversight&nbsp;&nbsp;
<ul>
<li>File closure – Secure the final bill to ensure all necessary documentation and information are provided to close out a settled claim.&nbsp;</li>
</ul>
<ul>
<li>Provide general administrative support to claims staff, including scanning, uploading correspondence, and sending claim file documents to coverage counsel securely.&nbsp;</li>
</ul>
<ul>
<li>Work with the collection agency that handles unpaid deductibles to provide them with any necessary information that mya need to pursue the collection.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Complete monthly regulatory compliance&nbsp;for the state of Florida</li>
</ul>
<ul>
<li>Assist with control legal spending by validating invoice data to determine where submitted rates and expenses are conforming to pre-determined billing guidelines.&nbsp;</li>
</ul>
Other Duties&nbsp;
<ul>
<li>Special projects &amp; duties as assigned.&nbsp;</li>
</ul>
Education Requirement
<ul>
<li>High school Diploma or equivalent required.</li>
<li>College degree preferred.&nbsp;</li>
</ul>
Qualifications:&nbsp; Include necessary skills/experience and core competencies required
<ul>
<li>Must have a minimum of 3-5 years of experience in an office administrative support role.</li>
<li>Strong critical thinking and analytical ability.&nbsp;</li>
<li>Prior claims or insurance experience is preferred.&nbsp;</li>
<li>Demonstrated skills in prioritization, evaluating and maintaining efficient processing of work, and maintaining confidentiality.&nbsp;</li>
<li>Must demonstrate a consistently high level of accuracy.&nbsp;</li>
<li>Has or will gain a thorough understanding of all claims administrative and professional handling procedures, including familiarity with legal terminology.&nbsp;</li>
<li>Must display a thorough understanding of all relevant software; including Microsoft Office, with at least an intermediate level of expertise in Excel.&nbsp;</li>
<li>Strong written and oral communication skills are necessary; must have experience composing several types of business correspondence.&nbsp;</li>
<li>Must be customer service oriented, a team player, willing to learn, organized, meticulous and flexible.&nbsp;&nbsp;&nbsp;</li>
</ul>

<h3>Job Description</h3>
Ready to Navigate Auto Claims and Support Our Customers? Join the NLC Insurance Team!&nbsp;
 
Are you a proactive, empathetic individual with 0-3 years of experience, looking to accelerate your career in the auto insurance claims field? NLC Insurance Companies is searching for a dedicated Claims Representative to join our dynamic Auto Claims Unit in Norwich, CT. This is an excellent opportunity to become an expert in auto claim investigations and provide crucial support to our policyholders during challenging times.&nbsp;
 
About NLC Insurance:&nbsp;
 
For nearly two centuries, NLC Insurance Companies has been a trusted partner for our customers, offering reliable protection and guidance. We are more than an insurance company; we are a dedicated team committed to excellence and compassionate service. At NLC, we cultivate a collaborative environment that champions employee development and provides a clear path for career growth, especially for those starting or advancing in the insurance sector.&nbsp;
 
Your Role:&nbsp;
 
As an Auto Claims Representative, you will be instrumental in managing first-party and potentially third-party auto claims from the initial report through to resolution. You will be a primary contact for our insureds and claimants, guiding them through the auto claims process with clarity, professionalism, and care. This role operates with hybrid flexibility from our Norwich office.&nbsp;
 
What You'll Do:&nbsp;
 
<ul>
<li>Investigate, evaluate, and negotiate auto claims, including physical damage and potentially minor bodily injury claims, ensuring fairness and efficiency.&nbsp;</li>
<li>Communicate clearly and empathetically with policyholders, claimants, repair shops, and other parties involved, explaining coverage, process, and settlement details.&nbsp;</li>
<li>Analyze claim documentation, such as police reports, photos, witness statements, and repair estimates, to determine liability and assess damages.&nbsp;</li>
<li>Maintain accurate and thorough records of all claim activity in our systems.&nbsp;</li>
<li>Work collaboratively with team members and other departments to ensure a seamless claims experience.</li>
</ul>
What We're Looking For:&nbsp;
 
<ul>
<li>0-3 years of relevant experience (experience in auto claims, auto damage appraisal, or customer service in the insurance industry is a plus).&nbsp;</li>
<li>A bachelor's degree is preferred, or equivalent work experience.&nbsp;</li>
<li>Exceptional communication (verbal and written), interpersonal, and customer service skills.&nbsp;</li>
<li>Strong analytical, problem-solving, and decision-making abilities.&nbsp;</li>
<li>Meticulous attention to detail and excellent organizational skills.&nbsp;</li>
<li>An eagerness to learn, adapt, and contribute to a fast-paced environment.&nbsp;</li>
<li>Ability to work effectively both independently and as part of a supportive team.&nbsp;</li>
</ul>
Why Join NLC Insurance?&nbsp;
 
<ul>
<li>Career Advancement: Structured opportunities for growth and development within a stable and reputable company.&nbsp;</li>
<li>Expert Mentorship: Learn from experienced auto claims professionals in a supportive and collaborative setting.&nbsp;</li>
<li>Make a Difference: Provide essential support to individuals involved in auto accidents, helping them navigate the claims process and recover.&nbsp;</li>
<li>Team-Oriented Culture: Be part of a company that values your contributions, fosters teamwork, and encourages continuous improvement.&nbsp;</li>
<li>Comprehensive Benefits: We offer a competitive salary and benefits package including 401(k) with matching, dental, health, life, and vision insurance, flexible spending account, and paid time off.&nbsp;</li>
<li>Hybrid Work Model: Enjoy the flexibility of working both remotely and in our Norwich office.&nbsp;</li>
</ul>

