3117 claims processor jobs found

Position Summary The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers’ Compensation, or disability.  May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits...

Job Description Claims Processor L1     Build the future with us Are you driven by delivering exceptional customer service and eager to contribute to a company that helps its clients feel confident and secure about their future? As a Claims Processor L1 , you will play a key role in supporting our contract holders and dealer partners by accurately adjudicating claims and ensuring a smooth, supportive customer experience. This position is a great opportunity to showcase your skills and fully realize your potential within a caring and trustworthy company. Here, people and their development are at the heart of our priorities, fostering an environment that encourages collaboration and innovation. What you’ll accomplish with us As a Claims Processor L1 , you’ll be at the core of our mission. Here are the main responsibilities: Answer at least 40 inbound calls per day from technicians, customers, and dealer partners Gather all...

Title: Customer Service Claims Processor                                 Department: Customer Service Union: OPEIU 29                                                                               Grade: 17 Position Summary The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine...

Title: Customer Service Claims Processor                                 Department: Customer Service Union: OPEIU 29                                                                               Grade: 17 Position Summary The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate....

Title: Claims Processor Department: Claims Bargaining Unit: UFCW 555 Grade: 3 Position Type: Non-exempt Hours per Week: 40 Position Summary The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum...

Job Description Gap Claims Representative Build the future with us Are you driven by delivering exceptional service and supporting clients with accuracy, empathy, and professionalism? Are you eager to contribute to a company that helps its clients feel confident and secure about their future? As a Gap Claims Representative , you will play a key role in reviewing documentation, resolving GAP claims, and ensuring a seamless and positive customer experience. This position is a great opportunity to showcase your attention to detail, communication skills, and ability to thrive in a fast‑paced environment. Here, people and their development are at the heart of our priorities, fostering an environment that encourages collaboration and innovation. What you’ll accomplish with us As a Gap Claims Representative , you’ll be at the core of our mission. Here are the main responsibilities: Answer incoming calls from the queue and resolve GAP claims in accordance...

Company: NICO National Indemnity Company Want to work for a company with unparalleled financial strength and stability that offers “large company” benefits with an exciting, friendly, and “small company” atmosphere?  Our companies, as members of the Berkshire Hathaway group of Insurance Companies, provides opportunities for professionals interested in just that.   Company: NICO National Indemnity Company Want to work for a company with unparalleled financial strength and stability that offers “large company” benefits with an exciting, friendly, and “small company” atmosphere?  Our companies, as members of the Berkshire Hathaway group of Insurance Companies, provides opportunities for professionals interested in just that.   A Brief Overview Processes and delivers incoming and outgoing mail per established procedures and deadlines. Enters data and check information into designated computer systems. Maintains confidentiality at all times. Performs all duties in a safe...

Company: NICO National Indemnity Company Want to work for a company with unparalleled financial strength and stability that offers “large company” benefits with an exciting, friendly, and “small company” atmosphere?  Our companies, as members of the Berkshire Hathaway group of Insurance Companies, provides opportunities for professionals interested in just that.   Company: NICO National Indemnity Company Want to work for a company with unparalleled financial strength and stability that offers “large company” benefits with an exciting, friendly, and “small company” atmosphere?  Our companies, as members of the Berkshire Hathaway group of Insurance Companies, provides opportunities for professionals interested in just that.   A Brief Overview Processes and delivers incoming and outgoing mail per established procedures and deadlines. Enters data and check information into designated computer systems. Maintains confidentiality at all times. Performs all duties in a safe...

The Litigation Processor is responsible for providing clerical support to the General Claims Legal Department by reviewing, analyzing, and processing incoming complaints directed to the Company. Essential Duties and Responsibilities: Provide support to staff attorneys in processing complaints. Provide support to the PIP Litigation team in processing PIP arbitration demands. Provide support as needed to FNOL (First Notice of Loss) Dept in taking claims. Receive, analyze, and process complaints, determine type of lawsuit, and prepare investigation file accordingly.  Assign trail adjuster, submit complaint to staff attorney for review. Process various types of legal letters to defense firms and insureds. Maintain Legal Exchange (electronic billing site) by creating matters, closing matter and processing attorney invoices for payment. Periodic telephone communications with insureds, plaintiff counsel and defense firms regarding the status of legal pleadings....

The Cross Family of Agencies welcomes you. We need your talent and expertise. Personal Lines Processor A Personal Lines Processor is primarily responsible for processing documents related to personal lines insurance and providing administrative support to the Producers and Account Managers. Standard duties of a Personal Lines Processor include but are not limited to : Understanding and following the Cross Basic Procedure Manual. Understanding and following the Personal Lines Workflow Manual. Auditing transaction to ensure that the correct Action Codes are being used. Following up and completing open suspense’s daily. Running the download reports daily. Processing the download report which includes reviewing new business, endorsements, renewals, cancellations, and reinstatements for accuracy. Invoicing all types of download transactions. Mailing new business letters to clients. Entering claims acknowledgements as received. Following up on...

Join NJM Insurance Group’s Medical Claim Services (MCS) team as a Business Process Operations Analyst, where you will play a key role in driving process improvement and support business continuity and technology initiatives. The primary purpose of this role is to provide consistent support to business users in both technology and non-technology operations, including incident management, production support, and departmental activities and assist in the seamless operationalization of new processes and technology solutions, ensuring smooth transitions and effective change management for business users. This position requires subject matter expertise (SME) in Personal Injury Protection (PIP), Workers’ Compensation, and/or General Claims. The ideal candidate will have a strong understanding of current business processes and the ability to identify, design, and implement effective improvements. Essential Duties and Responsibilities: Support Strategic Plan, Leadership, and...

