Current jobs related to Account Claims Representative - Philadelphia - Absolute Staffing & Consulting Solutions

  • Medical Claims Specialist

    2 days ago

    Philadelphia, Pennsylvania, United States Temple Health Full time

    Job SummaryWe are seeking a skilled Hospital Billing Representative to join our team at Temple Health. As a key member of our healthcare team, you will be responsible for ensuring accurate and timely claims submission, billing, and payment processing for inpatient and outpatient services.Key ResponsibilitiesSubmit claims to third-party carriers and process...

  • Account Services Representative II

    3 months ago

    Philadelphia, United States American Heritage Credit Union Full time

    Job DescriptionJob DescriptionAmerican Heritage Credit Union, a $4.8+ billion credit union, has an immediate opening for an Account Services Representative II. This position handles many different aspects of member accounts; answers member questions, and maintains member account records.To provide an ultimate level of service to the employees of American...

  • Accounts Receivable Representative

    4 weeks ago

    Philadelphia, United States IntePros Consulting Full time

    IntePros is seeking an Accounts Receivable Representative to join our Philadelphia based industry-leading healthcare client in a hybrid capacity. This person will provide consistent follow up on the open account receivables and will be responsible to review payments received for services rendered and to determine contractual compliance. They will provide...

  • Medical Claims Specialist

    4 days ago

    Philadelphia, Pennsylvania, United States Temple Health Full time

    Job SummaryWe are seeking a skilled Hospital Billing Representative to join our team at Temple Health. As a key member of our healthcare team, you will be responsible for ensuring accurate and timely claims submission, billing, and payment processing for inpatient and outpatient services.Key ResponsibilitiesSubmit claims to third-party carriers and process...

  • Account Consultant

    2 days ago

    Philadelphia, Pennsylvania, United States Sedgwick Full time

    About the RoleWe are seeking a highly skilled and experienced Account Consultant to join our team at Sedgwick. As a key member of our organization, you will play a critical role in managing claim caseloads, mentoring colleagues, and driving business growth.Key ResponsibilitiesManage claim caseloads, including basic to highly complex claims, within granted...

  • Account Services Representative II

    3 months ago

    Philadelphia, United States American Heritage Credit Union Full time

    American Heritage Credit Union, a $4.8+ billion credit union, has an immediate opening for an Account Services Representative II. This position handles many different aspects of member accounts; answers member questions, and maintains member account records.To provide an ultimate level of service to the employees of American Heritage Credit Union. This...

  • Senior Liability Claims Examiner

    1 week ago

    Philadelphia, Pennsylvania, United States Independence Blue Cross Full time

    In the role as a Senior Claims Adjuster, you will handle claims for bodily injury and property damage claims. These claims include auto accidents, premises liability, police professional liability, and subrogation. A working knowledge of the New Jersey Tort Claim Act (Title 59) is preferred.Promptly investigates all assigned claims for coverage, liability...

  • Customer Care Representative

    4 days ago

    Philadelphia, United States Reliance Standard Full time

    Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* The Customer Care Representative 1 will display a high level of compassion on a daily basis showing empathy, sympathy, and developed coping skills to maintain professionalism in every situation over the phone. This individual will treat every claimant with a high level of...

  • Medical Claims Specialist

    8 hours ago

    Philadelphia, Pennsylvania, United States Temple Health Full time

    Job SummaryWe are seeking a skilled Medical Claims Specialist to join our team at Temple Health. As a key member of our healthcare team, you will be responsible for ensuring accurate and timely claims submission, billing, and payment processing for inpatient and outpatient services.Key ResponsibilitiesProcess and submit claims to third-party carriers and...

  • Content Claims Specialist

    4 months ago

    Philadelphia, United States Crawford & Company Full time

    Position Summary The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: Acting/operating as a third party, intermediary between the Insurance Company's property adjusters, and their policyholders with respect to conducting valuations of...

  • Customer Care Representative

    3 days ago

    Philadelphia, United States Reliance Standard Full time

    Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* The Customer Care Representative 1 will display a high level of compassion on a daily basis showing empathy, sympathy, and developed coping skills to maintain professionalism in every situation over the phone. This individual will treat every claimant with a high level of...

  • Claims Reviewer

    2 months ago

    Philadelphia, United States Angeion Group LLC Full time

    Job DescriptionJob DescriptionJob descriptionThe essential functions, duties, and responsibilities include, but are not limited to the following:Data entry, annotation and review of documentation submitted for various administered projects.Recognize discrepancies or lack of information within claim documentation and take appropriate action.Contact claimants...

