<ul><li><strong>Position: Claims Examiner - Lost Time (Contract Role)</strong></li><li><strong>Location: 555 Long Wharf Drive New Haven CT USA 06511-5941</strong></li><li><strong>Type: 100% Onsite</strong></li><li><strong>Hourly Pay Range: $30-33/per hour</strong></li><li><strong>Interview Process: Virtual interview 1-2 round of 30 minute interview</strong></li></ul><p> </p><p><strong>Job Description: </strong></p><p>Job Schedule-100% ONSITE</p><p>Job hours-8:30am-5:00pm EST</p><p> </p><p>3 years of Workers Compensation Lost Time Claim Examiner or Commensurate Experience </p><p> </p><p>Duties and Responsibilities:</p><p>- Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.</p><p>- Reviews claim and policy information to provide background for investigation.</p><p>- Conducts 3-part ongoing investigations obtaining facts and taking statements as necessary with insured claimant and medical providers.</p><p>- Evaluates the facts gathered through the investigation to determine compensability of the claim.</p><p>- Informs insureds claimants and attorneys of claim denials when applicable.</p><p>- Prepares reports on investigation settlements denials of claims and evaluations of involved parties etc.</p><p>- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.</p><p>- Sets reserves within authority limits for medical indemnity and expenses and recommends reserve changes to Team</p><p>Leader throughout the life of the claim.</p><p>- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.</p><p>- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.</p><p>- Works with attorneys to manage hearings and litigation</p><p>- Controls and directs vendors nurse case managers telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.</p><p>- Complies with customer service requests including Special Claims Handling procedures file status notes and claim reviews.</p><p>- Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.</p><p>- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.</p><p>- Works with in-house Technical Assistants Special Investigators Nurse</p><p>Consultants Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.</p>
We are looking for a skilled Medical Claims Examiner II to join our team in Roseburg, Oregon. This Contract-to-permanent position involves analyzing and processing healthcare claims to ensure compliance with organizational policies and industry regulations. The role requires excellent attention to detail and the ability to collaborate effectively with healthcare providers, insurance representatives, and other stakeholders.<br><br>Responsibilities:<br>• Review and assess complex medical claims to verify coverage, eligibility, and payment accuracy in accordance with contractual agreements.<br>• Analyze medical records, billing statements, and supporting information to validate claims and ensure compliance with established standards.<br>• Investigate discrepancies in claims, resolve billing issues, and identify fraudulent activities.<br>• Communicate clearly and professionally with healthcare providers, patients, and insurance representatives to address claims-related inquiries.<br>• Collaborate with internal teams, such as billing, collections, and compliance, to resolve escalated claims and investigate claim histories.<br>• Maintain comprehensive electronic records of claims and related documentation for auditing and quality assurance purposes.<br>• Stay informed on healthcare billing practices, insurance policies, and regulatory updates to ensure adherence to current standards.<br>• Propose enhancements to existing processes to improve the efficiency and accuracy of claims handling.
We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal for someone with extensive experience in medical claims processing and a strong ability to manage repetitive clerical tasks effectively. The role requires a collaborative team player who is dependable, punctual, and committed to delivering high-quality results.<br><br>Responsibilities:<br>• Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date.<br>• Resubmit denied or rejected claims, following proper protocols to secure approvals.<br>• Post payments accurately into multiple systems, maintaining consistency and precision.<br>• Utilize payer portals to manage claims and track progress effectively.<br>• Perform clerical tasks such as data entry and filing with a focus on accuracy and attention to detail.<br>• Collaborate with a team of professionals to ensure smooth workflows and timely completion of tasks.<br>• Monitor claim statuses to identify and resolve discrepancies proactively.<br>• Maintain compliance with relevant policies and regulations in the healthcare industry.<br>• Provide support in behavioral health payment posting processes.<br>• Communicate effectively with team members and external parties regarding claim-related issues.
