• Document all provider contacts including phone calls, emails, and written correspondence
• Troubleshoot and identify root cause of problems and participate in developing solutions
• Provide follow up and intervention relating to provider claim inquiries
• Participate in and maintain the highest level of training and knowledge on software for billing
• Contributes to team effort by accomplishing related results 
• Ensure the integrity and confidentiality of all claims and other data
• Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
• Develops/creates test plans/scripts which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts.
• Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing 
• Identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations.

Skills: Documentation Management, Problem Identification and Resolution, Claims Inquiry Handling, Software Proficiency, Team Collaboration, Data Integrity and Confidentiality, Root Cause Analysis, System Configuration and Testing

• Collaborate with internal teams and departments to ensure Electronic Visit Verification home health visits and claims are processed correctly
• Evaluate the accuracy and completeness of the information provided to troubleshoot health claim information to ensure correct claim submission and payment
• Track service authorizations for services when appropriate for third party billing
• Interface with TELLUS clients via email and phone to meet all research and claims submission requirements
• Monitor claims processing, payments, and monitor for processing results
• Analyze provider issues and collaborate with other departments to resolve. 
• Identifies and documents opportunities for provider education
• Review provider disputes or appeals and provide a detailed analysis of findings
• Conduct claim testing for TELLUS products
• Offer expertise and assistance relative to provider billing and payment guidelines consistent with Medicaid claims policies

Skills: Cross-Departmental Collaboration, Claims Accuracy Evaluation, Service Authorization Tracking, Client Communication, Claims Monitoring, Issue Resolution, Provider Education, Dispute Analysis

• Manage the setup of new claims by identifying appropriate insurance policies and/or coverage
• Prepare the notice of loss details and reporting claims to insurers against identified policies (Auto, Property, Contractor Equipment, Liability, Builders Risk)
• Conduct full investigations into self-insured claims, reviewing, and analyzing legal precedent, legislative protections, or agreements/contracts
• Manage intake of the claims, and notification process using RMIS (Risk Management Information System) and working closely with stakeholders to align on strategy in order to ensure progress to closure of file
• Work closely with internal and external parties with respect to general claims inquiries, including Clients, Third Party Adjusters, Brokers or Ledcor Staff
• Independently engage the correct stakeholders and facilitate claim reviews with the Business
• Provide insight on Company’s insurable losses through regular internal reporting on claims and also preparing clear and concise resolution plans on claims
• Lead monthly internal claim reviews with Business 
• Responsible for overall maintenance of comprehensive claims records including claims notes, document management and online system management
• Complies with performance standards by completing assignments within the specified time.

Skills: Policy Identification, Loss Reporting, Claims Investigation, RMIS Proficiency, Stakeholder Engagement, Claims Resolution Strategy, Internal Reporting, Records Maintenance

• Effectively review and evaluate claims based on information received.
• Using results of the evaluation, determine an appropriate resolution to the claim based on the policy provisions.
• Keep accurate records of all customer interactions and transactions
• Record details of inquiries, complaints, and comments as well as actions taken.
• Logistics claims registration in claims management tool Radar
• Information collection for raising claim to carrier
• Calculation of potential damage / claim amount
• Issuing liability claims and following up status until closure
• External communication / contact with logistics partners in recovery process
• Reporting / KPI’s on claims proces

Skills: Claims Evaluation, Policy Analysis, Record Keeping, Data Collection, Damage Calculation, Claims Issuance and Follow-Up, External Communication, Performance Reporting

• Proactively identifying high risk claim escalations and reporting to the General Counsel and Senior Counsel, Litigation and Compliance
• Assisting the Companys Senior Counsel, Litigation and Compliance, and external legal counsel as needed with respect to ongoing litigation matters, garnishments, and subpoenas
• Work closely with Claims Department management and other business functions producing both recurring (production) and ad hoc analyses
• Produce and analyze monthly results reports against operational metrics, and deliver same to senior management
• Monitor company performance relative to history, targets and the competition through internal data sources, industry data and other publicly available data. 
• Take the lead in assembling and structuring data for analysis and introducing automation techniques 
• Manages deductible payments to insurer
• Partner with Health and Safety to develop streamlined incident reporting procedures
• Provide exceptional service to claimants, policy holders and travel agents who call about their claim.
• Collect information required to evaluate a claim.

Skills: Risk Identification, Litigation Support, Data Analysis, Performance Monitoring, Automation Techniques, Deductible Management, Procedure Development, Exceptional Customer Service

• Drive the Companys annual insurance renewal process over all lines of coverage, including compiling renewal applications and data, facilitating renewal meetings, identifying ways 
• Reduce annual premium costs, and negotiating premium financing arrangements
• Managing annual insurance audits
• Using the Companys SmartCompliance COI tracking tool and working with the Companys brokers
• Manage certificates of insurance, including requests and renewals
• Assisting the Companys Human Resources Team with management of the Companys light fleet program, and light duty and return-to-work requests and programs
• Proactively partnering with Operations Team and General Managers to identify, analyze, and mitigate risks regarding products, processes, and facilities
• Identify areas for safety improvement, particularly relating to workers compensation and OSHA
• Analyzing claims trends and data and generating reports and summaries
• Maintaining professional relationships with internal clients and business partners, including assigned claims adjusters and defense counsel (both internal and external) regarding status of claims

