Consultant, Claims Processing Oversight Job at Kirby Bates Associates

Wc Claims Consultant

OVERVIEW Alera Group is looking for a WC Claims Consultant. We are seeking high...

Location

United States , Portland

Salary:

80000.00 - 110000.00 USD / Year

Alera Group

Expiration Date

Until further notice

Requirements

Contact with clients, carrier and TPA claims adjusters, internal customers, and vendors on regular basis to serve as advocate, liaison, mediator, and resource
Prepare, coordinate & present Claim Reviews, Status Spreadsheets and other Claim meetings as requested
Coordinate with client/insured to assist with coverage issues
Participate in presentations with clients and prospects as requested
Documentation in Sagitta and ImageRight as required
Identify and notify Risk Manager/Producer of claims trends to help facilitate a resolution
Function as back-up for other WC Claims Team members
Assist team with highly complex losses and questions related to such
Provide assistance to clients seeking to enhance their return-to-work programs
Provide claims management training, “WC 101” to clients to educate them on the claims process

Job Responsibility

Work effectively with our Work Comp. Clients building solid relationships and retaining business
Work with all Sales Executives, internal Propel staff in Commercial Lines Departments, and externally with our Clients, Carriers and Vendors
Service timeline focus is on larger Valued or 360 Clients for onboarding new accounts and establishing claims services with their carrier/TPA/applicable vendors, providing claims oversight, employer training, and scheduling Claim Reviews and various presentations
Provide claims service for all Propel clients providing technical expertise and servicing as an advocate on client WC claim issues
Work independently with clients and their carrier/TPA consulting on large reserves, coverage issues, return to work issues, settlements, and other items that have a significant impact on retention and premiums
Present to prospects and clients at renewals, stewardship meetings and claim reviews

What we offer

Medical
dental
life and disability insurance
401k
generous paid time off

Fulltime

Consultant, Claims - Indemnity Specialty

Our team handles some of the most unique and interesting insurance claims at Nat...

Location

United States

Salary:

97000.00 - 180000.00 USD / Year

Nationwide

Expiration Date

Until further notice

Requirements

Demonstrated experience handling toxic tort with emphasis on asbestos and/or silica bodily injury claims, including evaluation, negotiation, and resolution
Proven ability to manage toxic tort bodily injury litigated files, including collaboration with defense counsel, strategy development, and oversight of litigation budgets and outcomes
Undergraduate degree in related field preferred
Post-graduate studies preferred
State licensing where required
Relevant professional designations or certifications desirable (CPCU, CLU, IIA, AEI, etc.)
Eight years of specialty claims experience preferred
Proven superior knowledge of the best claims practices used to resolve the most sever and technically complex claims
Demonstrated knowledge of insurance contracts and legal aspects affecting regulatory and liability issues that relate to environmental and other specialty claims
Proven ability to meet customer needs and provide outstanding service by informing customers of the claims process and ensuring a positive customer experience

Job Responsibility

Completes detailed review and analysis of claims
Investigates liability and damages
Brings files to closure, either by voluntary dismissals or by negotiation of settlements
Resolves amount of appropriate settlements or grounds for denial
Assists in the drafting of settlement documents
Provides reserve analysis to ensure timely and accurate case reserves in according to optimal claims practices
Negotiates cost sharing agreements between other insurance carriers and policyholders
Maintains current knowledge of assigned insurance lines, court decisions which may impact the claims function, current guidelines and policy changes and modifications
Creates and analyzes severe incident reports, reinsurance reports and other information to corporate office, Claims Management and Underwriting
Performs continuous review of claims inventory

What we offer

medical/dental/vision
life insurance
short and long term disability coverage
paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date
nine paid holidays
8 hours of Lifetime paid time off
8 hours of Unity Day paid time off
401(k) with company match
company-paid pension plan
business casual attire

Fulltime

Claims Fraud Consultant

Are you looking for a new challenge? Fancy helping us shape the future of motor ...

