1,732 Claims Adjusting jobs in the United States
Business Analyst (Healthcare / Claims Processing)
Posted today
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For over a decade, this organization has collaborated with stakeholders in sectors such as specialty pharmacies, manufacturers, prescribers, and payers to design solutions for the high-touch specialty pharmaceutical service model. Through integrated programs, innovative technology platforms, contracting strategies, and patient support services, the organization aims to enhance the patient journey.
Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.
** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **
Primary Function:
A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.
The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical.
Key Responsibilities:
- Collect and translate business requirements into detailed functional specifications for new and existing systems.
- Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.
- Create use cases for review during functional testing phases by developers and QA teams.
- Work with IT teams to evaluate project scope and affected systems, providing strategic insights.
- Assess new methodologies for feasibility and implementation efficiency.
- Gain in-depth knowledge of internal software platforms and their underlying functionalities.
- Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.
- Host regular meetings with development teams to resolve obstacles and track progress.
- Provide project status reports to business stakeholders.
- Identify potential risks and escalate issues as required.
- Continuously explore opportunities to improve application functionality, making recommendations for enhancements.
- Maintain compliance with HIPAA regulations and related amendments.
Required Qualifications:
- Minimum of 8 years of experience as a Functional or Software Business Analyst.
- Proven track record of managing multiple projects simultaneously while meeting deadlines and maintaining high-quality performance.
- Strong communication and interpersonal skills to engage with diverse internal and external stakeholders effectively.
- Excellent organizational and leadership skills, with the ability to meet tight deadlines without compromising project success.
- Passion for producing excellent work with meticulous attention to detail and a commitment to accuracy.
- Ability to think critically, embrace new technologies, and balance stakeholder needs with user requirements.
- Demonstrated ability to support large-scale IT solutions using modern technologies.
- Adept in detailed documentation and thoroughly considering technical changes.
- Strong eye for detail in designing and wireframing UI improvements that enhance user experiences.
- Experience using SDLC tools, such as JIRA and Confluence.
- Educational background in Computer Science or related IT fields is a plus.
- Familiarity with pharmacy operations or healthcare is required.
Data Operations Analyst - Excel & Claims Processing
Posted 5 days ago
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We are seeking a highly analytical and detail-oriented Data Operations Analyst to support our Charge Entry & Claims Submission processes. This role is ideal for someone who thrives in high-volume environments, enjoys solving data puzzles, and is an expert in Excel. You'll be responsible for transforming raw data into clean, accurate claim files ready for automated submission.
Key Responsibilities
+ Oversee manual data processes related to charge entry and claims submissions
+ Generate weekly and monthly charge reports using internal systems
+ Manipulate large datasets (30K+ lines) in Excel to identify missing or inaccurate data
+ Match and merge values across multiple data sets using formulas and conditional formatting
+ Apply logic to existing Excel formulas and troubleshoot breakdowns in data flow
+ Clean and prepare data for automated claims submission
+ Maintain accuracy and consistency across multiple systems and sheets
+ Provide insights and problem-solving based on data guidelines
Required Skills & Qualifications
+ Advanced Excel skills: Must be able to manipulate raw data independently using formulas, conditional formatting, and multi-sheet referencing
+ Data migration and processing experience: Recent roles must have involved Excel as a primary function
+ Tech-savvy: Comfortable managing multiple systems and remote setup
+ Typing speed: Minimum 60 WPM with high accuracy
+ Excel test required: Must score 94% or above
Preferred Experience
+ Experience in charge entry or claims processing
+ Familiarity with healthcare data and HIPAA compliance
Work Environment
+ Fully remote (must have a private, secure workspace)
+ Must provide own dual monitor setup, wireless keyboard & mouse (Mac-compatible)
+ No one else may be present in the room during work hours
Contract Details
+ Open-ended contract with no guaranteed conversion timeline
+ Top performers may be retained long-term
Pay and Benefits
The pay range for this position is $20.00 - $20.00/hr.
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 specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Oct 17, 2025.
h4>About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems and TEKsystems Global Services
We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Customer Service Dept - Service Clerk (Claims Processing)
Posted 1 day ago
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_| Vacation, 9 paid holidays, medical/prescription, dental, vision, life insurance, 401k / 401k match, flexible spending, and more!_
**Job Title** : Service Clerk, Claims Processing
**FLSA Status:** Non-exempt
**Summary** Aid service department with specific claims processing by performing the following tasks:
**Essential Duties and Responsibilities** include the following. Other duties may be assigned.
Create orders related to specific inspection and roof repairs
Create and maintain electronic and paper records in regard to roofing claims
Field Phone calls relating to roofing claim inquiries
Assist with coordination of field service technicians and scheduling
Performance of customer surveys for work performed
Create, maintain, and update excel spreadsheets
Coordinate with other intercompany departments for availability of materials
Assist with Recruitment of field roofing professionals and general contractors
Keeps area neat and clean
**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:
Problem Solving - Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Technical Skills - Assesses own strengths and weaknesses; Strives to continuously build knowledge and skills.
