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<h3>Job Description</h3>
Job Description
Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures. 
Required:
<ol>
<li>Ability to follow written directions and work independently.</li>
<li>Familiarity with medical terminology, CPT and ICD-10 coding is required.</li>
<li>Computer and typing experience is required. </li>
</ol>
Desired:
<ol>
<li>Experience in billing or physician office experience is preferred. .</li>
<li>Previous claims payment experience</li>
<li>Ability to understand medical terminology</li>
</ol>
Responsibilities:
<ol>
<li>Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan.</li>
<li>Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines.</li>
<li>Reports patterns of incorrect billing and utilization to the Medicare Claims Manager.</li>
<li>Advises Coordinators of items that are unclear or that are not addressed in the established criteria/payment guidelines.</li>
<li>Reviews claims from all areas as assigned on a daily basis with departmental standards for productivity, timeliness, confidentiality and accuracy of claims adjudication.</li>
<li>Responds to questions, telephone calls and documents regarding the company's payment and utilization review decisions.</li>
<li>Maintains quality ratings thresholds for 6 consecutive months.</li>
<li>Processes quantity thresholds of 17-20 claims per hour.</li>
<li>Participates in external and/or internal trainings as requested.</li>
<li>Consistently displays a positive attitude and acceptable attendance.</li>
<li>Maintains annual performance evaluations of commendable and distinguished.</li>
</ol>

Claims Analyst

<h3>Job Description</h3>
Job DescriptionAbout Lantern
Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com. 
About You:
<ul>
<li>You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small &amp; big wins. </li>
<li>INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives &amp; you cherish the differences in each individual that you interact with.</li>
<li>You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas. </li>
<li>You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren't just the individuals using your product. They are the driving factor in your motivation to make a change.</li>
<li>Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear. </li>
<li>You thrive in a Team Environment. Collaboration is key in innovation and creating change.</li>
</ul>
These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life. 
If this sounds like you, we would love to connect to speak further about career opportunities at Lantern.
Please apply to our role &amp; someone from our Talent Acquisition Team will reach out to help you navigate our interview process.
Job Overview
The Claims Department Auditor at Lantern is responsible for conducting comprehensive audits and reviews of operations within the claims department. This role focuses on evaluating the completeness and proper maintenance of departmental records and operations, ensuring compliance with established rules, policies, and procedures. The Claims Department Auditor plays a vital role in ensuring the integrity and efficiency of departmental operations.
Location: Dallas, Texas – onsite full time
Responsibilities:
<ul>
<li>Plan and execute audits to assess the efficiency and effectiveness of departmental operations in achieving objectives.</li>
<li>Conduct thorough examinations, inquiries, and observations to ascertain the completeness of records and compliance with regulations.</li>
<li>Develop and generate detailed audit reports, identifying areas for improvement and ensuring transparency in operations.</li>
<li>Provide recommendations based on audit findings to enhance departmental processes and compliance.</li>
<li>Utilize advanced Excel skills, including VBA, XLOOKUP, and Pivot Tables, to analyze data and support audit activities.</li>
<li>Track and report trends in departmental performance metrics to assist in decision-making.</li>
<li>Ensure that departmental operations adhere to established policies, procedures, and regulatory requirements.</li>
<li>Stay informed about changes in regulations that may impact auditing practices.</li>
<li>Work closely with departmental staff to facilitate audits and provide guidance on best practices for record-keeping and compliance.</li>
<li>Engage with management to discuss audit findings and action plans for improvements.</li>
<li>Engage with team to discuss trends and training on common trends found during audits.</li>
<li>Perform other tasks and duties as assigned to support the overall goals of the claims department.</li>
<li>Excellent communication skills, both verbal and written.</li>
<li>Ability to work independently and collaboratively in a fast-paced environment.</li>
<li>Proven experience in auditing, preferably within a healthcare or insurance setting.</li>
<li>Strong analytical skills and attention to detail.</li>
<li>Proficiency in Microsoft Excel, including advanced functions (VBA, XLOOKUP, Pivot Tables).</li>
<li>Excellent communication skills, both verbal and written.</li>
<li>Ability to work independently and collaboratively in a fast-paced environment.</li>
</ul>
Benefits
<ul>
<li>Medical Insurance</li>
<li>Dental Insurance</li>
<li>Vision Insurance</li>
<li>Short &amp; Long Term Disability</li>
<li>Life Insurance</li>
<li>401k with company match</li>
<li>Paid Time Off</li>
<li>Paid Parental Leave</li>
</ul>
Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