Skills: Insurance Renewal Management, Cost Negotiation, Compliance Tool Proficiency, Certificate of Insurance Management, Risk Analysis, Safety Improvement Identification, Claims Data Analysis, Professional Relationship Management

• Providing full claims supervisory services from inception to completion
• Conducting and assisting with accident / incident investigation and reporting
• Reporting and assisting with the reporting of claims to insurance carriers directly and through the Companys third-party administrator
• Retaining, directing, and managing investigators, experts, and legal counsel
• Coordinating with experts, attending physicians, health care professionals, and third-party agencies
• Providing and assisting with liability assessments, and approving or assisting with approving reserves and changes to reserves
• Managing the Companys third-party administrator relationship, including compliance with applicable agreements and reporting requirements
• Reviewing settlement documents and authorizing or facilitating authorization of claim payments
• Conducting and assisting with claim file reviews and audits
• Working directly with the Companys General Counsel, Senior Counsel, Litigation and Compliance, and insurance brokers 

Skills: Claims Supervision, Incident Investigation, Claims Reporting, Legal and Expert Management, Coordination with Healthcare Professionals, Liability Assessment, Third-Party Administrator Management, Settlement Review and Authorization

• Coordinate insurance claims reporting to broker and insurer
• Liaison with corporate counsel on litigated claims
• Attend mediation and hearings and subrogation management
• Manages insurance claims adjusters and manages broker claims advocates
• Manages third party administrator (TPA) relationship
• Develops key performance indicators and measures results
• Manages close and pay philosophy and manages return to work
• Conducts open claims review (reserves, claims development, close and pay)
• Manages managed care organization (MCO) relationship
• Manages medical bill review service provider

Skills: Claims Coordination, Legal Liaison, Mediation Attendance, Performance Metrics Development, Relationship Management, Strategy Implementation, Claims Review Analysis, Managed Care Oversight

• Appoint and manage defense counsel activities and coordinate case strategy
• Investigate, evaluate and develop strategy for professional liability claims within departmental guidance and service standards
• Establish reserves in accordance within protocols
• Effective and timely coordination of communication with insureds, defense counsel, claimants and other appropriate parties
• Conduct insured-specific problem solving and counseling
• Determine settlement value, negotiate settlement  
• Direct investigation and defense of individual claims
• Prepare case summaries for physician review committee meetings
• Management reporting, developing and maintaining information systems
• Handle data management requirements, including managing queries, jobs and stored procedures on Microsoft SQL Server

Skills: Claims Management, Strategic Planning, Reserve Analysis, Communication Coordination, Problem Solving, Negotiation, Data Management, SQL Server Proficiency

• Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. 
• Claims processing may be related to physician and hospital services
• Coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims.
• Research and determine status of medical related claims
• Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
• Clarify health insurance coverage for coordination of benefits to process claims
• Maintain records, files, and documentation 
• Meet department production and quality standards
• Maintains working knowledge of applicable statutes, case law, and regulations.
• Participate in pre-trial and settlement conference or mediations

Skills: Claims Analysis, Policy Interpretation, Data Entry Proficiency, Coordination of Benefits (COB), Problem-Solving, Record Keeping, Regulatory Compliance, Negotiation Skills

• Experience in claims administration or other relevant experience handling or assessing legal liability and damages 
• Ability to conduct complex liability and damages analysis 
• Ability to create and implement proactive strategies that result in favorable claims resolutions 
• Understanding of liability concepts, the court system, and the litigation process 
• High level of ability to prioritize and manage multiple projects and responsibilities 
• Good problem-solving skills, resourcefulness and attention to detail 
• Strong written and oral communications 
• Experience in either transportation shipping or sales in a 3PL environment.
• Experience in transportation cargo claims.
• Exceptional analytical skills with a desire to grow personally and professionally.

Qualifications: BA in Business Administration with 7 years of Experience

• An understanding of provider contracting and provider acceptance or reimbursement decision making
• A strong aptitude for listening and negotiation
• A working knowledge of ERISA benefit plans and claims adjudication and payment pursuant to ERISA benefit plans
• A strong understanding of provider reimbursement methodologies including facility-based methodologies and the nuances of professional medical bills. 
• Proficiency in Microsoft Windows, Office 365, Word, and Excel
• Basic knowledge of P&C insurance coverages
• Familiarity with AMS360
• Exceptional telephone demeanor, customer service and interpersonal skills
• Ability to work both collaboratively and independently
• Excellent verbal and written communication skills.

Qualifications: BA in Finance with 3 years of Experience

• Advanced proficiency with Microsoft Office applications including intermediate Excel skills.
• Ability to coordinate, prioritize, and pay close attention to details.
• Independent, outstanding planning, and multi-tasking skills with the ability and desire to work in a fast-paced environment.
• Effective verbal and written communication as well as problem solving skills.
• Ability to readily and positively adapt to change and technological innovation.
• Ability to speak Spanish or Portuguese
• Proficiency with word processing and spreadsheet software.
• Problem solving skills and appreciation for details.
• Knowledge of LifePro and Workflow systems and decision-making ability.
• High analytical ability - critical and logical thinking and optimization.