Interpersonal Skills - Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills. Participates in meetings.
Written Communication - Writes clearly and informatively; edits work for spelling and grammar; vary written style to meet needs; presents numerical data effectively; ability to read and interpret written information.
Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; give and welcome feedback; contribute to building a positive team spirit; put success of team above own interests.
Diversity **-** Demonstrates knowledge of EEO policy; shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes a harassment-free environment.
Ethics **-** Treats people with respect; Keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values.
Organizational Support -Follows policies and procedures; completes tasks correctly and on time; supports organization's goals and values; supports affirmative action and respects diversity.
Motivation - Demonstrates persistence and overcomes obstacles; measures self against standard of excellence.
Planning / Organizing - Uses time efficiently.
Professionalism - Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works Quickly.
Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions; Uses equipment and materials properly. Reports safety and security issues to upper management.
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Ability to deal with frequent change, delays, or unexpected events.
Attendance / Punctuality **-** Is consistently at work and on time.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate plan.
Initiative - Asks for and offers help when needed.
Innovation **-** Displays original thinking and creativity; Meets challenges with resourcefulness; Presents ideas and information in a manner that gets others' attention
**Qualifications** To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience High School degree or G.E.D. **-** or six months to one-year related experience and/or training; or equivalent combination of education and experience.
Computer Skills **-** To perform this job successfully, an individual must be proficient in Microsoft Office PowerPoint, Word, and Excel software. Must be able to adapt to new software when required.
Language Skills Ability to read, analyze and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
Mathematical Skills Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's.
Reasoning Ability Able to solve practical problems, apply common sense understanding to carry out simple one or two step instructions. Ability to deal with standardized situations with only occasional or no variables.
Physical Demands - The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, use hands to finger, handle or feel and reach with hands and arms. The employee is occasionally required to stand, walk, climb or balance and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Licensing or special certification required None
EEO Statement: Champion Home Builders is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other legally protected characteristics. Champion Home Builders participates in the E-Verify Program.
Insurance Claims Adjuster
Posted 1 day ago
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Job Description
Responsibilities:
- Investigate insurance claims by gathering information, interviewing claimants and witnesses, and reviewing relevant documents.
- Determine the extent of liability and coverage based on policy terms and conditions.
- Assess damages and negotiate settlements with policyholders in a fair and timely manner.
- Prepare detailed reports documenting claim investigations, findings, and settlement recommendations.
- Maintain accurate and organized claim files, ensuring all documentation is complete.
- Stay informed about relevant insurance laws, regulations, and industry best practices.
- Communicate effectively with policyholders, attorneys, repair shops, and other parties involved in the claims process.
- Manage a caseload of claims efficiently, prioritizing tasks and meeting deadlines.
- Identify potential fraudulent claims and follow established procedures for investigation.
- Participate in ongoing training to enhance knowledge of insurance products and claims handling procedures.
- High school diploma or equivalent; Bachelor's degree in Business, Finance, or a related field is preferred.
- Minimum of 2-3 years of experience as an insurance claims adjuster or in a related claims handling role.
- Valid state insurance adjuster license(s) as required.
- Strong understanding of various insurance policies (e.g., auto, property, casualty).
- Excellent investigative, analytical, and negotiation skills.
- Proficiency in claims management software and standard office applications.
- Exceptional communication, interpersonal, and customer service skills.
- Ability to work independently, manage time effectively, and handle sensitive information with discretion.
- Attention to detail and strong organizational skills.
- Willingness to travel within assigned territory for claim investigations.
Insurance Claims Adjuster
Posted 2 days ago
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Job Description
Responsibilities:
- Investigate insurance claims promptly and thoroughly.
- Interview claimants, witnesses, and relevant parties.
- Review policy coverage and determine liability.
- Analyze damage reports and repair estimates.
- Negotiate settlements with claimants and third parties.
- Document all claim activities and communications accurately.
- Maintain organized and up-to-date claim files.
- Ensure compliance with all state regulations and company policies.
- Provide exceptional customer service throughout the claims process.
- Prepare detailed reports for management and stakeholders.
- Associate's or Bachelor's degree in Business, Finance, or a related field.
- Minimum of 3 years of experience as a Claims Adjuster or in a similar insurance role.
- Valid Adjuster's License in the state of Oregon (or ability to obtain).
- Strong knowledge of insurance policies and claims procedures.
- Excellent analytical, negotiation, and problem-solving skills.
- Proficiency in claims management software.
- Exceptional communication and interpersonal skills.
- Ability to work independently and manage a caseload effectively.
- Commitment to ethical conduct and customer service.
