field_job_employment_type

field_job_occupational_field_parents_all

field_job_experience

job_organization_name

city

state

<h3>Job Description</h3>
Job Description
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.
 This is a remote role.
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives claims, confirms policy coverage and acknowledgment of the claim</li>
<li>Determines validity and compensability of the claim</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Assists other claims professionals with more complex or problematic claims as necessary</li>
<li>Requires regular and consistent attendance</li>
<li>Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”)</li>
<li>Additional projects and duties as assigned</li>
</ul>
KNOWLEDGE &amp; SKILLS: 
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management and organizational skills</li>
<li>Ability to meet or exceed performance competencies</li>
<li>Ability to work both independently and within a team environment</li>
</ul>
EDUCATION &amp; EXPERIENCE: 
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 1 year of industry experience and claims management preferred</li>
<li>State Certification as an Experienced Examiner</li>
</ul>
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. 
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. 
Pay Range: $51,807 – $83,551 
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management 
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). 
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote

Indemnity Claims Specialist

<h3>Job Description</h3>
Job Description
POSITION: Staff Accountant (Claims)
SUPERVISOR: Accounting Manager
STATUS: Hourly/Non-Exempt
 
PAY RANGE: $30.00 - $34.00 Hourly 
The base pay offered will consider internal equity and may vary based on the candidate’s job-related knowledge, skills, experience, and other factors.
 
 
LOS ANGELES REGIONAL FOOD BANK
The mission of the Food Bank is to mobilize resources to fight hunger in our community. To fulfill our mission, we source and acquire nutritious food and other products and distribute them to people experiencing nutrition insecurity through our partner agency network and directly through programs; energize the community to get involved and support hunger relief; and conduct hunger and nutrition education and awareness campaigns and advocate for public policies that benefit the people we serve. Food Bank employees are hired because of their unique skills, diverse perspective, and their commitment to our mission. This means that each of us, working together, will do all that we can to fulfill our vision that no one goes hungry in Los Angeles County. Our core values include: Respect, Stewardship &amp; Accountability, Collaboration, Urgency, Service, Integrity and Diversity. Our organization is committed to maintaining a positive and engaging workplace for all employees.
 
ESSENTIAL FUNCTIONS
The position of the Staff Accountant is responsible for overseeing various local, state &amp; federal programs that require invoicing for reimbursements &amp; monitoring for compliance. The Staff Accountant will also perform general duties relating to accounts receivable, and general ledger accounting. 
 
WHAT YOU’LL DO
 
Government Program Compliance &amp; Financial Monitoring: Monitors and analyzes Federal, State, and Local government programs to ensure compliance with contracts and budgets. Prepares applications required for State, Local, and Federal awards. Prepares source documents for Federal reimbursements (FEMA – EFSP, CACFP, SFSP, DPH, and other Federal funding). Prepares source documents for State reimbursements (CalFood Fund, EFAP Tax Check-Off, Food Bank Capacity, and other State funding). Coordinates with the Programs department to ensure compliance with regulations for all government programs. Serves as the point person for compliance monitoring, reviews, and audits conducted by program auditors and government associations. Contributes to improving processes to enhance efficiency in monitoring government claims.
 
Financial Reporting &amp; Accounting Support: Prepares government reimbursement requests, schedules, and journal entries to record receivables. Monitors various accounting transactions to ensure compliance with Local, State, and Federal regulations. Coordinates with the Product Acquisitions &amp; Inventory Planning team for government program-related purchases. Prepares and analyzes monthly reconciliations for Accounts Payable (including Aging) and accounts payable accruals. Prepares journal entries for bank-related transactions not tied to donations or payables. Provides support to the Accounting Department and performs other job-related tasks as assigned.
 
