Insurance Operations Associate II Job at Engage Cleveland (Richfield)

Claims Operations Associate II

National Interstate is looking for a Claims Operations Associate II to join thei...

Location

United States , Richfield, OH

Salary:

Not provided

Engage Cleveland

Expiration Date

Until further notice

Requirements

High School Diploma (Associate degree preferred)
Generally, a minimum of 3 years of experience in claim operations or customer service
Develops knowledge of local, state, and federal insurance-related policies
Effective analytical and organizational abilities with a focus on prioritization
Working knowledge of claim data processing systems
Excellent interpersonal and communication skills

Job Responsibility

Processes and organizes claim file information for basic claims for one or more lines
Handles moderately complex claims including claims with coverage questions or recovery potential
Assists in identifying opportunities to streamline claims procedures, enhance efficiency, and reduce costs
Performs other duties as assigned

What we offer

medical, dental, and vision coverage
wellness plans
parental leave
adoption assistance
tuition reimbursement
Paid Time Off and paid holidays
a 401(k) plan with company match
an employee stock purchase plan
commuter benefits

Fulltime

Site Contract Associate Ii

Parexel are looking for a Site Contract Associate I to join our Site Contracts t...

Location

Serbia; Romania

Salary:

Not provided

Parexel

Expiration Date

Until further notice

Requirements

Fluent command of German and English (written and oral) is required in addition to the local language
Solid working proficiency of all MS Office Products specifically, Excel, Word, and PowerPoint
Some experience of working on contracts/agreements
Strong negotiation, diplomacy, and excellent organizational skills with demonstrated experience handling multiple projects
Excellent interpersonal, verbal and written communication skills
Strong problem-solving skills
Ability to successfully work in a “virtual” team environment
Must have strong analytical skills with the ability to create or interpret legal language and budgets
Maintain grace under pressure while displaying a high level of professionalism
Align internal and external resources to achieve objectives

Job Responsibility

Draft, review and negotiate all site agreements including but not limited to clinical study agreements, service agreements, team member agreements and other types of related documents like letters, notices, etc.
Provide context to comments received from sites in light of local legal and business framework, common practices, and past negotiation experience for the purpose of further review up the decisioning chain
Apply and scrutinize site contract and related documents and their revisions against negotiation and budget parameters (as applicable)
Ensure final documents comply with applicable laws, regulations, and guidelines, including ICH – GCP
Ensure the best interest of both clients and Parexel are met
Serves as key communication liaison between site contracts staff and internal and external customers. Provides functional guidance and keeps internal and external teams aware of all contract statuses or pending issues. Prepares correspondence as necessary.
Manage the contract execution process, including obtaining required signatures and ensuring timely execution of the document by all parties
Follow record maintenance and archival guidelines to ensure they are met
Develop and maintain positive relationships with clinical trial sites
Develop and maintain a thorough understanding of the clinical trial protocol, budget, and timelines to ensure that contract terms align with the overall trial goals and objectives

Fulltime

Service Associate II

Participates in examining and processing new insurance policies, renewals, endor...

Location

United States , Richfield

Salary:

Not provided

Engage Cleveland

Expiration Date

Until further notice

Requirements

High School Diploma (Associate degree preferred)
Generally, a minimum of 3 years of experience in insurance operations or customer service
Completion of or continuing progress toward a professional designation preferred, such as Property/Casualty Insurance license
Working knowledge of local, state, and federal insurance-related policies
Strong analytical and organizational abilities with a focus on prioritization
Working knowledge of insurance data processing systems
Excellent interpersonal and communication skills

Job Responsibility

Participates in examining and processing new insurance policies, renewals, endorsements, and cancellations using various systems
Enters or loads data into appropriate systems and researches and resolves data errors
Generates and distributes policy documents, certificates of insurance, and other related materials
Organizes, prepares, and updates reports
Participates in determining and adjusting billing status as needed
Participates in identifying opportunities to streamline procedures, enhance efficiency, and reduce costs
Performs other duties as assigned

What we offer

Medical, dental, and vision coverage
Wellness plans
Parental leave
Adoption assistance
Tuition reimbursement
Paid Time Off and paid holidays
401(k) plan with company match
Employee stock purchase plan
Commuter benefits

Fulltime

Pia P&C Service Associate (Tier Ii)

This Long-term Contract position is ideal for someone who can manage service-rel...

