Claims Examiner Job at Randstad (Winnipeg)

Claims Examiner Senior

The Claims Examiner Senior is responsible for reviewing, analyzing, researching,...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate's degree or equivalent job-related experience required
Minimum of 3 years’ experience processing medical claims in the healthcare industry
Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies
Must have excellent written, verbal, organizational and interpersonal communication skills
Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills

Job Responsibility

Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations
Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc
Work claim projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes
Process provider refunds, reconsiderations, and direct member reimbursements
Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication
Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager
Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes
Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management
Sets high standards of performance and promotes teamwork to achieve established team goals, while maintaining a positive, professional attitude
Contacting/responding to internal and external customers for resolution on claim issues

Fulltime

Risk Management Specialist

As a family company, we serve people and communities. When you work at Meijer, y...

Location

United States , Grand Rapids

Salary:

Not provided

Meijer

Expiration Date

Until further notice

Requirements

Bachelor's degree or equivalent experience
5 years of claims adjusting experience
Strong communication, analytical and negotiation skills
Self-motivation

Job Responsibility

Adjudicates general liability claims
Handle and evaluate assigned represented claims
Conduct claim investigations for Represented claims, including store visits and recorded statements when appropriate
Assist in the evaluation of claims for potential indemnification from outside sources
Assist with the administration of complicated claims being handled by examiners
Audit examiner claim files
Train and mentor claims staff
Handle and evaluate assigned False Arrest claims
Handle and evaluate assigned Pharmacy claims
Participate in Claim review meetings

What we offer

Weekly pay
Scheduling flexibility
Paid parental leave
Paid education assistance
Team member discount
Development programs for advancement and career growth

Supervisor, Claims Examiners

The Supervisor, Claims Examiners is responsible for overseeing a team of risk ma...

Location

United States , Grand Rapids

Salary:

Not provided

Meijer

Expiration Date

Until further notice

Requirements

Associate's degree in business, insurance, or a related field
Minimum of two (2) years of experience in general liability claims handling
At least one (1) year of previous supervisory or leadership experience
Strong knowledge of general liability insurance policies and regulations
Excellent analytical and problem-solving skills
Effective communication and interpersonal skills
Ability to manage multiple priorities and meet deadlines
Proficiency in claims management software and Microsoft Office Suite

Job Responsibility

Supervise and mentor a team of risk management examiners
Review and approve claims settlements within authority limits, as decided by the company
Ensure timely and accurate processing of claims, while holding examiners to a high level of customer service
Handle complex and high-value claims
Provide training and development opportunities for risk management examiners
Monitor and ensure compliance with company policies, procedures, and industry regulations
Assist with implementation of claims handling strategies to improve efficiency and effectiveness
Conduct regular audits of risk management examiner claim files to ensure quality and accuracy
Collaborate with other departments, such as legal, asset protection and safety, to resolve claims issues
Prepare reports on claims activities and performance metrics for leadership as requested

What we offer

Weekly pay
Scheduling flexibility
Paid parental leave
Paid education assistance
Team member discount
Development programs for advancement and career growth

Fulltime

New

Customer Support Representative

As a Customer Service Representative, You will interact with customers to provid...

Location

Mexico , Guadalajara

Salary:

Not provided

Helpware

Expiration Date

Until further notice

Requirements

6 plus months of experience in customer service-related field
Microsoft Office skills
Communication, Written - Ability to communicate in writing clearly and concisely
Communication, Oral - Ability to communicate effectively with others using the spoken word
Accountability - Ability to accept responsibility and account for his/her actions
Customer Oriented - Ability to take care of the customers’ needs while following company procedures
Working Under Pressure - Ability to complete assigned tasks under stressful situations
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
Detail Oriented - Ability to pay attention to the minute details of a project or task
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others

Job Responsibility

Confer with customers by telephone or by email to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
Check to ensure that appropriate changes were made to resolve customers' problems
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Resolve customers' service or billing complaints by performing activities such as exchanging products or services, refunding money, or adjusting bills
Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
Refer unresolved customer grievances to designated departments for further investigation
Determine charges for services requested, collect deposits or payments, or arrange for billing
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Order tests that could determine the causes of product malfunctions
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes

Parttime

Customer Support Representative

As a Customer Service Representative, You will interact with customers to provid...