 
QUALIFICATIONS
<ul>
<li>
Bachelor's degree in Business Administration, with a major in Accounting or Finance with at least 3 years' experience in all phases of accounting from analysis, detail journal entry, reconciliation and closing.
</li>
<li>
Computer experience and proficiency in Microsoft applications, especially in Excel; intermediate user preferred. Familiar with pivot tables and formulas, such as VLOOKUP.
</li>
<li>
Detail-oriented, strong analytical capabilities are needed to formulate and prepare reports.
</li>
<li>
Demonstrates problem-solving and organizational abilities. Participates in operational aspects of the department and maintains/participates in performance improvement activities within the department.
</li>
<li>
Demonstrates integrity, strong planning, organizing, time management and interpersonal skills.
</li>
<li>
Passion for the Food Bank’s mission and commitment to the values of the organization: collaboration, inclusion, diversity, equity, accessibility, respect, service, stewardship &amp; accountability.
</li>
</ul>
 
 
BENEFITS
We offer a comprehensive benefits package:
<ul>
<li>
Medical: Employee HMO coverage as little as $10 per bi-weekly paycheck and access to Nonstop Health funds
</li>
<li>
Dental: Employee HMO coverage available at no cost
</li>
<li>
Vision: Comprehensive vision insurance with generous allowances for examinations and material costs 
</li>
<li>
Flexible Spending Accounts
</li>
<li>
Employer-paid Life Insurance and Long-Term Disability
</li>
<li>
Optional Long-Term Care Insurance
</li>
<li>
403(b) retirement savings plan with employer match
</li>
<li>
Employee Assistance Program (EAP) with expanded Mental Health 
</li>
<li>
Employee recognition programs
</li>
<li>
Growth &amp; career development support for professional certifications and additional training resources
</li>
<li>
Vacation: Two weeks annually for the first three years
</li>
<li>
Holiday: Nine paid holidays; eligible upon date of hire
</li>
<li>
Sick Leave Time available
</li>
</ul>
 
 
As a part of the Food Bank’s pre-employment screening process, all potential employees are subject to a Criminal Background Check.
In instances of a federal, state or locally declared emergency, Los Angeles Regional Food Bank is typically considered an essential service and emergency responder; all of its employees may be called in to perform regular or emergent duties.
The Los Angeles Regional Food Bank is proud to be an “Equal Opportunity Employer.” Applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. The Food Bank fosters an organizational culture where ideas and decisions from all people help us grow, innovate, and serve in a rapidly changing world. We strongly encourage people from underrepresented groups to apply.

Staff Accountant (Claims)

<h3>Job Description</h3>
Job Description
Claims Processor
Whittier, CA.
We are currently hiring for a Claims Processor in the Whittier, CA area. We have several opportunities available due to our growing needs! We are specifically looking for entry to mid-level candidates who are interested in a long-term career with opportunities for growth, development, and advancement. If you’re interested in such an opportunity, this position could be the right fit for you.
Claims Processor Pay Rate:
<ul>
<li>starting pay is $24-$28.00</li>
</ul>
Claims Processor Shift :
<ul>
<li>1st shift</li>
<li>7:00am-3:30pm</li>
</ul>
Claims Processor Job Description:
<ul>
<li>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.</li>
<li>Investigate the claims filed and decide to deny, pay, or negotiate a settlement with the policyholder themselves or their representatives.</li>
<li>Submit claims to patients’ insurance carriers using codes that are assigned to each of the medical or diagnostic procedures performed by the provider and communicate with insurance companies as they track and monitor the status of payments</li>
</ul>
Claims Processor Requirements:
<ul>
<li>High School Diploma or GED.</li>
<li>Minimum of 2 years Claims Adjudication related experience in ambulatory, acute care hospital, HMO, or IPA environment.</li>
<li>Ability to pass a drug and background check.</li>
<li>Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services</li>
<li>Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims</li>
<li>Knowledge of compliance issues as they relate to claims processing</li>
<li>Experience in interpreting provider contract reimbursement terms desirable</li>
</ul>
Apply today to be considered for this opportunity.
Job Type: Full-time
Salary: From $24.00 -$28.00 per hour
Experience level:
<ul>
<li>2 years of experience</li>
</ul>
Schedule: 7:00am-3:30pm
<ul>
<li>8 hour shift</li>
<li>Day shift</li>
<li>Monday to Friday</li>
</ul>
Work Location: In person