Location

United Kingdom , Manchester

Salary:

Not provided

Prima

Expiration Date

Until further notice

Requirements

Proven experience in managing Claims Fraud
Aware of current market strategies
High level of technical competency, which can be demonstrated in case handling and through case discussion
High level of knowledge of market-leading Fraud tools such as SIRA
Ability to utilise data to interpret performance trends and translate insights into actionable commercial strategies
Highly effective communicator and influencer with strong influencing skills, capable of building credibility and managing relationships with both internal senior leaders and external partners

Job Responsibility

TPA Oversight & Relationship Management: Supervise and manage the Third Party Administrator, conduct case reviews and audits, identify leakage or process gaps, and maintain a strong, constructive working relationship
Technical Expertise & Complex Claims Support: Provide fraud expertise, supporting the UK Claims Manager with large or complex cases and presentations to reinsurers and internal stakeholders
Fraud Claims Handling & Team Development: Initially manage fraud claims directly, later supporting leadership as the team grows, and contribute to the design and delivery of technical training to strengthen fraud capability
Platform & System Development: Contribute to the development of the Global Claims Platform, shaping efficient processes and driving its evolution to become market-leading
Strategy, Governance & Compliance: Support the long-term fraud strategy, establish robust governance and performance frameworks, and ensure adherence to protocols and case strategies
Process Improvement & Escalation Management: Lead change initiatives to improve efficiency, digital adoption, and customer experience, while acting as the final escalation point for complex or high-value fraud cases

What we offer

Hybrid working, with a mix of home and office days
Access to learning resources, mentorship and a growth plan tailored to you
Private healthcare, gym discounts, wellbeing programs and mental health support

Fulltime

New

Construction Project Manager

The Construction Project Manager supports the Engineer Procure Construct (EPC) P...

Location

Canada , Toronto

Salary:

64.64 - 68.00 CAD / Hour

Randstad

Expiration Date

August 15, 2026

Requirements

Bachelor Degree in Construction, Construction Management, Engineering, or a related field and 7 years relevant project management experience in the construction industry
Excellent computer skills and proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint and Access)
Excellent written and verbal communication skills and strong organizational skills
Strong analytical and problem-solving skills, and attention to detail
Ability to handle large volumes of work and multi-task in a fast-paced environment
A basic understanding of Generally Accepted Accounting Principles is required
Must be able to meet the company's driving requirements

Job Responsibility

Oversee day-to-day operations from pre-construction through project completion and warranty periods
Manage construction project safety, quality, schedule, cost control, contracts, subcontractors, suppliers, proposals, estimates, documentation turnover, client relations/management, field staff and other duties required to execute EPC, Construction Management, Construction, and Program Management projects
Adhere to company's safety programs, trainings, and policies, as well as promote and manage the Safety & Health performance of project team members and subcontractors
Responsible for the oversight of day-to-day construction activities and the successful execution of a single or multiple projects simultaneously
Provide direction and participate in project planning, scheduling, estimating, cost development, and establishing critical project objectives
Develop new and manage existing client relationships while interfacing with the client for proposal and project related items
Participate in internal and external project risk reviews and consult with Legal Department as required
Negotiate prime contracts, CM contracts, subcontracts, and change orders
Participate in risk review process
Implement assigned sections of the Project Execution Plan, including construction execution, construction quality assurance plan, safety & health plan, subcontracting plan, project staffing plan, organization chart, and procurement plan

Fulltime

Technical Product Manager III

The Technical Product Manager (TPM) III serves as a strategic bridge between bus...

