Claims Examiner

About the Role:Sedgwick is seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing and processing low-mid level General Liability claims on behalf of our valued clients. Your primary goal will be to determine benefits due while ensuring ongoing adjudication of claims within service expectations,...

Optum Job DescriptionAt Optum, we deliver care and technology to help millions of people live healthier lives. We're seeking a Senior Claims Examiner to join our team in reviewing, analyzing, and researching complex health care claims. As a Senior Claims Examiner, you will be responsible for identifying discrepancies, verifying pricing, confirming prior...

Job SummaryAt University Health, we are seeking a skilled Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will be responsible for the adjudication of medical claims for Medicaid, Commercial, and CHIP according to departmental and regulatory requirements. Your expertise in claim processing and billing will ensure that our patients...

Job SummaryAt University Health, we are seeking a skilled Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will be responsible for the adjudication of medical claims for Medicaid, Commercial, and CHIP according to departmental and regulatory requirements.ResponsibilitiesPerform adjudication of medical claims for Medicaid,...

Job SummaryOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and...

Job Title: Medical Claims ExaminerJob Summary:TRIAD is seeking a highly skilled Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will be responsible for accurately processing health plan delegated claims, addressing provider inquiries, and handling various administrative tasks within the department.Key Responsibilities:Process...

About the RoleUSAA is seeking a highly skilled Injury Examiner to join our team. As a dedicated professional, you will be responsible for adjusting complex bodily injury claims and UIM claims, ensuring timely and accurate resolution of claims in compliance with state laws and regulations.Key ResponsibilitiesAdjusts complex bodily injury claims with...

Claims Adjudicator for Argo GroupWe're seeking a highly skilled Workers' Compensation Claims Adjudicator to join our team at Argo Group. As a Claims Adjudicator, you will be responsible for adjudicating indemnity workers' compensation claims of higher technical complexity for our customers in the states of AR, LA, MA, and TX.Key Responsibilities:Adjudicate...

Job Title: Manager, Claims OperationsJob Summary: We are seeking a dedicated Manager, Claims Operations to lead a team of Auto Injury Examiners at USAA. The successful candidate will have a strong background in claims handling and leadership experience.Key Responsibilities:Lead and Manage Team: Direct a team of Auto Injury Examiners responsible for...

Job Title: Manager, Claims OperationsAt USAA, we're seeking a dedicated Manager, Claims Operations to lead a team of Auto Injury Examiners. As a Manager, Claims Operations, you will be responsible for leading and being accountable for auto, property, and other claims operations member service employees who investigate, evaluate, and negotiate claims.Key...

Senior Auditor Job DescriptionCGS is seeking a highly skilled Senior Auditor to join our team. As a Senior Auditor, you will play a critical role in conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses.Key Responsibilities:Analyze complex personal and business financial records...

Job SummaryTotal Behavioral Health is a virtual mental health clinic providing clinical services to diverse clients with mental health needs. Our team includes psychiatrists, nurse practitioners, and mental health counselors. We collaborate with referral sources, such as the Dept. of Mental Health, local hospitals, and health centers. Our specialty...

Job SummaryWe are seeking a Medical Quality Assurance Specialist to support our Veteran Affairs Operations in San Antonio, TX. As a Medical QA Specialist, you will work closely with medical providers and the Veterans Administration to ensure the documentation process is complete and accurate.Key ResponsibilitiesReview and audit exam reports sent over from...

Job DescriptionCGS is seeking a highly skilled Senior Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection.The ideal candidate will develop, coordinate, and draft technical audit guidelines, be proficient in a...

Job DescriptionSan Antonio Women's Health is seeking a board certified or board eligible Physician Assistant to join our growing practice. Our team provides a complete range of women's health care services to patients from all over the San Antonio Metropolitan area. We are passionate about delivering the safest, highest quality, and most compassionate...

