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<h3>Job Description</h3>
Job DescriptionDescription:
SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care, and Personal Assistant industries with the delivery of health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve. 
 
Position Summary:
The Claims Examiner, Level 1, is responsible for analyzing, processing, and auditing PPO, HMO and other medical claims for plan participants who are union members of SEIU Healthcare Illinois and Indiana (HCII). Claims Examiners are able to handle and accurately adjudicate assigned medical claims following established guidelines and industry best practices with a minimal amount of supervision.
 
This position must maintain excellent working relationships with peers in the Claims Department and interdepartmentally, vendors, medical providers, plan participants and all key stakeholders related to the Fund Office.
Claims Examiner, Level 1 will be responsible for the following:
 
Key Duties and Responsibilities:
<ul>
<li>Process medical and facility claims in an accurately and timely manner; ensure all necessary information is present including accident details/subrogation form, other insurance information, referral and/or pre-certification, repricing, auditing, and all other information needed to properly process the claim</li>
<li>Review and adjudicate claims for compliance with contract terms, benefit coverage, and regulatory requirements.</li>
<li>Review provider reconsiderations and reprocess the claim or generate letter(s) in response to the request.</li>
<li>Respond to inquiries from coworkers or other departments via email or a ticketing system within three (3) business days.</li>
<li>Apply appropriate pricing and coding standards (e.g., CPT, ICD-10, System Benefit codes) and reimbursement methodologies to ensure accurate claim payment.</li>
<li>Process check-run cycles and check run audits when assigned.</li>
<li>Perform audits of auto-adjudicated claims when assigned.</li>
<li>Attend meetings with vendors, providers, partnering organizations or any other meeting as assigned.</li>
<li>Identify and report system issues, test and troubleshoot system configuration, completing reports, and run other system tasks or reports as assigned.</li>
<li>Monitor pended claims to ensure unnecessary delays are avoided.</li>
<li>Monitor claims inventory to assure consistent processing time across the plans.</li>
<li>Correspond to providers, members and external vendors via mail, email or phone.</li>
<li>Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for question or error trends, as well as identify potential process improvements.</li>
<li>Create one-on-one (1:1) agendas with the Claims Supervisor using the Purpose, Outcome and Process (POP) Model and keeping thorough notes for each meeting.</li>
<li>Back-up all duties of the Claims Clerk as needed.</li>
</ul>
Privacy and Security Responsibilities:
This position requires employees to handle Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected HIPAA violation or breach to our HIPAA Privacy and Security Officer.
 
 
Requirements:
Job Requirements
 
Education Requirements:
<ul>
<li>High School diploma or GED equivalent</li>
<li>Associate degree or higher in Health Care, Business Administration, or similar field is preferred</li>
</ul>
Job Requirements:
<ul>
<li>Minimum of five (5) years of experience in medical claims examination, preferably in a managed care operation or insurance setting.</li>
<li>Meet or exceed 98% financial and 95% procedural for quality and production standards.</li>
<li>Knowledge and understanding of the health care industry, including medical claim processing, subrogation, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-02 claim forms.</li>
<li>Strong analytical skills with the ability to interpret complex medical documentation and make sound claim decisions.</li>
<li>Excellent attention to detail and accuracy in data entry and claim adjudication.</li>
<li>Knowledge of healthcare regulations, compliance requirements, and industry standards related to claims processing.</li>
<li>Proficient use of desktop computers, laptop computers, printers, copiers, scanners, fax and other office equipment.</li>
<li>Ability to type 35 words per minute accurately.</li>
<li>Proficient skills, intermediate to expert level, in Microsoft Office Suite (Word, Excel, Access, Power Point, Visio, and Outlook) </li>
<li>Excellent written and verbal communication skills</li>
<li>Excellent interpersonal and customer services skills required</li>
<li>Ability to develop and maintain positive working relationships with both internal and external stakeholders</li>
<li>Strong analytical mindset</li>
<li>Ability to organize and prioritize task</li>
<li>Ability to demonstrate teamwork and work independently</li>
<li>Ability to meet deadlines</li>
<li>Exercise clear and concise judgment</li>
<li>Ability and willingness to assist in special projects and handle multiple tasks</li>
</ul>
Preferred Skills:
<ul>
<li>Taft-Hartley experience</li>
<li>Knowledge of the Fund’s benefit administration system (Basys/Bridgeway)</li>
<li>Experience with project management software, such as Smartsheet</li>
<li>Experience working in a hybrid environment, in-person and remote </li>
<li>Experience with virtual conference software (Teams and Zoom)</li>
</ul>
Career Development &amp; Continuing Education Opportunities: Yes
 
