Claims Investigator jobs in Springfield, MA

The Claims Investigator examines, and authorizes insurance claims investigated by insurance adjusters. Reviews, evaluates and processes insurance claims and makes recommendations for resolution. Being a Claims Investigator has contact with agents, claimants, and policy holders. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. In addition, Claims Investigator determines settlement according to organization practices and procedures. Typically requires a bachelor's degree. Typically reports to a supervisor or manager. Being a Claims Investigator works on projects/matters of limited complexity in a support role. Work is closely managed. Working as a Claims Investigator typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)

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Investigator
  • Behavioral Health Network, Inc.
  • Springfield, MA FULL_TIME
  • Join our team of competent and compassionate professionals!

    Be part of a collaborative team as an Investigator at Behavioral Health Network!

    • Actively participates on the ICI teams, including regular scheduled review of all new and pending investigations.
    • Based on input and direction from the ICI team and within BHN ICI protocol, the analyzes the reported concern, develops an investigation plan, conducts the investigation, completes a written report, communicates an appropriate summary of the investigation outcome(s) to relevant parties, and maintains accurate and thorough records in the appropriate systems.
    • Interviews complainant(s), witnesses, and subject(s), as well as identifies and collects relevant documentation and/or other investigatory evidence. There may also be a need to consult with appropriate Subject Matter Experts (SMEs). Throughout the process, it will be critical to document interviews, process steps, and other investigation findings in accordance with BHN’s ICI process.
    • Works collaboratively with program leadership, administrative departments, such as Compliance, Human Resources, Social Justice, Quality and other stakeholder departments to complete investigations.
    • As a member of the broader team, may also have other assignments, such as conducting and developing training, assisting with the development of policies and/or procedures related to complaint investigations, and partnering with colleagues or other departments on special related projects. Maintains confidentiality under HIPAA regulations and 42 CFR part 2.

    Behavioral Health Network is a growing non-profit community behavioral health agency that has been providing services to children, adults, families and communities in Western Massachusetts since 1938. BHN provides comprehensive, outcome-driven behavioral health care. We are dedicated to offering high quality, affordable and culturally appropriate care to people of all ages and income levels in our constituent communities.

    Reasons to work with BHN:

    • Work with an agency who does amazing things for others
    • You will be able to change a person’s life
    • You will expand your experience in various areas of mental & behavioral health
    • You will have the opportunity to grow within the agency
    • You will not be bored with our fast-paced environment
    • You will have excellent benefits package & time off benefits available

    Qualifications/Requirements

    Investigators at Behavioral Health Network have the following qualities:

    • High School Diploma or GED required. Bachelor’s Degree preferred.
    • Minimum 5 years of progressive experience in employee relations/complaint investigations or related experience.
    • Knowledge of mental illness and substance use preferred.
    • Must have familiarity with internet, word processing and email systems.
    • Excellent verbal and written communication skills.
    • Demonstrates willingness and ability to work collaborative with teams of diverse people.
    • Demonstrates knowledge and experience working within and with social justice principles.
    • Knowledge of Healthcare Compliance – in depth understanding of HIPAA and 42/2 regs; knowledge of fraud in a BH setting; command of core compliance regs such as Stark, False Claims Act, and Anti-Kickback laws.
    • Advanced knowledge of relevant HR regs including Federal and state anti-discrimination regs, FMLA/PFLA, ADA, ADEA, as well as related BHN policies

    How do I apply?

    If you are interested in this opportunity, please click “Apply for Job” from Kronos/WFD or visit our website at www.bhnworks.org and click on “Browse All Jobs” to apply!

    BHN maintains its commitment to social justice and diversity and strongly encourages diverse candidates to apply.

    **NOTICE**

    In accordance with the BHN Mandatory COVID vaccine policy - all staff, interns, temps, residents and contractors are required to be fully vaccinated no later than day one of employment. Medical or religious exemptions will be offered and must be approved prior to starting work.

    The same guidelines noted above apply during flu season (defined as December 1st – through end of flu season as announced by the CDC) for BHN’s Mandatory Influenza Vaccine policy.

    Additionally, BHN is a Tobacco Free workplace. All Staff, interns, temps, residents and contractors agree not to smell of or use Tobacco or ENDS products while on paid work time or within sight of any BHN facility.

