918 Policy Terms jobs in the United States

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. This position responsible for assuring all appointments and procedures are authorized. Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection. Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.

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:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

UNTWN Uniontown Hospital

Cost Center:

8265 UNTWN Urology

Address:

500 W Berkeley Street Uniontown Pennsylvania

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.

Benefits offered for Full-time Insurance Claims Specialists:

• 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

Perks & Rewards for Full-time Insurance Claims Specialists:

• 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.

**Job Description:**
DXC Technology (NYSE: DXC) helps global companies run their mission-critical systems and operations while modernizing IT, optimizing data architectures, and ensuring security and scalability across public, private, and hybrid clouds. The world's largest companies and public sector organizations trust DXC to deploy services across the Enterprise Technology Stack to drive performance, competitiveness, and enhanced customer experience. Learn more at DXC.com .
At DXC, we harness the power of technology to deliver mission-critical IT services that enable our customers to modernize operations and drive innovation across their IT ecosystems. Our portfolio spans business process outsourcing, insurance services, analytics and engineering, applications, security, cloud, IT outsourcing, and the modern workplace.
Our **Insurance Services practice** helps clients transform and streamline operations, reduce costs, and create scalable, agile platforms for growth. We specialize in automating complex middle- and back-office processes while delivering meaningful improvements in customer experience.
**Required Qualifications**
+ Services Life & Annuity Customer Care customer requests received via incoming phone calls and written correspondence.
+ Proven ability to diffuse escalated situations through ownership of effectively analyzing, partnering and resolving complex customer related issues.
+ Proven ability to rely on pre-established guidelines to perform the primary functions of the job with minimal supervision.
+ Focused on providing outstanding service delivery through effective communication with our customers on the telephone and via written correspondence.
+ Initiates daily contact with our internal and external customers, working to simplify and explain complexities of our products & processes.
+ Responsible for maintaining accurate product & process knowledge as well as staying abreast of regulatory updates.
+ Review, analyze and process written requests and documents as required.
+ Updates and ensures integrity of customer accounts including history.
+ Educates customers about their products features as well as self-service functionality via the IVR and web.
+ Perform at or above individual quality, productivity and timeliness standards set by the business.
**Preferred Qualifications**
+ Demonstrates consistent ownership and initiative in call follow-up, documentation, & work item management.
+ Able to achieve positive team goals and results by adaptation to varying work schedules, improving through feedback, participating in teams and maintaining strong/ongoing relationships with customers and teammates.
+ General Insurance background
**Work Enviroment**
+ **Work Schedule:** Monday - Friday, standard business hours (8:00 AM - 5:00 PM EST).
Compensation at DXC is influenced by an array of factors, including but not limited to the experience, job-related knowledge, skills, competencies, as well as contract-specific affordability and organizational requirements. A reasonable estimate of the current compensation range for this position is $31,800 - $52,000.
Full-time hires are eligible to participate in the DXC benefit program. DXC offers a comprehensive, flexible, and competitive benefits program which includes, but is not limited to, health, dental, and vision insurance coverage; employee wellness; life and disability insurance; a retirement savings plan, paid holidays, paid time off.
At DXC Technology, we believe strong connections and community are key to our success. Our work model prioritizes in-person collaboration while offering flexibility to support wellbeing, productivity, individual work styles, and life circumstances. We're committed to fostering an inclusive environment where everyone can thrive.
**If you are an applicant from the United States, Guam, or Puerto Rico**
DXC Technology Company (DXC) is an Equal Opportunity employer. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, pregnancy, veteran status, genetic information, citizenship status, or any other basis prohibited by law. View postings below.
We participate in E-Verify. In addition to the posters already identified, DXC provides access to prospective employees for the **Federal Minimum Wage Poster, Federal Polygraph Protection Act Poster as well as any state or locality specific applicant posters** . To access the postings in the link below, select your state to view all applicable federal, state and locality postings. Postings are available in English, and in Spanish, where required. View postings below.
Postings link ( Accommodations**
If you are an individual with a disability, a disabled veteran, or a wounded warrior and you are unable or limited in your ability to access or use this site as a result of your disability, you may request a reasonable accommodation by contacting us via email ( ) .
Please note: DXC will respond only to requests for accommodations due to a disability.
Recruitment fraud is a scheme in which fictitious job opportunities are offered to job seekers typically through online services, such as false websites, or through unsolicited emails claiming to be from the company. These emails may request recipients to provide personal information or to make payments as part of their illegitimate recruiting process. DXC does not make offers of employment via social media networks and DXC never asks for any money or payments from applicants at any point in the recruitment process, nor ask a job seeker to purchase IT or other equipment on our behalf. More information on employment scams is available here _._

