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job_organization_name

city

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<h3>Job Description</h3>
Essential Duties and Responsibilities:
<ul>
<li>Manage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Manage increasingly complex cases with larger financial exposure.</li>
<li>Investigate and evaluate claim files including complying with the standards of performance, interviewing members, reviewing medical records, corresponding with plaintiff attorneys, obtaining preliminary expert evaluation/opinions, and preparing interview summaries.</li>
<li>Prepare case evaluation reports for publication and presentation to the CRC and CSC.</li>
<li>Prepare case evaluation reports for discretionary authority on selected cases.</li>
<li>Manage and participate in all litigation activity, including discovery plan, mediation, MSC, and negotiation under supervision, as necessary.</li>
<li>Monitor trials and arbitrations including daily progress reports, providing member and defense attorney with support.</li>
<li>Prepare claim file resolution documentation.</li>
<li>Timely update the claims database.</li>
<li>Document all important case developments under the chronology tab.</li>
<li>Code the claims file and update as relevant information is available. </li>
<li>Timely review and index documents to the On Base system.</li>
<li>Provide assistance to management as indicated on special project.</li>
<li>Identify, investigate and follow-up on coverage issues.</li>
<li>Take Hotline calls as requested and as necessary and prepare hotlines.</li>
<li>Attend staff and department meetings as indicated.</li>
<li>Assist management in training of Claims Specialist I and II’s.</li>
<li>Perform other duties as necessary.</li>
<li>Education and/or Experience:</li>
<li>Bachelor’s degree from four-year college or university.</li>
<li>Relevant legal and/or medical education background or the equivalent.</li>
<li>Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.</li>
<li>Certificates, Licenses, Registrations:</li>
<li>Valid California driver license </li>
</ul>
 
Skills
<ul>
<li>Time management skills.</li>
<li>computer literate</li>
<li>Claims Specialist</li>
<li>medical malpractice claims management experience</li>
<li>CAP claims experience.</li>
</ul>

Claims Specialist (CAP Claims)

<h3>Job Description</h3>
Job Description Claims Analyst - Construction Claims US-NY-Syracuse Job ID: 2025-3206 Type: Regular Full-Time # of Openings: 1 Category: Construction Management The LiRo Group Overview 
We have an immediate need for a Construction Claims Analyst based in Syracuse NY location.
Come join our team! We are looking to build services and capabilities through the growth of our key asset- our staff. Ranked among the nation's top A/E firms by Engineering News-Record, LiRo-Hill provides construction management, engineering, environmental, architectural, and program management solutions. You can become part of an organization that has a strong track record and is looking to strengthen relationships and capabilities to continue being a trusted resource for our clients in the public and private sector. We are proud to be known as an “Integrated Construction, Design and Technology Solutions” firm and we have delivered on that label time and again.
Recently, Global Infrastructure Solutions Inc. (GISI), the parent company of The LiRo Group and Hill International, Inc. consolidated a portion of the highly experienced staff of both LiRo and Hill in the Northeast to create a larger, more efficient, and cost-effective team to serve clients.&nbsp; LiRo-Hill is a 1100-person firm with offices in NYC, Long Island, Buffalo, Rochester, Boston and Metro Park, NJ.
The client for this project is the NYS Office of General Services (OGS).
 Responsibilities 
Construction Claims Analyst&nbsp;
The Construction Claims Analyst will focus on the careful review and analysis of construction delay claims filed against the NY State. This role is well-suited for someone who values independent, detail-oriented work and thrives in an environment where critical thinking and written analysis are essential.
Key Responsibilities:
<ul>
<li>Evaluate contractors’ delay claim notices for validity in accordance with contract requirements.</li>
<li>Review and interpret detailed schedule analyses using Primavera P6.</li>
<li>Conduct forensic delay analysis by examining project records, such as meeting minutes, schedules, and correspondence.</li>
<li>Track, document, and manage assigned delay claims with accuracy and consistency.</li>
<li>Facilitate fact-finding meetings with design and construction staff to gather information and ensure thorough review.</li>
<li>Audit claim costs—including certified payrolls and invoices—and prepare clear, well-documented recommendations; negotiate settlements when appropriate.</li>
<li>Prepare clear, concise reports on high-priority and problem projects for executive staff on a regular basis.</li>
</ul>
 Qualifications 
<ul>
<li>Education/Experience:</li>
<ul>
<li>Bachelor’s degree in Construction Management or a related field, or</li>
<li>Associate degree with 2+ years of experience in a similar role, or</li>
<li>4+ years of experience in a comparable position.</li>
</ul>
<li>Strong knowledge of construction schedules, schedule analysis, and time impact analysis.</li>
<li>Experience in contracts, project management, and scheduling in a construction environment.</li>
<li>Ability to work independently, manage workload efficiently, and produce clear, well-documented analysis.</li>
<li>Strong attention to detail, critical thinking, and problem-solving skills.</li>
<li>Effective written communication skills for reports and documentation; comfortable participating in structured, focused meetings.</li>
<li>Construction&nbsp; project management or scheduling experience preferred.</li>
<li>OSHA 10 certification required.</li>
</ul>
At Liro-Hill we are committed to your success, and we invest in your growth and development to unlock your full potential. 
Our benefits include:
<ul>
<li>Competitive Total Compensation Package</li>
<li>Employee- Only Stock Purchase Plan</li>
<li>Mentoring programs</li>
<li>Continuing Education Program</li>
<li>Employee referral bonus</li>
<li>Compensation range for this role:&nbsp; Minimum: $100,000 to&nbsp; - $125,000 annually</li>
<li>The range provided is the salary that the Firm in good faith believes at the time of this posting is willing to pay for the advertised position. Exact compensation will be determined on the individual candidates’ qualifications and location</li>
</ul>
#ID22
#ZR22
#LI-CM1
 
