Senior Claims Adjuster
1 month ago
Method Workers' Compensation LLC is seeking a highly skilled Senior Claims Adjuster to join our team in California. As a Senior Claims Adjuster, you will be responsible for analyzing claims to determine benefits due, ensuring the ongoing adjudication of claims within service expectations, industry, and company best practices, and identifying subrogation of claims and negotiating settlements.
Key Responsibilities:- Promptly investigate, evaluate, and manage workers' compensation claims beginning with coverage evaluation, compensability determination, and recovery.
- Manage the medical and return to work process throughout the life of the claim.
- Exercise discretion and independent judgment with respect to evaluating and managing claims and determining reserve amounts.
- Evaluate exposure of claims by reviewing medical records and claim facts to develop and calculate appropriate reserves as well as manage reserve adequacy throughout the life of the claim.
- Adhere to Method Best Practices, Method Claims Protocol, and Claims Handling Guidelines.
- Maintain appropriate claim file documentation and claim coding is complete and accurate.
- Communicate claim activity regularly to any relevant internal and external stakeholders, including injured workers, policyholders, medical providers, and legal counsel, if appropriate.
- Prepare timely any state filings within the state statutory regulations.
- Calculate the average weekly wage and indemnity benefits owed.
- Approve medical and expense payments.
- Ensure all benefits are paid timely.
- Ensure timely and cost-effective claims resolution; negotiate settlement of claims within adjusters' assigned authority when appropriate.
- Manage the litigation process and work with legal counsel when necessary.
- Coordinate vendor utilization while considering claim cost containment techniques and outcomes, including but not limited to nurse case management, surveillance, etc.
- Manage claim recoveries, including but not limited to subrogation and Medicare offsets.
- Notify management of large loss, denial, coverage disputes, subrogation potential, or other matters requiring escalation or collaboration.
- Maintain knowledge of jurisdictional requirements and applicable case law, including appropriate licensure and continuing education requirements.
- In-depth knowledge of workers' compensation insurance principles and laws, as well as cost containment principles.
- Detail-oriented with the ability to work in a team environment.
- Excellent customer service, written and verbal communication skills.
- Ability to prioritize and balance multiple projects simultaneously.
- Results-driven, proactive, and able to work autonomously.
- Ability to exercise discretion and independent judgment.
- Proficient in Microsoft Office Suite, PDF Professional, G Suite, or similar software.
- Bachelor's degree from an accredited college or university.
- At least 5 years of experience in workers' compensation claims experience.
- A combination of education and experience in an insurance company (TPA or brokerage environment) will be considered.
- State adjuster's licenses as required.
In exchange for your time and expertise, we offer competitive compensation, 401(k) plus matching, health benefits (including HSA Contribution), paid disability, paid parental leave, professional development opportunities, and a hybrid/remote work environment. This is an opportunity to play a key role in the continued success of a growing organization.
Method Workers' Compensation LLC is an equal opportunity employer regardless of race, color, gender, age, sexual orientation, gender identity, gender expression, religious beliefs, marital status, genetic information, national origin, disability, protected veteran status, or any other basis protected by federal, state, or local law.
-
Insurance Claims Specialist
3 weeks ago
Lewisville, Texas, United States StoneGate Senior Living Full timeInsurance Biller Job DescriptionStoneGate Senior Living is seeking an experienced Insurance Biller to join our team. As an Insurance Biller, you will be responsible for verifying and facilitating insurance authorizations for Skilled Nursing patients.Key Responsibilities:Verify and process insurance claims for Skilled Nursing patientsCommunicate with clinical...
-
Insurance Claims Specialist
4 days ago
Lewisville, Texas, United States StoneGate Senior Living Full timeInsurance Biller Job DescriptionStoneGate Senior Living is seeking an experienced Insurance Biller to join our team. As an Insurance Biller, you will be responsible for verifying and facilitating insurance authorizations for Skilled Nursing patients.Key Responsibilities:Verify insurance benefits and obtain preauthorization for Skilled Nursing...
-
Commercial Large Loss Claims Specialist
1 week ago
Lewisville, Texas, United States Zurich Insurance Company Full timeCommercial Property Claims AdjusterZurich North America is seeking an experienced property claims professional to join our large loss property claims team. We are open to remote work for the right candidate located in the western states of TX, OK, LA, AR, KS, MO, NE, IL, MN, WI, CO, NM, AZ, NV, UT, OR, WA, or WI.The Property Claims organization is dedicated...
-
Medical Biller
1 week ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a skilled Medical Biller to join our team at Guidehouse. As a Medical Biller, you will be responsible for performing all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.You will work closely with other departments to facilitate the meeting of both departmental and...