Benefits:
SEIU Healthcare IL Benefit Funds offers a comprehensive health benefits (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.
 
Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.

Claims Examiner Level 1

<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 DescriptionDescriptionAbout Reserv
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.
We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. 
About the role
We are seeking a skilled BI-LIT Claims Examiner to manage litigated files and attend trials, conferences, mediations, and arbitrations. The successful candidate will:
<ul>
<li>Investigate and gather all necessary information and documentation related to claims</li>
<li>Evaluate liability and damages</li>
<li>Negotiate and settle claims</li>
<li>Manage litigation cases related to auto claims disputes</li>
</ul>
The BI-LIT Claims Examiner will also be responsible for maintaining electronic files, analyzing defense counsel's performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements.
Who you are
<ul>
<li>Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org.</li>
<li>Passionate adjuster who cares about the customer and their experience.</li>
<li>Empathetic. You exercise empathy and patience towards everyone you interact with. </li>
<li>Sense of urgency - at all times. That does not mean working at all hours.</li>
<li>Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. </li>
<li>Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. </li>
<li>Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. </li>
<li>Anti-status quo. You don't just wish things were done differently, you action on it. </li>
<li>Communicative. (we'd love to know what this means to you)</li>
<li>And did we mention, a sense of humor. Claims are hard enough as it is. </li>
</ul>
What we need
We need you to do all the things typical to the role:
<ul>
<li>Managing legal aspects of litigated cases, including evaluation of legal process and expenses</li>
<li>Analyzing and reviewing auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers</li>
<li>Managing litigation cases related to auto claims disputes, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders</li>
<li>Collaborating with defense counsel, claims counsel, and litigation claims management for strategic planning, including developing and maintaining positive working relationships with approved defense firms and other vendors in the industry</li>
<li>Reviewing legal documents and ensuring compliance with initial suit-handling plan of action</li>
<li>Serving as corporate representative for discovery review and depositions, and appearing as Corporate Representative at depositions and trials when needed</li>
<li>Analyzing policy language and reaching appropriate coverage decisions, drafting frequent and complex coverage correspondence, and proactively managing primarily litigated claim files from inception to closure</li>
<li>Directing and controlling the activities and costs of numerous outside vendors including defense counsel and coverage counsel, experts and independent adjusters</li>
<li>Maintaining adjuster licenses and continuing education requirements</li>
</ul>
Requirements
<ul>
<li>Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)</li>
<li>10+ years of claim handling experience, with 5+ of those years handling a pending of &gt;60% in litigation</li>
<li>Transportation litigation (rideshare, auto, trucking, etc) is preferred but those with personal lines experience should still apply if they meet all other requirements.</li>
<li>You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable</li>
<li>Understand transportation coverages. Understand contractual risk transfer and additional insured forms</li>
<li>You have strong medical knowledge </li>
<li>You have a sense of urgency and understanding of how to manage time-sensitive demands</li>
<li>Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner</li>
<li>Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel</li>
<li>Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines</li>
<li>Ability to professionally collaborate with all stakeholders in a claim</li>
<li>Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing</li>
<li>Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment</li>
<li>Curious and motivated by problem solving and questioning the status quo</li>
<li>Desire to engage in learning opportunities and continuous professional development</li>
<li>Willingness to travel for client and claims needs</li>
</ul>
Benefits
<ul>
<li>Generous health-insurance package with nationwide coverage, vision, &amp; dental</li>
<li>401(k) retirement plan with employer matching</li>
<li>Competitive PTO policy – we want our employees fresh, healthy, happy, and energized!</li>
<li>Generous family leave policy</li>
<li>Work from anywhere to facilitate your work life balance</li>
<li>Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li>
</ul>
Additionally, we will
<ul>
<li>Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account</li>
<li>Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster </li>
<li>Work toward reducing and eliminating all the administrative work from an adjuster role</li>
<li>Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li>
</ul>
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Litigation Claims Examiner

