CrawlJobs Logo

Claims Specialist

sammonsfinancialgroup.com Logo

Sammons Financial Group

Location Icon

Location:
United States , Sioux Falls ▼

Category Icon
Category:
Insurance

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

37650.00 - 70595.00 USD / Year
Save Job
Save Icon
Apply Position

Job Responsibility:

  • Request and review claims requirements to determine coverage and finalize settlement of policy/contract benefits
  • Complete follow up on outstanding claim requirements with Agents, Policy Holders, Beneficiaries and Attorneys
  • Adhere to various legislation or settlement agreement requirements
  • Request and follow up for all outstanding claim requirements
  • Determine all requirements are met to company, state and regulatory standards before completing payment
  • Ensure all policy/contract settlements are completed within the Service Level and Quality Standard Agreements
  • Review and complete the review of data to meet all service level requirements in audits and settlement agreements
  • Request and gather medical records, legal documents, duplicate policies, etc. to assist in review for determining coverage
  • Apply department standards to escalate complex claim or benefit related requests
  • Correspond in writing and communicate via telephone to assist internal and external customers
  • Phone call handling for all Claims related calls
  • Review and complete all Benefit processing requests
  • Support the initial notification process
  • Participate in and complete all monthly balancing of department accounts
  • Follow all procedures to ensure all controls are being maintained
  • Follow up on pending claim files every 30 days in writing, or per state regulations
  • Acquire and maintain a working knowledge of company products
  • Acquire and maintain basic system, tax, procedural and compliance knowledge
  • Assist with projects that enhance productivity and system integrity
  • Track and provide customer feedback via the ACT Log
  • Provide feedback and opinions to your Manager
  • Model Core values daily and display the values within your work
  • Drive to meet/exceed all performance goals including KPIs, SLAs and other communicated standards
  • Proactively participate in daily huddle board discussions
  • Actively participate in problem solving sessions
  • Take ownership of implementing standard work and other changes
  • Continuously strive to create a positive customer experience
  • All other duties as assigned
  • Commitment to embrace Sammons Financial Group Companies shared values
  • Regular attendance is required and expected

Requirements:

  • Bachelor's Degree Preferred
  • 2-4 years' Insurance or Annuity/Life Claim experience Preferred
  • Must have the ability to communicate effectively and tactfully with agents, policyholders, beneficiaries and other staff members
  • Must have knowledge of and ability to maneuver through multiple information screens
  • Previous customer service experience preferred
  • Must have strong organizational skills
  • Ability to work efficiently and independently or in a team environment
  • Able to adapt to frequent change, including daily transition of work duties, between tasks and lines of business
  • An appreciation for detail and problem solving skills
  • Computer skills, PC, Microsoft Office
  • Excellent verbal and written communication skills
  • Criminal background check required
  • FINRA regulations require fingerprinting for this position
What we offer:
  • Health, Dental, Vision, Company Paid Retirement, PTO and Holiday Pay
  • Employee Stock Ownership Plan (ESOP) is a 100% company-funded retirement plan
  • Friday afternoons off all year long, competitive PTO, and generous number of paid holidays
  • Incentive program for defined goals subject to eligibility and performance

Additional Information:

Job Posted:
March 04, 2026

Employment Type:
Fulltime
Icon
Sammons Financial Group - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Claims Specialist

