Claims Associate

3 weeks ago


Signal Hill, United States Synectics Inc Full time
Job DescriptionJob Description

Job Description

  • To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

  • Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

  • Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

  • Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

  • Administers subrogation of claims and negotiates settlements.

  • Communicates claim action with claimant and client.

  • Ensures claim files are properly documented and claims coding is correct.

  • May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

  • Maintains professional client relationships.

  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

  • Travels as required.

Qualifications:

  • Bachelor's degree from an accredited college or university preferred.

  • 2 years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

  • Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Ability to work in a team environment

  • Ability to meet or exceed Service Expectations

  • Work Comp Experience - limited is acceptable


  • Claims Examiner

    3 weeks ago


    Signal Hill, California, United States Synectics Inc Full time

    Job SummaryWe are seeking a skilled Claims Associate to join our team at Synectics Inc. The ideal candidate will have a strong background in claims management and excellent communication skills.Key ResponsibilitiesProcess and adjudicate workers compensation claims to determine benefits due, ensuring compliance with company standards and industry best...

  • Claims Specialist

    2 weeks ago


    Rocky Hill, Connecticut, United States Zurich Insurance Company Ltd. Full time

    Claims Specialist - Commercial General LiabilityZurich North America is seeking a skilled Claims Specialist to handle Commercial General Liability (CGL) litigated files within our dedicated team for one of our largest customers. This exciting opportunity is available in one of the following locations: Rocky Hill, CT, Schaumburg, IL, Parsippany, NJ, New York,...


  • Rocky Hill, United States Zurich Insurance Company Ltd. Full time

    Zurich North America is seeking a skilled Claims Specialist to handle Commercial General Liability (CGL) litigated files within our dedicated team for one of our largest customers! This exciting opportunity is available in one of the following locations: Rocky Hill, CT, Schaumburg, IL, Parsippany, NJ, New York, (WTC). With moderate direction, this position...


  • Chapel Hill, North Carolina, United States CultivaHR Full time

    Job OverviewCultivaHR is seeking a highly skilled Revenue Cycle Associate to join our team. As a key member of our revenue cycle management team, you will play a critical role in resolving challenging healthcare insurance claim denials and delays.Key Responsibilities:Contact insurance companies to request status updates on claim submissions.Perform...

  • Warehouse Associate

    2 weeks ago


    Rock Hill, South Carolina, United States Sam's Club Full time

    Job Summary:As a Backroom Associate at Sam's Club, you will play a critical role in maintaining and processing shipments for the Club. This involves developing and posting delivery schedules, compiling and organizing receiving reports, verifying merchandise counts, routing merchandise to proper locations, and paying expenses. You will also receive...


  • Chapel Hill, North Carolina, United States InsideHigherEd Full time

    Job Title: Postdoctoral Research AssociateWe are seeking a highly motivated Postdoctoral Research Associate to join our team in the Department of Epidemiology at the University of North Carolina at Chapel Hill. The successful candidate will work under the direction of Dr. Jennifer Lund and Dr. Louise Henderson on a NCI-funded project evaluating the...

  • Litigation Associate

    2 months ago


    Camp Hill, Pennsylvania, United States Margolis Edelstein Full time

    Margolis Edelstein is in search of talented Litigation Associates to enhance our distinguished insurance defense law practice. We are particularly interested in attorneys with expertise in general liability who can cultivate strong relationships with clients, assess their legal requirements, provide informed counsel, and clarify legal options. This role...


  • Cherry Hill, New Jersey, United States Prism Specialties Full time

    About Prism SpecialtiesWe are a leading provider of restoration services for electronics, art, textiles, and documents. With over 25 years of experience, we have established ourselves as a world-class operation in restoring these items quickly and effectively.Job SummaryWe are seeking a highly motivated and experienced Business Development Associate to join...

  • Meal Prep Associate

    3 weeks ago


    High Hill, Missouri, United States Sam's Club Full time

    About the RoleWe are seeking a highly skilled and detail-oriented Meal Prep Associate to join our team at Sam's Club. As a Meal Prep Associate, you will be responsible for preparing fresh food items daily for our members through following recipes and preparing our always warm and ready rotisserie chicken.You will also be responsible for properly wrapping,...

