What Jobs are available for Claims Adjusters in Des Moines?
Showing 3 Claims Adjusters jobs in Des Moines
Marine Claims Senior Claims Specialist
50381 Des Moines, Iowa
Zurich NA
Posted 1 day ago
Job Viewed
Job Description
Marine Claims Senior Claims Specialist
Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and Liability experience preferred) to join our team! We are open to remote work for the right candidate located within the U.S.
In this role you will be responsible for:
+ Ability to handle dedicated accounts.
+ Frequent interaction with Assureds, Brokers and Underwriters.
+ Some travel may be required but this is not very frequent.
Basic Qualifications:
+ Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.AND
+ Must obtain and maintain required adjuster license(s)
+ Microsoft Office experience
+ Knowledge of insurance regulations, markets, and products
Preferred Qualifications:
+ Extensive Marine claims experience preferred.
+ Emphasis on Marine Liability, Hull, Blue water and brown water claims, Jones Act, General Average and Ocean Cargo Claims experience preferred.
+ Licensed in all states as needed preferred.
+ Effective verbal and written communication skills
+ Strong analytical, critical thinking and problem-solving skills
+ Strong multi-tasking and prioritization skills
+ Experience collaborating in a team environment and building cross functional working relationships
+ Proactively shares and promotes sharing of insights
+ Ability to gather unique perspectives from other teams/functions to optimize outcomes.
+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims
+ Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
+ Ability to determine the scope and exposure for complex claims
+ Ability to leverage trend and relationships to provide high-quality customer service
+ Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
+ Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
+ Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here ( . Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $74,300.00 - $121,700.00, with short-term incentive bonus eligibility set at 15%.
As an insurance company, Zurich is subject to 18 U.S. Code § 1033.
A future with Zurich. What can go right when you apply at Zurich?
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please clickhere ( to learn more.
Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.
Location(s): AM - Remote Work (US)
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE
EOE Disability / Veterans
Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and Liability experience preferred) to join our team! We are open to remote work for the right candidate located within the U.S.
In this role you will be responsible for:
+ Ability to handle dedicated accounts.
+ Frequent interaction with Assureds, Brokers and Underwriters.
+ Some travel may be required but this is not very frequent.
Basic Qualifications:
+ Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.AND
+ Must obtain and maintain required adjuster license(s)
+ Microsoft Office experience
+ Knowledge of insurance regulations, markets, and products
Preferred Qualifications:
+ Extensive Marine claims experience preferred.
+ Emphasis on Marine Liability, Hull, Blue water and brown water claims, Jones Act, General Average and Ocean Cargo Claims experience preferred.
+ Licensed in all states as needed preferred.
+ Effective verbal and written communication skills
+ Strong analytical, critical thinking and problem-solving skills
+ Strong multi-tasking and prioritization skills
+ Experience collaborating in a team environment and building cross functional working relationships
+ Proactively shares and promotes sharing of insights
+ Ability to gather unique perspectives from other teams/functions to optimize outcomes.
+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims
+ Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
+ Ability to determine the scope and exposure for complex claims
+ Ability to leverage trend and relationships to provide high-quality customer service
+ Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
+ Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
+ Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here ( . Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $74,300.00 - $121,700.00, with short-term incentive bonus eligibility set at 15%.
As an insurance company, Zurich is subject to 18 U.S. Code § 1033.
A future with Zurich. What can go right when you apply at Zurich?
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please clickhere ( to learn more.
Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.
Location(s): AM - Remote Work (US)
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE
EOE Disability / Veterans
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0
Specialist, Claims Recovery (Remote)
50381 Des Moines, Iowa
Molina Healthcare
Posted today
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments.
**Job Duties**
+ Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments.
+ Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims, and auto-payment recoveries.
+ Prepares and provides write-off documents that are deemed uncollectible or collections efforts are exhausted for write off approval.
+ Researches simple to complex claims payments using tools such as DSHS and Medicare billing guidelines, Molina claims' processing policies and procedures, and other such resources to validate overpayments made to providers.
+ Completes basic validation prior to offset to include, but not limited to, eligibility, COB, SOC and DRG requests.
+ Enters and updates recovery in recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy. Processes claims as a refund or auto debit in claim systems and in recovery application meeting expected production and quality expectations.
+ Follows department processing policies and correctness in performing departmental duties, including but not limited to, claim processing (claim reversals and adjustments), claim recovery (refund request letter, refund checks, claim reversals), reporting and documentation of recovery as explained in departmental Standard Operating Procedures.
+ Responds to provider correspondence related to recovery requests and provider remittances where recovery has occurred.
+ Works with Finance to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse providers.
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION** :
+ HS Diploma or GED
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
+ 1-3 years' experience in claims adjudication, Claims Examiner II, or other relevant work experience
+ Minimum of 1 year experience in customer service
+ Minimum of 1 year experience in healthcare insurance environment with Medicaid, or Managed Care
+ Strong verbal and written communication skills
+ Proficient with Microsoft Office including Word and Excel
**PREFERRED EDUCATION** :
+ Associate's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE** :
Recovery experience preferred
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $34.88 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments.
**Job Duties**
+ Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments.
+ Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims, and auto-payment recoveries.
+ Prepares and provides write-off documents that are deemed uncollectible or collections efforts are exhausted for write off approval.