Claims Experience Specialist

The Claims Experience team is responsible for providing premium support for our ...
Location
Location
Canada
Salary
Salary:
63000.00 CAD / Year
airbnb.com Logo
Airbnb
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years in a fintech or customer experience role
  • Minimum of 1+ years experience handling insurance claims, preferably including first and third party property damage claims
  • Proficiency in both English and in French (must be able to handle technical claims discussions in French)
  • Critical thinking skills with a proven track record in solving challenging customer problems and making claims decisions with consistency and fairness whilst adhering to policy terms and workflows
  • Strong verbal and written communication skills with experience interacting with customers through multiple channels including email, messaging and phone
  • Active listening skills to understand user needs and provide personalized recommendations and assistance
  • Ability to explain complex and sensitive issues to customers with confidence and clarity
  • Analytical skills with the ability to organize and work independently with rapidly changing priorities
  • Negotiation skills to ensure customer issues are resolved in a timely and efficient manner
  • Solution and outcome-oriented with an ability to balance fraud prevention alongside a positive user experience
Job Responsibility
Job Responsibility
  • Evaluate, investigate and resolve claims submitted across our AirCover products (including but not limited to Host Damage Protection claims) including claims of high value and complexity that require complex investigation and negotiations to reach satisfactory outcomes
  • Closely monitor for fraud detection and mitigate risks associated with bad actors to protect the Airbnb brand and community
  • Verify all relevant facts and evidence to determine case resolution outcomes whilst following internal policies and workflows
  • Go above and beyond to create personalized interactions and exceptional premium support throughout the end-to-end claims process, tailoring the experience offered whilst ensuring each user’s needs and preferences are met with the highest level of care and attention
  • Provide continuous education and guidance for users about our Aircover products, terms and policies to enable the seamless resolution of their requests
  • Work closely with stakeholders and third party claims administrators to align on case strategies and ensure a timely resolution is reached for our users
  • Communicate regularly with Supervisors and Manager to provide feedback on the status of claims
  • Maintain high levels of confidentiality whilst conducting investigations
  • Identify gaps in workflow, process or policy whilst striving to provide upward feedback as required to further improve the experience for our customers
  • Act as subject matter expert for change initiatives and/or cross functional projects taking place across the Aircover Scaled Ops and Optimization org, including assisting internal stakeholders to test, refine, ideate, and deploy new internal products and processes
What we offer
What we offer
  • bonus
  • equity
  • benefits
  • Employee Travel Credits
  • Fulltime
Read More
Arrow Right

Property Claims Specialist

We’re working with a global broker known for handling complex risk. They’re look...
Location
Location
United Kingdom , Leeds
Salary
Salary:
40000.00 GBP / Year
https://www.lawesrecruitment.co.uk Logo
Lawes Consulting Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven track record of managing claims end-to-end
  • Familiar with domestic and/or commercial property policies
  • Experience with CMS platforms and Microsoft Office
Job Responsibility
Job Responsibility
  • Manage a portfolio of property claims from notification to resolution
  • Accurately assess policy coverage and determine liability
  • Liaise with loss adjusters, contractors, and customers
  • Ensure claims are settled efficiently, fairly, and within SLA
  • Maintain clear, accurate, and professional documentation
  • Escalate complex cases as needed, supporting a team-focused approach
  • Handle incoming claims and guide policyholders through the process
  • Investigate commercial property damage claims
  • Communicate regularly with stakeholders to keep claims moving
  • Collaborate with internal teams (underwriting, risk, customer care)
  • Fulltime
Read More
Arrow Right

Construction Engineer (Construction Claims Specialist)

The Honolulu Authority for Rapid Transportation (HART) is the public transit aut...
Location
Location
United States , Honolulu
Salary
Salary:
72520.00 - 103210.00 USD / Year
honolulutransit.org Logo
Honolulu
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree in Engineering from an accredited college or university. Degrees in related disciplines demonstrating equivalent knowledge may also be considered
  • Minimum of 10 years' experience in construction management
  • At least 3 years of experience demonstrating substantive knowledge of contract management, change orders, or construction fieldwork
  • Experience on major public transit construction projects or within legal departments/law firms is preferred but not required
  • Strong written and oral communication skills
  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint)
  • Candidates must meet the health and physical condition standards necessary to perform the essential duties of this position effectively
Job Responsibility
Job Responsibility
  • Review contracts, project documentation, and correspondence to identify potential claims issues
  • Analyze contractor claims for validity and prepare detailed reports with findings and recommendations
  • Interpret terms and conditions in proposals, awards, and contracts
  • Communicate with HART project managers and staff to gather project documentation and facts relevant to claims
  • Prepare reports, chronologies, summaries, and other documents to support HART's position on claims
  • Collaborate with construction management staff and experts to evaluate and monitor claims
  • Develop correspondence, task orders, and other claims-related documents
  • Create reports using Word, Excel, PowerPoint, and other software as required
  • Organize claims materials and files to ensure appropriate access for all stakeholders
  • Strategize with project managers, corporate counsel, or other involved parties to provide litigation support for claims
What we offer
What we offer
  • Medical, prescription drug, vision, dental, and life insurance plans
  • Generous vacation and sick leave, earning up to 21 days per year
  • 13 paid holidays annually (14 days during election year)
  • Retirement plan contributions through the Employees' Retirement System (ERS)
  • Deferred compensation options to invest pre-tax income for retirement
  • Flexible spending accounts for health and dependent care expenses
  • Pre-tax transportation benefits, including TheBus and vanpool options
  • Access to confidential counseling services through the Employee Assistance Program (EAP)
  • Additional perks include training opportunities and employer-funded Holo Card for eligible employees to use on public transit
  • Eligibility for the public Service Loan Forgiveness (PSLF) program, supporting employees dedicated to public service
  • Fulltime
Read More
Arrow Right