Claims Auditor

<h3>Job Description</h3>
Job Description Reports directly to the Claims Supervisor and will work closely with the Claims team. Responsible for providing clerical operations support and will review Workers Compensation claims for accurate ICD-10 coding, including reading through medical records and/or reports to identify correct injury codes. Equal Opportunity Employer / Disabled / Protected Veterans The Know Your Rights poster is available here: <a href="https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf" target="_blank">https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRi…</a> The pay transparency policy is available here: <a href="https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf" target="_blank">https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_…</a> For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required. We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team. AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program. <a href="https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf" target="_blank">https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Partici…</a> We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. #1086 Company DescriptionThis company offers growth and a great group of people to work with. 
<h3>Company Description</h3>
This company offers growth and a great group of people to work with.

Claims Specialist

<h3>Job Description</h3>
Job Description
At ACERTUS culture is everything. We want people to want to work here. We have weekly huddles to hear from our team on how we can improve. And guess what? We act on your ideas!
As a Claims Specialist, you will review and analyze claims and expenses, process new claims and complete old ones, and work with internal teams.
Schedule: Monday-Friday (8:00am -4:30pm)
Hybrid schedule after training is complete! 3 days in office ( Mon, Tues, Thurs) and 2 days remote (Wed and Fri). 
Pay: $22 - $25/hr. Based on Experience
What will you be doing?
<ul>
<li>Collect and analyze required documentation needed for claim resolution.</li>
<li>Communicate with Transportation Carriers/Insurers/Customers to gather necessary information.</li>
<li>Assist with claims resolution and collection of payments on Claims.</li>
<li>Manage customer claims portals and monthly reports.</li>
<li>Interact with external parties like 3rd party claims management and/or insurance providers.</li>
<li>Collect payment for damages caused by the carrier.</li>
<li>Personal responsibility to manage change.</li>
<li>Run weekly data to capture any trending Drivers and Customers.</li>
<li>Review data to pinpoint damage trends for call out and executive action.</li>
<li>Assist with preventative measures to reduce claims.</li>
<li>Claim mitigation start to finish.</li>
<li>End of Month close auditing and balancing checks.</li>
<li>Must be willing and able to perform all other duties as assigned by management. </li>
</ul>
What are we looking for?
<ul>
<li>This position requires a minimum of a High School Diploma or equivalent.</li>
<li>Must have one to two years of experience in claims resolution.</li>
<li>Must have working knowledge with Windows computer system and Microsoft Office Programs (Word, Excel, Outlook, etc.).</li>
<li>Great oral and written communication skills.</li>
<li>Ability to effectively organize and prioritize work as well as concentrate on multiple tasks simultaneously.</li>
<li>Creative, can think outside of the box to resolve problems.</li>
<li>Excellent customer service skills.</li>
<li>Previous Transportation or Automotive Industry knowledge a plus.</li>
<li>Personal responsibility to manage change.</li>
<li>Critical thinking / ability to think outside of the box to resolve issue at hand.</li>
</ul>
Benefits
At ACERTUS we believe that our employees are our greatest asset. Our benefits include:
<ul>
<li>Medical, Dental and Vision Insurance benefits start on the 1st day of the month following your start date.</li>
<li>Company Paid Time Off</li>
<li>8 Company Paid Holidays</li>
<li>401(k) with auto-enrollment at 3% starts on the 1st day of the month following your start date.</li>
<li>Casual Dress Code</li>
</ul>