Compensation details: 100000-125000 Yearly Salary
 
PI652cc8545eb9-25405-38781940

Claims Analyst - Construction Claims

<h3>Job Description</h3>
Job Description
Claims Manager
Location: Byron Center, MI - Onsite Job Type: Full-Time, Exempt
Company Overview Martin Transportation Systems and affiliated companies deliver excellence in transportation and logistics. We prioritize safety, risk management, and operational performance.
Position Summary We’re looking for an experienced Claims Manager to manage auto liability, bodily injury, property damage, and general liability claims. You’ll lead claims investigations, coordinate with insurance carriers, TPAs, and attorneys, and support litigation and risk reduction initiatives.
Key Responsibilities
<ul>
<li>Oversee full life cycle of transportation claims and litigation support.</li>
<li>Conduct investigations and review police reports, dashcam footage, and statements.</li>
<li>Manage subrogation and ensure compliance with FMCSA, DOT, and provincial regulations.</li>
<li>Collaborate with operations, safety, and maintenance teams.</li>
</ul>
Qualifications
<ul>
<li>Experience in claims management, insurance adjusting, or trucking/transportation claims.</li>
<li>Strong analytical, organizational, and communication skills.</li>
<li>Proficiency in Microsoft Office; familiarity with claims systems, TPA portals, and TMW preferred.</li>
<li>Valid driver’s license; minimal travel. Preferred: Paralegal certificate or litigation support experience.</li>
</ul>
Why Work With Us? Make a meaningful impact on risk management, safety compliance, and claims resolution across a diverse portfolio of businesses.
Apply Now
Apply online at <a href="https://www.mtstrans.com/office-shop-jobs" target="_blank">https://www.mtstrans.com/office-shop-jobs</a>

Claims Manager

<h3>Job Description</h3>
Job DescriptionClaims Processor Familiarity with general merchandise manufacturing process, technical composition of product parts and the plumbing industry. Commercial insurance knowledge, and/or understanding in processing claims. This position requires up to 25% travel. Attend product inspections-offsite upon request. Associate degree in business or related field; at-least two years’ relevant work experience and/or training; or equivalent combination of education and experience. will analyze and review claims for accuracy, completeness and eligibility. Prepare and maintain reports and retain account records for processing. Essential Duties and Responsibilities: Responsible for processing of all product claims. Review and analyze new claims and disseminate claims to the appropriate insurance carrier. Liaison with intercompany parties, insurance adjusters and customers in resolving product claims. Evaluate claims submitted to insurance companies to determine whether or not the claims meet the eligibility standards of the company. Research and resolve issues with the scope of job. Establish and maintain contact between corporate and field offices to facilitate the gathering of information that will allow proper response to legal documents and claim losses in a timely manner Develop written and oral correspondences relative to processing of all product claims. Identify exposure to the company and report to superiors on pending claims and litigations that may result in asset loss and/or any adverse impact on corporate goals. 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. #1013 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/ Analyst

<h3>Job Description</h3>
Job Description
Job Title: Claims Examiner
Location: New Haven, CT 06511
Expected Duration: 3+ months to start off
Shift: Monday through Friday (8:30 am-5:00 pm EST)
100% Onsite

Description:
3+ years of Workers’ Compensation Lost Time Claim Examiner or Commensurate Experience (Having experience in worker’s compensation is not a requirement but a nice thing to have, as long as the skills they do have are transferable.)