Claims Experience Specialist

The Claims Experience team is responsible for providing premium support for our ...
Location
Location
Japan
Salary
Salary:
Not provided
airbnb.com Logo
Airbnb
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years in a fintech or customer experience role
  • Minimum of 1+ years experience handling insurance claims, preferably including first and third party property damage claims
  • Critical thinking skills with a proven track record in solving challenging customer problems and making claims decisions with consistency and fairness whilst adhering to policy terms and workflows
  • Strong verbal and written communication skills with experience interacting with customers through multiple channels including email, messaging and phone
  • Active listening skills to understand user needs and provide personalized recommendations and assistance
  • Ability to explain complex and sensitive issues to customers with confidence and clarity
  • Analytical skills with the ability to organize and work independently with rapidly changing priorities
  • Negotiation skills to ensure customer issues are resolved in a timely and efficient manner
  • Solution and outcome-oriented with an ability to balance fraud prevention alongside a positive user experience
  • Calm and Empathetic with ability to adapt to any situation by personalizing responses and educating our community whilst remaining level headed in challenging situations
Job Responsibility
Job Responsibility
  • Evaluate, investigate and resolve claims submitted across our Aircover products (including but not limited to Host Damage Protection claims) including claims of high value and complexity that require complex investigation and negotiations to reach satisfactory outcomes
  • Closely monitor for fraud detection and mitigate risks associated with bad actors to protect the Airbnb brand and community
  • Verify all relevant facts and evidence to determine case resolution outcomes whilst following internal policies and workflows
  • Go above and beyond to create personalized interactions and exceptional premium support throughout the end-to-end claims process, tailoring the experience offered whilst ensuring each user’s needs and preferences are met with the highest level of care and attention
  • Provide continuous education and guidance for users about our Aircover products, terms and policies to enable the seamless resolution of their requests
  • Work closely with stakeholders and third party claims administrators to align on case strategies and ensure a timely resolution is reached for our users
  • Communicate regularly with Supervisors and Manager to provide feedback on the status of claims
  • Maintain high levels of confidentiality whilst conducting investigations
  • Identify gaps in workflow, process or policy whilst striving to provide upward feedback as required to further improve the experience for our customers
  • Act as subject matter expert for change initiatives and/or cross functional projects taking place across the Aircover Scaled Ops and Optimization org, including assisting internal stakeholders to test, refine, ideate, and deploy new internal products and processes
  • Fulltime
Read More
Arrow Right

Employee Relations Specialist

As an Employee Relations Specialist, you will be leveraging your skills in Claim...
Location
Location
United States , Beaverton
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • At least three years of experience in an Employee Relations Specialist role or a similar position
  • Proficiency in Claim Administration
  • Excellent Communication skills
  • Demonstrated experience in Complaint Handling
  • Familiarity with Compliance procedures and regulations in employee relations
  • Proven ability in Disciplining Employees in a fair and consistent manner
  • Experience in conducting Employee Relations Investigations
  • Experience in designing and delivering Employee Training programs
  • Experience in dealing with Union Grievances
  • Knowledge of NeoGov software is a plus
Job Responsibility
Job Responsibility
  • Conduct thorough investigations related to employee relations matters
  • Address and resolve employee relations issues efficiently
  • Provide expert guidance on labor and employment matters
  • Support in developing innovative workforce policies related to employee relations
  • Assist in the creation and implementation of training programs for employees
  • Handle complaints and administer claims related to employee relations
  • Ensure adherence to compliance and disciplinary measures
  • Manage and resolve union grievances
  • Use NeoGov for efficient process management
  • Prepare and maintain detailed investigation reports
What we offer
What we offer
  • Medical, vision, dental, and life and disability insurance
  • Eligibility to enroll in company 401(k) plan
  • Fulltime
Read More
Arrow Right