About ACERTUS
ACERTUS is an automotive logistics company specializing in vehicle lifecycle solutions. Our client centric model is enabled by our people, processes and innovative technology that are a differentiator in the industry. Our comprehensive portfolio of services is designed to provide solutions throughout the lifecycle of a vehicle. We offer a full suite of vehicle transportation services, customizable technology, a national title and registration platform plus compliance services, and a growing vehicle storage footprint throughout North America. ACERTUS – Relentless Drive to Deliver!
 ACERTUS is committed to employing a diverse workforce. Qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity, gender expression, veteran status, or disability.

Claims Specialist - Automotive Claims

<h3>Job Description</h3>
Job Description
FlatRate Moving® is seeking an experienced and detail orientated&nbsp;Claims Associate&nbsp;to join our Customer Service &amp; Claims Department.
Responsibilities include but are not limited to:&nbsp;
<ul>
<li>Investigate, negotiate and settle routine and moderate claims over the phone or mail;</li>
<li>Provide exceptional and timely service which ensures prompt and fair settlement of claims in accordance to company policies and guidelines;</li>
<li>Review and interpret all pertinent documents;</li>
<li>Evaluate each claim assigned and conduct investigation(s) when necessary;</li>
<li>Maintain proper files for claims by collecting and organizing all relevant documents; and set up new claims using company software;</li>
<li>Complete company reports as required; and</li>
<li>Work closely with other department(s) to quickly resolve claims and issues.&nbsp;</li>
</ul>
Requirements:
<ul>
<li>Excellent computer skills using computer software including Microsoft Office products and other pertinent software(s);</li>
<li>2-3 years experience in the claims/customer services field;</li>
<li>Excellent communication skills (written and verbally) and telephone skills;</li>
<li>Negotiation and problem-solving skills; and</li>
<li>Ability to work independently and in a team environment;</li>
</ul>
Company DescriptionFlatRate Moving is a high-end, national moving company with offices in major cities throughout the US: New York, Los Angeles, San Francisco and Miami. In addition to our residential clients, we also cater to commercial, international and military clients. 
<h3>Company Description</h3>
FlatRate Moving is a high-end, national moving company with offices in major cities throughout the US: New York, Los Angeles, San Francisco and Miami. In addition to our residential clients, we also cater to commercial, international and military clients.