We are looking for a dedicated Medical Claims Analyst to join our healthcare team in Minneapolis, Minnesota. In this long-term contract position, you will play a vital role in processing leave of absence claims, ensuring compliance with medical certifications, and calculating benefit allocations. This is an excellent opportunity to contribute to a fast-paced industry while leveraging your expertise in medical claims and benefits administration.<br><br>Responsibilities:<br>• Process and manage leave of absence claims by coordinating medical certifications and ensuring timely submissions.<br>• Calculate benefit amounts, including allocations from corporate and state sources, to ensure accurate disbursements.<br>• Review, approve, or deny claims based on established guidelines and medical documentation.<br>• Utilize systems such as ServiceNow and Workday to track, manage, and process claims efficiently.<br>• Maintain detailed records of claims and benefits to ensure compliance and accuracy.<br>• Communicate with healthcare providers to confirm certifications and resolve discrepancies.<br>• Address rejected claims by investigating issues and providing resolutions.<br>• Collaborate with team members to streamline leave administration processes.<br>• Provide guidance to employees regarding medical leave policies and benefits.<br>• Stay updated on state and federal regulations related to leave and benefits administration.
<p>Our client is seeking a highly organized and detail-oriented Litigation Paralegal Analyst to join their Legal team. This is a fully remote, contract-to-hire opportunity offering the chance to work with a mission-driven organization that has been transforming lives for over 40 years.</p><p><br></p><p>If you're passionate about legal operations, thrive in fast-paced environments, and want to contribute to meaningful work that impacts real people, we want to hear from you!</p><p><br></p><p><strong>Requirements:</strong></p><ul><li>Must have prior remote work experience and be comfortable operating independently in a virtual environment.</li><li>In-house litigation experience is essential.</li><li>Provide litigation support in labor & employment, civil rights, sexual assault, real estate, and consumer law matters.</li><li>Review and analyze legal claims, demand letters, and subpoenas.</li><li>Identify, preserve, and collect records and electronically stored information using legal hold processes.</li><li>Pull records from HRIS and membership systems.</li><li>Organize, summarize, and analyze records and data.</li><li>Manage insurance claims reporting and respond to adjuster requests.</li><li>Maintain organized records across various lines of coverage.</li><li>Assist attorneys with internal/external complaints and government agency filings.</li><li>Support development of training and presentation materials using case metrics.</li><li>Serve as liaison for witnesses in litigation.</li><li>Perform legal research and draft basic legal documents using Lexis/Nexis templates.</li><li>Administer matter management, e-billing, and legal hold systems, including report creation and scheduling.</li><li>Support other legal projects and tasks as needed.</li></ul>
We are looking for a dedicated Claims Adjustor to join our team on a contract basis in Des Moines, Iowa. In this role, you will handle medical-only workers' compensation claims, ensuring accuracy and prompt processing. This position requires excellent customer service skills and attention to detail to effectively manage a low volume of daily calls and claims.<br><br>Responsibilities:<br>• Review workers' compensation claims to ensure compliance with medical and insurance standards.<br>• Process medical-only claims accurately and in a timely manner.<br>• Communicate with customers to address inquiries and provide exceptional service.<br>• Collaborate with team members to maintain organized and efficient claim workflows.<br>• Handle medical billing and insurance claim documentation with precision.<br>• Monitor and manage medical denials and appeals to resolve issues.<br>• Support hospital billing processes and ensure proper claim handling.<br>• Maintain detailed records for claims and related communications.<br>• Identify discrepancies in claim submissions and take corrective actions.<br>• Provide regular updates and reports on claim processing activities.
We are looking for a detail-oriented Medical Claims Representative to join our team in Voorhees, New Jersey. In this long-term contract role, you will play a key part in ensuring the accuracy and timeliness of medical claims processing and administration. This position offers an excellent opportunity to contribute your expertise in billing, claims, and insurance verification.<br><br>Responsibilities:<br>• Process and manage medical claims with a focus on accuracy and compliance.<br>• Ensure that all required authorizations are current and meet payor requirements.<br>• Verify patient insurance details to confirm coverage and eligibility.<br>• Collaborate with billing teams to resolve discrepancies and ensure timely submissions.<br>• Handle payor accounts, including follow-up on outstanding claims and payments.<br>• Investigate and resolve claim denials or rejections in a timely manner.<br>• Maintain detailed and organized records of claims and billing activities.<br>• Communicate effectively with insurance providers, patients, and internal teams.<br>• Stay updated on changes in medical billing regulations and insurance policies.