  • Associate Attorney

    3 months ago


    Camp Hill, United States Margolis Edelstein Full time

    Margolis Edelstein is seeking Associate Attorneys to join our premier insurance defense law firm located in Harrisburg, Pennsylvania. We are looking for general liability attorneys who are able to develop relationships with clients as they establish their legal needs, provide counsel, and help clients to understand legal options. This position offers the...


  • Signal Mountain, Tennessee, United States State Farm Insurance Full time

    State Farm Insurance **Job Summary:** As an Account Associate at State Farm Insurance, you will play a crucial role in providing exceptional customer service and ensuring customer satisfaction. **Key Responsibilities:** * Assist customers with their insurance needs by providing accurate and timely information * Process policy changes and updates in the...


  • Chapel Hill, North Carolina, United States InsideHigherEd Full time

    Job SummaryWe are seeking a highly motivated Postdoctoral Research Associate to join our team in the Department of Epidemiology at the University of North Carolina at Chapel Hill. The selected candidate will support the generation and communication of scientific findings from our NCI-funded project, which aims to evaluate the effectiveness of lung cancer...


  • Pilot Hill, United States Air Treatment Corporation Full time

    Job Title: Air Distribution Inside Sales AssociateAbout the Role:At Air Treatment Corporation, we are seeking a highly skilled and motivated Air Distribution Inside Sales Associate to join our dynamic team. As a key member of our sales team, you will play a crucial role in providing exceptional customer service, building strong relationships with clients,...


  • Pilot Hill, United States Air Treatment Corporation Full time

    Description:Air Treatment Corporation is a dynamic and collaborative work environment that values high-quality customer service. We strive to create a cohesive team that exceeds expectations by actively promoting a culture of excellence and growth.We offer a robust benefit package and opportunities for advancement from within. Our Inside Sales Associate...


  • Chapel Hill, North Carolina, United States Brighton Health Plan Solutions, LLC Full time

    Job SummaryBrighton Health Plan Solutions, LLC is seeking a highly skilled ERISA Benefits Analyst to join our team. As a key member of our team, you will be responsible for ensuring the accurate administration of Self-Insured Health Plans for our clients.Key Responsibilities:Review and interpret client plan documents, amendments, notices, and summary plan...

  • Warehouse Associate

    1 month ago


    Rock Hill, South Carolina, United States Sam's Club Full time

    Job SummaryMaintain a safe and efficient warehouse environment by processing shipments, verifying merchandise counts, and routing merchandise to proper locations. Ensure accurate and timely delivery of merchandise to customers while adhering to company policies and procedures.Key Responsibilities:Develop and post delivery schedules to ensure timely delivery...


  • Pilot Hill, United States Air Treatment Corporation Full time

    Job Summary:At Air Treatment Corporation, we are seeking a highly skilled and detail-oriented Inside Sales Associate to join our dynamic team. As a key member of our sales team, you will be responsible for providing exceptional customer service, communicating with clients and manufacturers, and ensuring seamless project execution.Key Responsibilities:•...


  • Chapel Hill, United States InsideHigherEd Full time

    Department:Epidemiology - 463501Posting Open Date:02/23/2024Open Until Filled:YesPosition Type:Postdoctoral ScholarPosition Title:Postdoctoral Research AssociateVacancy ID:PDS004117Full-time/Part-time:Full-Time TemporaryHours per week:40FTE:1Work Location:Chapel Hill, NCPosition Location:North Carolina, USHiring Range:Dependent on QualificationsEstimated...


  • Chapel Hill, United States InsideHigherEd Full time

    Department:Epidemiology - 463501Posting Open Date:02/23/2024Open Until Filled:YesPosition Type:Postdoctoral ScholarPosition Title:Postdoctoral Research AssociateVacancy ID:PDS004117Full-time/Part-time:Full-Time TemporaryHours per week:40FTE:1Work Location:Chapel Hill, NCPosition Location:North Carolina, USHiring Range:Dependent on QualificationsEstimated...


  • Cherry Hill, New Jersey, United States Jobot Full time

    Job Title: Professional Liability Associate AttorneyWe are seeking a highly skilled and experienced Professional Liability Associate Attorney to join our team at Jobot. As a key member of our litigation team, you will work closely with our partners to defend construction professionals against professional liability claims.Job Summary:The ideal candidate will...