1,206 Claims Advisor jobs in the United States

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent.
2. State criminal background check and Federal (if applicable), as required for regulated areas.

PREFERRED QUALIFICATIONS:

EXPERIENCE:
1. Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
2. Follows up on accounts as indicated by system flags.
3. Contacts insurance company or employer to determine eligibility and benefits for requested services.
4. Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
5. Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
6. Performs medical necessity screening as required by third party payors.
7. Documents referrals/authorization/certification numbers in the EPIC system.
8. Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
9. Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
10. Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
11. Communicates problems hindering workflow to management in a timely manner.
12. Assesses all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an 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.

1. Prolonged periods of sitting.
2. Extended periods on the telephone requiring clarity of hearing and speaking.
3. Manual dexterity required to operate standard office equipment.

WORKING 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.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills.
2. Basic knowledge of medical terminology.
3. Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
4. General knowledge of time of service collection procedures.
5. Excellent customer service and telephone etiquette.
6. Minimum typing speed of 25 works per minute.
7. Must have reading and comprehension ability.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Insurance Claims Specialist

Snaggle Dental

West Monroe, LA 71291

Job details

Salary: Starting from $16.00-$20.00/hourly

Pay is based on experience and qualifications.

**incentives after training vary and are based on performance

Job Type: Full-time

Full Job Description

With our hearts, minds, and hands, we build better smiles, better relationships, and better lives. Living this purpose over the last 25 years has allowed us to create a world-class dental organization that continues to grow. At every turn, you will see our continued investment in leadership, the community, and advanced technologies. Do you want to be a part of developing one of the leading models of dental care in Louisiana? Do you thrive in a fast-paced, progressive environment? The role of the Insurance Claims Specialist could be for you!

Please go to WWW.PEACHTREEDENTAL.COM to complete your online application and assessments or use the following URL:

Qualifications

• High school or equivalent (Required)
• Takes initiative.
• Has excellent verbal and written skills.
• Ability to manage all public dealings in a professional manner.
• Ability to recognize problems and problem solve.
• Ability to accept feedback and willingness to improve.
• Ability to set goals, create plans, and convert plans into action.
• Is a Brand ambassador, both in and outside of the facility.

• Medical, Dental, Vision Benefits
• Dependent Care & Healthcare Flexible Spending Account
• Simple IRA With Employer Match
• Basic Life, AD&D & Supplemental Life Insurance
• Short-term & Long-term Disability

• Competitive pay + bonus
• Paid Time Off & Sick time
• 6 paid Holidays a year

Job Summary:

Join our dynamic team as an Insurance Claims Specialist. In this role, you will play a crucial part in analyzing and processing insurance claims to determine insurance carrier liabilities while upholding our company’s mission and values. Your primary responsibilities will include efficient adjudication of claims, clear communication with insured parties, travel suppliers, medical facilities, and compliance with all state Department of Insurance regulations. Some weekend work may be required. This position reports to the Claims Supervisor.

Principal Duties and Responsibilities:

Claims Processing and Coordination

1. Process assigned claims promptly, accurately, and efficiently while following established policies and best practices.
2. Review claim forms, Physician Statements, and documentation to validate completeness.
3. Communicate with insured individuals, healthcare providers, agents, and other necessary parties to obtain proper documentation and resolve claims.
4. Maintain accurate reserves for each claim file.
5. Ensure comprehensive file documentation is collected and retained, including all correspondence.
6. Investigate claims and coordinate with outside adjusters and investigators as required.
7. Issue denial of benefits letters when necessary.
8. Manage attorney-represented claims effectively.
9. Address and respond to Department of Insurance complaint letters.
10. Respond to inquiries related to claims status both via written and phone communication.
11. Ensure timely and accurate payment issuance.
12. Consistently apply current Federal and State insurance regulations across all jurisdictions.

Customer Service

1. Provide clear responses to internal and external customer inquiries regarding coverage and policy information.

Teamwork and Department Support

1. Assist in mentoring and training new employees as needed.
2. Take on additional assignments or special projects as directed by management.

Required / Desired Knowledge, Experiences, and Skills:

1. Exceptional verbal and written communication, problem-solving, and organizational skills.
2. Strong reading, writing, comprehension, and proofreading abilities.
3. Familiarity with standard practices, regulations, and laws in the insurance field is preferred.
4. Bilingual proficiency in English and Spanish (verbal, reading, and writing) is a plus.