Medical Claims Examiner

<h3>Job Description</h3>
Job DescriptionSalary: $20/hr and $.50/mile 
Position: Field Claims Investigator
Job Type: 1099/Contracted Work
Location: 50% working from home, 50% working in thefield
Compensation: $20/hrand$.50/mile
 
COMPANY OVERVIEW
Phoenix Loss Control (Phoenix orPLC) is abusiness servicesproviderin the cable, telecom, and utilities sector. PLCs core service is outside plant damage investigation, recovery, and prevention. We help our clients recover the costs of third-partydamageto their infrastructure, such asunderground fiber optic or gas lines. PLC currently employs over 120people, servicing some of the largest cableandtelecomsoperatorsacross the country(Comcast,Spectrum,AT&amp;T, and Google, to name a few).Phoenix is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth.
POSITION SUMMARY 
Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on call contract job to help support our clients with damagerecovery. Forour field investigators, each day and every investigationisdifferent. We need inquisitive, self-driven individualswhoare comfortable rolling up their sleeves and working in a constantly changing, dynamic environment.
Duties
<ul>
<li>Conduct on-site fieldinvestigations</li>
<li>Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costingestimates</li>
<li>Develop andmaintaincomprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility servicelines</li>
<li>Remain prepared and willing to respond to damage calls withina timelymanner</li>
<li>Complete damage investigations within7 daysand then work with and support our claims managers to complete the investigation and begin the recoveryprocess</li>
<li>Respond to damages same day if received duringbusiness hours(if not, first response following day)</li>
<li>Accurately record all time, mileage, and other associated specific items</li>
</ul>
Required Skills and Capabilities 
<ul>
<li>Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, andpossibledamagers</li>
<li>Smartphone to gather photos, videos, and other information while conductinginvestigations</li>
<li>Computer, with high internet access, to upload and download reports, research cases, and to interact with our claims system and other databases andportals</li>
<li>Exceptional attention to detail and strong written and verbal communicationskills</li>
<li>Proven ability tooperateindependently and prioritize while adhering totimelines</li>
<li>Strong and objective analytical skills</li>
<li>Valid drivers license, current insurance, and reliable vehicle with ability to respond to damages at anytime</li>
<li>Safety vest, work boots, and hard-hat</li>
</ul>
Preferred Qualifications and Skills 
<ul>
<li>Current orprevioustelecommunication or utility experience</li>
<li>Knowledge of underground utilitylocatingprocedures and systems</li>
<li>Investigation, inspection, or claims/fieldadjusting</li>
<li>Criminal justice, legal, or military training or work experience</li>
<li>Engineering, infrastructure construction, or maintenance background</li>
<li>Remote location determined at discretion of investigations manager</li>
</ul>
This is a1099contract position. There are no benefits offered with this position.

Field Claims Investigator

<h3>Job Description</h3>
Job Description
**This role is onsite at our Roslyn, NY or Rochester, NY office, with the option for a hybrid schedule after the training period. **
General Summary: A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. 
 
Essential Duties &amp; Responsibilities:
<ul>
<li>Follow standard claims protocols for documentation, coverage investigations, and file management.</li>
<li>Maintain accurate and organized claims files.</li>
<li>Investigate and document incident particulars, setting appropriate indemnity and expense reserves</li>
<li>Negotiate and bring to resolution directly and through defense attorneys </li>
<li>Attend trials and mediations when necessary.</li>
<li>Adhere to industry Best Practices for effective claim management.</li>
<li>Expand skills through participation in training and professional development courses. </li>
<li>Ensure exceptional data integrity</li>
<li>Proactive communication with insureds, other departments and claims leadership.</li>
<li>Perform additional duties and responsibilities as assigned. </li>
</ul>
Education &amp; Qualifications:
<ul>
<li>Bachelor’s degree or JD required </li>
<li>Three years’ claims handling experience </li>
<li>NY adjusters license required within the first 6 – 12 months of employment. </li>
<li>Strong analytical and problem-solving skills with attention to detail.</li>
<li>Proficient business writing and oral communication skills </li>
<li>Ability to work independently as well as collaboratively within a team.</li>
<li>Strong ethical judgement and a commitment to maintaining confidentiality.</li>
<li>Must be able to work on site</li>
<li>Travel required as needed; may include overnight travel </li>
</ul>
The actual compensation for this position will be determined by experience and other factors permitted by law.

