Claims Program Specialist Job at Marriott Bonvoy (Bethesda)

New

Pharmacy Assistant - ODB and Private Payor Insurance Claims Specialist

Experienced Pharmacy Assistant looking for something new and exciting? Maybe it'...

Location

Canada , Markham

Salary:

23.00 - 24.00 CAD / Hour

Randstad

Expiration Date

August 24, 2026

Requirements

Previous experience as a pharmacy assistant, regardless of the setting, is required
Exposrure to Kroll in a steady-to-fast paced pharmacy setting is preferred
Strong communication skills are crucial for this role
This role involves on-site work at all times (not remote, not hybrid)
Positive team spirit, initiative, and interest in a specialty setting are also a must

Job Responsibility

Manage multiple tasks related to prescription-related admin and calls to the programs and clinics to ensure faxes are received and they are aware of the same / requesting info related to prescription processing
Dispensing and managing patient medication administration in Kroll as part of duties
Demonstrate strong English communication skills, particularly when interacting with patients over the phone and in written communication
Calls require professionalism, empathy and clear communication as many calls require you to utilize your problem solving skills to support patients dealing with various conditions
Perform data entry tasks, including working with Kroll and supporting fax management

What we offer

Up to 3-month contract based on work performance with full-time hours (extension potential)
The pharmacy is clean, ergonomic, technologically advanced, and beautifully designed
The work schedule is Monday to Friday, with 8-hour shifts between 7:00 AM and 7:00 PM - all shifts must be worked as part of a rotation - no weekends, ensuring a better work-life balance
Insurance and benefits are optional through Randstad
Potential for this role to eventually transition into a permanent opportunity with the pharmacy
On-site, free parking is available for your convenience
Opportunity to learn alongside passionate pharmacy professionals who prioritize quality patient care in their practice

Fulltime

New

Workers Compensation Claims Specialist

Randstad, the world’s leading talent company and a partner of choice to clients,...

Location

Canada , Toronto

Salary:

58400.00 - 87600.00 CAD / Year

Randstad

Expiration Date

September 30, 2026

Requirements

Experience: Proven experience in disability management, workers' compensation claims, or risk management is an asset
Knowledge: Strong understanding of regional occupational health and safety legislation and workers' compensation board processes
Communication: Exceptional interpersonal skills with the ability to coach field staff and influence stakeholders at all levels
Analytical Thinking: Ability to spot trends in data and translate them into actionable safety improvements
Organization: Highly organized with the ability to manage multiple moving files while meeting strict legal deadlines
Bilingual fluency Preferred: French and English

Job Responsibility

Incident Response: Act as the first point of contact for all lines of business regarding incident and injury reporting on non work related claims, first aid, near misses, no lost time claims and modified no loss time claims
End-to-End Processing: Oversee the claims submission process, ensuring all data and forms are transferred to various workers compensation boards within legally prescribed timelines
Field Support & Coaching: Guide branch managers through workplace accident investigations
Modified Work Program Management: Act as the ongoing liaison between the field, the injured workers and champion early return-to-work strategies
Appeals & Documentation: Assist in the preparation of formal appeal submissions and maintain meticulous records of all claims activity
Customer Service: Handling all certification of insurance requests and generic certificate of Insurance, clearance certificates
Administrative Task: Mail (Digital mailroom - Xerox), Mail in CNESST portal, other duties as required

What we offer

Work-Life balance: Embrace a remote work environment with a competitive salary
Dynamic environment: Thrive in an atmosphere with diverse challenges and opportunities for continuous learning
Collaborative leadership: Work with a leadership team committed to a collaborative and participatory approach
RRSP
health spending account
comprehensive medical, dental, vision, disability, and life insurance
personal spending account
employee assistance program (EAP)
generous time off policy
discounts on everything from cell phone plans to car purchases

Fulltime

Claims Specialist

We are looking for an experienced Claims Specialist to join our team in Los Ange...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience managing workers' compensation claims
Strong knowledge of medical management processes and workers' compensation regulations
Excellent organizational skills with the ability to track and process claim information efficiently
Effective communication skills for liaising with supervisors, employees, and insurance adjusters
Ability to work collaboratively with hospital managers and injured employees
Proficiency in computer systems for inputting and auditing claim data
Detail-oriented approach to managing deadlines and ensuring compliance
Commitment to maintaining accurate records and providing timely updates

