3,402 Claims jobs in the United States

Job Description

Job Description

Wilson Elser is a leading defense litigation law firm with more than 1300 attorneys in 43 offices throughout the United States. Founded in 1978, we rank among the top 100 law firms identified by The American Lawyer and 36 in the National Law Journal's survey of the nation's largest law firms. We're also Mansfield Certified Plus.

Our firm is committed to attracting and retaining professionals who value each other and the service we provide by embracing Teamwork, Collaboration, Client Service, and Innovation. If you are a motivated professional looking for a long-term fit where you can grow in a role, and will be valued and empowered, then we invite you to apply to our Claims Management & Coverage Counsel position reporting to our New York City Office.

The Position

Wilson Elser is currently seeking highly skilled attorneys with Claims Management & Coverage Counsel experience to join our dynamic team. In this role, the Claims Management & Coverage Counsel will provide expert guidance in claims, coverage analysis, and risk management for various specialty and professional lines of insurance. As part of our national team, you will help independently manage complex claims and coverage disputes and will focus on developing resolution and/or settlement strategies to mitigate potential legal exposure.

This position offers the flexibility to be fully remote.

Key Responsibilities:

• Independently manage a claims caseload, from claim notification through resolution.
• Evaluate coverage, liability and damages issues for complex professional liability, employment liability, real estate liability, miscellaneous liability and D&O matters.
• Draft reservation of rights and coverage denial letters
• Proactively monitor claims, prepare and develop handling and resolution strategies.
• Assign, coordinate, and manage outside counsel to obtain optimal resolutions.
• Prepare reports to clients with exposure analysis and reserve recommendations.
• Resolve claims through direct negotiations and participation in mediation.
• Work closely with other attorneys and Partners on legal projects.
• Ability to regularly interface with clients, carriers and outside counsel

Qualifications

• JD from an accredited Law School
• Licensed to practice law in at least one U.S. jurisdiction
• 3+ years of legal practice experience in the insurance area.
• Previous experience drafting coverage letters and opinions, a plus.
• Experience in private practice, preferred.
• Superior written and oral communication skills required.
• Strong legal research and negotiation skills required.
• Ability to assess and interpret insurance policies, identify potential legal risks, and offer strategic solutions to prevent disputes from escalating.
• Strong organizational skills to effectively manage a high-volume caseload in a fast paced environment.

Why Should You Apply?

• Flexibility: Hybrid work arrangements to support work-life blend
• Benefits: Outstanding benefits package, including 401k match and generous PTO plan
• Career Growth: Ample opportunities for professional development and advancement
• Employee Perks: Access to corporate discount plans and other benefits

Wilson Elser welcomes submissions of candidates for our open positions exclusively from recruitment agencies with an active, signed fee agreement who have been granted access to a position through our dedicated Recruitment Agency Portal. We are unable to consider submissions from recruitment agencies without a current (dated as of 7/1/2024) agreement in place. We appreciate your understanding. For collaboration inquiries or to establish an agreement, please contact us at Wilson Elser is committed to a collegial work environment in which all individuals are treated with respect and dignity. It is the Firm's policy that employment will be based on merit, qualifications, and competence. Further, employment decisions will be made without regard to an applicants race, color, age, sex, religion, creed, national origin, ancestry, citizenship, marital status, sexual orientation or preference, gender identity, physical or mental disability, status as a victim of domestic violence, sex offenses, or stalking, past or present service in the uniformed services or application or obligation to serve in the uniformed services, or any other characteristic protected by law. Wilson Elser endeavors to make the Wilson Elser website accessible to any and all users. You may review our Accessibility Policy here. California Residents may review our CCPA notice for applicants and employees here.