Location

United States , Rochester

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Strong verbal and written communication skills with the ability to interact professionally across teams and external partners
experience handling inbound and outbound calls in a service-oriented or operations-focused environment
ability to work within multiple computer systems, websites, and digital tools with accuracy and efficiency
familiarity with insurance carrier processes, policy servicing, or claims-related support is preferred
skilled at identifying documentation gaps, resolving deficiencies, and keeping work organized through completion
effective planning and time-management abilities, including the capacity to balance changing priorities
exposure to Paychex or similar administrative platforms is helpful
ability to remain productive in a role that involves prolonged periods of sitting and computer use

Job Responsibility

Manage day-to-day service activity for property and casualty accounts, ensuring requests are handled accurately and within expected timelines
respond to incoming inquiries and place outbound calls to gather information, provide updates, and coordinate next steps with clients, partners, and insurance carriers
review documentation for completeness, identify missing items or deficiencies, and follow through to obtain the information needed for processing
use internal systems, online platforms, and related tools to update records, track progress, and maintain organized service documentation
coordinate with external carriers and internal stakeholders to support claim-related or policy service matters, including disability-related inquiries when applicable
assist with workflow planning and prioritization to keep multiple assignments moving efficiently in a high-volume environment
support activities involving Paychex and other business platforms as required for service execution and record accuracy
remain effective during extended periods of desk and computer work while maintaining consistent attention to detail and service quality

What we offer

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

Fulltime

Managed Long Term Services And Supports Nurse Specialist Rn Ii

The Managed Long-Term Services and Supports (MLTSS) Nurse Specialist RN II appli...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 3 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care that may include at least 2 years of relevant Licensed Vocational Nurse (LVN) experience in a UM or CM capacity substituted for 1 year of RN experience
Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a UM/CM environment
Excellent verbal and written communication skills
with effective charting practices
Excellent organizational, time-management and priority-setting skills
Strong clinical skills with a knowledge of care needs for elderly, disabled, and/or frail populations and has applied knowledge of End-of-Life care
Customer Service Skills: Provision of excellent customer service required due to frequent communication with providers, members and interdisciplinary team
Technical Skills: Must be computer literate and proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint, Teams)
Ability to effectively utilize computer and appropriate software and interacts as needed with L.A. Care Information System

Job Responsibility

Responsible for performing assessments and clinical review of medical records to determine appropriate care including physical health, behavioral health, and social determinants of health needs for members referred to
MLTSS administered programs
Responsible for UM authorization functions for services requiring prior authorizations in a timely manner with adherence to regulatory requirements
Identify and address gaps in care or overutilization, including overlapping services
Engages with members by conducting telephonic nursing follow up and care coordination when necessary, including transitions of care for Long Term Care (LTC) and ICF/DD populations
Provides direction to non-clinicians who assist members with accessing services and arranges for all services required while coordinating with the health care team to eliminate duplication of services
Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT)
Participates in ICT meetings and makes recommendations for MLTSS and other programs
Establishes relationships with referral sources and community resources, such as external providers and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements
Performs oversight and monitoring of provider performance for adherence to regulatory standards and contractual agreements

What we offer

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

Fulltime

Rn Med Policy Development/Research Specialist (Um Experience)