Job Responsibility

Manage a portfolio of modified duty and lost time claims, ensuring accurate and timely updates
Coordinate the forwarding of work-related injury medical records to insurance adjusters
Input medical record data into the system and communicate initial diagnoses and work statuses to supervisors
Assist injured employees and hospital managers in implementing early return-to-work programs
Schedule follow-up medical appointments and ensure documented medical statuses are secured within 24 hours of each appointment
Relay outcomes of medical appointments to supervisors and insurance adjusters within 24 hours of receipt
Monitor lost time and modified work statuses in the system, maintaining accurate tracking
Maintain regular communication with insurance adjusters every 60 days until claims are resolved
Conduct audits of claim data and related information to ensure accuracy and compliance
Perform monthly audits on organization-related data to support operational efficiency

What we offer

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

Claims Review Specialist

We're seeking a detail-oriented professional who can support the coordination an...

Location

United States , Tempe

Salary:

20.00 - 30.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED) required
Minimum 3 years related experience and/or training, or equivalent combination of education and experience
Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
Knowledge of insurance database systems preferred
Experience with EDOCS platform or similar documentation management systems
Detail-oriented, analytical, financially minded approach to Stop Loss coordination
Ability to read, analyze, and interpret common financial reports and legal documents
Capability to work with mathematical concepts such as probability and statistical inference

Job Responsibility

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes
Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests
Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims
Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders
Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers
Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention
Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Unlimited PTO
Mental health support
Retirement planning
Financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture

Fulltime

Marketing Program Partner Specialist

The Partner Marketing Program Specialist supports the execution and administrati...

Location

Canada , Toronto

Salary:

58000.00 - 81000.00 CAD / Year

Mastercard

Expiration Date

Until further notice

Requirements

1-2 years of experience in program support, operations or an administrative role (e.g., partner program support, business operations, consulting or related functions)
Comfortable assisting with planning, prioritizing and executing short-term cross-functional projects
Experience supporting stakeholders across partner management, product marketing or operations to implement process improvements or support reporting and analysis
Strong attention to detail with excellent written and verbal communication skills
Solid analytical skills, with the ability to help gather, track and summarize data to inform decisions
Ability to follow established processes and execute assigned tasks reliably and efficiently
Team-oriented with strong collaboration skills and a service-minded approach
Impactful communicator who confidently shares ideas and perspectives

Job Responsibility

Review, process and track CMF proposals and claims to ensure compliance with program guidelines
Management of partner creative review as part of approval process
Maintain and update content, resources and tools within the partner portal
Manage and execute content update requests to partner pages on .com
Support and coordinate with third-party vendors executing partner marketing initiatives
Document, maintain and monitor partner marketing processes, ensuring consistency and adherence
Assist in tracking program metrics and generating operational reports
Collaborate cross-functionally with marketing, finance, operations and other internal teams to support partner programs
Identify process improvements to increase efficiency and partner satisfaction
Identify process improvements to increase efficiency and internal stakeholder satisfaction

Fulltime

Erp/crm Consultant

We are looking for an ERP/CRM Consultant to support a manufacturing organization...

Location

United States , Elgin

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

5+ years of experience in techno-functional consulting with a strong emphasis on functional analysis and business process leadership
Hands-on experience implementing, improving, or assessing CRM, ERP, or case management platforms such as Oracle Service Cloud, Salesforce, Dynamics, or ServiceNow
Demonstrated ability to review existing system environments and translate operational needs into practical solution recommendations
Strong background in documenting business requirements, functional specifications, workflows, and related process materials
Experience supporting system implementation programs or transformation initiatives in complex cross-functional environments
Ability to collaborate effectively with business stakeholders, IT teams, and external vendors throughout planning and delivery activities
Excellent communication, workshop facilitation, and stakeholder management skills
Familiarity with warranty management, claims handling, case management processes, or JD Edwards integrations is strongly valued