Location

United States , Los Angeles

Salary:

207808.00 - 353272.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Computer Science or Related Field
At least 10 years of experience in a health plan, payer organization and/or health system, ideally as a Technical Product Management or similar role
Experience in at least one of the following healthcare domains: Customer Engagement / Front Office Operations: enrollment and eligibility, call center, member/provider portals, member outreach, appeals and grievances, sales/marketing portals
Health Services Delivery and Quality Oversight: care management, population health, behavioral health, pharmacy, UM authorizations, quality oversight
Provider Network Operations / Data: provider portals, provider data management & network operations enablement, Prior Authorization Interoperability (PAI) submission workflows
Finance / Claims / HR / Compliance Enablement: claims processing & payments, payment integrity, encounter processing, billing/reporting, HR/compliance systems
Proven experience translating complex business needs into clear problem statements that enable technically ready requirements for IT and development teams
Experience delivering enterprise digital solutions that improve member and provider experience, operational efficiency, and maintain regulatory compliance
Experience with agile product management frameworks, backlog prioritization, sprint planning and related tools, including prior exposure to health plans or health system digital solutions
Experience collaborating with cross-functional business and IT teams to drive enterprise solution delivery and ensure alignment with organizational priorities

Job Responsibility

Leads business stakeholders in defining product vision, solution intent, scope, value hypothesis, and roadmap aligned with enterprise strategy and measurable business outcomes
ensures enterprise-wide impact and alignment across multiple business verticals and strategic objectives, while owning one or more domains and coordinating cross-domain roadmaps in collaboration with other TPMs
Drives the translation of complex business needs into clear problem statements and outcomes that inform technically ready requirements for IT and development teams
Ensures requirements are accurate, complete, timely, and aligned with defined success metrics to support product strategy and enterprise delivery of business value
Partners with internal teams ensure business requirements and product intent are clearly understood and proposed solutions align with enterprise reference architecture and governance standards
Provides guidance and oversight to ensure requirements are technically ready and aligned with product strategy and evaluates integration dependencies and trade-offs across systems
Collaborates with key stakeholders to ensure the product backlog for the domain is effectively prioritized, supports other TPMs with cross-domain backlog coordination, and participates in sprint planning and review sessions to maintain strategic alignment
Manages the delivery of quality and member-focused digital solutions
Ensures the business units understand the technology solution, overall solution delivery, and compliance with governance processes, architecture standards, as well as their roles and accountabilities in each phase of the delivery cycle
Provides oversight for testing, validation, and deployment activities to ensure solutions align with business intent, success metrics, and regulatory requirements, while advising teams on enterprise-level expectations

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Manager, Clinical Operations - FSP

Location

Lithuania

Salary:

Not provided

Parexel

Expiration Date

Until further notice

Requirements

Substantial monitoring/data management experience or equivalent experience in clinical research with strong understanding & knowledge of clinical trials environment
Educated to degree level (biological science, pharmacy, or other health-related discipline preferred) or equivalent nursing qualification or relevant clinical other equivalent experience

Job Responsibility

Project Delivery Management and Oversight
Monitor performance by close interaction with project leadership/functional leadership and ensure that ongoing/revised project documentation and correspondence is accurate and complete
May be responsible for own assignments as project team member
Provide consultation, facilitate metrics collection and develop action plans in conjunction with Management/Project Leadership/Leads to keep project on time and within budget
Manage and oversee team activities including appropriate resourcing of staff, staff assignments, quality control and efficiency of project deliverables
Where assigned, produce accurate resourcing plans in conjunction with appropriate Project Team Members
Serve as an ongoing liaison with Project Team, Sponsor and management regarding performance of direct reports
Performance Management, Staff Development and Talent Management
Provide technical support to staff to ensure that they have the required knowledge to fulfill their duties
Ensure direct reports meet departmental and project productivity and quality metrics by efficient execution of their project in line with project plan by conducting quality check of deliverables

Legal Project Supervisor (Call Center)

This role will serve as a Project Supervisor (Call Center) assigned to the Radia...