Our client is seeking a diligent and customer-focused Insurance Claims Adjuster to join their team. While the company operates across various locations, this role is based in Washington, D.C., US and offers a hybrid work model, blending remote flexibility with essential on-site responsibilities. You will be responsible for investigating, evaluating, and negotiating insurance claims to ensure fair and prompt resolution for policyholders. Key responsibilities include interviewing claimants and witnesses, inspecting damaged property, reviewing policy coverage, and determining liability. The ideal candidate will possess excellent communication skills, strong analytical abilities, and a deep understanding of insurance policies and legal requirements. You will need to manage a caseload efficiently, maintain accurate records, and provide exceptional customer service throughout the claims process.
Responsibilities:

• Investigate insurance claims by gathering information, interviewing parties involved, and inspecting property damage.
• Analyze policy coverage, determine liability, and assess the extent of damages.
• Negotiate settlements with claimants, attorneys, and other parties involved in the claims process.
• Prepare detailed reports documenting investigation findings, damage assessments, and settlement recommendations.
• Maintain accurate and organized claim files, ensuring all documentation is complete.
• Provide clear and timely communication to policyholders regarding claim status and next steps.
• Adhere to all relevant insurance laws, regulations, and company policies.
• Identify potential fraud or subrogation opportunities.
• Collaborate with legal counsel, repair specialists, and other experts as needed.
• Contribute to the continuous improvement of claims handling processes.

Qualifications:

• Bachelor's degree in Business Administration, Finance, or a related field.
• Minimum of 3 years of experience as an insurance claims adjuster.
• Possession of relevant state adjuster licenses (or willingness to obtain them).
• Strong knowledge of insurance policies, coverage types, and claims procedures.
• Excellent investigative, analytical, and negotiation skills.
• Exceptional written and verbal communication skills.
• Proficiency in claims management software and Microsoft Office Suite.
• Ability to manage time effectively and handle a caseload of claims.
• Strong customer service orientation.
• Ability to work effectively in both remote and on-site environments.

This role is an excellent opportunity to advance your career in the insurance industry with a reputable organization.

Our client is seeking a detail-oriented and professional Insurance Claims Adjuster to manage claims efficiently in **Minneapolis, Minnesota, US**. This role involves investigating insurance claims, determining coverage, negotiating settlements, and ensuring compliance with company policies and regulatory requirements. You will be responsible for examining policy details, gathering evidence, interviewing claimants and witnesses, and assessing damages. The ideal candidate will possess strong analytical skills, excellent communication abilities, and a thorough understanding of insurance principles and practices. Experience with claims management software is beneficial. You should be adept at resolving disputes and negotiating settlements in a fair and timely manner. This position requires a high degree of integrity, organizational skills, and the ability to manage a caseload effectively. You will work with various stakeholders, including policyholders, legal counsel, and repair professionals. This is an excellent opportunity to build a career in the financial services sector, contributing to the equitable resolution of insurance claims.
Responsibilities:

• Investigate insurance claims to determine coverage and liability.
• Gather necessary documentation, including police reports, medical records, and repair estimates.
• Interview claimants, witnesses, and other involved parties.
• Assess damages and determine the extent of the insurer's liability.
• Negotiate settlements with claimants and their representatives.
• Prepare detailed claims reports and documentation.
• Ensure compliance with company policies and industry regulations.
• Manage a caseload of claims efficiently and effectively.
• Maintain accurate and up-to-date records in the claims management system.
• Provide excellent customer service to policyholders throughout the claims process.
• Collaborate with legal counsel and other experts as needed.

Qualifications:

• Bachelor's degree in Business Administration, Finance, or a related field.
• Valid state adjuster's license or ability to obtain one.
• Minimum of 2 years of experience in insurance claims adjusting.
• Strong knowledge of insurance policies, procedures, and regulations.
• Excellent analytical, negotiation, and problem-solving skills.
• Proficiency in claims management software and MS Office Suite.
• Strong written and verbal communication skills.
• Ability to manage time effectively and prioritize tasks.
• High level of integrity and professionalism.

Our client is seeking a diligent and detail-oriented Insurance Claims Adjuster to join our esteemed team in Provo, Utah . In this role, you will be responsible for investigating, evaluating, and settling insurance claims accurately and efficiently. You will interact directly with policyholders, witnesses, and other relevant parties to gather information, assess damages, and determine liability. The ideal candidate possesses strong analytical skills, excellent customer service abilities, and a thorough understanding of insurance policies and claims procedures. Responsibilities include conducting on-site inspections, reviewing policy coverage, negotiating settlements, and ensuring compliance with all applicable laws and regulations. You will also be responsible for maintaining accurate claim files and documentation. This is an excellent opportunity for an individual seeking a challenging and rewarding career in the insurance industry. We require candidates with a Bachelor's degree in Business, Finance, or a related field, or equivalent work experience. Previous experience as an insurance claims adjuster or in a related role within the insurance sector is highly preferred. A valid state insurance adjuster license is required, or the ability to obtain one quickly. Strong negotiation skills, excellent report-writing abilities, and a commitment to ethical practices are essential. If you are a motivated professional looking to contribute your expertise to a reputable insurance provider, we encourage you to apply.
Key Responsibilities:

• Investigate insurance claims thoroughly.
• Evaluate damages and determine policy coverage.
• Assess liability and negotiate fair settlements.
• Conduct on-site inspections and interviews.
• Maintain accurate and complete claim files.
• Communicate effectively with policyholders and involved parties.
• Ensure compliance with industry regulations.
• Prepare detailed claims reports.