-
Medical Billing Specialist
4 days ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Medical Biller will be responsible for performing all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims. This role requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.Key Responsibilities Correcting and billing...
-
Medical Biller
1 month ago
Lewisville, Texas, United States Guidehouse Full timeAbout the RoleWe are seeking a skilled Medical Biller to join our team at Guidehouse. As a Medical Biller, you will play a critical role in ensuring the accurate and timely processing of healthcare claims.Key ResponsibilitiesPerform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.Work with...
-
Senior Financial Analyst
4 days ago
Lewisville, Texas, United States HOYA Vision Care Full timeJob Title: Financial Analyst Lab OperationsJob Summary:As a Financial Analyst at HOYA Vision Care, you will play a critical role in analyzing business performance, developing financial models, and providing insights to senior management. Your expertise in financial analysis, budgeting, and forecasting will drive informed decision-making and contribute to the...
-
Senior Business Operations Manager
1 week ago
Lewisville, Texas, United States Guidehouse Full timeJob Summary:The Senior Business Operations Manager will be an extension of a client's business office staff as well as our in-house client specific training program. This role will perform any and all job-related duties as assigned, providing training to staff members for all projects and positions assigned to their role related to revenue cycle...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeAbout the RoleWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a key member of our revenue cycle team, you will be responsible for performing specific billing processes, follow-up, account resolution, adjustments, and scanning as required.Key ResponsibilitiesContacts third-party payers and guarantors via payer...
-
Senior Clinical Data Engineer
4 days ago
Lewisville, Texas, United States Motion Recruitment Full timeWe are seeking a skilled Data Engineer with experience in healthcare to work on our team in a hybrid setting. This role will require 4 days a week in-office and involves extracting, processing, and visualizing data using PowerBI.The ideal candidate will have a strong background in clinical data sets and a passion for enhancing patient and provider...
-
Senior Inventory Analyst
2 weeks ago
Lewisville, Texas, United States WESCO Full timeJob SummaryWe are seeking a highly skilled Senior Inventory Analyst to join our team at Wesco International, Inc. As a key member of our supply chain team, you will be responsible for analyzing and optimizing inventory levels to ensure maximum efficiency and minimal waste.Key Responsibilities:Develop and execute daily, weekly, and monthly production reports...
-
Lewisville, Texas, United States Soliant Full timeAbout the JobSoliant Education is partnering with a school district in the Lewisville, OH area to fill a School Special Education Teacher position.This is an excellent school district with a wonderful and welcoming team environment.They are seeking a candidate who is already licensed and can start quickly and adjust seamlessly into this...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Patient Account Representative will be responsible for performing specific billing processes, follow-up, account resolution, adjustments, and scanning as required. This position will work with other departments to facilitate the meeting of both departmental facility goals and objectives.Key ResponsibilitiesContacts third-party payers and...
-
Patient Account Representative
4 days ago
Lewisville, Texas, United States Guidehouse Full timeJob Summary:The Insurance Patient Account Representative is an extension of a client's business office staff. This role is responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client policies and procedures are followed.Key Responsibilities:Account Review: Review patient accounts to...
-
Patient Account Representative
4 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a Patient Account Representative, you will play a critical role in ensuring the smooth operation of our billing and accounts receivable processes.Key ResponsibilitiesResolve account balances with third-party payers and guarantors via payer websites or...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Insurance Patient Account Representative is a key member of our client's business office staff, responsible for resolving account balances with patients and insurance companies. This role requires strong communication and problem-solving skills, as well as the ability to work independently with minimal supervision.Key ResponsibilitiesResolve...
-
Patient Account Specialist
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryGuidehouse is seeking a highly skilled Patient Account Representative to join our team. As a Patient Account Representative, you will be responsible for performing specific billing processes, following up on accounts, resolving account issues, and working with other departments to meet facility goals and objectives.Key ResponsibilitiesContacts...
-
Patient Account Specialist
4 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a Patient Account Representative, you will be responsible for performing specific billing processes, following up on account resolutions, and working with other departments to facilitate the meeting of departmental facility goals and objectives.Key...
-
Patient Account Representative
4 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a Patient Account Representative, you will be responsible for performing specific billing processes, following up on account resolutions, and working with other departments to facilitate the meeting of departmental facility goals and objectives.Key...
-
Patient Account Specialist
4 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a Patient Account Representative, you will be responsible for performing specific billing processes, following up on accounts, resolving account issues, and scanning as required. This role works closely with other departments to facilitate the meeting...