Claims Associate

<h3>Job Description</h3>
Job DescriptionJob Description 
Are you ready to take the wheel and drive success? As a full-time Claims Specialist at SIXT, you’ll be at the heart of our dynamic operation, ensuring every detail aligns for a seamless process. If you’re a pro at juggling tasks, thrive in fast-paced environments, and love turning challenges into wins, this is the role for you. Apply now! &nbsp;&nbsp;  &nbsp; YOUR ROLE AT SIXT&nbsp;
<ul>
<li>You collaborate with external organizations to streamline the collections process and improve efficiency in recovering owed amounts</li>
<li>You make informed decisions regarding the pursuit or closure of damage claims, balancing accountability, and strategic judgment</li>
<li>You de-escalate and resolve outstanding damage claims, turning complex situations into satisfactory outcomes for all parties</li>
<li>You provide exceptional customer service, addressing client inquiries with empathy and professionalism</li>
<li>You explain the claims process and Sixt coverage, ensuring clients fully understand their options</li>
<li>You gather necessary documentation from clients, insurers, and other parties, ensuring thoroughness in the claims process while maintaining confidentiality and legal compliance</li>
</ul>
YOUR SKILLS MATTER&nbsp;
<ul>
<li>Experience&nbsp;You have a minimum of 1 year of experience in claims, collections, or an administrative role &nbsp;</li>
<li>Education&nbsp;You have a high school diploma or bachelor’s degree (preferred)</li>
<li>Technical Proficiency&nbsp;You are proficient in computer navigation, including Microsoft Office Applications</li>
<li>Soft Skills&nbsp;You demonstrate strong organizational skills, can multi-task effectively, and excel in professional communication</li>
<li>Commitment To Excellence&nbsp;You are success-oriented and willing to take on multiple tasks</li>
</ul>
WHAT WE OFFER&nbsp;
<ul>
<li>Comprehensive Health Insurance&nbsp;Healthcare coverage (medical, dental, vision), life insurance, critical illness, hospital indemnity, pet insurance, and a 401k retirement plan</li>
<li>Paid Time Off &amp; Sick Leave&nbsp;Access Enjoy PTO, sick leave, floating paid holidays and a healthy work-life balance &nbsp;&nbsp;</li>
<li>Exclusive Employee Rentals&nbsp;Leverage special rental discounts exclusive to employees, offering great savings for you and your immediate family &nbsp;</li>
<li>Additional Perks&nbsp;Experience the advantages of working in a cutting-edge office in downtown Tulsa, OK, free parking, and ample opportunities for professional advancement</li>
</ul>
Additional Information 
About us:
We are a globally leading mobility service provider with a revenue of €4.00 billion and around 9,000 employees worldwide. Our mobility platform ONE combines our products SIXT rent (car rental), SIXT share (car sharing), SIXT ride (taxi, ride, and chauffeur services), and SIXT+ (car subscription), giving our customers access to our fleet of 350,000 vehicles, the services of 4,000 cooperation partners, and around 5 million drivers worldwide. Together with our franchise partners, we are present in more than 110 countries at 2,000 rental stations. At SIXT, top-tier customer experience and outstanding customer service are our highest priorities. We believe in true entrepreneurship and long-term stability and align our corporate strategy with foresight. Get started with us and apply now!

<h3>Job Description</h3>
Job Description
Job Summary:
Americo is seeking a full-time Supervisor for our Claims Team. This position ensures that Claims tasks are executed efficiently on a day-to-day basis, providing immediate oversight and guidance to frontline staff. The position also ensures claims and compliance guidelines are followed and appropriate decisions are made on each claim by making final decisions within financial authority, is involved in projects that improve effectiveness of the department, and operates within a defined budget. Additionally, development of the team and its individual members to be productive, service-minded associates is vital to this role.
Key Responsibilities:
<ul>
<li>Ensure all service level agreements are met or exceeded</li>
<li>Create and maintain reporting illustrating department performance against key performance indicators</li>
<li>Track associate performance and provide feedback</li>
<li>Identify process improvement opportunities</li>
<li>Lead and/or be subject matter expert on department and enterprise projects</li>
<li>Handle referrals and quality review of non-contestable life and annuity claims</li>
<li>Coaching, mentoring, developing, and training of Claims associates</li>
</ul>
Experience and Qualifications:
<ul>
<li>Microsoft tools proficiency</li>
<li>Prior Claims experience or Claims-related experience</li>
<li>Strong interpersonal and communications skills; ability to coach and lead team</li>
<li>4 year degree or comparable work experience is required.</li>
</ul>
#AMERICO

Supervisor, Claims

<h3>Job Description</h3>
Position: Claims Coder
Facility: McLaren Health Plan - Flint, MI
Contract: 13 Weeks
Start Date: September 15, 2025 (Tentative) 
Schedule: 8 Hours/day (Remote)
&amp;#x1F4B0; Pay Package (40 hours/week):
<ul>
<li>$27/Hour</li>
</ul>
Requirements:
Associate degree in Health Information Management, Applied Science, Business Administration,Health Care Administration or equivalent program with emphasis on coding; or High school diploma with two (2) years of related experience.
Certified Medical Coder (CPC, RHIT or RHIA).
Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.
Two (2) years’ experience in analytic role utilizing systems and data
<ul>
<li>Understands this is a temp job only - Required</li>
<li>1 year of experience in Claims or Data Entry - Required </li>
<li>Please verify full home address - Required</li>
</ul>