Duties and Responsibilities:
- Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
- Reviews claim and policy information to provide background for investigation.
- Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
- Evaluates the facts gathered through the investigation to determine compensability of the claim.
- Informs insureds, claimants and attorneys of claim denials when applicable.
- Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
- Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team
Leader throughout the life of the claim.
- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
- Works with attorneys to manage hearings and litigation
- Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
- Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
- Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations.
- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
- Works with in-house Technical Assistants, Special Investigators, Nurse
Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Technical Skills &amp; Competencies:
- Lost Time Claim Examiner position with prior experience in workers’ compensation as a medical only examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability or as a claim technical assistant for lost time claims.
- Requires knowledge of workers’ compensation statutes, regulations and compliance.
- Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
- Exceptional customer service and focus.
- Ability to openly collaborate with leadership and peers to accomplish goals.
- Demonstrates a commitment to a career in claims.
- Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
- Use analytical skills to find mutually beneficial solutions to claim and customer issues.
- Ability to prepare and make exceptional presentations to internal and external customers.
- Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
- Willing to take ownership and tackle obstacles to meet the company's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
- Superior verbal and written communication skills.

Experience, Education &amp; Requirements:
- Experience working in a customer focused, fast-paced, fluid environment
- Experience utilizing strong communication and telephonic skills
- Prior experience requiring a high level of organization, follow-up and accountability
- Prior workers’ compensation claim handling experience is a plus but not required
- Familiarity with claim handling (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability) is a plus but not required
- Prior insurance, legal or corporate business experience is a plus but not required
- AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
- Proficiency with Microsoft Office Products
- Knowledge of medical terminology is a plus but not required
- Knowledge of bill processing is a plus but not required
- Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island and Vermont, are necessary; however, they are not required at the time of posting for the position. - If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure
Company DescriptionAbout BCforward: Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally. BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work. BCforward is an equal opportunity employer. 
<h3>Company Description</h3>
About BCforward:\r\n\r\nFounded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.\r\n\r\nBCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work.\r\n\r\nBCforward is an equal opportunity employer.

Claims Examiner

<h3>Job Description</h3>
Job Title: Claims Examiner 
Job Location: 9557 Greenleaf Avenue, Job Title: Claims Examiner 
Job Location: 9557 Greenleaf Avenue, Whittier, CA 90601
Duration: 13 weeks
SHIFT: Monday - Friday - 07:00am - 03:30pm
 
Job Description:
Must have listed claims reimbursement experience
 Must have DOFR
 Must have processed lab claims
 * Will Need References to Submit.
 * Will Need References to Submit.
 * Will Need References to Submit.
 **ONSITE INTERVIEW REQUIRED**
 PLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTED
 *** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION***
Position Summary:
 The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
Education/Experience/Training:
 • High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
 • Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
 • Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
 * Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
 * Knowledge of compliance issues as they relate to claims processing
 • Experience in interpreting provider contract reimbursement terms desirable
 • Ability to identify non-contracted providers for Letter of Agreement consideration
 • Data entry experience
 • Training on basic office automation and managed care computer systems
Duration: 13 weeks
SHIFT: Monday - Friday - 07:00am - 03:30pm
 
Job Description:
Must have listed claims reimbursement experience
 Must have DOFR
 Must have processed lab claims
 * Will Need References to Submit.
 * Will Need References to Submit.
 * Will Need References to Submit.
 **ONSITE INTERVIEW REQUIRED**
 PLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTED
 *** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION***
Position Summary:
 The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
Education/Experience/Training:
 • High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
 • Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
 • Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
 * Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
 * Knowledge of compliance issues as they relate to claims processing
 • Experience in interpreting provider contract reimbursement terms desirable
 • Ability to identify non-contracted providers for Letter of Agreement consideration
 • Data entry experience
 • Training on basic office automation and managed care computer systems
 
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit <a href="http://www.ustechsolutions.com" target="_blank">www.ustechsolutions.com</a>.
 
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.
 
Recruiter Details:
Name: Adil Saifi
Email: <a href="mailto:adil@ustechsolutionsinc.com" target="_blank">adil@ustechsolutionsinc.com</a>
Internal Id: 24-22803

<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>High school diploma or equivalent.</li>
<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>Previous claims processing.</li>
<li>Experience in billing or physician office experience is preferred.</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 manager or claims coordinator.</li>
<li>Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines.</li>
<li>Maintain a quality rating of 98%.</li>
<li>Processes 15-20 claims per hour.</li>
<li>Consistently displays a positive attitude and acceptable attendance.</li>
<li>Participate in external and/or internal trainings as requested.</li>
</ol>
Equal Opportunity Employer
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Claims Analyst

<h3>Job Description</h3>
Job DescriptionPeople Plus is hiring clerical candidates! Are you detail-oriented and people-friendly with a strong work ethic? If you are, then we have the perfect position for you!The candidate will be making calls to hospitals/insurance companies and checking on the status of claims. Also, I will be entering codes and charges and setting up claims to be billed.*1st Shift- Hours may vary depending on the position *$13.50*Mandatory Overtime one Saturday per quarter from 8 am-12 pm*Clerical Experience would be a plus Please call 270-825-8939 or show interest in the app.

78,685 claims Jobs