**About the Role**
Uber is a technology company that is changing the way the world thinks about transportation. Whether it's heading home from work, getting a meal delivered from a favorite restaurant, or a way to earn extra income, Uber is becoming part of the fabric of daily life. We're making cities safer, smarter, and more connected.
As a Claims Senior Manager, you and your team will provide strategic guidance to external insurance partners, align on best-in-class claims management processes, and leverage data-driven insights to drive impactful results. If you thrive in a fast-paced environment, enjoy solving complex claims issues, and want to influence industry-leading claims operations, this role offers the perfect opportunity to make a meaningful impact.
Uber embraces a hybrid work model, which allows employees to alternate between three days in the office one week and two days in the office the following week. This approach promotes a balanced and productive work environment that accommodates both individual preferences and organizational needs.
**What You'll Do**
+ **Consulting and Advisory** : You and your team will provide expert consultation to external insurance partners on the best practices for commercial auto claims handling, primarily bodily injury, underinsured and uninsured motorist claims.
+ **Process Implementation:** You and your team will develop and implement preferred processes for claims management, ensuring alignment with industry standards and Uber needs.
+ **Strategic Planning:** You will work closely with Uber's Chief Claims Officer and lead your team to design and execute strategic plans to enhance claims operations. You will utilize data-driven insights and claims management behavioral expertise to create industry leading approaches to design best in class TNC/DNC best claim practices in partnership with our business partners and stakeholders.
+ **Complex Issue Resolution:** Lead and develop your team to advise on the resolution of complex coverage issues and litigation management, helping external and internal business partners navigate and mitigate risks.
+ **Data Analysis and Recommendations:** Use data analytics to identify trends, inform recommendations and implement solutions that improve claim outcomes while providing guidance to internal stakeholders such as Risk Management, Legal, Safety and Product lines.
+ **Documentation and Training:** Lead your team to use optimal framework to document processes and collaborate with both internal and external Learning and Development to design and provide training ensuring successful adoption and adherence to new procedures and technology.
+ **Contract Review, Budgeting and Staffing:** Experienced in contractual review and managing compliance, adherence to expense management budgets and proven application of varying staffing models to ensure desired internal team and external business partner results.
+ **Stakeholder Engagement:** Develop relationships with internal and external stakeholders and business partners to understand Uber needs while tailoring solutions aligned with contractual requirements and market needs as well as maintain retention of talent through satisfaction with consulting services as well as improved results.
**Basic Qualifications**
+ Minimum of 5 years experience in auto (commercial or personal) or general liability claims handling with experience managing bodily injury claims.
+ Proven experience in managing litigation related to auto or general liability claims.
+ A minimum of 3 years claims leadership experience.
**Preferred Qualifications**
+ Demonstrated ability in the successful design and implementation of actionable insights using data and claims management behavioral expertise.
+ Experience handling high policy limits and complex coverage issues
+ Exceptional ability to adopt presentations and messaging to different levels of audience from individual contributors to senior executive leaders.
+ Experience managing relationships with TPAs, insurance carriers and suppliers.
+ High degree of adaptability to meet changing business needs
+ Ability to serve as an insurance and claims subject matter expert
+ Insurance designation(s) (AIC, ARM, SCLA, CPCU)
+ Extraordinary attention to detail
For Chicago, IL-based roles: The base salary range for this role is USD$162,000 per year - USD$80,000 per year. For Phoenix, AZ-based roles: The base salary range for this role is USD 144,000 per year - USD 160,000 per year. For all US locations, you will be eligible to participate in Uber's bonus program, and may be offered an equity award & other types of comp. You will also be eligible for various benefits. More details can be found at the following link is proud to be an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you have a disability or special need that requires accommodation, please let us know by completing this form-