Claims Coder

<h3>Job Description</h3>
Job Description
Overview
Step Into a Rewarding Role as a Claims Specialist with PharMerica!
Are you ready to make a real impact in a growing organization? Join our PharMerica team as a Claims Specialist, where you'll play a key role in ensuring our long-term care and senior living clients receive the pharmaceutical support they need. We offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters—delivering exceptional care and service.
This is a remote opportunity. Applicants can reside anywhere within the Continental USA. 
Schedule: Monday - Friday 9 am-5:30 pm 
Why Join PharMerica?
<ul>
<li>Focused on Service Excellence: Our mission is to provide top-quality care and outstanding customer service to hospitals, rehabilitation centers, long-term acute care hospitals, and specialized care centers across the nation.</li>
<li>Career Growth: We’re in high growth mode, offering plenty of opportunities for those looking to advance their careers.</li>
<li>Remote Flexibility: This position is 100% remote, giving you the freedom to work from anywhere!</li>
</ul>
What You’ll Do: As a dynamic Claims Specialist, you will:
<ul>
<li>Leverage your Pharmacy Claims Experience to manage and resolve claims efficiently, ensuring our clients get the support they need.</li>
<li>Be a vital part of a team that’s dedicated to enhancing patient care through meticulous claims management and customer service.</li>
<li>Pharmacy Technician experience, preferred</li>
</ul>
What We Offer:
<ul>
<li>DailyPay</li>
<li>Flexible Schedules</li>
<li>Competitive Pay with Shift Differentials</li>
<li>Health, Dental, Vision, and Life Insurance</li>
<li>Company-Paid Disability Insurance</li>
<li>Tuition Assistance &amp; Reimbursement</li>
<li>Employee Discount Program</li>
<li>401k Plan</li>
<li>Paid Time Off</li>
<li>Non-Retail, Closed-Door Environment</li>
</ul>
 
Responsibilities
The Claims Specialist - 3rd Party:
<ul>
<li>Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks</li>
<li>Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines</li>
<li>Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement</li>
<li>Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes</li>
<li>Works as a team to identify, document, communicate and resolve payer/billing trends and issues</li>
<li>Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans</li>
<li>Prepares and maintains reports and records for processing</li>
<li>Performs other tasks as assigned</li>
</ul>
 
Qualifications
Education/Learning Experience:
<ul>
<li>Required: High School Diploma or GED</li>
<li>Desired: Associate’s or Bachelor’s Degree</li>
</ul>
Work Experience:
<ul>
<li>Required: Customer Service</li>
<li>Desired: Up to one year of related experience. Pharmacy Technician experience</li>
</ul>
Skills/Knowledge:
<ul>
<li>Required: Ability to retain a large amount of information and apply that knowledge to related situations. Ability to work in a fast-paced environment. Basic math aptitude. Microsoft Office Suite</li>
<li>Desired: Knowledge of the insurance industry’s trends, directions, major issues, regulatory considerations and trendsetters</li>
</ul>
Licenses/Certifications:
<ul>
<li>Desired: Pharmacy technician, but not required</li>
</ul>

<h3>Job Description</h3>
Job Description
This position requires strong interpersonal, organizational and communication skills. The candidate must have proficient computer skills, especially in Microsoft Office products. A successful candidate must be able to work independently as well as in a fast paced group environment, prioritize and handle fluctuating workloads. General responsibilities may include: Complete claim forms and documents. Assists the Claim Manager on assigned claim files. Performs various administration duties including but not limited to; Processing incoming correspondence Data entry Electronic filing
Rely on instructions and pre-established guidelines, practices and procedures to perform the functions of the job. Manage internal and external customer relationships and provide exceptional customer service. &nbsp;
Years of experience 1-2 years of experience in insurance/claims&nbsp; Education Level High school diploma or equivalent &nbsp;
Company DescriptionMust live in Georgia 
<h3>Company Description</h3>
Must live in Georgia

43,800 claims Jobs