Senior Claims Analyst

<h3>Job Description</h3>
Job Description
Who We Are
PCMI (Policy Claim Management International) is a fast-growing, leading provider of integrated software for Extended Warranty Management and Finance and Insurance (F&amp;I) administration. We are a SaaS company that operates in a fast paced, entrepreneurial environment. Our 3 teams located in the US, Poland, and Thailand work collaboratively around the clock to build our PCRS platform that automates the full administration lifecycle of all extended warranties, F&amp;I products, and service contracts for our customers.
What You’ll Do 
The Product Owner will be responsible for setting, prioritizing and accepting the work generated by a team in order to ensure the most valuable and proper functionality of the product. This role will gather feature requests, schedule releases and coordinate Sprints. You will identify user needs, help a customer understand the product’s business value and work with cross-functional teams to manage product releases.
In this role, you will: 
<ul>
<li>Serve as the voice of the Client.</li>
<li>Work with internal and external customers to analyze the needs and align product roadmap to strategic goals.</li>
<li>Assess value, develop cases and prioritize Epics and stories to ensure work focuses on those with a maximum value that are aligned with product strategy.</li>
<li>Act as an ambassador for the product and as the primary contact for questions related to the product.</li>
<li>Identify and help the client understand the business model, value and value proposition.</li>
<li>Work closely with Product Management and Senior Management to create a product that fits the company portfolio.</li>
<li>Research and analyze industry and the users to help build a product roadmap that adds value and increases Company revenue.</li>
<li>Follow the competitors and the industry.</li>
<li>Define the backlog items that guide the Agile software development team.</li>
<li>Work within the team to develop and deliver new solutions within the application.</li>
<li>Translate features and business requirements into documented solutions, including user stories and acceptance criteria.</li>
<li>Collaborate with the Development team on release plans, delivery of functional enhancements and support of production systems.</li>
<li>Work with the Scrum Master during Sprint Planning and throughout Sprint Cycle to ensure the Development team has a clear understanding of the development requests.</li>
<li>Facilitate solution definition and design with business and Development team stakeholders.</li>
<li>Participate in Sprint Reviews and Sprint Retros.</li>
<li>Support the development of user documentation and training materials.</li>
<li>Advise on situation-specific configuration needs.</li>
<li>Assist with investigation of user-reported and internally identified system issues to determine causes and propose solutions.</li>
</ul>
What You’ll Need to Join Our Team
Experience
<ul>
<li>Bachelor’s degree in Business Administration, IT or related field or equivalent work experience. </li>
<li>2-5 years prior experience in a Product Owner or related role.</li>
<li>Previously employed at a software company.</li>
<li>Software Development Lifecycle exposure.</li>
<li>Experience in the Extended Warranty or Service Contract industry.</li>
<li>Experience with Ticketing software like Jira, Confluence, Service Bench. </li>
<li>Experience with Tools such as GoToMeeting, Zoom, Google Meet, Microsoft Teams.</li>
<li>Must have experience working on large scale projects as well as handling day-to-day operational requests.</li>
<li>Must have technical knowledge and understanding.</li>
<li>Experience following Agile methodologies.</li>
</ul>
Travel
<ul>
<li>Travel to client meetings; up to 10-15%</li>
</ul>
Why Work for Us
<ul>
<li>Competitive Compensation from $95,000 to $115,000 Annually. *</li>
<li>Comprehensive Benefit Package**
<ul>
<li>Health, Dental &amp; Vision Insurance</li>
<li>Health Savings Account (HSA) </li>
<li>Flexible Spending Account (FSA)</li>
<li>Short- &amp; Long-Term Disability Insurance
<ul>
<li>Company-paid Long-Term Disability</li>
</ul>
</li>
<li>Company-paid Life Insurance </li>
<li>Voluntary Life Insurance </li>
<li>Voluntary Accident Insurance </li>
<li>Employee Assistance Program </li>
<li>401k with generous Company Match</li>
<li>Commuter Benefits </li>
</ul>
</li>
<li>Paid Time Off accrued per pay period </li>
<li>10 Paid Holidays</li>
<li>Paid Parental Leave</li>
<li>Annual Bonus Program </li>
<li>Professional Development Opportunities </li>
<li>Employee Events </li>
<li>Wellness Programs </li>
<li>Employee Discount Programs </li>
<li>Office in Park Ridge, IL - Convenient location to Blue Line </li>
</ul>
 