Job Responsibility

Lead discovery workshops to understand existing operational processes and evaluate the current Oracle Service Cloud landscape
Analyze workflows and business procedures to identify gaps, recommend enhancements, and define scalable future-state process models
Work across business units, internal technology teams, and third-party partners to build alignment on solution direction and delivery plans
Support the assessment and selection of warranty or case management platforms by gathering requirements, organizing evaluation criteria, and contributing to vendor comparisons
Produce detailed functional deliverables such as business requirements documents, functional designs, process maps, use cases, and user stories
Partner with technical resources to shape, validate, and test integrations involving JD Edwards EnterpriseOne, Oracle-related platforms, and connected applications
Contribute to full lifecycle delivery activities, including solution design, configuration support, testing coordination, and production readiness
Serve as a functional advisor for warranty and case management operations, ensuring system capabilities reflect business objectives
Facilitate meetings with stakeholders and communicate recommendations clearly to both technical specialists and business audiences
Assist with adoption planning, process improvements, and ongoing optimization efforts, including initiatives related to Oracle Service Cloud enhancement or replacement when needed

What we offer

medical
vision
dental
life and disability insurance
401(k) plan
free online training

Medical Biller/Collections Specialist

We are looking for a detail-oriented Medical Biller/Collections Specialist to su...

Location

United States , Old Bethpage

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in medical billing and collections within a healthcare setting
Working knowledge of claim denial research, appeals processing, and payment follow-up
Familiarity with hospital or behavioral health billing practices and related documentation requirements
Ability to review coding and billing details for accuracy and identify issues that may delay reimbursement
Strong written and verbal communication skills for interacting with internal teams, payers, and responsible parties
Proficiency in documenting account activity, claim status updates, and payer conversations with accuracy
Organized approach to managing deadlines, aging accounts, and multiple follow-up activities simultaneously

Job Responsibility

Track benefit eligibility for individuals in behavioral health programs and notify operational teams when recertification deadlines are approaching within the required timeframe
Coordinate with program staff to monitor recertification progress and help ensure renewals are completed in accordance with behavioral health regulations
Review billing documentation for accuracy and completeness before claim submission, and address missing or inconsistent information promptly
Provide guidance to operational teams on appropriate coding and billing practices to support clean claim submission
Analyze aging reports and take action to improve collection timeliness on outstanding accounts
Contact responsible parties regarding overdue balances, document unresolved matters, and escalate complex issues to the Billing Manager for further review
Investigate unpaid, denied, or partially reimbursed claims by examining supporting records and payer correspondence to determine next steps
Prepare and submit appeals for denied or underpaid claims, maintain detailed records of all payer communications, and follow through until resolution is reached
Alert the Billing Manager to payment barriers caused by billing errors, coding issues, or inaccurate patient information, and assist with special projects or general office support as needed
Ensure all paper and electronic records are processed accurately, completed on time, and aligned with quality and compliance expectations

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

New

Inventory Specialist

Location

United States , Epping

Salary:

17.00 - 20.00 USD / Hour

Walgreens

Expiration Date

Until further notice

Requirements

Six months of prior work experience with Walgreens (internal candidates) or one year of prior retail work experience (external candidates)
Must be fluent in reading, writing, and speaking English (except in Puerto Rico)
Must have a willingness to work a flexible schedule, including evening and weekend hours
Demonstrated attention to detail and ability to multi task and manage execution
Experience in identifying operational issues and recommending and implementing strategies to resolve problems

Job Responsibility

Responsible for executing, monitoring, and training inventory best practices and standard operating procedures for the entire store, including both front end and pharmacy
Supports pharmacy inventory management activities, including receiving, counting, ordering, and facilitating returns
Champions On-Shelf Availability and is responsible for receiving, counting, pricing, returns, and all in-store inventory processes
Validates and ensures accuracy of planograms
Responsible for reviewing and coordinating the proper use of reports and system applications, which have an impact on the accuracy of front end and pharmacy on-hand balances and pricing
Responsible for executing and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods including prescription drugs
In designated stores, as required, opens and closes the store in the absence of store management, including all required systems start-ups, required cash handling and cashier responsibilities, and ensuring the floor and stock room are ready for the business day
Engages customers by greeting them and offering assistance with products and services
In designated stores, when serving as the leader on duty, resolves customer issues and answers questions to ensure a positive customer experience
Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.)

Fulltime

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Claims Program Specialist

Job Description

Job Responsibility

Requirements

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