+ Researches simple to complex claims payments using tools such as DSHS and Medicare billing guidelines, Molina claims' processing policies and procedures, and other such resources to validate overpayments made to providers.
+ Completes basic validation prior to offset to include, but not limited to, eligibility, COB, SOC and DRG requests.
+ Enters and updates recovery in recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy. Processes claims as a refund or auto debit in claim systems and in recovery application meeting expected production and quality expectations.
+ Follows department processing policies and correctness in performing departmental duties, including but not limited to, claim processing (claim reversals and adjustments), claim recovery (refund request letter, refund checks, claim reversals), reporting and documentation of recovery as explained in departmental Standard Operating Procedures.
+ Responds to provider correspondence related to recovery requests and provider remittances where recovery has occurred.
+ Works with Finance to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse providers.
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION** :
+ HS Diploma or GED
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
+ 1-3 years' experience in claims adjudication, Claims Examiner II, or other relevant work experience
+ Minimum of 1 year experience in customer service
+ Minimum of 1 year experience in healthcare insurance environment with Medicaid, or Managed Care
+ Strong verbal and written communication skills
+ Proficient with Microsoft Office including Word and Excel
**PREFERRED EDUCATION** :
+ Associate's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE** :
Recovery experience preferred
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $34.88 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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1
STD Claims Support Specialist
50265 West Des Moines, Iowa
MetLife
Posted 1 day ago
Job Viewed
Job Description
Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR, West Des Moines, IA office
Once a month in office for meetings
Key Responsibilities:
- Partners with the STD Unit Leader to analyze and Identify barriers for the success and efficiency of their team. Supports and guides assigned team member to ensure that they have the knowledge and skills, tools, and resources to be successful in achieving those expectations by delivering on commitments, timely return of phone calls, clear communication, accuracy of decisions and financial accuracy
- Drives Claim Management Accuracy and Customer Centricity through support of the Pre-QA Program, claim file reviews and call monitoring auditing claim file reviews to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance
- Accountable for Reviews and approves key decisions made by team member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates other income/offsets in accordance with Customer's plan/policy
- Managing operation efficiency goals and provides positive reinforcement to team members that is directly linked to their behaviors and performance objectives and maintains data integrity.
- Performs other related duties as assigned or required
Essential Business Experience and Technical Skills:
Required:
· A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
· Ability to coach and mentor members of the team
· Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim.
· Basic knowledge of medical conditions, treatments, prognosis
· Critical-thinking skills
· Ability to give and receive feedback to/from partners
· Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
· Prioritization skills. Ability to balance quantity and quality.
· Ability to Partner with Internal/External Customers
· High School Diploma
Preferred:
· Associate Degree
· 2 plus years of claims management experience preferably in Healthcare field
· 5 plus years of Management
· Proficient in Microsoft Word/Excel
Key Competencies, Qualifications and Skills, Preferred:
* Prior STD, state leave and/or Family Medical Leave Act claims knowledge preferred.
* Strong communication skills, both written and oral.
* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
* Strong problem solving and analytical skills.
* Ability to work independently
* Ability to multitask, comfortable working with multiple priorities in a changing environment.
* Ability to prioritize and maintain quality
Equal Employment Opportunity/Disability/Veterans
If you need an accommodation due to a disability, please email us at This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
Once a month in office for meetings
Key Responsibilities:
- Partners with the STD Unit Leader to analyze and Identify barriers for the success and efficiency of their team. Supports and guides assigned team member to ensure that they have the knowledge and skills, tools, and resources to be successful in achieving those expectations by delivering on commitments, timely return of phone calls, clear communication, accuracy of decisions and financial accuracy
- Drives Claim Management Accuracy and Customer Centricity through support of the Pre-QA Program, claim file reviews and call monitoring auditing claim file reviews to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance
- Accountable for Reviews and approves key decisions made by team member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates other income/offsets in accordance with Customer's plan/policy
- Managing operation efficiency goals and provides positive reinforcement to team members that is directly linked to their behaviors and performance objectives and maintains data integrity.
- Performs other related duties as assigned or required
Essential Business Experience and Technical Skills:
Required:
· A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
· Ability to coach and mentor members of the team
· Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim.
· Basic knowledge of medical conditions, treatments, prognosis
· Critical-thinking skills
· Ability to give and receive feedback to/from partners
· Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
· Prioritization skills. Ability to balance quantity and quality.
· Ability to Partner with Internal/External Customers
· High School Diploma
Preferred:
· Associate Degree
· 2 plus years of claims management experience preferably in Healthcare field
· 5 plus years of Management
· Proficient in Microsoft Word/Excel
Key Competencies, Qualifications and Skills, Preferred:
* Prior STD, state leave and/or Family Medical Leave Act claims knowledge preferred.
* Strong communication skills, both written and oral.
* Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
* Strong problem solving and analytical skills.
* Ability to work independently
* Ability to multitask, comfortable working with multiple priorities in a changing environment.
* Ability to prioritize and maintain quality
Equal Employment Opportunity/Disability/Veterans
If you need an accommodation due to a disability, please email us at This information will be held in confidence and used only to determine an appropriate accommodation for the application process.
MetLife maintains a drug-free workplace.
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