<h3>Job Description</h3>
Job Description
Education and / or Experience:
<ul>
<li>High School Diploma and 3 years adjudication experience in a managed care setting.</li>
<li>Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding.</li>
<li>Knowledge of HMO, DHS, DMHC, and CMS claims processing guidelines.</li>
<li>Strong knowledge of Microsoft Windows environment such as Word and Excel.</li>
<li>Self-starter, willing to take on multiple tasks.</li>
<li>Must meet minimal claims adjudication production standards.</li>
<li>Strong knowledge of Coordination of Benefits (COB) applications.</li>
<li>Must be able to interpret health plan benefits.</li>
<li>Must be able to review, interpret and apply contract rates.</li>
<li>Ability to communicate effectively orally and written typing 35 words per minute.</li>
<li>Strong organizational skills with emphasis on prioritizing and attention to details</li>
</ul>
Position Summary:
To evaluate and determine the appropriate path and to assist in the expedited processing of all claims, special projects and escalated reconsiderations originating from various internal and external sources and to serve as the first level of telephonic and written response for such issues.
Essential Duties and Responsibilities include the following:
<ul>
<li>Maintain the workflow of all departmental projects.</li>
<li>Provide reports and on-going updates to Claims management.</li>
<li>Assist in the processing of claims, special projects and medical records from all sources.</li>
<li>Oversees staff activities to maintain high level of productivity.</li>
<li>Monitor claims related functions to ensure health plan and regulatory compliance.</li>
<li>Participate with training determined by unit Supervisor regarding claims adjudication issues discovered in audit or through appeals.</li>
<li>Perform audits of claims activities such as turnaround time for acknowledgement, forwarding of claims to correct payer, and processing timeframes.</li>
<li>Provide primary support to the Supervisor of the Institutional unit including special projects.</li>
<li>Recommend process improvements based on appeal tracking and trending reports.</li>
<li>Support Claims management in other company functions such as Medical Review management.</li>
<li>Handle and document resolution to escalated telephone and written claims.</li>
<li>Implement and coordinate issue resolution processes.</li>
<li>Liaison for department with outside providers and internal departments.</li>
<li>Provide supervisory coverage for Claims unit as needed.</li>
<li>All other duties as directed by management.</li>
</ul>
The pay range for this position at commencement of employment is expected to be between&nbsp;&nbsp;$28 - $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare &amp; Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
<ul>
<li>Employer-paid comprehensive medical, pharmacy, and dental for employees</li>
<li>Vision insurance</li>
<li>Zero co-payments for employed physician office visits</li>
<li>Flexible Spending Account (FSA)</li>
<li>Employer-Paid Life Insurance</li>
<li>Employee Assistance Program (EAP)</li>
<li>Behavioral Health Services</li>
</ul>
Savings and Retirement:
<ul>
<li>401k Retirement Savings Plan</li>
<li>Income Protection Insurance</li>
</ul>
Other Benefits:
<ul>
<li>Vacation Time</li>
<li>Company celebrations</li>
<li>Employee Assistance Program</li>
<li>Employee Referral Bonus</li>
<li>Tuition Reimbursement</li>
<li>License Renewal CEU Cost Reimbursement Program</li>
<li>Business-casual working environment</li>
<li>Sick days</li>
<li>Paid holidays</li>
<li>Mileage</li>
</ul>
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Company DescriptionAs one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare &amp; Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success. 
<h3>Company Description</h3>
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare &amp; Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Claims Adjudication Examiner

