UNKNOWN

FEED

Performs other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars. Scope of Role & Responsibilities: Process claims involving medical and/or surgical services; screens for complete member/provider information.

YEAR

Metroplus Health Plan Inc

Claims Examiner I

OTHER

This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. Key responsibilities include but are not limited to: Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.

Berkley

Associate Claims Examiner

[AW]-iCims

The Claims Examiner & Support Specialist Level I is responsible for accurately processing health plan delegated claims, addressing provider inquiries via phone calls, and handling various administrative tasks within the department. Additionally, maintaining a customer-centric approach when dealing with inquiries and issues is essential to ensure a positive experience for providers and stakeholders.

HealthTexas Primary Care Doctors

Claims Examiner & Support Specialist Level I

Equally comfortable advising executives, facilitating difficult conversations after patient events, and coaching teams through complexity - with the judgment and credibility to lead through ambiguity, high emotional intelligence, and the ability to balance compassion and transparency with effective risk mitigation on behalf of patients, families, and care teams. Ensure the Clinical Risk Management strategy reflects the five CPHRM domains - Clinical/Patient Safety, Risk Financing, Legal and Regulatory, Health Care Operations, and Claims and Litigation - across role expectations, metrics, escalation pathways, and leadership reporting.

Mayo Clinic

Senior Manager Clinical Risk Management

Additionally, the Dealer Auditor will maintain oversight of Company’s warranty policies and programs, performing root cause analysis, recommending corrective actions, and identifying opportunities to improve internal and external processes and system functionality. The Dealer Auditor will also be responsible for preparing and communicating audit-related information, such as notification letters and specialized reports detailing audit results, and in maintaining the audit tools.

We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc). 
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.

Lancesoft

Audit - Dealer Auditor

HaleyMarketing

Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment. Relying on limited experience and knowledge, the Aviation Claims Examiner is responsible for accomplishing the following assignments.

HCC Life Insurance Company

Aviation Claims Examiner

HOUR

The Claims Examiner III works closely with claimants, attorneys, medical providers, nurse case managers, vocational experts, vendors, clients, and internal staff to ensure claims are handled in compliance with state regulations and company best practices. This role is responsible for managing complex and litigated workers' compensation indemnity claims from assignment through resolution.

Roth Staffing Companies

Worker Compensation Claims Examiner III (Hybrid)

Broadbean

Bachelor's degree is required; a Master's degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency. The ideal candidate will have experience processing healthcare claims in a high-volume Claims Department.

Claims Examiner II

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Point C

Claims Examiner

The candidate should have a minimum of 2 years of commercial general liability claims handling experience which would include reviewing and analyzing coverage, liability and damages. The ideal candidate will be responsible for investigating, evaluating, and settling commercial liability claims.

Richmond National Group, Inc

Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

Sigma Systems

The Claims Examiner will work closely with claimants, clients, legal teams, and vendors to drive timely resolution and maintain high-quality claim file documentation. This position is ideal for a claims professional with strong experience in workers' compensation, claim investigation, and settlement negotiation who can manage claims independently while maintaining compliance and cost effectiveness.

Epitec is a leading staffing and recruiting services company with a mission to make staffing personal. We go beyond traditional hiring by truly understanding our candidates and matching them with the perfect opportunities. We offer competitive compensation, career growth, and support throughout the entire process. Working with top Fortune 500 companies, we are recognized for our excellence with numerous awards, including Best & Brightest and diversity recognitions. At Epitec, we're redefining the future of employment.

Epitec Inc

Claims Examiner - Workers Compensation

Tokio Marine HCC – Surety Group, a member of the Tokio Marine Group of Companies, has an exciting opportunity for an Associate Claims Examiner position on-site at our office in Los Angeles, California. We are looking for motivated individuals to join our team of highly skilled claims examiners who are part of a successful division that specializes in surety bond business.

Tokio Marine HCC

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

Looking for a great job? Join eTeam. We’re looking for talented staffing professionals to join our staff. We also provide contract assignments and full-time jobs at Fortune 2000 Companies. We’ve been named one of the best companies to work for by Staffing Industry Analysts and New Jersey Business.

eTeam Inc.

Claims Examiner - Workers Compensation (Hourly)

jobdiva

This role is ideal for an experienced examiner with strong Colorado Workers’ Compensation knowledge who can independently manage files, make sound compensability decisions, and move claims efficiently from first report through resolution. You will manage an active caseload of approximately 150 claims, including medical-only, indemnity, lifetime medical, and permanent partial benefit files.

TEEMA

Workers’ Compensation Claims Examiner III - Hybrid

WorkWolf

We are hoping you will join us as a Claims Examiner - Lead Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.

CalOptima

Claims Examiner - Lead Covered California

We are hoping you will join us as a Claims Examiner - Lead and help shape the future of healthcare where you'll be an integral part of our CLA - Claims Production team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.

Claims Examiner - Lead

Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.

Guide Well

ea_via_bold

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes. This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services.

Claims Examiner Jobs in the United States

Claims Examiner I Metroplus Health Plan Inc

Associate Claims Examiner Berkley

Claims Examiner & Support Specialist Level I HealthTexas Primary Care Doctors

Senior Manager Clinical Risk Management Mayo Clinic

Audit - Dealer Auditor Lancesoft

Aviation Claims Examiner HCC Life Insurance Company

Worker Compensation Claims Examiner III (Hybrid) Roth Staffing Companies

Claims Examiner II Metroplus Health Plan Inc

Claims Examiner Point C

Claims Examiner Richmond National Group, Inc

Claims Examiner Sigma Systems

Claims Examiner - Workers Compensation Epitec Inc

Claims Examiner Tokio Marine HCC

Claims Examiner - Workers Compensation (Hourly) eTeam Inc.

Workers’ Compensation Claims Examiner III - Hybrid TEEMA

Claims Examiner - Lead Covered California CalOptima

Claims Examiner - Lead CalOptima

Claims Examiner I Guide Well

Claims Examiner - Workers Compensation eTeam Inc.

Claims Examiner III TEEMA Group

Similar Job Searches

See More Jobs

Stand out to leading employers.