**About the Role**
Uber is a technology company that is changing the way the world thinks about transportation. Whether it's heading home from work, getting a meal delivered from a favorite restaurant, or a way to earn extra income, Uber is becoming part of the fabric of daily life. We're making cities safer, smarter, and more connected.
As a Claims Senior Manager, you and your team will provide strategic guidance to external insurance partners, align on best-in-class claims management processes, and leverage data-driven insights to drive impactful results. If you thrive in a fast-paced environment, enjoy solving complex claims issues, and want to influence industry-leading claims operations, this role offers the perfect opportunity to make a meaningful impact.
Uber embraces a hybrid work model, which allows employees to alternate between three days in the office one week and two days in the office the following week. This approach promotes a balanced and productive work environment that accommodates both individual preferences and organizational needs.
**What You'll Do**
+ **Consulting and Advisory** : You and your team will provide expert consultation to external insurance partners on the best practices for commercial auto claims handling, primarily bodily injury, underinsured and uninsured motorist claims.
+ **Process Implementation:** You and your team will develop and implement preferred processes for claims management, ensuring alignment with industry standards and Uber needs.
+ **Strategic Planning:** You will work closely with Uber's Chief Claims Officer and lead your team to design and execute strategic plans to enhance claims operations. You will utilize data-driven insights and claims management behavioral expertise to create industry leading approaches to design best in class TNC/DNC best claim practices in partnership with our business partners and stakeholders.
+ **Complex Issue Resolution:** Lead and develop your team to advise on the resolution of complex coverage issues and litigation management, helping external and internal business partners navigate and mitigate risks.
+ **Data Analysis and Recommendations:** Use data analytics to identify trends, inform recommendations and implement solutions that improve claim outcomes while providing guidance to internal stakeholders such as Risk Management, Legal, Safety and Product lines.
+ **Documentation and Training:** Lead your team to use optimal framework to document processes and collaborate with both internal and external Learning and Development to design and provide training ensuring successful adoption and adherence to new procedures and technology.
+ **Contract Review, Budgeting and Staffing:** Experienced in contractual review and managing compliance, adherence to expense management budgets and proven application of varying staffing models to ensure desired internal team and external business partner results.
+ **Stakeholder Engagement:** Develop relationships with internal and external stakeholders and business partners to understand Uber needs while tailoring solutions aligned with contractual requirements and market needs as well as maintain retention of talent through satisfaction with consulting services as well as improved results.
**Basic Qualifications**
+ Minimum of 5 years experience in auto (commercial or personal) or general liability claims handling with experience managing bodily injury claims.
+ Proven experience in managing litigation related to auto or general liability claims.
+ A minimum of 3 years claims leadership experience.
**Preferred Qualifications**
+ Demonstrated ability in the successful design and implementation of actionable insights using data and claims management behavioral expertise.
+ Experience handling high policy limits and complex coverage issues
+ Exceptional ability to adopt presentations and messaging to different levels of audience from individual contributors to senior executive leaders.
+ Experience managing relationships with TPAs, insurance carriers and suppliers.
+ High degree of adaptability to meet changing business needs
+ Ability to serve as an insurance and claims subject matter expert
+ Insurance designation(s) (AIC, ARM, SCLA, CPCU)
+ Extraordinary attention to detail
For Chicago, IL-based roles: The base salary range for this role is USD$162,000 per year - USD$80,000 per year. For Phoenix, AZ-based roles: The base salary range for this role is USD 144,000 per year - USD 160,000 per year. For all US locations, you will be eligible to participate in Uber's bonus program, and may be offered an equity award & other types of comp. You will also be eligible for various benefits. More details can be found at the following link is proud to be an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you have a disability or special need that requires accommodation, please let us know by completing this form-

**ABOUT THIS POSITION**
This role reports to a Director, Product Management and work closely with User Experience team and Technology teams. The Sr. Product Manager will coordinate with key stakeholders in sales, marketing, design, development, and operations. This role will be charged with leading game changing efforts at Waystar within the company's Product team for new to market and existing solutions.
**WHAT YOU'LL DO**
+ Analyzing various product inputs, customer requirements, designing solution architectures and developing the business case for new product development 
+ Preparing software design plans including product specifications, use case documentation and user interface wireframes (both independently and with assistance from our User Experience team)
+ Organizing market research including analyzing customer segments, reviewing industry research reports, and assessing strengths and weaknesses of competitors 
+ Studying healthcare industry standards and staying up-to-date on industry changes and compliance issues
+ Gathering inspiration and ideas by visiting customers regularly and reviewing software and other products that solve similar problems in other domains
+ Collecting direct customer feedback by organizing user tests, studying customer support incidents, administering user surveys, and visiting customers to study product interaction in their natural environment
+ Working closely with internal and external resources to define system requirements that meet changing market needs and ensure customer satisfaction and product quality
+ Assisting your VP of Product Management in coordinating with sales, marketing, development, and customer support to bring together divergent ideas and convince various stakeholders to rally behind a single product vision
+ Working with your VP of Product Management to manage the product roadmap, including documenting product strategy, maintaining the feature backlog, and coordinating releases
**WHAT YOU'LL NEED**
+ You know how to execute and like to roll up your sleeves to get things done
+ You are comfortable in front of a whiteboard and can describe complex information in a concise but thorough fashion
+ An understanding of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare setting or an RCM focused HIT company
+ Provided leadership on a team that designed, built, or used RCM Revenue Integrity products
+ Ability to interpret regulatory guidelines from CMS, Tricare, and Medicaid websites
+ Ability to understand the vocabulary used in hospital & professional revenue cycle operations, including healthcare coding such as DRGs, CPT/HCPC, Revenue Codes, APG and APC
+ Organizing market research including analyzing customer segments and industry trends
+ Possess robust technical fundamentals, especially when it comes to building software
+ Problem solving skills; able to analyze a problem and design creative solutions 
+ Attention to detail; extraordinary eye for usability and the customer experience 
+ Excellent written communication skills; able to succinctly convey complex ideas through the written word
+ Great people skills; able to facilitate, negotiate and persuade stakeholders
+ Flexible and agile; able to rapidly adapt to changing situations and inputs
+ College Degree required; Business or Computer Science degree preferred
**ABOUT WAYSTAR**
Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.
Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.
Waystar products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com or follow @Waystar ( on Twitter.
**WAYSTAR PERKS**
+ Competitive total rewards (base salary + bonus, if applicable)
+ Customizable benefits package (3 medical plans with Health Saving Account company match)
+ We offer generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays
+ Paid parental leave (including maternity + paternity leave)
+ Education assistance opportunities and free LinkedIn Learning access
+ Free mental health and family planning programs, including adoption assistance and fertility support
+ 401(K) program with company match
+ Pet insurance
+ Employee resource groups
Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
**Job Category:** Technology/Engineering
**Job Type:** Full time
**Req ID:** R2708

