Claims Examiner Job at Robert Half (New Haven)

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

Claims Examiner - Xcelys

The Claims Examiner position at NTT DATA requires a minimum of 3 years of claims...

Location

United States , Ontario

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

3+ years claims adjudication experience
Minimum of 1 year experience in Xcelys
2+ years in coding (CPT, ICD-10, HCPCS)
2+ years provider contracts, pricing, regulatory guidelines experience
Verifiable high school diploma or GED

Job Responsibility

Process comprehensive medical claims using Xcelys and associated subsystems
Resolve complex pends, coding issues, and contract exceptions
Author overpayment/underpayment determinations and coordinate appeals
Engage in quality reviews, audits, root cause analyses
Monitor accuracy, variance, and rework metrics
Ensure alignment with regulatory and internal compliance guidelines
Act as escalation point and subject matter expert
Participate in system testing, UAT, and workflow enhancements
Recommend improvements, document system and process changes
Prepare production, pending, and quality reports

Fulltime

Workers’ Compensation Claim Examiner

Location

United States , New Haven

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of Workers’ Compensation Claim Examiner experience or commensurate transferable experience
Direct workers’ compensation experience is preferred but not required, provided transferable claims skills are present
Experience working in a fast‑paced, customer‑focused environment
Strong verbal, written, and telephonic communication skills
Prior roles requiring high levels of organization, follow‑up, and accountability
Proficiency with Microsoft Office products
Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are required but not necessary at the time of posting
If not currently licensed, the selected candidate will be required to obtain an applicable resident or designated home‑state adjuster license and any required additional state licenses

Job Responsibility

Handle all aspects of workers’ compensation claims from inception to closure while maintaining strong customer relations
Review claim and policy information to establish investigative background
Conduct ongoing three‑part investigations, including fact‑finding and statement collection from insureds, claimants, and medical providers
Evaluate investigation findings to determine claim compensability
Notify insureds, claimants, and attorneys of claim denials when applicable
Prepare investigative reports, settlements, denials, and evaluations of involved parties
Administer statutory medical and/or indemnity benefits accurately and timely throughout the life of the claim
Set medical, indemnity, and expense reserves within authority limits and recommend reserve changes to the Team Leader as needed
Perform regular claim reviews and recommend corrective or remedial actions to address issues
Identify and escalate unusual or potentially adverse exposures to leadership

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Examiner - Workers Compensation

We are looking for a skilled Claims Examiner specializing in Workers Compensatio...

Location

United States , Alpharetta

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Active Adjuster’s license to handle Workers Compensation claims, or the ability to obtain one immediately upon starting employment
Minimum of three years of experience in Workers Compensation claim handling
Bachelor’s degree or equivalent relevant experience preferred
Proven ability to evaluate, analyze, and interpret complex information
Strong organizational skills and ability to manage multiple tasks effectively
Excellent verbal and written communication skills
Demonstrated critical thinking and decision-making abilities
Experience working collaboratively in team environments

Job Responsibility

Manage and investigate Workers Compensation claims, ensuring compliance with established procedures and regulations
Deliver outstanding customer service to insureds, claimants, agents, and other stakeholders through clear and effective communication
Accurately assess expenses and losses related to Lost Time claims, providing timely and detailed reports
Identify and address coverage issues, potential fraud, and subrogation opportunities while adhering to company guidelines
Develop and execute effective claim strategies to achieve early resolutions and positive outcomes
Maintain organized and up-to-date files using a diary system to monitor progress and follow up on new developments
Communicate trends, issues, and claim activities to internal and external customers in a timely manner
Collaborate with team members to ensure claims are managed and resolved effectively
Provide guidance and direction to colleagues to facilitate efficient claim processing and resolution

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Examiner – Workers’ Compensation

This Workers’ Compensation Claims Examiner role requires an analytical, detail‑o...

Location

United States , Alpharetta

Salary:

30.00 - 31.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

Must hold a valid adjuster's license to manage Workers Compensation claims or obtain one promptly after starting employment
A minimum of 3 years of experience handling Workers Compensation claims is required
Strong analytical skills with the ability to evaluate and interpret complex information effectively
Excellent organizational and time management skills, with the ability to handle multiple tasks simultaneously
Proven ability to work collaboratively in team settings and maintain positive working relationships
Exceptional verbal and written communication skills to convey information clearly and effectively
Bachelor's degree or equivalent detail-oriented experience is preferred
Commitment to delivering superior performance and customer satisfaction
Current Georgia Workers’ Compensation Adjuster License (required)
Additional licenses: Florida, South Carolina, North Carolina (strong plus)

Job Responsibility

Provide accurate and timely assessments of Workers’ Compensation Lost Time claims
Conduct thorough investigations, evaluate coverage, assess loss exposure, and manage cases according to established guidelines
Identify and appropriately address potential fraud, subrogation opportunities, and coverage concerns
Establish and execute effective case strategies to ensure timely and appropriate claim resolution
Deliver superior customer service to insureds, claimants, agents, underwriters, and internal partners
Communicate timely updates regarding claim activity, trends, and issue escalation
Maintain professional and effective interactions with all stakeholders
Ensure all claim files are up‑to‑date using a consistent diary system to monitor developments, follow‑ups, and required actions
Maintain accurate documentation aligned with regulatory requirements and internal quality standards
Achieve consistent compliance in investigation, coverage evaluation, loss assessment, and case management practices

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

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

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

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Claims Examiner

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