*Individual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related aspects.
 **Eligible to enroll in the first day of employment for immediate coverage.
 
Although the role is remote, PCMI can only hire employees in the following states: 
<ul>
<li>AL</li>
<li>CT</li>
<li>FL</li>
<li>GA</li>
<li>IL</li>
<li>MO</li>
<li>NH</li>
<li>NC</li>
<li>OH</li>
<li>PA</li>
<li>TX</li>
</ul>
Note: It is required for this role to be in the Park Ridge, IL office 2 days per week if the candidate is located in the Chicagoland area.

Product Owner - Claims

<h3>Job Description</h3>
Job Description
About ECBM
ECBM is a family-owned and operated insurance broker and consulting firm based in Media, PA. We specialize in high-risk industries that require dedicated, client-based broker services in the areas of Commercial Insurance, Workers' Compensation, Employee Benefits, Cyber Liability, Professional Liability, Farm &amp; Agriculture, and Personal Insurance. Founded in 1970, our mission is to put people- our clients and employees- first. As a privately-owned company, our motto has always been: "No Shareholders, Just Transparency."
ECBM operates on three main core values: Empathy, Energy and Tenacity. We test every employee who works here for these three core values because employees must have Empathy to care about our clients, Energy to provide the level of service we require, and Tenacity to go that "extra mile" to solve our clients' challenges.
In addition to caring for our clients, we also take pride in caring for our employees. We've been a Best Place to Work in Insurance recipient for the last eight years, and the average length of service of our employees is 11 years.
About the Role
ECBM is looking for a Claims Intake Associate to join our Team! This person will report to the Vice President of Claims Services. This person will contribute to the profit and growth of ECBM by monitoring, managing and reporting all first notices of loss received in the Claims Department. The Claims Intake Associate will obtain, review and evaluate all first notice of loss information from ECBM clients for all insurance lines of business including, but not limited to, automobile, general liability, property, workers' compensation and specialty lines of business. They will continuously monitor the Report Claims mailbox.
Responsibilities 
<ul>
<li>Overall maintenance and management of ReportClaims mailbox</li>
<li>Receive and review initial claim reports from ECBM clients via phone, email or dedicated reporting mailbox</li>
<li>Collaborate with Claims Team staff to evaluate claim, proper reporting and internal staff claim assignment</li>
<li>Report claims to insurance carrier(s) within 24 hours of receipt of claim by ECBM Claims Department</li>
<li>Enter and document all First Notice of Loss information in AMS Claims Management System and Paperwise Document Filing System</li>
<li>Establish standardized diary/suspense tasks as determined by claims line of business</li>
<li>Acknowledge Claim receipt to ECBM client</li>
<li>Follow for Carrier Adjuster assignment and provide claim information to ECBM client contact</li>
<li>Communicate with internal Claims Team members relative to new claim assignments and carrier claims assignment</li>
</ul>
Skills &amp; Abilities
<ul>
<li>Ability to provide excellent customer service to both external and internal clients</li>
<li>Ability to work as team member and perform based on established standards and expectations</li>
<li>Detail oriented</li>
<li>Excellent written and oral communication skills</li>
<li>Excellent organizational skills</li>
</ul>
Education &amp; Experience
<ul>
<li>College degree preferred, but high school diploma or equivalency is required.</li>
<li>Must have good communication skills, both verbal and written.</li>
<li>Detail-oriented as well as ability to process high volume of transactions.</li>
<li>Property/Casualty insurance experience not required but preferred.</li>
<li>Skills Preferred: Microsoft Office including Outlook, Word, Excel and Adobe</li>
</ul>
Benefits
<ul>
<li>Competitive Pay</li>
<li>Health and Welfare Programs Including Medical, Dental, and Vision Insurance</li>
<li>Retirement and Income Protection Programs, including a 401k plan</li>
<li>Work/Life Balance Including PTO, Holidays and Remote work opportunities</li>
<li>Career Advancement Opportunities</li>
</ul>