**ABOUT THIS POSITION**
This role reports to a Director, Product Management and work closely with User Experience team and Technology teams. The Sr. Product Manager will coordinate with key stakeholders in sales, marketing, design, development, and operations. This role will be charged with leading game changing efforts at Waystar within the company's Product team for new to market and existing solutions.
**WHAT YOU'LL DO**
+ Analyzing various product inputs, customer requirements, designing solution architectures and developing the business case for new product development 
+ Preparing software design plans including product specifications, use case documentation and user interface wireframes (both independently and with assistance from our User Experience team)
+ Organizing market research including analyzing customer segments, reviewing industry research reports, and assessing strengths and weaknesses of competitors 
+ Studying healthcare industry standards and staying up-to-date on industry changes and compliance issues
+ Gathering inspiration and ideas by visiting customers regularly and reviewing software and other products that solve similar problems in other domains
+ Collecting direct customer feedback by organizing user tests, studying customer support incidents, administering user surveys, and visiting customers to study product interaction in their natural environment
+ Working closely with internal and external resources to define system requirements that meet changing market needs and ensure customer satisfaction and product quality
+ Assisting your VP of Product Management in coordinating with sales, marketing, development, and customer support to bring together divergent ideas and convince various stakeholders to rally behind a single product vision
+ Working with your VP of Product Management to manage the product roadmap, including documenting product strategy, maintaining the feature backlog, and coordinating releases
**WHAT YOU'LL NEED**
+ You know how to execute and like to roll up your sleeves to get things done
+ You are comfortable in front of a whiteboard and can describe complex information in a concise but thorough fashion
+ An understanding of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare setting or an RCM focused HIT company
+ Provided leadership on a team that designed, built, or used RCM Revenue Integrity products
+ Ability to interpret regulatory guidelines from CMS, Tricare, and Medicaid websites
+ Ability to understand the vocabulary used in hospital & professional revenue cycle operations, including healthcare coding such as DRGs, CPT/HCPC, Revenue Codes, APG and APC
+ Organizing market research including analyzing customer segments and industry trends
+ Possess robust technical fundamentals, especially when it comes to building software
+ Problem solving skills; able to analyze a problem and design creative solutions 
+ Attention to detail; extraordinary eye for usability and the customer experience 
+ Excellent written communication skills; able to succinctly convey complex ideas through the written word
+ Great people skills; able to facilitate, negotiate and persuade stakeholders
+ Flexible and agile; able to rapidly adapt to changing situations and inputs
+ College Degree required; Business or Computer Science degree preferred
**ABOUT WAYSTAR**
Through a smart platform and better experience, Waystar helps providers simplify healthcare payments and yield powerful results throughout the complete revenue cycle.
Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data, and unparalleled client support to streamline workflows and improve financials so providers can focus on what matters most: their patients and communities. Waystar is trusted by 1M+ providers, 1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers. We are deeply committed to living out our organizational values: honesty; kindness; passion; curiosity; fanatical focus; best work, always; making it happen; and joyful, optimistic & fun.
Waystar products have won multiple Best in KLAS® or Category Leader awards since 2010 and earned multiple #1 rankings from Black Book surveys since 2012. The Waystar platform supports more than 500,000 providers, 1,000 health systems and hospitals, and 5,000 payers and health plans. For more information, visit waystar.com or follow @Waystar ( on Twitter.
**WAYSTAR PERKS**
+ Competitive total rewards (base salary + bonus, if applicable)
+ Customizable benefits package (3 medical plans with Health Saving Account company match)
+ We offer generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays. We also offer flexible time off for our exempt team members + 13 paid holidays
+ Paid parental leave (including maternity + paternity leave)
+ Education assistance opportunities and free LinkedIn Learning access
+ Free mental health and family planning programs, including adoption assistance and fertility support
+ 401(K) program with company match
+ Pet insurance
+ Employee resource groups
Waystar is proud to be an equal opportunity workplace. We celebrate, value, and support diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
**Job Category:** Technology/Engineering
**Job Type:** Full time
**Req ID:** R2708