<h3>Job Description</h3>
Job Description
Summary:
A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Research, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff. The Claims auditor also performs special projects and helps department manager and director as needed. They review and audit the Examiners’ adjudicated claims for accuracy and providing feedback.
Duties and Responsibilities:
· Audit daily processed claims through random selection as outlined by organizational Policies and Procedures. Utilize appropriate system-generated reports applicable to specialty claims.
· Conduct Claims Examiner training as required. Document training materials and attendees.
· Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions to Senior Management.
· Work with other organizational departments
· Assist in the development of Claims Department Policies and Procedures.
· Provide backup for other auditors/trainers within the Department.
· Perform other tasks as assigned by Senior Management.
· Promote a spirit of cooperation and understanding among all personnel.
· Attend organizational meetings as required
· Adhere to organizational Policies and Procedures.
· Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation &amp; Collaboration
Minimum Job Requirements:
· High School Diploma required.
· Three years of experience in a managed care claims adjudication setting e.g., HMO/MSO, required.
· Expertise in coding structure, ICD-10, CPT-4 and Revenue Codes, required.
· Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.
Knowledge, Skills and Abilities Required:
· Strong organizational, analytical and oral/ written communication (English) skills required.
· Proficiency in PC application skills, e.g., word processing, spreadsheets, preferred
· Experience in training development and presentation preferred
· Must be able to follow directions and also perform independently according to departmental standards.

Hospital Claims Auditor

<h3>Job Description</h3>
Job Description
First for a reason:
At First Student, we are a family of 60,000+ employees who take pride in safely transporting more than 5 million students and passengers to and from their destinations each day! Our family of brands include Transco, Total Transportation, Maggies Paratransit, and GVC II. Our employees are at the forefront of safety and innovation; they create and implement the most advanced training and technology the transportation industry has to offer. 
We are seeking a detail-oriented and organized Claims Administrative Assistant to support our team of Transportation Claim Adjusters. This role plays a key part in ensuring the efficiency of claims processing by handling administrative tasks, maintaining accurate records, and facilitating communication between claimants, adjusters, and other departments. This is a hybrid position, allowing for 1-2 remote workdays per week after the training period. Please note that the position will be 100% on-site during training.
Key Responsibilities:
<ul>
<li>Support Claims Adjusters in the intake, documentation, and processing of transportation-related incidents (e.g., bus accidents, student injuries, property damage).</li>
<li>Collect, organize, and manage relevant documentation, including driver and police reports, student rosters, medical records, driver logs, and photographs.</li>
<li>Receive and route calls, emails, and correspondence; professionally respond to internal and external inquiries (e.g., law firms, insurance companies, parents, medical offices).</li>
<li>Track and document compliance with transportation safety and reporting regulations.</li>
<li>Maintain accurate and up-to-date electronic claim files in the claims management system.</li>
<li>Prepare and send claim-related communications such as letters, reports, and summaries.</li>
<li>Handle confidential information with discretion and professionalism.</li>
<li>Provide general administrative support and assist with special projects as assigned.</li>
</ul>
Qualifications:
<ul>
<li>High school diploma or equivalent (Associate degree or higher preferred).</li>
<li>3+ years of administrative experience, preferably in insurance, logistics, or claims support.</li>
<li>Familiarity with legal and transportation terminology/documents is a plus.</li>
<li>Strong organizational skills with high attention to detail and accuracy.</li>
<li>Proficient in Microsoft Office (Outlook, Word, Excel)</li>
<li>Experience with claims management software (a plus, but not required).</li>
<li>Excellent verbal and written communication skills.</li>
<li>Ability to multitask, prioritize, and work efficiently in a fast-paced environment.</li>
</ul>
In the state of Washington, all technician and driving positions, including but not limited to van drivers and any other position requiring employees to drive a company-owned vehicle, are considered safety-sensitive and are therefore subject to drug and alcohol testing, including cannabis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. First is also committed to providing a drug-free workplace. First will consider for employment qualified applicants with criminal histories consistent with the requirements of the San Francisco Fair Chance Ordinance, Los Angeles Fair Chance Ordinance, and any other fair chance law. Philadelphia's Fair Criminal Record Screening Standards Ordinance Poster is at this link or upon request <a href="https://www.phila.gov/media/20210423160847/Fair-Chance-Hiring-law-poster.pdf" target="_blank">https://www.phila.gov/media/20210423160847/Fair-Chance-Hiring-law-poste…</a>.