  • 24 Days Ago

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Field Technician
  • Hancock Claims Consultants
  • Northampton, MA CONTRACTOR
  • CLIMB to New Heights… And live the_ American Dream. _Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carri...
  • 1 Month Ago

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Field Roof Inspector
  • Hancock Claims Consultants
  • Amherst, MA CONTRACTOR
  • CLIMB to New Heights… And live the_ American Dream. _Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carri...
  • 1 Month Ago

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Fire Investigator
  • Rimkus Consulting Group, Inc
  • Springfield, MA FULL_TIME
  • DescriptionJoin Rimkus and unlock your potential with endless opportunities for growth, learning, and making a difference! Rimkus (www.rimkus.com) is a worldwide leader in Engineering and Technical Co...
  • 10 Days Ago

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Fire Investigator
  • Rimkus
  • Springfield, MA PART_TIME
  • Join Rimkus and unlock your potential with endless opportunities for growth, learning, and making a difference! Rimkus (www.rimkus.com) is a worldwide leader in Engineering and Technical Consulting. R...
  • 12 Days Ago

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SIU Investigator
  • Insight Service Group, ISG
  • Springfield, MA PART_TIME
  • Insight Service Group "ISG" is a national investigative services firm specializing in cost containment and anti-fraud related services. We are currently seeking individuals for Full/Part-Time SIU Inve...
  • 2 Months Ago

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0 Claims Investigator jobs found in Springfield, MA area

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Claims Specialist- Latent Bodily Injury
  • The Hartford Financial Services Group, Inc.
  • Hartford, CT
  • Specialist Claims - CH07DE We're determined to make a difference and are proud to be an insurance company that goes well...
  • 4/18/2024 12:00:00 AM

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Sr. Business Analyst, Life Insurance
  • Covr Financial Technologies
  • Hartford, CT
  • Sr. Business Analyst REPORTS TO: Operations Technology Product Owner DEPARTMENT: Product Management FLSA STATUS: Exempt ...
  • 4/18/2024 12:00:00 AM

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Senior Claims Representative
  • The Jacobson Group
  • Glastonbury, CT
  • Job Description: A medical professional liability insurance carrier is seeking a Senior Claims Representative to handle ...
  • 4/18/2024 12:00:00 AM

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Regulatory Compliance Manager
  • Hiring Now!
  • Hartford, CT
  • Our client is currently seeking a Regulatory Compliance Manager for their operations in the Philadelphia, PA metro area....
  • 4/17/2024 12:00:00 AM

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Senior Claims Representative
  • Integris Group
  • Glastonbury, CT
  • Work for a company that values you! Integris Group is a medical professional liability insurance carrier. We put our tal...
  • 4/17/2024 12:00:00 AM

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Claims Adjuster-Auto Damage
  • Progressive Corp.
  • Springfield, MA
  • Job Description - Claims Adjuster-Auto Damage (186513) **** Claims Adjuster-Auto Damage **Job Number** : 186513 As an **...
  • 4/16/2024 12:00:00 AM

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Sr. Business Analyst, Life Insurance
  • Covr Financial Technologies
  • Hartford, CT
  • Sr. Business AnalystREPORTS TO: Operations Technology – Product Owner DEPARTMENT: Product Management FLSA STATUS: Exempt...
  • 4/14/2024 12:00:00 AM

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Senior Claims Representative
  • The Jacobson Group
  • Glastonbury, CT
  • Job Description: A medical professional liability insurance carrier is seeking a Senior Claims Representative to handle ...
  • 4/14/2024 12:00:00 AM

Springfield is located at 42°6′45″N 72°32′51″W / 42.11250°N 72.54750°W / 42.11250; -72.54750 (42.112411, −72.547455). According to the United States Census Bureau, the city has a total area of 33.1 square miles (85.7 km2), of which 31.9 square miles (82.5 km2) are land and 1.2 square miles (3.1 km2), or 3.65%, are water. Once nicknamed "The City in a Forest," Springfield features over 4.0 square miles (10.4 km2) of urban parkland, 12% of its total land area. Located in the fertile Connecticut River Valley, surrounded by mountains, bluffs, and rolling hills in all cardinal directions, Spring...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Investigator jobs
$49,921 to $66,198
Springfield, Massachusetts area prices
were up 1.6% from a year ago