**Position Summary.**
**What you'll do.**
**About the Team**
Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers' compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process.
The **Case Manager II** is responsible for investigating, evaluating, and resolving **mid complexity** workers' compensation or general liability claims.
**What you'll do.**
**Claims Management**
+ Secure and maintain the required licensure required by the state(s).
+ Manage an active caseload of up to 140 **mid complexity** workers' compensation or general liability claims.
+ Secure and review initial claim reports, gather information, facts, and evidence to determine compensability or negligence in accordance with state specific statutes.
+ Identify and escalate potential fraudulent claims.
+ Communicate with injured associates or customers that have sustained bodily injury with empathy and help them navigate the claims process.
+ Establish timely and accurate reserves; Escalate claims to the Claims Manager if claim value exceeds reserve authority.
+ Adjudicate claims within reserve authority up to **$150,000** and payment authority **$5,000.**
+ Authorize, monitor, and approve payment for medical treatment that is reasonable, necessary, and related.
+ Leverage the Official Disability Guidelines (ODG) and nurse resources to coordinate early return to work to prevent/mitigate lost time; If lost time occurs, calculate wages and issue indemnity payment(s) timely in accordance with the jurisdictional requirement.
+ Negotiate and resolve claims with associates, customers or their attorney.
+ Prepare for and present claims during roundtable and serious case reviews to discuss claim or resolution strategies and/or secure settlement authority.
+ Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority.
+ Escalate claims complex claims or claims with litigation potential to leadership.
+ Participate in roundtable reviews and complete serious case reviews.
+ Meet or exceed goals on key performance metrics.
+ Ensure compliance with all regulatory, jurisdictional, and internal standard operating procedures.
+ Deliver exceptional customer service to injured associates, customers, the employer, and clients.
**What you'll bring.**
+ High School Diploma or GED required
+ Strong organizational skills and the ability to manage time effectively in a fast-paced environment.
+ Excellent verbal and written communication skills
_The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process._
**Benefits & Perks:**
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
‎
You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.
**About Walmart**
At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability-and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries-all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for?
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
‎br> r> r>You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.
r>For information about PTO, see .
r> r>Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
r>Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.
r>For information about benefits and eligibility, see One.Walmart ( .
r>The annual salary range for this position is $70,000.00-$130,000. 0
r>Additional compensation includes annual or quarterly performance bonuses.
r>Additional compensation for certain positions may also include:
r> r>- Stock
r> r>**Minimum Qualifications.**
_Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications._
Bachelor's degree OR 2 years' experience in insurance claims or related area.
Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date
**Preferred Qualifications.**
_Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications._
Settling claims and customer service
**Primary Location.**
608 Sw 8Th St, Bentonville, AR , United States of America
Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.
Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.