<p>We are looking for a detail oriented Entry-level Claims Representative to join our clients' team in Ontario, California. In this role, you will provide critical support in managing claims-related tasks, ensuring accuracy and efficiency in processing, reconciling, and auditing claims. This is a long-term contract position ideal for professionals with strong organizational skills and a background in medical office operations.</p><p><br></p><p>Responsibilities:</p><p>• Match checks with remittance advice, prepare and insert them into envelopes for mailing.</p><p>• Reconcile processed batches within the audit database to ensure accuracy.</p><p>• Create and mail denial trailers and letters to providers.</p><p>• Print and send out claim requirement letters for Covered California members.</p><p>• Forward claims to the appropriate health plan when necessary.</p><p>• Process and mail claims deemed unable to process, including generating the necessary correspondence.</p><p>• Batch trailers created by various departments and ensure proper documentation.</p><p>• Audit the batch log key to confirm claims have been assigned and logged correctly.</p><p>• Verify member information to determine line of business and coordination of benefits in the system.</p><p>• Collaborate on process adjustments and work independently or as part of a team.</p>
<p><strong>Firm seeks Coverage Opinion Writing Attorney (No Litigation)</strong></p><p><br></p><p>This Attorney opening involves working closely with insurers to provide expert advice and analysis on insurance coverage matters. The ideal attorney will have a deep understanding of various insurance policies and be adept at drafting comprehensive coverage opinions.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Collaborate with insurers to provide advice on insurance coverage and interpret policies.</li><li>Analyze various types of insurance policies across an array of industries.</li><li>Draft detailed coverage opinions based on policy analysis and contract interpretation.</li><li>Maintain effective communication with clients and internal team members.</li></ul><p><br></p><p>Billable hour target: 1850/year</p><p><br></p><p>Can work 100% remote in US (PST work hours)</p><p><br></p><p><u>Perks of Firm</u>:</p><ol><li>Established for over 30 years</li><li>Multiple offices with large firm resources</li><li>Women-owned firm</li></ol><p><br></p>
We are looking for an experienced Insurance Service Associate to join our team on a long-term contract basis in Rochester, New York. In this role, you will provide exceptional customer service to clients in the Paychex Property and Casualty Insurance division, ensuring that all claims and inquiries are managed efficiently and in alignment with company policies. This position offers an opportunity to work in a fast-paced environment, where attention to detail and effective communication are essential.<br><br>Responsibilities:<br>• Deliver outstanding customer service to clients by addressing inquiries, resolving complaints, and processing claims in adherence to company policies.<br>• Develop and maintain a solid understanding of the Paychex Property and Casualty Insurance product offerings.<br>• Utilize various software systems, including Salesforce and Adobe Flex, to manage client interactions and maintain accurate records.<br>• Perform data entry tasks with precision, ensuring timely and organized completion of assignments.<br>• Document all client interactions and service activities to maintain detailed and accessible records.<br>• Collaborate with team members and other departments to ensure seamless customer service delivery.<br>• Prioritize and organize tasks effectively to meet deadlines and support operational efficiency.<br>• Stay updated on industry procedures and policies to enhance service quality and compliance.<br>• Assist with administrative tasks such as photocopying, scanning, and preparing documents.<br>• Provide support for HRIS systems and other tools integral to operations.
We are looking for a dedicated Insurance Service Associate for Property and Casualty to join our team in Rochester, New York. In this long-term contract position, you will provide exceptional customer service to clients, ensuring their needs are addressed promptly and with attention to detail. Your role will involve handling client interactions, resolving complaints, and maintaining accurate documentation in alignment with company policies.<br><br>Responsibilities:<br>• Deliver outstanding customer service to clients by addressing inquiries and resolving claims in a timely and detail-oriented manner.<br>• Maintain accurate records of all client interactions, ensuring compliance with company policies and procedures.<br>• Utilize software tools, including Salesforce and Adobe Flex, to manage customer data and streamline processes.<br>• Develop a foundational understanding of Paychex products to better support client needs.<br>• Perform data entry tasks with a focus on prioritization and organizational accuracy.<br>• Handle complaints effectively, ensuring fair resolutions while maintaining positive customer relations.<br>• Collaborate with team members to provide quality service and support for property and casualty insurance clients.<br>• Scan, photocopy, and organize documents as needed to support administrative functions.<br>• Stay updated on industry best practices and internal procedures to enhance service delivery.<br>• Assist in claim administration and policy-related tasks to ensure seamless operations.