Location

United States , Washington, District of Columbia

Salary:

65000.00 USD / Year

Amentum

Expiration Date

Until further notice

Requirements

At least two years of progressively more responsible experience on major litigation support projects, including at least one year of supervisory experience, including proven capabilities and communication skills to successfully interact with clients and attorneys
Requires in-depth knowledge of litigation support, excellent written and oral communication skills
Must be able to anticipate litigation support and claims processing needs, and develop and execute detailed plans for addressing those needs
Experience in claim management or processing environments, particularly having worked with a claim management system
Familiarity with the review of claims documents, both electronically and in hard-copy – to include assessing document information against decision-tree guidance and applying categorization standards
Experience with claim review lifecycles and the ability to triage claims based on established guidelines
Highly skilled in coordinating across teams and with other Managers, Supervisors, team members, and clients
Demonstrated ability to oversee and coordinate numerous complex and time-critical claim support activities simultaneously, including technical/data processing support activities
Requires hands-on familiarity with the Government's office and network environment, including but not limited to, data processing environments, including office automation networks, PC-based databases and other applications, and internet and server-based databases and other applications
Undergraduate degree required

Job Responsibility

Act as primary supervisor for assigned staff members, to include oversight of timekeeping, narratives, corrective action, and other staff management concerns
Oversee and direct all aspects of Amentum staff assigned to the RECA Call Center, to include supervision of Call Center activities, training new team members, and updating training materials as guidance changes
Assist claimants with substantive questions as they relate to the filing of claims, timing of submissions, and troubleshooting issues with submission
Assist claimants and Call Center staff with resolving discrepancies, missing information, and explanations of policies and procedures
Perform troubleshooting for the platforms on which calls are received and databases used in reviewing claims and potential claims
Reports directly to leadership on issues identified in Call Center activities and calls escalated for unique circumstances
Interfaces with Federal attorney team members to identify daily team priorities and communicate expectations of priorities to team members
Reports to the Project Manager on the performance of Call Center staff and recommendations for process improvement in associated workflows
Tracks, compiles, and reports on Call Center activity performance metrics, and assesses Call Center staff performance against measurable standards and goals
Determine individual team member capacity and reassign members to high priority tasks, while maintaining coverage of other team tasks

What we offer

Health, dental, and vision insurance
Paid time off and holidays
Retirement benefits (including 401(k) matching)
Educational reimbursement
Parental leave
Employee stock purchase plan
Tax-saving options
Disability and life insurance
Pet insurance

Fulltime

Global Injury & Claim Coordinator

This is where your work makes a difference. At Baxter, we believe every person—r...

Location

United States , Deerfield

Salary:

80000.00 - 110000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Bachelor's degree in Nursing (BSN) required
Minimum of 5+ years of experience in Occupational Health Nursing, Workers Compensation case management, or clinical injury management
Registered Nurse (RN) – US Compact, active and unrestricted license required
Ability to obtain RN license for IL, NY, CA, MN within 6 months months of employment
Occupational Health Nursing certification preferred (COHN, COHN-S)
Certified Case Manager (CCM) preferred
Demonstrated expertise in complex workers compensation claim management across multiple jurisdictions
Experience collaborating with TPAs, insurers, medical providers, and legal partners
Strong ability to interpret claims, medical, and absence data
Experience supporting self-insured or large multinational employers

Job Responsibility

Manages and oversees complex workers’ compensation and injury management cases across Baxter’s United States and global jurisdictions
Provides expert clinical guidance and oversight for complex, high risk, and litigated workers’ compensation cases impacting Baxter employees globally
Coordinates medical management activities and return to work accommodations in partnership with Baxter facilities, medical providers, and regional stakeholders
Ensures Baxter’s injury and claim management practices comply with applicable global workers’ compensation, occupational health, and regulatory requirements, as well as internal Baxter standards
Leads the development and enhancement of Baxter’s global injury management, early intervention, and return to work programs
Serves as Baxter’s primary clinical and operational liaison with third party administrators, insurers, occupational health vendors, and international claims partners across supported regions
Analyzes global claim, injury, and return to work data to identify trends, risks, and improvement opportunities and uses insights to drive operational excellence at Baxter
Provides actionable insights from claims and medical data to support hazard reduction and risk mitigation efforts
Identifies systemic injury, claim, or return to work risks and partners with EHS and Operations to inform upstream prevention strategies
Standardizes Baxter’s care management and injury management processes to ensure consistent service delivery and outcomes across geographic regions

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave
Commuting benefits

Fulltime

Select Country

Consultant, Claims Processing Oversight

Job Description

Job Responsibility

Requirements

What we offer

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