Claims Administrative Assistant

<h3>Job Description</h3>
Job Description
Description of services: 
Audit a portion, as mutually agreed between the parties, of the combined financially stratified/attribute claim sample of medical and dental claims processed by medical care administrators. During the identified audit period (i.e., audits performed in 2024 will review claims processed through January 1, 2023 - through December 31, 2023, etc.). The audits will be conducted virtually with each administrator.
 
Tasks, Activities and Deliverables
The claims audit elements include review and validation:
The claimant was eligible for benefits on the date(s) of service based on data in the administrator's eligibility files, 
<ul>
<li> The provider's network participation was correctly determined based on the date of service, </li>
<li> Claims requiring utilization review approval were reviewed and processed in accordance with utilization review decisions, </li>
<li> Deductibles, coinsurance and other appropriate cost-sharing features of the benefit plan were considered and correctly applied, </li>
<li> The claim data was entered into the claim system correctly, and whether a paper claim was keyed or scanned, </li>
<li> Appropriate checks were made to ensure that there was no other coverage available to the claimant or, if there was other coverage, payments were coordinated correctly, </li>
<li> The "reasonable and customary" or provider discount features of the plan were correctly applied, including unbundling for physician services, </li>
<li> Appropriate edits were made to ensure that the claim was not paid twice, </li>
<li> The procedure(s) billed and paid were, in fact, covered by the plan and do not appear to be fraudulent billings by the provider, </li>
<li> The mathematics and computations were correct, </li>
<li> Any pre-authorization limits were appropriately applied, </li>
<li> The paper claim form was completed appropriately and signed by the appropriate parties, </li>
<li> The administrator adhered to its own internal policies and procedures when processing the claim, </li>
<li> Appropriate approvals were applied to high dollar claims (pre- and post-payment), and</li>
<li>Sufficient documentation was included in the file to support the adjudication of the claim.</li>
</ul>
Education and Experience
<ul>
<li>Bachelor's degree in accounting, finance, or a related field such as health information management.</li>
<li>At least three years of experience as a claims auditor or similar role in the health care industry. </li>
</ul>
Skills
<ul>
<li>Strong analytical and problem-solving skills</li>
<li>Excellent attention to detail</li>
<li>Ability to communicate complex information effectively and clearly</li>
<li>Good understanding of insurance policies and regulations</li>
<li>Proficiency in using computer software such as Microsoft Office Suite</li>
</ul>
Personal Attributes
<ul>
<li>Ability to work independently and in a team environment.</li>
<li>High level of integrity and ethical behavior.</li>
<li>Strong organizational and time-management skills.</li>
<li>Flexible and adaptable to change.</li>
</ul>