**Position Summary.**
**What you'll do.**
**About the Team**
Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers' compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process
The **Case Manager I** is responsible for investigating, evaluating, and resolving **low complexity** workers' compensation or general liability claims.
**What you'll do.**
**Claims Management**
+ Secure and maintain the required licensure required by the state(s).
+ Manage an active caseload of up to 140 **low complexity** workers' compensation or general liability claims.
+ Secure and review initial claim reports, gather information, facts, and evidence to determine compensability or negligence in accordance with state specific statutes.
+ Identify and escalate potential fraudulent claims.
+ Identify and escalate claims with Early Claims Assessment (ECA) potential.
+ Communicate with injured associates or customers that have sustained minor bodily injury or property damage with empathy and help them navigate the claims process.
+ Establish timely and accurate reserves on claims; Escalate claims to the Claims Manager if claim value exceeds reserve authority.
+ Adjudicate claims within reserve authority up to **$35,000** ; Payment authority **$,500**
+ Authorize and approve payment for reasonable and related medical treatment or damages.
+ Negotiate and resolve claims with associates and customers.
+ Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority.
+ Escalate claims with increasing complexity or litigation potential to the Claims Manager.
+ Meet or exceed goals on key performance metrics.
+ Ensure compliance with all regulatory, jurisdictional, and internal standard operating procedures.
+ Deliver exceptional customer service to injured associates, customers, the employer, and clients.
+ Pass the adjuster licensing exam and obtain the state-issued adjuster license within required deadlines.
**What you'll bring.**
+ High School Diploma or GED required
+ Strong organizational skills and the ability to manage time effectively in a fast-paced environment.
+ Excellent verbal and written communication skills
+ Prior claims, insurance, or customer service experience is preferred.
_The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process._
**Benefits & Perks:**
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.
**About Walmart**
At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability-and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries-all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for?
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
‎
‎br> r>You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.
r>For information about PTO, see .
r> r>Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
r>Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.
r>For information about benefits and eligibility, see One.Walmart ( .
r>The annual salary range for this position is $60,000.00-$110,00 .00
r>Additional compensation includes annual or quarterly performance bonuses.
r>Additional compensation for certain positions may also include:
r> r>- Stock
r> r>**Minimum Qualifications.**
_Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications._
Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date.
**Preferred Qualifications.**
_Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications._
Bachelor's degree OR 2 years' experience in insurance claims or related area, Settling claims and customer service
**Primary Location.**
608 Sw 8Th St, Bentonville, AR , United States of America
Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.
Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.

**Details**
+ **Department:** Cardiology
+ **Schedule:** Full Time, Monday - Friday, 7am - 5pm
+ **Facility:** Ascension Medical Group
+ **Location:** Jacksonville, FL
+ **Salary:** $18.72 - $25.33 hourly
**Benefits**
Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community
_Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer._
**Responsibilities**
Prepare and issues bills for reimbursement to individual and third party payers in an out-patient or medical office environment.
+ Prepare insurance claims for submission to third party payers and/or responsible parties.
+ Review claims for accuracy, including proper diagnosis and procedure codes.
+ Review claim rejections and communicates with payers to resolve billing issues.
+ Prepare and review routine billing reports.
+ Recommend process improvements based on findings.
+ Respond to complex telephone and written inquiries from patients and/or third party payers and physician practices.
**Requirements**
Education:
+ High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
+ Note: Required professional licensure/certification can be used in lieu of education or experience, if applicable.
**Additional Preferences**
No additional preferences.
**Why Join Our Team**
Ascension St. Vincent's is expanding in the fastest-growing county in Northeast Florida with the addition of a fourth regional hospital, Ascension St. Vincent's St. Johns County. Serving Northeast Florida and Southeast Georgia, Ascension St. Vincent's has been providing caregivers in every discipline a rewarding career in healthcare since 1873.
Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
**Equal Employment Opportunity Employer**
Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws.
For further information, view the EEO Know Your Rights (English) ( poster or EEO Know Your Rights (Spanish) ( poster.
As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.
Pay Non-Discrimination Notice ( note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
**E-Verify Statement**
This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.
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Job Description

Job Description

Job Overview:

A Healthcare Claims Processing Specialist plays a crucial role in the insurance industry, ensuring that claims are handled efficiently and accurately. Here’s a detailed description of the role:

Claims Processing Specialist Responsibilities:

• Review and Evaluate Claims : Assess all types of healthcare insurance claims for accuracy and completeness.
• Investigate Claims : Analyze details to determine the level of liability, often involving communication with policyholders, claimants, and healthcare providers.
• Adjudicate Based on Plan Documentation : Work with plan documentation to adjudicate based on plan summary of coverages.
• Documentation : Maintain detailed records of all claim activities for review and auditing purposes.
• Compliance : Ensure all actions comply with company policies and legal requirements.
• Customer Service : Provide high levels of customer service by answering questions and providing information to all parties involved in the claims process.
• Fraud Detection : Identify and investigate potential fraudulent claims.
• Continuous Learning : Stay updated with changes in regulations, best practices, and industry trends.

Qualifications:

• Experience : Proven experience in a similar role within the healthcare insurance industry.
• Skills : Strong analytical, problem-solving, and negotiation skills. Detail-orientation a must. Excellent communication and customer service abilities.
• Technical Proficiency : Familiarity with insurance software and digital claim processing tools.