Qualifications: BA in Economics with 4 years of Experience

• Excellent written and verbal communications skills
• Proficient in Microsoft Office including Teams
• Proficient in virtual communication platforms including GoToMeeting, Webex and Zoom
• Proven negotiation skills and relationship management expertise
• Self-motivated with excellent time management skills
• Detail oriented with strong organizational skills
• Strong ability to coordinate and prioritize claims activity
• Professional remote working environment with reliable internet connectivity
• Litigation Management skills and SAP experience
• Exceptional customer service mindset

Qualifications: BA in Risk Management and Insurance with 5 year of Experience

• Prior claims and/or insurance experience 
• Exceptional analytical and creative problem solving abilities
• Intrinsic sense of urgency with ability to prioritize workload, meet project deadlines and drive results
• Intellectually curious and interested in exploring new ways to analyze data
• Ability to analyze both financial and non-financial quantitative data, determine trends, identify anomalous results, draw conclusions and communicate findings
• Always willing to wrestle even minor unexplained variances found in data to the ground
• Effective communication skills (both verbal and written)
• Ability to strike the right balance between working independently and collaboratively depending upon the individual task or project 
• Skilled in SQL Server Management Studio
• Advanced knowledge of Excel

Qualifications: BA in Health Administration with 2 years of Experience

• Comfort in working with relational databases
• Experience with Tableau or other interactive business intelligence tools
• Ability to manage structured and non-structured data from multiple sources
• Proficient in other Microsoft Office suite products
• Basic understanding of statistical analysis 
• Experience with Python or other open source tools 
• Experience developing web applications and experience with NoSQL databases 
• High proficiency with spreadsheets (Excel / Google Sheets).
• Proficiency (or ability to learn) SQL is an advantage.
• Professional oral and written communication skills 
• Willing to take on new challenges and opportunities

Qualifications: BA in Statistics with 3 years of Experience

• Experience in WC claims area, ARM or CPCU accreditation
• Experience in risk management and claims related work experience, preferably in-house risk management, insurance broker, insurance company, or third-party administrator experience
• Proficient Microsoft Office skills
• Results-driven, has a strong sense of urgency and is able to drive results
• Fast-paced, yet detail oriented
• Service oriented, treats colleagues as clients
• Strong communication skills and the ability to work well with others
• Comfortable in an entrepreneurial environment where demands and priorities change rapidly
• Robust organizational and time management skills
• Enjoys working in a fast-paced, high growth environment
• Working knowledge of Microsoft Suite products (i.e. Excel), database concepts, and query tools.

Qualifications: BA in Actuarial Science with 6 years of Experience

• Requires basic job knowledge of systems and procedures obtained through prior work experience or education.
• Experience in cash application or claims resolution.
• Excellent communication skills, written and verbal, with attention to detail and accuracy.
• Demonstrated ability to work well with others is a matrix team environment.
• Proficient computer skills and in-depth knowledge of relevant software such as MS Office Suite.
• Demonstrates ability to work well with others in a matrix team environment.
• Demonstrates ability to consistently meet deadlines and prioritize tasks.
• Ability to read, analyze, and interpret financial statements.
• Advance mathematical skills including the ability to calculate discounts and percentages.
• Experience with Oracle Receivables 
• Claims management experience 
• Excellent interpersonal skills with the ability to work in a team environment.

Qualifications: BA in Accounting with 2 years of Experience

• Must demonstrate and maintain strong ethics.
• Proficiency in English. Bi-lingual candidate who speaks Spanish 
• Strongly prefer a Bachelor’s degree in business, accounting, finance, information sciences, computer/data forensics or another relevant degree. 
• Previous work experience will be considered 
• Previous experience in fraud identification and detection, analysis, investigation, and management.
• An understanding of operational controls, auditing standards, and risk-assessment practices.
• Strong organizational skills and an ability to effectively prioritize competing goals to meet expectations.
• Proficiency in Microsoft Office applications, including: Excel, Word, Access, PowerPoint, and Outlook.
• Excellent verbal, written, and presentation skills 
• Ability to present complex and sensitive issues to all levels of leadership and internal and external stakeholders.
• Must have flexibility and have the ability to work in a fast-paced and ever-changing business environment.
• Must be able to apply systems-thinking to generate solutions and focus on root cause and process rather than isolated instances.

Qualifications: BA in Legal Studies with 2 years of Experience

• Experience in claim handling, relevant litigation, or TPA management.
• Demonstrate success evaluating claims, making coverage determinations based on policy provisions, and managing litigation.
• Strong communication (verbal and written) and interpersonal skills.
• Working knowledge of Microsoft Word and Excel.
• Ability to manage time effectively, set priorities and meet deadlines.
• Ability to work and interact with departments throughout the organization.
• Time management skills and analytical skills.
• Excellent attention to detail.
• Work well in a team environment
• Able to maintain confidential information.

Qualifications: BA in Information Systems with 4 year of Experience