Claims Examiner Salary at Pomco Inc BETA

Claims Examiner at Sedgwick in Boise, Idaho, United States Job Description Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Plac

Sr. Claim Examiner 3-month contract - high possibility of extension or conversion Remote Workers Compensation - Liability Interprets and makes decisions using independent judgment on more complex and unusual policy coverage's and determines if coverage's apply to claims submitted. Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. Analyzes claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. Develops subrogation and third party recovery potential and follows reclaim procedures. Analyzes claims activities and prepares reports for clients, carriers and/or management. Partic

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor’s degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related c

Job Title: Medical Claims Examiner Location: El Monte, CA Job Type: Temporary (3-Month Project) Pay Rate: $24/hour Schedule: Monday - Friday, 8:30 AM - 4:30 PM Overview: We are seeking three Medical Claims Examiners to assist with an increased workload for a three-month project. This role requires candidates with prior experience processing medical or hospital claims (HMO and PPO). Dental claims experience is also highly valued. Responsibilities: Review and assess submitted claims for accuracy and completeness, ensuring all required documentation is provided. Verify compliance with insurance policies, guidelines, and regulations, confirming eligibility and coverage. Investigate discrepancies or issues related to claims by contacting healthcare providers, policyholders, or other relevant parties. Determine claim outcomes, including approvals, denials, or adjustments, based on thorough evaluations and criteria. Accurately input claim information into databases and maintain detailed recor

Manages complex, high-value claim and suit files independently. Cases will involve complex coverage, liability, damages and/or injuries. May give technical assistance to staff adjusters. Manages independent adjusters and attorneys assigned to the Examiner’s files. Has settlement authority in excess of adjusters. May extend settlement authority to staff adjusters. Does not administratively supervise staff adjusters. Essential Duties and Responsibilities: Analyze, review, and interpret policies to resolve coverage and assess liability. Independently handle more complex and high-exposure Commercial General Liability claims, including claims in litigation and construction defect claims. Under general supervision and direction, resolves complex claims by investigating losses, negotiating settlements, presenting evidence in legal proceedings while maintaining adequate production and quality levels. Investigates claims by interviewing shipper, consignee, witnesses, requesting and obtaining of

Manages complex, high-value claim and suit files independently. Cases will involve complex coverage, liability, damages and/or injuries. May give technical assistance to staff adjusters. Manages independent adjusters and attorneys assigned to the Examiner’s files. Has settlement authority in excess of adjusters. May extend settlement authority to staff adjusters. Does not administratively supervise staff adjusters. Essential Duties and Responsibilities: Analyze, review, and interpret policies to resolve coverage and assess liability. Independently handle more complex and high-exposure Commercial General Liability claims, including claims in litigation and construction defect claims. Under general supervision and direction, resolves complex claims by investigating losses, negotiating settlements, presenting evidence in legal proceedings while maintaining adequate production and quality levels. Investigates claims by interviewing shipper, consignee, witnesses, requesting and obtaining of

Manages complex, high-value claim and suit files independently. Cases will involve complex coverage, liability, damages and/or injuries. May give technical assistance to staff adjusters. Manages independent adjusters and attorneys assigned to the Examiner’s files. Has settlement authority in excess of adjusters. May extend settlement authority to staff adjusters. Does not administratively supervise staff adjusters. Essential Duties and Responsibilities: Analyze, review, and interpret policies to resolve coverage and assess liability. Independently handle more complex and high-exposure Commercial General Liability claims, including claims in litigation and construction defect claims. Under general supervision and direction, resolves complex claims by investigating losses, negotiating settlements, presenting evidence in legal proceedings while maintaining adequate production and quality levels. Investigates claims by interviewing shipper, consignee, witnesses, requesting and obtaining of

Health Advocates Network is hiring a **Denials Analyst** **(2 Years Exp Req)** ! This is a full-time contract position at a nationally recognized hospital located in **Folsom, CA.** + **Pay Rate: $24.00/hour** + **Shift: Days (8hrs)** + **Start Date: ASAP** + **Contract Length: 13 weeks** **Job Summary: ** Responsible for researching and resolving claim denials, ADR requests, and certs, submitting and tracking appeals, noting trends, and providing monthly reports. Respond to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirements for pre-authorization, medical necessity, and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials. **Denials Analyst** ** Qualification and Requirements:** + High school diploma or equivalent. + Minimum of two (2) years of Professional Billing with an emphas