Medical Billing Specialist

We are looking for a detail-oriented Medical Billing Specialist to join a team i...
Location
Location
United States , King of Prussia
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • At least 1 year of experience in medical billing, claims, or collections
  • Proficiency in accounting software systems and electronic health record (EHR) systems
  • Familiarity with Medicaid processes and commercial insurance claims
  • Strong understanding of accounts receivable, denial management, and appeals
  • Experience working with billing and authorization functions
  • Ability to accurately input and manage billing data
  • Excellent communication skills to collaborate with team members and external payors
  • Knowledge of compliance policies related to medical billing and collections
Job Responsibility
Job Responsibility
  • Process and submit primary and secondary claims for both commercial insurance and Medicaid
  • Investigate and resolve claim denials, performing appeals as necessary to ensure proper reimbursement
  • Manage accounts receivable by following up on claims through resolution, including correcting billing errors and addressing rejections
  • Input and review billing data for accuracy, ensuring compliance with company policies and procedures
  • Collaborate with the Billing Manager and clinic teams to ensure accurate and timely billing
  • Track and verify Medicaid status for clients while maintaining relationships with payors to facilitate successful claims processing
  • Assist intake teams with Medicaid documentation for new clients and those requiring reassessment
  • Utilize various insurance portals and systems, including Waystar, to handle denial responses and claims follow-ups
  • Ensure adherence to compliance standards in all billing and collections activities
  • Perform other tasks as assigned by the Billing Manager or Director
What we offer
What we offer
  • Medical insurance
  • Vision insurance
  • Dental insurance
  • Life insurance
  • Disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right

Medical Reimbursement Specialist

We are in search of a Medical Reimbursement Specialist to join our team. Station...
Location
Location
United States , Princeton
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Minimum of 3 years of experience in a similar role
  • Proficient in benefit functions
  • Demonstrated expertise in billing functions
  • Experience in claim administration
  • Familiarity with collection processes
  • Ability to handle and resolve medical denials
  • Comprehensive knowledge of Medicare
Job Responsibility
Job Responsibility
  • Analyze and categorize outstanding claims based on payer, denial reason, and claim value
  • Investigate and take corrective action on unpaid, denied, or underpaid claims
  • Collaborate with internal teams to obtain missing documentation and expedite claim resubmission
  • Evaluate common denial reasons and address them accordingly, such as coding errors, medical necessity, and prior authorization
  • Submit corrected claims and formal appeals as required
  • Communicate with insurance payers to resolve aged claims and escalate unresolved claims as necessary
  • Maintain comprehensive records of all payer interactions
  • Identify the root causes of denials and implement best practices to prevent future issues
  • Suggest changes to workflow to enhance claim submission accuracy and speed
  • Conduct training for in-house billing teams on claim recovery strategies
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligibility to enroll in company 401(k) plan
  • Fulltime
Read More
Arrow Right

Medical Billing Specialist

Location
Location
United States , Dothan
Salary
Salary:
Not provided
realtime-it.com Logo
RealTime (AL)
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Medical Billing Experience
  • Perform posting charges
  • Perform completion of claims to payers
  • Conduct duties in a professional and timely fashion
  • Submit billing data to the appropriate insurance providers
  • Process claims
  • Resolve denial instances
  • Perform claim follow-up
  • Achieve maximum reimbursement for services provided
  • Deploy, maintain and report on various programs
Job Responsibility
Job Responsibility
  • Medical billers play a vital role in the connection between health care providers, patients, and insurance companies. At RealTime, we provide excellent Revenue Cycle Management to medical practices across the Southeast and through the Midwest.
What we offer
What we offer
  • Training
  • Competitive pay
  • Phone allowance
  • Generous PTO
  • 401(k) with company match
  • Health & Wellness Benefits including medical, dental, and vision
  • Company-sponsored events for fun and fellowship
  • Fulltime
Read More
Arrow Right
Jobs by Category
Art and Entertainment Jobs Banking Jobs Call Center Jobs Construction Jobs Consulting Jobs Customer Service Jobs Education Jobs Energy Jobs Finance Jobs Gastronomy Jobs Health and Beauty Jobs Hospitality and Tourism Jobs Human Resources Jobs Insurance Jobs IT - Administration Jobs IT - Software Development Jobs Legal Jobs Logistics Jobs Manufacturing Jobs Marketing, Digital Marketing, SEO, SEM Jobs Media Jobs Nursing Jobs Office Administration Jobs Pharmacy Jobs Physical Work Jobs Public Relations Jobs Public Sector Jobs Purchasing Jobs Quality Control Jobs Real Estate Jobs Research and Development Jobs Sales Jobs
Job Positions Jobs by Country
United States Jobs United Kingdom Jobs India Jobs Canada Jobs Australia Jobs Germany Jobs Ireland Jobs Poland Jobs
Company
Blog About Us Contact
Follow Us
Facebook
X (Twitter)
LinkedIn
Instagram
CrawlJobs Group
ITFlashcards AllDevBlogs
© 2026 CrawlJobs Ltd. All Rights Reserved
Terms & Conditions Privacy Policy