Claims Intake Associate

<h3>Job Description</h3>
Job Description
We are currently seeking a Claims Processing Coordinator for a fully remote, temporary full-time position through October. This role is with a mission-driven organization that provides essential healthcare services to seniors. We're looking for a qualified candidate who can start as soon as possible.
<ul>
<li>Job Title: Claims Processing Coordinator</li>
<li>Reports to: Director of Health Plan Administration</li>
<li>Job Type: Full-Time, Contract (through October 2025)</li>
<li>Work Schedule: Monday-Friday, Day Shift (40 hours/week)</li>
<li>Start Time: 7:00 AM, 7:30 AM, or 8:00 AM EST (flexible start time available)</li>
<li>Location: Fully Remote (equipment provided)</li>
</ul>
Position Summary:
The Claims Processing Coordinator is responsible for overseeing and coordinating claims-related operations including in-house claims adjudication, authorizations, eligibility reporting, and subrogation. This position ensures processes are compliant with state and federal regulations and supports the organization's mission to assist older adults in maintaining their dignity and independence.
Key Responsibilities:
<ul>
<li>Uphold the mission and values of our company and the PACE model of care.</li>
<li>Coordinate timely adjudication of claims within 30 days of receipt. Monitor claim volume, distribute work, and ensure resolution of pended claims.</li>
<li>Review and verify claim payments processed outside of the claims system, entered by a Claims Processing Specialist.</li>
<li>Manage the claims appeals process:</li>
<li>Log and review appeals.</li>
<li>Collaborate with Medical Director on clinical denials.</li>
<li>Respond in writing to providers within 30 days.</li>
<li>Oversee Coordination of Benefits (COB) and subrogation for Medicare Part A/B claims.</li>
<li>Collaborate with interdisciplinary teams (IDT) and the Health Plan Data Analyst to ensure accurate claims processing.</li>
<li>Process weekly check runs:</li>
<li>Review claim vouchers for accuracy.</li>
<li>Handle refunds and voided checks.</li>
<li>Provide payment data to the Finance department.</li>
<li>Develop and conduct audits to ensure accuracy of claims and authorizations.</li>
<li>Manage Excess Loss Reinsurance reporting:</li>
<li>Track high-cost claims and catastrophic cases.</li>
<li>Work with Medical Director to compile and submit reports to reinsurers.</li>
<li>Address escalated provider complaints and unresolved inquiries.</li>
<li>Serve as the primary liaison with the Claims Processing System (CPS) vendor:</li>
<li>Review documentation and troubleshoot errors.</li>
<li>Test and implement upgrades in collaboration with IT.</li>
<li>Perform ongoing system maintenance including updates to profiles, vendors, and providers.</li>
<li>Review and correct CMS encounter data rejections due to processing errors.</li>
<li>Prepare and audit monthly membership files for accuracy.</li>
<li>Generate reports for internal teams on demand or as part of regular operations.</li>
<li>Educate and support Health Plan staff on claim issues and system errors.</li>
<li>Provide backup coverage for Health Plan team roles as needed.</li>
<li>Perform additional duties as assigned.</li>
</ul>
If you are interested in this opportunity, we encourage you to apply! We will be conducting interviews ASAP!
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine. Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us? 
<h3>Company Description</h3>
Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

38,240 claims Jobs