Qualifications:

• Bachelor's degree or equivalent experience.
• Proven experience as an Insurance Claims Adjuster.
• Valid state insurance adjuster license.
• Strong analytical and negotiation skills.
• Excellent customer service and communication abilities.
• Proficiency in claims management software.
• Knowledge of insurance policies and legal regulations.

Our client is seeking a diligent and customer-focused Insurance Claims Adjuster to join their team. This is a fully remote position, allowing you to manage claims and assist policyholders from the comfort of your home office. The ideal candidate will possess strong investigative, negotiation, and communication skills, with a thorough understanding of insurance policies and claims processing. You will be responsible for evaluating insurance claims, determining coverage, negotiating settlements, and ensuring efficient and fair claim resolution.

Key Responsibilities:

• Investigate insurance claims by gathering necessary information, including policy details, incident reports, and witness statements.
• Analyze insurance policies to determine coverage for claims.
• Conduct thorough damage assessments and estimate repair costs.
• Negotiate settlements with policyholders and third parties.
• Communicate effectively with policyholders, claimants, and other relevant parties throughout the claims process.
• Maintain accurate and detailed records of all claim activities in the claims management system.
• Ensure compliance with all applicable state and federal insurance regulations.
• Identify potential fraud and escalate suspicious claims as needed.
• Provide excellent customer service and support to policyholders.
• Process claim payments and manage claim files efficiently.

Qualifications:

• Proven experience as a Claims Adjuster or in a similar role within the insurance industry.
• Strong knowledge of insurance policies, procedures, and regulations.
• Excellent investigative, analytical, and problem-solving skills.
• Proficiency in claims management software.
• Exceptional negotiation and communication skills, both written and verbal.
• Ability to work independently and manage a caseload effectively in a remote environment.
• Attention to detail and strong organizational skills.
• Relevant insurance licenses (e.g., Adjuster License) are required or must be obtainable.
• High school diploma or equivalent required; Bachelor's degree preferred.
• A history of providing outstanding customer service.

This is an excellent opportunity for an experienced Claims Adjuster seeking a remote role within a reputable insurance company. If you are a detail-oriented professional committed to fair and efficient claims handling, we encourage you to apply.

Our client, a leading insurance provider, is seeking a meticulous and empathetic Insurance Claims Adjuster to join their team in **Milwaukee, Wisconsin**. This hybrid role offers a balance of on-site collaboration and remote flexibility, allowing you to manage a diverse caseload effectively.

As an Insurance Claims Adjuster, you will be the primary point of contact for policyholders navigating the claims process. You will be responsible for investigating insurance claims, determining coverage, negotiating settlements, and ensuring fair and timely resolution for all parties involved. This role requires strong analytical skills, excellent communication, and a commitment to upholding company standards and customer satisfaction.

Responsibilities:

• Investigate and evaluate insurance claims by gathering information, interviewing involved parties, and reviewing relevant documents.
• Determine coverage based on policy terms and conditions, and assess liability.
• Calculate and negotiate fair settlements with policyholders and third parties.
• Conduct property inspections or arrange for specialized assessments (e.g., engineering, medical) as needed.
• Maintain accurate and thorough claim files, documenting all activities and decisions.
• Communicate effectively with policyholders, providing clear explanations of the claims process and status updates.
• Ensure compliance with all state regulations and company policies.
• Collaborate with internal departments, such as legal and underwriting, to resolve complex claims.
• Manage a caseload of claims efficiently, prioritizing tasks and meeting deadlines.
• Identify potential fraudulent claims and escalate for further investigation.

Qualifications:

• Bachelor's degree in Business, Finance, or a related field; relevant insurance coursework or certifications (e.g., AIC, CPCU) are a plus.
• 2-4 years of experience in claims adjusting or a related insurance role.
• Strong understanding of insurance policies, legal principles, and claims handling procedures.
• Excellent analytical, critical thinking, and problem-solving skills.
• Exceptional negotiation and communication abilities, both written and verbal.
• Proficiency in claims management software and Microsoft Office Suite.
• Ability to work independently and as part of a team.
• Strong organizational skills and attention to detail.
• Valid driver's license and a good driving record.
• Comfortable with hybrid work arrangements, including occasional travel for property inspections.

This is a valuable opportunity to grow your career in the insurance industry with a reputable organization. If you are dedicated to providing excellent service and possess the required skills, we invite you to apply.