Insurance Claims Adjuster
Posted 3 days ago
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Job Description
Insurance Claims Adjuster
Posted 4 days ago
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Job Description
Responsibilities:
- Investigate insurance claims promptly and thoroughly to determine coverage and liability.
- Conduct interviews with policyholders, witnesses, and other relevant parties.
- Inspect damaged property or review medical records and other documentation pertinent to the claim.
- Analyze claim information, policy coverage, and applicable laws and regulations.
- Assess the extent of damages or injuries and estimate repair or replacement costs.
- Negotiate settlements with policyholders or their representatives in a fair and equitable manner.
- Prepare detailed reports documenting claim investigations, findings, and recommendations.
- Maintain accurate and organized claim files.
- Communicate effectively with policyholders, attorneys, and other involved parties throughout the claims process.
- Ensure compliance with all company policies and industry regulations.
- Stay updated on insurance laws, industry best practices, and emerging trends.
- Identify potential fraud and escalate suspicious claims for further investigation.
- Manage a caseload of claims efficiently, prioritizing tasks to meet deadlines.
- Collaborate with underwriters, legal counsel, and other departments as needed.
- Bachelor's degree in Business Administration, Finance, or a related field.
- Minimum of 3 years of experience as a claims adjuster or in a related insurance role.
- Possession of relevant state adjuster licenses (or willingness to obtain them).
- Strong understanding of insurance policies, claims investigation procedures, and liability principles.
- Excellent analytical, negotiation, and conflict-resolution skills.
- Exceptional communication and interpersonal abilities.
- Proficiency in claims management software and standard office applications.
- Ability to manage time effectively and handle multiple priorities in a hybrid work environment.
- Detail-oriented with a commitment to accuracy.
- Ethical conduct and integrity.
- Experience with (Specify type of insurance, e.g., auto, property, liability) claims is preferred.
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Insurance Claims Adjuster
Posted 4 days ago
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Insurance Claims Adjuster
Posted 4 days ago
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Job Description
Responsibilities:
- Investigate and evaluate insurance claims, including property, casualty, and auto claims, to determine liability and coverage.
- Conduct thorough interviews with policyholders, witnesses, and other relevant parties.
- Examine police reports, medical records, and other documentation to gather evidence.
- Assess damages and determine the appropriate settlement amount based on policy provisions and fair market value.
- Negotiate settlements with claimants and/or their legal representatives.
- Communicate effectively with policyholders, providing clear explanations of the claims process, coverage, and settlement offers.
- Maintain accurate and detailed claim files, documenting all activities and communications.
- Ensure compliance with all state and federal insurance regulations.
- Manage a caseload of claims efficiently, prioritizing tasks and meeting deadlines.
- Identify potential subrogation or salvage opportunities.
- Provide exceptional customer service throughout the claims handling process.
- Stay up-to-date with industry best practices and policy changes.
- Collaborate with internal legal counsel and other departments as needed.
- High school diploma or equivalent; Bachelor's degree preferred.
- Relevant claims adjusting license(s) for the state of Texas (or ability to obtain quickly).
- Minimum of 3 years of experience in insurance claims adjusting.
- Solid understanding of insurance policies, contract language, and claims procedures.
- Excellent investigative, analytical, and problem-solving skills.
- Strong negotiation and communication skills, both verbal and written.
- Proficiency in claims management software.
- Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
- Strong customer service orientation.
- Detail-oriented with a high degree of accuracy.
- Ability to work independently and collaboratively in a hybrid work setting.
Insurance Claims Adjuster
Posted 4 days ago
Job Viewed
Job Description
Responsibilities:
- Investigate insurance claims by gathering information, interviewing claimants, and inspecting damages.
- Evaluate policy coverage and determine liability and extent of coverage.
- Assess the value of damaged property or losses incurred.
- Negotiate settlements with policyholders and other parties involved in the claim.
- Communicate claim status and decisions clearly and professionally to all parties.
- Maintain accurate and detailed records of all claim investigations and actions taken.
- Ensure compliance with company policies, industry regulations, and legal requirements.
- Work collaboratively with legal counsel, medical professionals, and other experts as needed.
- Identify potential fraud and report any suspicions according to company procedures.
- Provide excellent customer service throughout the claims process.
- Bachelor's degree in Business, Finance, or a related field, or equivalent work experience.
- Previous experience as an insurance adjuster, claims representative, or in a similar role.
- Valid state insurance adjuster license (or willingness to obtain one).
- Strong understanding of insurance policies, coverage, and claims processing.
- Excellent investigation, negotiation, and conflict resolution skills.
- Proficiency in claims management software and Microsoft Office Suite.
- Strong analytical and problem-solving abilities.
- Exceptional communication and interpersonal skills.
- Ability to manage a caseload effectively and prioritize tasks.
- Commitment to ethical conduct and customer service excellence.