Ready to Apply?&nbsp;
 
If you are passionate about helping people and are ready for a challenging and rewarding role in auto claims, we encourage you to apply!&nbsp;
Please submit your application to: <a href="mailto:employment@nlcinsurance.com" target="_blank">employment@nlcinsurance.com</a> &nbsp;
Application Deadline:&nbsp; Open Until Filled&nbsp;
 
Location:&nbsp;
 
Norwich, CT 06360 (Hybrid work, must be able to commute to Norwich, CT)&nbsp;
NLC Insurance is an Equal Opportunity Employer&nbsp;

Claims Representative, Auto Claims

<h3>Job Description</h3>
Job Description
About Us:
We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.
PayerFusion is seeking to hire an experienced claims processor, claims examiner to process hospital claims "UB-04" and physician claims collections "CMS 1500", claims adjudication, coding and claims coverage determination.
Responsibilities:
<ul>
<li>Claims processing and claims examining of all incoming claims based departments’ procedures.</li>
</ul>
<ul>
<li>Interpret, apply and comprehend policy terms, deductibles, coinsurance, copay and policy max</li>
<li>Coding ICD 10, knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles. </li>
<li>Responsible for searching the various PPO networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from PayerFusion cost containment efforts. </li>
<li>Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established PayerFusion criteria. </li>
<li>Follow up on network pending claims to ensure that they are released meeting the deadlines. </li>
<li>Handles Provider Statements/invoices by contacting the providers to request a complete</li>
<li>Meets deadlines promised to clients for claims processing.</li>
<li>Other office duties as assigned by Supervisor.</li>
</ul>
 
Requirements:
<ul>
<li>Must have experience in medical claims processing and adjudication, self-motivated, responsible, and with a desire for advancement.</li>
<li>Must have extensive knowledge of hospital and physician billing and collections, knowledge of Medicare, Medicaid, Commercial and PPO claims processing is a must.</li>
<li>Must be proficient with the use of telephone in dealing with customers, providers and members.</li>
<li>Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance.</li>
<li>Fully computer literate in use of Microsoft Office Programs (Word, Excel, Outlook, Teams software). </li>
</ul>
Bonus Points:
<ul>
<li>PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.</li>
<li>PayerFusion provides competitive benefits that include vacation, holiday, sick time as well as health insurance and other corporate benefits such as 401K.</li>
</ul>

Medical Claims Examiner-Claims Processor

<h3>Job Description</h3>
Job Description&nbsp; PRINCIPLE CHOICE SOLUTIONS VA Claims Processor POSITION PURPOSE This position will complete distribution or processing (review and determine payment of claims) for FMP, Spina Bifada, CHAMPVA, Beneficiary Travel and Non-VA Medical Care claims for the VA. This includes processing claims from the Aged Claims inventory and any current claims as requested by the VA CBO and will utilize the VA systems for claims adjudication. Training will be provided on all VA claims systems. &nbsp; ORGANIZATION This position reports to the designated Operations Manager for Principle Choice Solutions. ESSENTIAL FUNCTIONS 
<ul>
<li>Research and evaluate accounts for proper adjudication.</li>
<li>Perform electronic claims editing and submit claims validation for payment processing.</li>
<li>The systems used, include but are not limited to, the ClaimsXM system, Datanet, and the Daper system. </li>
<li>Utilize VA's contracts to evaluate accuracy of payment.</li>
<li>Document claims processing activity into VA systems.</li>
<li>Maintain a working knowledge of applicable VA regulations as they relate to proper claims adjudication.</li>
<li>Maintain access for all client systems, as assigned.</li>
<li>Meet/Exceed monthly productivity and accuracy standards. </li>
<li>Acts as an effective team member.</li>
<li>Other duties as assigned.</li>
</ul>
 KNOWLEDGE &amp; EXPERIENCE
<ul>
<li>High School Diploma or GED required.</li>
<li>Candidates must provide two valid forms of identification, one of which must be either a REAL ID (indicated by a star in the top corner) or a valid U.S. passport.</li>
<li>Preferred 1-2 years' experience in medical claims, patient accounting, comprehension of insurance contracts and/or EOBs, and other medical billing methodologies or demonstrated ability.</li>
<li>Demonstrated negotiation skills.</li>
<li>General office skills and knowledge of standard office equipment.</li>
<li>Working knowledge of software such as Excel and Word.</li>
<li>Data entry and 10 key experience necessary.</li>
<li>Excellent verbal and written communication skills</li>
<li>Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.</li>
</ul>
 GENERAL AREAS OF ACCOUNTABILITY: Must conduct business and personal affairs in a manner that is always a credit to the company. Must maintain a good credit rating while employed with the company. May be required to apply for and maintain NACi or higher-level security clearance to support government (DoD, VA, etc.) assignments. MACHINES &amp; EQUIPMENT The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as a copier. PHYSICAL REQUIREMENTS Must be able to lift and carry up to 20 pounds.&nbsp; Must be able to talk, listen, and speak clearly on the telephone. WORKING CONDITIONS The incumbent works in an office environment that is not substantially exposed to adverse environmental conditions such as heat, cold, or extreme noise.&nbsp; Routine periods of being on the phone utilizing a headset, sitting and data keying are required.&nbsp; Periodic times working at the office site may be required. Security and privacy training will be provided as part of this role to protect the confidentiality, integrity, and availability of PCS’ associate and customer data. The above statements are intended to describe the general nature of work being performed by people assigned to this classification.&nbsp; They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. &nbsp;
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