Claims Quality Auditor

<h3>Job Description</h3>
Job DescriptionAbout Us
"Inspired by Spaces, Empowered by People." At Enclave, we don't just build structures; we cultivate environments where our partners, team members, and communities flourish. Our very name reflects our essence - creating distinct spaces that inspires growth and success. As a unified real estate investment firm, Enclave brings together exceptional development, construction, and property management expertise to specialize in multifamily, industrial, and commercial developments across the Midwest and Mountain West. 
Our Growth Story: Since our founding in 2011, we've expanded to over 250 team members, completing more than 150 projects and managing assets exceeding $1.75 billion. Our rapid growth is a testament to the innovative and collaborative spirit that drives everything we do. For six consecutive years, Enclave has been recognized as one of the 50 Best Places to Work. This accolade reflects our commitment to fostering an environment where everyone feels valued, supported, and inspired to excel. 
About the Role Insurance &amp; Claims Manager
The Insurance &amp; Claims Manager will be responsible for identifying, assessing, and managing all Insurance related to the real estate development and property management operations. This includes managing insurance portfolios, ensuring compliance with insurance requirements, and working closely with Construction, Property Management, and legal teams, and external insurance brokers to ensure proper coverages are in place for the company’s real estate assets and developments. The role demands an individual who has in-depth knowledge of the insurance industry, real estate , and property management practices.
Position Logistics
<ul>
<li>Primary Work Location: West Fargo, ND or St. Louis Park, MN Corporate Office</li>
<li>Work Environment: On-Site </li>
<li>Work Schedule: Monday - Friday | Standard Hours</li>
<li>Work Type: Full Time </li>
</ul>
Position Responsibilities
Insurance &amp; Coverage Management:
<ul>
<li>Oversee and manage all corporate insurance programs, including general liability, property, builders’ risk, workers’ compensation, and professional liability.</li>
<li>Work closely with brokers to review, negotiate, and optimize insurance coverage at competitive rates.</li>
<li>Ensure all projects, properties, and company operations are properly insured and compliant with contractual and regulatory requirements.</li>
<li>Evaluate policy renewals, endorsements, and claims history to make data-driven recommendations on risk financing.</li>
<li>Manage the claims process, including resolution and disputes with insurance carriers and third parties, in collaboration with legal and finance teams.</li>
<li>Conduct reviews of policies to outline the coverage limits to clearly reflect the risk exposure</li>
<li>Work with outside brokers and internal legal to understand risk exposure and areas to monitor within corporate policy structure</li>
<li>Regularly update risk management practices to align with industry standards and regulatory changes.</li>
<li>Collaborate with operations, finance, and legal teams to create and enforce risk control policies and best practices.</li>
<li>Implement loss prevention programs and provide training on risk mitigation strategies to employees, contractors, and tenants.</li>
</ul>
Claims Administration &amp; Loss Control:
<ul>
<li>Oversee the claims process, including reporting, tracking, and resolution of property damage, general liability, workers’ compensation, and other claims.</li>
<li>Serve as the primary liaison with insurance carriers, adjusters, attorneys, and third-party administrators to ensure timely claim resolutions.</li>
<li>Analyze claims data to identify trends, root causes, and cost-saving opportunities.</li>
<li>Work with insurance carriers on loss recovery efforts through subrogation, ensuring proper reimbursement and minimizing the impact on loss run reports.</li>
</ul>
Contract &amp; Compliance Review:
<ul>
<li>Review and enforce insurance provisions in contracts, leases, and vendor agreements to align with company risk standards.</li>
<li>Ensure compliance with federal, state, and industry regulations related to insurance and risk management.</li>
<li>Monitor insurance compliance for tenants, contractors, and subcontractors.</li>
<li>Assist in developing and enforcing risk-related guidelines across projects and property management operations.</li>
</ul>
Financial &amp; Budget Oversight:
<ul>
<li>Work with finance teams to develop budgets for insurance premiums, claims, and reserves while managing costs effectively.</li>
<li>Track and manage insurance expenses to ensure adequate financial planning and protection.</li>
<li>Report insurance claims and risk management financial impacts to senior leadership.</li>
</ul>
Stakeholder Collaboration &amp; Training:
<ul>
<li>Act as a key liaison with internal teams (legal, finance, operations) and external stakeholders (brokers, consultants, insurers).</li>
<li>Provide training and education on risk management, loss control, and insurance best practices to staff and relevant parties.</li>
