29 jobs found in ontario

Job Summary: This role is responsible for designing, developing, and implementing projects and initiatives within a subset of a field discipline that aligns with claims strategic direction and supports strategic goals. The TCL manages a subset of the operations of a team within a market claim office (MCO), including leading, training, inspiring, engaging and motivating leaders and employees in one or more business segments with a focus on collaboration, innovation, and customer centricity. Key Responsibilities: Analyzes results and contributes to the development of strategies and action plans to support the achievement of operational goals related to customer service, loss cost management, and expense controls Responsible for complex claim decisions, identification of hiring, training, and succession planning opportunities, and the development and implementation of short- and long-term strategies and process improvements to achieve corporate financial outcomes...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Accurately process institutional claims Editing and adjusting of claims per the EDI daily audit report Analyze and adjudicate claims to ensure accurate payment Interpret Fee for Service (FFS) and capitated provider contracts Review claims on a periodic basis Meet...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

The right candidates will work Monday-Friday 8-5pm hours. Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities:...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)   If you are located within Ontario, CA you will have the flexibility to work remotely* as you take on some tough challenges POSITION OVERVIEW Processing of medical claims including verification, adjudication and accuracy.                   Primary Responsibilities: Accurately process professional claims Responsible for editing and adjusting of claims per the EDI daily audit report Analyze and adjudicate...

Job Summary: Responsible for investigating and confirming the facts of loss for automobile accidents. Applies analytical thinking to determine coverage, liability, damages and otherwise adjusts and negotiates bodily injury claims within limit of authority. Key Responsibilities: Handles investigation regarding most aspects of auto claims (coverage, liability and injury damages) with the exercise of limited discretion (limited independence) Applies basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Determines subrogation or fraud potential and how to handle Identifies customer needs and works to meet those needs using appropriate customer service skills Recognizes and identifies body parts of a vehicle and understands other potential property damage For claims involving injuries, learns how to review, evaluate, and negotiate injury claims Supervisory Responsibilities:...

Job Summary: Responsible for investigating and confirming the facts of loss for basic automobile accidents. Applies analytical thinking to determine coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. Key Responsibilities: Handles investigation regarding most aspects of auto claims (coverage, liability and damages) with the exercise of limited discretion (limited independence) Applies basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Determines subrogation or fraud potential and how to handle Identifies customer needs and works to meet those needs using appropriate customer service skills Recognizes and identifies body parts of a vehicle and understands other potential property damage For claims involving injuries (if handled), learns how to review, evaluate, and negotiate basic injury claims Supervisory Responsibilities:...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

Litigation Experience Preferred Job Summary: The Associate Manager develops strategies to achieve employee performance levels and the expert execution of claim processes. The individual monitors staffing levels and workloads, provides coaching and mentoring, and participates in performance reviews. Key Responsibilities: Reviews employee work quality and interactions with customers through conducting file reviews / audits Defines, analyzes, and tracks department, section, and/or unit measures Analyzes unit reports and supports the achievement of business unit objectives Must have experience in reviewing and directing coverage investigations Oversees the resolution of highly complex customer conflicts or issues Oversees the negotiation of highly complex claim settlements Oversees response to highly complex arbitrations contentions Manages and oversees performance of vendors Frequently participates in special projects as a subject matter expert Supervisory...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

Job Summary: Responsible for investigating and confirming the facts of loss for basic automobile accidents. Applies analytical thinking to determine coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. Key Responsibilities: Handles investigation regarding most aspects of auto claims (coverage, liability and damages) with the exercise of limited discretion (limited independence) Applies basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Determines subrogation or fraud potential and how to handle Identifies customer needs and works to meet those needs using appropriate customer service skills Recognizes and identifies body parts of a vehicle and understands other potential property damage For claims involving injuries (if handled), learns how to review, evaluate, and negotiate basic injury claims Supervisory Responsibilities:...

Combine two of the fastest-growing fields on the planet with culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliable. There’s no room for error. Join us and start doing  your life’s best work. (sm) This position is responsible for reviewing, investigating and completing the resolution of Provider Disputes in writing as set forth in laws pertaining to AB1455 for Commercial Health Maintenance Organization (HMO) Enrollees of Provider Disputes and Medicare Appeals for Medicare HMO Enrollees. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Reviews written dispute requests received from providers of denied or incorrect payments based on...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

Combine two of the fastest-growing fields on the planet with culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliable. There’s no room for error. Join us and start doing  your life’s best work. (sm) This position is responsible for reviewing, investigating and completing the resolution of Provider Disputes in writing as set forth in laws pertaining to AB1455 for Commercial Health Maintenance Organization (HMO) Enrollees of Provider Disputes and Medicare Appeals for Medicare HMO Enrollees. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Reviews written dispute requests received from providers of denied or incorrect payments based on...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...

This position is remote for any experienced casualty adjuster in the Pacific or Mountain Time Zones Job Summary: Responsible for investigating and confirming the facts of loss for basic to advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates bodily injury claims within limit of authority. Key Responsibilities: Handles investigation regarding all aspects of auto claims involving bodily injuries with the exercise of discretion and independence within increased level of authority Applies intermediate understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Determines subrogation or fraud potential and how to handle Identifies customer needs and works to meet those needs using appropriate customer service skills For claims involving fraud or subrogation, partners with assigned reps from those areas to achieve best outcome...

Litigation Experience Preferred Job Summary: The Associate Manager develops strategies to achieve employee performance levels and the expert execution of claim processes. The individual monitors staffing levels and workloads, provides coaching and mentoring, and participates in performance reviews. Key Responsibilities: Reviews employee work quality and interactions with customers through conducting file reviews / audits Defines, analyzes, and tracks department, section, and/or unit measures Analyzes unit reports and supports the achievement of business unit objectives Must have experience in reviewing and directing coverage investigations Oversees the resolution of highly complex customer conflicts or issues Oversees the negotiation of highly complex claim settlements Oversees response to highly complex arbitrations contentions Manages and oversees performance of vendors Frequently participates in special projects as a subject matter expert Supervisory...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) Primary Responsibilities: Correspond via email and telephone with physicians and office staff to tend to provider needs, issues, and concerns.  Process new NammNet account requests  Assist users with accessing Argon and Krypton Monthly GI & other Specialties Cap Split report calculations Distribution of Specialty CAP Report/Pre-Cap Summaries to providers  Receive Letters of Interest for EC...

Job Summary: The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. Key Responsibilities: Handles basic investigation regarding most aspects of auto claims (coverage, liability and damages) Exhibits basic understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department Partners to determine subrogation or fraud potential and how to handle Applies a basic understanding of systems and technology used within the company Identifies customer needs and works to meet those needs using appropriate customer service skills Begins recognizing and identifying body parts of a vehicle and other potential property damage Supervisory Responsibilities: This job does not have supervisory duties Preferred...