  • Claims Review Nurse

    3 weeks ago

    Philadelphia, Pennsylvania, United States Genesis Healthcare LLC Full time

    Claims Review NursePOSITION SUMMARY:Supports the denial management team by performing a thorough analytical evaluation of patient medical records. The Claims Review Nurse will develop logical, well-founded, and factual arguments that effectively advocate for the reimbursement of services rendered. Specific reasons for claim denials will be directly addressed...

  • Accounts Receivable Specialist

    13 hours ago

    Philadelphia, Pennsylvania, United States IntePros Consulting Full time

    Accounts Receivable RepresentativeIntePros Consulting is seeking a skilled Accounts Receivable Representative to join our team in a hybrid capacity. This role involves providing follow-up on open account receivables, reviewing payments for services rendered, and ensuring contractual compliance.Responsibilities:Review accounts receivable reports to determine...

  • Accounts Receivable Specialist

    2 months ago

    Philadelphia, United States WES Health System Full time

    Job DescriptionJob DescriptionThe Accounts Receivable Specialist position performs various fiscal duties. This individual will assist the Accounts Receivable Manager to ensure that the AIR Department runs efficiently. The Specialist represents and supports the fiscal policy and procedures of the office, assisting with interpretation and follow up.Works with...

  • Accounts Receivable Specialist

    7 days ago

    Philadelphia, Pennsylvania, United States IntePros Consulting Full time

    Accounts Receivable RepresentativeIntePros Consulting is seeking a skilled Accounts Receivable Representative to provide exceptional follow-up on open account receivables and ensure timely payment processing. This role requires strong organizational skills, attention to detail, and effective communication with interdisciplinary teams.Key...

  • LTD Claims Assessor I

    3 weeks ago

    Philadelphia, Pennsylvania, United States Reliance Standard Full time

    Job Overview As a key member of our team, the LTD Claims Examiner I is responsible for evaluating and processing claims related to Long-Term Disability (LTD), Voluntary Disability, and Waiver of Premium. The primary objective of this role is to ensure accurate and fair claim determinations based on comprehensive reviews of all relevant information and...

  • Senior Claim Specialist-Life Sciences

    2 months ago

    Philadelphia, United States CHUBB Full time

    Chubb is seeking a Senior Claim Specialist for our Life Sciences Claims team. The Life Sciences Claims Team provides claim handling with regard to some of the largest medical products manufacturers and providers of instruments with worldwide distribution on the cutting edge of innovation, research and technology. Typical Life Sciences claims include...

  • Stable & Mature LTD Claims Examiner

    4 months ago

    Philadelphia, United States Reliance Matrix Full time

    Job Responsibilities and Requirements The Stable and Mature LTD Claim Examiner will manage an assigned caseload of Long Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. Stable and Mature LTD Claim Examiners will have meaningful and transparent conversations with their customers and...

  • LTD Claims Examiner I

    3 months ago

    Philadelphia, United States Reliance Standard Full time

    Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability, and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the...

Account Claims Representative

4 months ago

Philadelphia, United States Absolute Staffing & Consulting Solutions Full time
Job DescriptionJob Description

Absolute Staffing is searching for an Account Claims Representative to work with our client.


Location: Philadelphia, PA- Remote

Pay rate: $24-30

Job Description:

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more moderate to complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

Responsibilities:

  • Promptly investigate all assigned claims with minimal supervision
  • Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
  • Alert Supervisor and Special Investigations Unit to potentially suspect claims
  • Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
  • Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
  • Negotiate claims settlements with client approval
  • Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
  • Work collaboratively with client's nurse professionals to develop and execute return to work strategies
  • Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome
  • Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced
  • Demonstrate technical proficiency through timely, consistent execution of best claim practices
  • Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
  • Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
  • Authorize treatment based on the practiced protocols established by statute or the Managed Care department
  • Assist clients by suggesting panel provider information in accordance with applicable state statutes.
  • Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Requirements:

  • Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required
  • At least 3-5 years' experience handling lost time workers compensation claims required; past experience with Pennsylvania jurisdiction is required
  • Associate in Claims (AIC) Designation or similar professional designation desired.
  • Active license required or ability to obtain license within 90 days of employment in mandated states.
  • Familiarity with medical terminology and/or Workers' Compensation
  • Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
  • Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
  • Strong verbal, written communication skills and customer service skills
  • Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
  • Ability to travel for business purposes, approximately less than 10%.