<p>Reputable personal injury firm is seeking an experienced and compassionate Case Manager to join their team. This position is ideal for someone with a strong background in personal injury law who thrives in a fast-paced environment and is committed to delivering exceptional client service. As a key member of our legal team, you will play a vital role in managing cases, communicating with clients, and supporting attorneys to ensure successful outcomes.</p><p><br></p><p>Responsibilities:</p><p>• Conduct initial interviews with prospective clients to gather relevant case information.</p><p>• Request, review, and organize medical records related to client cases.</p><p>• Maintain consistent communication with insurance companies, medical providers, and clients to provide updates and address inquiries.</p><p>• Draft and send correspondence letters to clients, insurance companies, and healthcare providers.</p><p>• Collaborate closely with attorneys to review case status and develop strategies.</p><p>• Perform investigative tasks related to claims and pre-litigation case work.</p><p>• Manage administrative duties such as faxing, filing, and copying to support case management.</p><p>• Oversee and prioritize a substantial caseload while ensuring accuracy and timeliness.</p><p>• Assist staff and team members with various tasks, ensuring seamless workflow and collaboration.</p><p>• Utilize software tools, including Microsoft Word and Excel, to maintain organized records and documentation.</p>
<p>Are you an experienced <strong>Patient Financial Authorization Specialist</strong> looking to make a direct impact in a clinical setting? We are currently seeking a <strong>Patient Financial Authorization Specialist </strong>to join our in-person team. This is not a remote opportunity—the Patient Financial Authorization Specialist will work Monday through Friday, 8:00 AM to 5:00 PM CST, in a fast-paced, collaborative healthcare environment.</p><p><br></p><p><strong>Responsibilities</strong></p><ul><li>Obtain and manage patient authorizations in a timely and efficient manner</li><li>Provide accurate cost estimates to patients prior to the start of treatment</li><li>Scrub the Daily Appointment Report (DAR) to ensure all scheduled patients have valid authorizations on file</li><li>Support patients in navigating claims reimbursements, particularly those covered by grants</li><li>Collaborate with a remote team and receive hands-on training from a Senior PAA</li><li>Ensure compliance with business casual dress code and participate in on-site interviews</li></ul>
We are looking for a skilled Case Manager to join our team in Encino, California. In this role, you will oversee multiple pre-litigation cases, ensuring prompt and effective resolution while providing exceptional support to clients. This is an onsite position that offers a dynamic work environment and opportunities for growth.<br><br>Responsibilities:<br>• Manage multiple pre-litigation cases, ensuring timely and effective resolution.<br>• Supervise and guide entry-level case managers in their daily tasks and responsibilities.<br>• Facilitate claims processing with insurance carriers, including health insurance, Medicare, and Medi-Cal.<br>• Coordinate property damage and loss of use claims, ensuring proper resolution.<br>• Identify healthcare providers and schedule medical appointments for injury treatment.<br>• Advocate for clients by monitoring their medical treatment and arranging necessary care based on provider recommendations.<br>• Review, analyze, and interpret medical records, surgical reports, and medical bills.<br>• Prepare case files and documentation for submission to the demands department.<br>• Communicate effectively with clients, healthcare providers, and internal staff to maintain a high level of service.
<p>We are looking for a detail-oriented Personal Injury Plaintiff Case Manager to join our team in Los Angeles, California. In this role, you will oversee personal injury cases, ensuring efficient claim processing, effective communication, and timely management of client needs. The ideal candidate will have a strong background in case management and a commitment to delivering exceptional client service.</p><p><br></p><p>Responsibilities:</p><p>• Process and open health insurance claims with accuracy and attention to detail.</p><p>• Upload and organize critical documents into the company’s case management software.</p><p>• Schedule and coordinate medical appointments while maintaining an up-to-date calendar.</p><p>• Serve as the primary point of contact for clients, addressing their concerns promptly and professionally.</p><p>• Ensure proper documentation and tracking of case details to support smooth claim administration.</p><p>• Collaborate with internal teams to streamline workflows and maintain case progress.</p><p>• Utilize CRM tools to manage client interactions and maintain detailed records.</p><p>• Monitor case timelines and ensure all deadlines are met.</p><p>• Stay informed about personal injury law and regulations to provide informed support.</p><p>• Maintain confidentiality and adhere to legal compliance standards.</p>