</ul>
General Responsibilities
<ul>
<li>Perform other duties as assigned</li>
<li>All employees are responsible for the general upkeep of work and shared spaced</li>
<li>Punctual and regular attendance is required of all employees</li>
</ul>
We're Seeking Individuals Who Are:
<ul>
<li>
Highly knowledgeable in insurance policies and risk management, particularly within the real estate, construction, and property management sectors.
</li>
<li>
Experienced in managing complex insurance portfolios including general liability, property, workers’ comp, and builders’ risk coverages.
</li>
<li>
Strategic thinkers who can evaluate insurance needs, negotiate with brokers, and implement cost-effective coverage solutions.
</li>
<li>
Skilled at managing claims from initial reporting to resolution, working effectively with carriers, adjusters, and attorneys.
</li>
<li>
Detail-oriented professionals who can analyze claims data to uncover trends, identify risks, and recommend proactive solutions.
</li>
<li>
Committed to compliance and staying up to date with evolving insurance regulations and industry best practices.
</li>
<li>
Collaborative team players who can partner with legal, finance, construction, and operations to ensure proper insurance structures are in place.
</li>
<li>
Independent, self-motivated professionals who can prioritize effectively in a dynamic, fast-paced environment.
</li>
<li>
Committed to continuous improvement, always seeking ways to strengthen the company’s risk posture and coverage strategies.
</li>
<li>
Confident decision-makers with strong negotiation and interpersonal skills, comfortable liaising across all levels of the organization.
</li>
</ul>
Qualifications
<ul>
<li>Bachelor’s in , Insurance, Business, Accounting, Finance, or related field.</li>
<li>CRM, ARM, or CPCU (preferred).</li>
<li>5+ years in insurance, ideally in real estate development, construction or property management.</li>
<li>Strong understanding of real estate, construction, development, leasing, and property management.</li>
<li>Experience managing complex insurance programs and claims for real estate or construction projects.</li>
<li>In-depth understanding of liability, property, workers' comp, builders’ risk, and commercial insurance.</li>
<li>Skilled in Microsoft Office (Excel, Word, PowerPoint</li>
<li>Strong verbal and written communication and negotiation skills.</li>
<li>Able to manage multiple priorities in a fast-paced environment.</li>
<li>Detail-oriented and highly organized.</li>
<li>Proactive, with strong decision-making abilities.</li>
<li>Ability to work independently and within a team.</li>
<li>Strong at building relationships with key stakeholders</li>
</ul>
Culture &amp; Total Rewards ApproachWhy Join Enclave? 
When you become part of Enclave, you join a team of trailblazers in the real estate, construction, and property management industry. Our collaborative and fun-loving culture encourages you to thrive both professionally and personally. Our Core Values define what we say and do. 
<ul>
<li>Care For Each Other: We value people for who they are and take pride in our relationships with team members, clients, and partners</li>
<li>Do The Honorable Thing: We are committed to upholding the highest standards in our words and actions.</li>
<li>Be Empowered: We encourage true autonomy, which results in team members who are remarkably inspired and high-performing.</li>
<li>Promote Innovation: We constantly reach further and don't accept the status quo to bring the best service and product to the marketplace.</li>
</ul>
Total Rewards Approach 
Our salary ranges are established based on a combination of market data, internal equity, and the unique characteristics of our organization such as our size, revenue, and industry. Within the range, individual pay is determined by multiple factors including job-related skills, experience, and relevant education or training. 
We offer comprehensive health, dental, and vision insurance plans, a 401k retirement plan with company match, and company-paid life and disability insurance. Here's what else you can look forward to:
<ul>
<li>Work-Life Balance: Enjoy Paid Time Off (PTO), paid holidays, and dedicated volunteer time, ensuring you have the time to recharge and give back to the community. </li>
<li>Professional Growth: Be part of a company that values your development, offering a culture that supports learning, innovation, and career progression. </li>
<li>Additional Perks: Take advantage of our Health Savings Account (HSA), Flexible Spending Account (FSA), supplemental voluntary benefits, paid maternity/paternity leave, and more! Enclave supports your overall well-being and financial security. </li>
</ul>
Join Enclave and be part of a dynamic team that's shaping the future of real estate, construction, and property management. With us, you'll find more than just a job - you'll find a place where your contributions matter, your growth is supported, and your potential is limitless. Together, we'll create spaces that inspire and empower. 
Enclave provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

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