Job DescriptionHOLT Truck Centers views the service department as a vital part of the dealership, and the way it builds open, honest, trusting relationships with customers and other departments is essential to the dealership's success.The main objective of the Service Technician is to diagnose and repair vehicle components and systems for the Service...

Job Summary:This is a NAF position with the 17th Force Support Squadron, located at the Mathis Fitness Center, within the Sustainment Services Flight on Goodfellow AFB, San Angelo, Texas.The position is considered Flexible. The position is not guaranteed any hours, but has the potential to work up to 40 hours per week. You may be required to work some...

Claims Analyst OpportunityTPS Group LLC is seeking a skilled Claims Analyst to support their public utilities and energy client. The ideal candidate will have experience in claims investigation, liability analysis, and case management.Key Responsibilities:Investigate and analyze recovery/subrogation and/or liability and property damage claims.Adjust and...

POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE A high school diploma or GED equivalent is...

POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE A high school diploma or GED equivalent is...

Job SummaryWe are seeking a highly skilled Field Claims Examiner to join our team at CCMS & Associates. As a Field Claims Examiner, you will be responsible for investigating claims, inspecting damages, and recommending claim reserves based on thorough investigations.Key Responsibilities:Conduct thorough investigations of claims, including inspecting damages...

Reporting to the Manager, Claims, the Claims Examiner is responsible for claims processing, adjudication, and research. You will stay current on claim processing procedures, produce a quality work product, and assist Claims Management with special projects. You will have claims processing experience with the ability to maintain high qualitative and...

POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE A high school diploma or GED equivalent is...

SWBC is seeking a talented individual to review and evaluate incoming claims for payment or denial and acts as a liaison for the carrier and the financial institution. This role allows you to help those who are dealing with difficult circumstances in their lives. Your help gives them a sense of relief in times of need. You will also have a team who is...

Job SummaryWe are seeking a skilled Insurance Claims Examiner to join our team at Progressive Insurance. As a Claims Adjuster, you will be responsible for managing claims, including the injury portion, and ensuring a swift resolution.Key ResponsibilitiesMaking coverage decisions that determine the extent of Progressive's liabilityGathering details through...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

Job Title: Workers Compensation Claims ExaminerJob Summary:Mary Kraft HR is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices,...

KellyMitchell Group is seeking a skilled Claims Analyst to join their team in San Diego, California. The ideal candidate will have a strong background in claims investigation, liability analysis, and case management. Key responsibilities include: * Investigating and analyzing recovery and liability claims * Adjusting and settling claims as necessary *...

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff on complex claim issue resolutions. Work cooperatively with configuration...

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff on complex claim issue resolutions. Work cooperatively with configuration...

Job DescriptionMary Kraft HR is seeking an experienced Workers Compensation Claims Examiner to analyze complex claims and ensure adherence to industry best practices. The role involves managing high-exposure claims, including those with litigation and rehabilitation, and identifying subrogation opportunities.Key ResponsibilitiesAnalyze and process complex...

Job SummaryWe are seeking a skilled Claims Investigator to join our team at Command Investigations. The ideal candidate will possess a strong background in commercial or personal lines experience, with a focus on multi-lines including AOE/COE, Auto, and Homeowners. SIU experience is highly desirable, but not required. The successful candidate will...

Why USAA?Let’s do something that really matters.At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nation’s military, but we all share in the mission to give back to those who did. We’re working as one to build a great experience and...

POSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff on complex claim issue resolutions. Work cooperatively with configuration...

Claims Resolution ExpertThis position is available in various locations across California, including Riverside, Irvine, San Diego, Pasadena, Torrance, Thousand Oaks, Sherman Oaks, Fresno, Modesto, Sacramento, and Concord.As a Claims Resolution Expert, you'll independently manage claims, including the injury portion, while supporting customer needs and...

Job Introduction Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a F/T Audiologist to perform Veteran Audiology Examinations. Your Role You will apply your expertise in the evaluation and diagnosis of audiological conditions to support a Veterans disability claim. As a medical...