Job Description General Accounting Associate ______________________________________________________________________________ Build the future with us Are you eager to contribute to the purpose of a company that aims to help its clients feel confident and secure about their future? As a General Accounting Associate , you will play a key role in [summary of the position’s impact or main mission]. This position is a great opportunity to showcase your skills and fully realize your potential within a caring and trustworthy company. Here, people and their development are at the heart of our priorities, fostering an environment that encourages collaboration and innovation. _____________________________________________________________________________ What you’ll accomplish with us   As a General Accounting Associate], you’ll be at the core of our mission. Here are the main responsibilities: Review and compare the current supplemental contract file to the...

Responsibilities We are looking for an IT Project Manager to join our growing team. This role is primarily responsible for the overall delivery and management of application development and technology projects/products and serves as the project management lead in working with enterprise skill teams touching different areas of IT and Business Solutions.  Ability to work on a hybrid model located in Farmington Hills, MI.   Responsibilities In this role, you will report to the project management office (PMO) Provide leadership and support for the overall delivery and management of medium to high complexity projects This is a highly collaborative role that requires someone who is motivated with a positive demeanor, exhibits perseverance, collaboration, critical thinking, and problem-solving skills Responsible for project delivery, maintaining plans and processes, driving project decisions, resource and...

Position Summary     Do you want to be part of a collaborative Agent Contracting &   Licensing   (AC&L)   team? Are you self-motivated, able to multi-task across several responsibilities and   possess   high quality interpersonal skills to effectively communicate with the field and business partners? Do you   lead with   a growth mindset? Do you challenge the status quo and take   incentive   to tackle   new problems ? Is a culture where “People Count,” “We Do the Right Thing,” and “We Hold Ourselves to Very High Standards” important to you ?     Are you skilled in a consumer-centric mindset?   If so,   then you may be a great fit for this CARE Specialist position   accountable for   delivering   exceptional   consumer experiences   through the work that we do .       CARE expresses the emotion we want to generate, and   it’s   also an acronym for Communicate, Advocate, Respond, and Empower –...

Marketing Manager, Enrollment and Service Marketing Come join Guardian’s team of innovative and collaborative marketing professionals. If you're ready to challenge yourself with work that matters, then this is the place for you. We're committed to making employee benefits insurance simple to understand, choose and use – and we have a blast doing it! Is a culture where “We believe people count,” “We do the right thing,” “We courageously shape our future together,” and “We go above and beyond for the people we serve” important to you? If so, Guardian is seeking an experienced, results-focused, and energetic marketing manager to join our Member Engagement and Service Marketing Team for the Group Employee Benefits business. This role will collaborate closely across marketing, product, enrollment, claims and client management teams to develop and execute omnichannel marketing strategies that enable our members to better understand and use their benefits.  Based on this, the...

Join the dynamic team at Guardian Life as a  Business Intelligence Analyst III and be part of a data-driven environment. This role focuses on improving risk management and operational efficiency in our Underwriting and Operations vertical. Collaborate with BI Consultants, end users, and IT teams to convert data into critical information for sound business decisions. Your insights will be highly accurate, actionable, and reliable, contributing to the education and training of business partners and clients. In this role, you will be responsible for providing leadership with comprehensive information gathering, structured documentation, and the effective presentation of findings to management at all levels. You will Work independently on highly complex, cross-functional, analytical projects, proactively addressing business needs. Provide analytical subject matter expertise and recommendations to the Underwriting & Operations organization. Participate in workstream planning...

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Overview: The Vice President of Consumer Claims is responsible for overseeing the staffing, operational processes, and workflows for consumer claims related to warranty products, lender claims (such as GAP waivers, mortgage and lender-placed insurance), as well as travel, accident, and health claims. This executive role ensures efficient claim resolution, regulatory compliance, and exceptional customer service within a fast-paced and evolving environment. Key Responsibilities Develop, implement, and optimize claims management strategies and processes across warranty, lender, and insurance/non-insurance products. Lead and manage claims teams, including recruitment,...

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Responsibilities Independently manage assigned Third Party Administrator (TPA) relationship s Address and resolve TPA performance issues in coordination with internal partners (Stat Reporting, Finance, Claims Finance, DQ, Claims IT, Underwriting, Claims, Legal) Collaborate with internal partners to identify and address process gaps or potential efficiencies Manage day to day issues and inquiries from our TPAs and internal partners Complete comprehensive due diligence reviews of potential new TPAs Complete multi-step onboarding process of new TPAs Participate in projects as requested Complete annual TPA reviews, PWC testing and other key initiatives for assigned TPAs Mentor...

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Arch Insurance Group, part of Arch Capital Ltd, is a specialty insurer built around talent intensive businesses. We prioritize niche focus, underwriting expertise, flexibility, diversification and disciplined cycle management. We work creatively to provide new value and solutions to our clients and distribution partners. Arch highly values actuaries and actuarial expertise. Many senior executives and business unit leaders are actuaries by training. Arch Insurance Company is seeking a motivated actuarial candidate to join a dynamic Reserving & Loss Analytics team. This leadership role will assist with reserving, loss analytics, and results management for the recently acquired...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation | Jurisdiction: NV | Licensing: NV Job Description Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?  Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  Deliver innovative customer-facing solutions to clients who represent virtually every...