10 senior complex claims director jobs found in Fort Worth, TX

Description Senior Property Adjusters investigate commercial property claims, evaluate damages, determine coverage, set accurate loss cost estimates, control the insured's exposures and losses, manage consultants, and achieve a prompt, fair and equitable settlement according to fair claims handling requirements. Negotiate settlement of claims with varying complexity and perils. Training is a critical component to your success and that success starts with reliable attendance.  Attendance and active engagement during training is mandatory Responsibilities: Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin, and extent of loss losses. Reviews and utilizes financial statements to adjust complex business interruption losses. Conduct on-site appraisal or direct independent adjuster to determine facts relevant causation, damages and exposure. Engages and manages consultants as required...

Higginbotham , a privately held, independent insurance and financial services firm that ranks within the top 20 nationwide, has an immediate opening for an Employee Benefits Strategic Account Executive for our Fort Worth, TX office.  The  Employee Benefits Strategic Account Executive  serves as the strategic leader or member of the client management team for the most complex benefit accounts, and is responsible for client satisfaction, strategic planning, and quality assurance. Position Summary: The Account Executive serves as the strategic leader or member of the client management team for the most complex benefit accounts and is responsible for client satisfaction, strategic planning, and quality assurance. Essential Tasks: Manage a complex book of business comprised of clients with various funding methods, advanced contract features and structures that require a higher level of expertise. Provide strong insurance technical expertise to clients and members...

The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider appeals. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and appeals. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.  This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Supervises all daily activities of payment integrity team related to quality assurance and provider appeals Ability to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERIS Ability to...

Position Summary: The Sr. Claims Operations Specialist is responsible for driving operational excellence within the claims function. This role focuses on improving efficiency, streamlining workflows, and optimizing processes within the insurance broker Claims Advocacy Service Model. The position works closely with the Claims Leadership Team to support strategic initiatives, provide operational insights, and implement scalable solutions that enhance productivity and effectiveness. Supervisory Responsibilities:   None Essential Tasks: Analyze existing claims operations workflows to identify inefficiencies, gaps, and areas for improvement to enhance the Claims Advocacy Service Model. Develop, implement, and monitor process enhancements to optimize claim intake, review, and tracking. Collaborate closely with the Claims Leadership Team to align operational initiatives with business goals and strategic priorities. Partner with IT, analytics, and business teams to...

The Correspondence Department Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid position reporting to Fort Worth, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible for monitoring quality control of results per employee as well as the entire unit overall Responsible for ensuring Metrics are in compliance daily Responsible for tracking and reporting of department metrics to Director...

The Document Processing Department Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid role reporting to Fort Worth, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible for monitoring quality control of results per employee as well as the entire unit overall Responsible for ensuring Metrics are in compliance daily Responsible for tracking and reporting of department metrics to Director of Operations...

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position includes a moderate volume of inbound calls and a high volume of outbound calls. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receive incoming calls, emails and faxes from the Medical Access Assistant line Communicate clearly and professionally with providers and other stakeholders via phone and email Provide excellent customer service...

The Senior CERIS Operations Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid role reporting to Fort Worth, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible for monitoring quality control of results per employee as well as the entire unit overall Responsible for ensuring Metrics are in compliance daily Responsible for tracking and reporting of department metrics to Director of...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...

The Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Take inbound calls and makes outbound calls as needed. Analyzes client and provider inquiries to determine appropriate steps for resolution. Performs review of claim history to ensure accurate information is communicated to internal and external customer. Works directly with internal departments and management for resolution of Customer Service inquiries. Able to accurately communicate CERIS findings to clients and providers in written and verbal format. Maintain reports and spreadsheets as needed. Additional duties as assigned.   KNOWLEDGE & SKILLS:  Excellent communication, verbal, written and organizational skills. Prior knowledge of...