Perform medical technology research to support the Medical Director Staff and Me...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in clinical field of practice, health insurance, or other health care related field (All Levels)
1 year(s) of experience in medical policy and technology research field (Applies to Level 2)
2 year(s) of experience in medical policy and technology research field (Applies to Level 3)
Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program (Applies to All Levels)
Active, current, and unrestricted license to practice in the State of Arizona as a health professional, including RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels)
Intermediate PC proficiency
Intermediate Adobe PDF Standard proficiency
Intermediate word processing, spreadsheet and presentation software proficiency (Applies to All Levels)
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform medical technology research to support the Medical Director Staff and Medical Policy Panel with decisions to ensure that medical policies are consistent with the standards of accepted medical practice in the community
Perform medical technology research related to coverage guidelines and new technology and provide evaluation and summarization to Medical Director Staff and/or Medical Policy Panel
Perform medical technology research as requested by other areas of BCBSAZ thru the Medical Policy Referral Form
Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel
Communicate medical policy information in protocol format to all areas of BCBSAZ requiring this information
Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion and, as required, on the Clinical Coding Governance Committee (CCGC)
Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies, such as BCBS Association Medical Policy Reference Manual, MCG care guidelines and/or Change Healthcare InterQual, and eviCore criteria
From the direction of management, Medical Director staff or Medical Policy Panel, facilitate external consultant reviews concerning a coverage guideline or new technology
Communicate medical policy information in protocol format to healthcare providers upon request
With moderate assistance and review by management, perform basic level of code review

Fulltime

Lead Electronic Security Systems & Project Manager

Reporting to the Director of Facility Management & Campus Operations in the Depa...

Location

United States , Denver

Salary:

37.00 - 40.00 USD / Hour

The University Of Denver

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
technical certification or associate degree preferred
Minimum of five years of experience with fire alarm, access control, and security systems in a campus or institutional environment
Demonstrated experience managing multiple system brands and coordinating with fire authorities
NICET II (or higher) Fire Alarm Systems certification or equivalent required
Denver Fire Department Fire Alarm Journeyman License
Previous experience as an installer and/or service technician of low voltage electronic systems (i.e. intrusion alarm systems, card access, fire alarm systems and CCTV)
Must possess and maintain a valid Colorado drivers license and be insurable under University guidelines
or, obtain a valid Colorado's driver's license within the required time frame
Must pass a complete background check to include criminal, motor vehicle report and verification of employment and education

Job Responsibility

Facilitate the maintenance, programming and repair of all campus-wide access control (C-Cure) and alarmed security systems as required
Install, program, test, maintain, and repair multiple brands of fire alarm panels, initiating devices, and notification appliances
Participate in fire and life safety system testing, including annual inspections, load testing, and device replacement
Creates and maintains records of each fire alarm account
Serves as project manager to oversee contracted vendors performing life safety system work to ensure quality and code compliance
Assists in the coordination of installation and/or integration of all new fire alarm systems
Assist in design review and commissioning of new construction or renovation projects affecting life safety systems
Develop and facilitate training for Campus Safety personnel to trouble-shoot fire alarm problems and the operation of new fire alarm systems
Leads one full-time electronic systems technician
Adheres to all Department and University policies, procedures, directives, rules, and regulations

What we offer

medical
dental
retirement
paid time off
tuition benefit
ECO pass

Fulltime

Quality Control Technician

This is a FlexSteel position and is located in Baytown, TX. Training Period- 30 ...

Location

United States , Baytown

Salary:

Not provided

Cactus Wellhead LLC

Expiration Date

Until further notice

Requirements

Must have a High School Diploma or GED
plus quality systems training
ANST Level II certification in at least one discipline
2 - 4 years hands-on inspection experience
including documented safety training
general leadership ability
or an equivalent combination
All requirements must be accomplished in primary language, which is English
Must have knowledge of quality systems
including an understanding of ISO 9001 and API

Job Responsibility

Assure Quality representation for assigned shift
Prepare Quality shift reports as needed
Perform Quality inspection audits
identifies anomalies
writes
and routes NCR/AR/SDR and performs inspection training
Ensure process inspections are adequate and in compliance to Quality System
Document own work and verify that proper procedures are followed
Research and prepare records for processing
Track documents and records

Fulltime

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Insurance Operations Associate II

Job Description

Job Responsibility

Requirements

What we offer

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