Education/Certifications:

1. High School Diploma or equivalent is required; a Bachelor's degree from an accredited institution is a plus.
2. Prior experience in claims processing and customer service is highly preferred.

Physical Working Environment:

This role requires the ability to stand, walk, and sit for extended periods. The employee will use hands for grasping and handling and may need to lift or move up to 10 pounds frequently and up to 25 pounds occasionally. Specific vision abilities required include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

The above statements describe the general nature of work involved in this role and are not intended to be an exhaustive list of all responsibilities, duties, and skills necessary for employees in this classification.

Under general supervision, provides support in the administration of workers' compensation claims, auto liability claims, general liability claims, and the maintenance of driver qualification files. This role is responsible for the timely and accurate handling of claims, ensuring compliance with regulatory standards, and assisting in the implementation of safety and risk mitigation initiatives. The Claims Specialist collaborates closely with internal teams and external partners to support operational efficiency and regulatory compliance.

• Assists in the management of workers' compensation claims, auto liability claims, and general liability claims, including intake, documentation, investigation, and follow-up to ensure timely resolution.
• Maintains and updates driver qualification files for CDL and non-CDL drivers in compliance with DOT, FMCSA, and company policies.
• Conducts preliminary investigations of workplace incidents and vehicle accidents, gathering statements, reports, and supporting documentation.
• Supports the Claims Manager in preparing reports on injury trends, claims status, and compliance metrics.
• Assists in internal audits of claims files and driver records to ensure accuracy and regulatory compliance.
• Provides administrative support for compliance tracking and safety initiatives.
• Other duties as assigned.

• 2 years of experience preferred.
• Possession of a high school diploma or GED required.
• Bachelor's degree preferred.
• Computer programs, including Microsoft Office suite of applications.
• Oral and written communication skills.
• Time management skills.
• Ability to identify and seek needed information/research skills.

• An ecologically innovative company that finds and mentors people committed to protecting the environment and sustaining our communities.
• The largest employee-owned resource recovery company in the industry with terrific benefits to help you prosper.
• A creative and caring culture that values community, diversity, altruism, accountability, collaboration, and learning by doing.
• An inspired company mission driven to use and return resources to their best and highest use through the practice of the 4R's: Reduce, Re-use, Recycle, and Recologize.
• Distinct professional challenges to connect with, care for, and grow a community that sees a world without waste.

• Paid time off and paid holidays.
• Health and wellness benefits including medical, dental, and vision.
• Retirement plans (Employee Stock Ownership Plan, 401(k) with match).
• Annual wellness incentives.
• Employee Assistance Program (EAP).
• Educational assistance.
• Commuting benefits.
• Employee referral program.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job; and pursuant to applicable law, we will consider for employment qualified applicants with criminal records. It is important that you provide accurate information on the job application, inaccurate information may cause delays in the processing of your application and/or may disqualify you as a candidate.

Recology is an equal opportunity employer committed to supporting an inclusive work environment where employees are valued, heard, and provided development opportunities. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, citizenship, disability, protected veteran status, or any other basis that is prohibited by law.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, effort, work conditions, and benefits associated with the job.

• Bilingual in Spanish and English
• Input date entry on all new claims
• Provide indemnity payment and cycles.
• Identify, prevent, and mitigate potential case penalties.
• Deliver 3-point contact ( Medical Only &/ or Indemnity files) to verify the mechanics of the injury, compensability, and discharge. - Calculate and pay mileage benefits.
• Verify lost time and waiting periods.
• Perform maintenance of current legal claims
• Identify issues requiring conversion to Indemnity to include supporting documentation.
• Input basic notes relating to claim, status and treatment.
• Process medical/legal bills daily to avoid penalty and interest.
• Return phone calls on a timely manner.
• Input status letters, delay letters, or any other required initial letters.
• Comply to subpoenas
• Interaction with nurse on case management regarding return to work status.
• New hires protocol
• Background checks
• Coordinating PPE supplies request.
• Assist safety team on identifying injury trends.
• Performs other related duties as assigned

• Minimum of one (1) year of Claims Specialist experience required. - Ability to multitask, communicate effectively in writing and verbally, within all aspects of job requirements. - Experience in insurance and/or Workers Compensation claims is preferred. SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint, and Word.
• Bilingual English/Spanish is preferred but not required for the position