Location

Mexico , Guadalajara

Salary:

Not provided

Helpware

Expiration Date

Until further notice

Requirements

6 plus months of experience in a customer service-related field
Microsoft Office skills
Communication, Written - Ability to communicate in writing clearly and concisely
Communication, Oral - Ability to communicate effectively with others using the spoken word
Accountability - Ability to accept responsibility and account for his/her actions
Customer Oriented - Ability to take care of the customers’ needs while following company procedures
Working Under Pressure - Ability to complete assigned tasks under stressful situations
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
Detail Oriented - Ability to pay attention to the minute details of a project or task
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others

Job Responsibility

Confer with customers by telephone or by email to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
Check to ensure that appropriate changes were made to resolve customers' problems
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Resolve customers' service or billing complaints by performing activities such as exchanging products or services, refunding money, or adjusting bills
Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
Refer unresolved customer grievances to designated departments for further investigation
Determine charges for services requested, collect deposits or payments, or arrange for billing
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Order tests that could determine the causes of product malfunctions
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes

Parttime

Customer Support Representative

As a Customer Service Representative, You will interact with customers to provid...

Location

Mexico , Guadalajara

Salary:

Not provided

Helpware

Expiration Date

Until further notice

Requirements

6 plus months of experience in customer service-related field
Microsoft Office skills
Communication, Written - Ability to communicate in writing clearly and concisely
Communication, Oral - Ability to communicate effectively with others using the spoken word
Accountability - Ability to accept responsibility and account for his/her actions
Customer Oriented - Ability to take care of the customers’ needs while following company procedures
Working Under Pressure - Ability to complete assigned tasks under stressful situations
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
Detail Oriented - Ability to pay attention to the minute details of a project or task
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others

Job Responsibility

Confer with customers by telephone or by email to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
Check to ensure that appropriate changes were made to resolve customers' problems
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Resolve customers' service or billing complaints by performing activities such as exchanging products or services, refunding money, or adjusting bills
Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
Refer unresolved customer grievances to designated departments for further investigation
Determine charges for services requested, collect deposits or payments, or arrange for billing
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Order tests that could determine the causes of product malfunctions
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes

Fulltime

Customer Support Representative

As a Customer Service Representative, You will interact with customers to provid...

Location

Mexico , Guadalajara

Salary:

Not provided

Helpware

Expiration Date

Until further notice

Requirements

6 plus months of experience in customer service-related field
Microsoft Office skills
Communication, Written - Ability to communicate in writing clearly and concisely
Communication, Oral - Ability to communicate effectively with others using the spoken word
Accountability - Ability to accept responsibility and account for his/her actions
Customer Oriented - Ability to take care of the customers’ needs while following company procedures
Working Under Pressure - Ability to complete assigned tasks under stressful situations
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
Detail Oriented - Ability to pay attention to the minute details of a project or task
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others

Job Responsibility

Confer with customers by telephone or by email to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
Check to ensure that appropriate changes were made to resolve customers' problems
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Resolve customers' service or billing complaints by performing activities such as exchanging products or services, refunding money, or adjusting bills
Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
Refer unresolved customer grievances to designated departments for further investigation
Determine charges for services requested, collect deposits or payments, or arrange for billing
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Order tests that could determine the causes of product malfunctions
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes

Parttime

Customer Support Representative

As a Customer Service Representative, You will interact with customers to provid...

Location

Mexico , Guadalajara

Salary:

Not provided

Helpware

Expiration Date

Until further notice

Requirements

6 plus months of experience in customer service-related field
Microsoft Office skills
Communication, Written - Ability to communicate in writing clearly and concisely
Communication, Oral - Ability to communicate effectively with others using the spoken word
Accountability - Ability to accept responsibility and account for his/her actions
Customer Oriented - Ability to take care of the customers’ needs while following company procedures
Working Under Pressure - Ability to complete assigned tasks under stressful situations
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
Detail Oriented - Ability to pay attention to the minute details of a project or task
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others

Job Responsibility

Confer with customers by telephone or by email to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints
Check to ensure that appropriate changes were made to resolve customers' problems
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Resolve customers' service or billing complaints by performing activities such as exchanging products or services, refunding money, or adjusting bills
Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
Refer unresolved customer grievances to designated departments for further investigation
Determine charges for services requested, collect deposits or payments, or arrange for billing
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Order tests that could determine the causes of product malfunctions
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes

Parttime

Claims Examiner

Randstad

Location:
Canada , Winnipeg

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 13, 2026

Expiration:
March 12, 2026

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Expiration:
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