Top 1369 Medical claims investigator Jobs

Claims Specialist
Blue Cross and Blue Shield of Kansas —Topeka, KS
- $27.08 - $33.85 an hour
- Contract
- Hybrid work
- Medical office experience
- Basic math
- Mid-level
- Paid parental leave
- AD&D insurance
8d
Senior Fraud Investigator-NYC (Hybrid)
1199SEIU Family of Funds —New York, NY
- $89,200 - $111,500 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Office
Medical Claims Investigator
Claritev —Remote
- $50,000 - $55,000 a year
- Full-time
- HIPAA
- Mid-level
- Office
- Paid parental leave
- Employee stock purchase plan
Digital Fraud Investigator
Municipal Credit Union —New York State
- $81,700 - $113,400 a year
- Full-time
- Remote
- 5 years
- Analysis skills
- Senior level
- Paid holidays
- Disability insurance
Quick Apply
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- 1 year
- Paid holidays
- Health insurance
FWA Special Investigations Unit (SIU) Investigator
Summa Health —Remote
- $28.10 - $42.15 an hour
- Full-time
- Remote
- Background check
- Microsoft Office
- Analysis skills
- AD&D insurance
- Disability insurance
Quick Apply
Investigator
UnitedHealthcare —Houston, TX
- $49,700 - $88,800 a year
- Full-time
- Remote
- Microsoft Word
- Pass drug screening
- Mid-level
Senior Investigator – Special Investigations Unit( Illinois, Indiana, and Michigan )
West Bend Insurance Company —Remote
- $77,204 - $97,000 a year
- Full-time
- Remote
- Research
- Mentoring
- In-person
- Health savings account
- Disability insurance
3d
Investigator A (Claims)
NJ Transit —Newark, NJ
- Writing skills
- Mid-level
- Driver's License
- Health insurance
- Dental insurance
Claims Investigator/Examiner
AIDS Healthcare Foundation —Los Angeles, CA
- $34 - $36 an hour
- Mid-level
- Organizational skills
- Health insurance
Quick Apply
Senior Investigator
UnitedHealthcare —Dallas, TX
- $60,200 - $107,400 a year
- Full-time
- Remote
- Microsoft Word
- Pass drug screening
- Driver's License
- AD&D insurance
- Employee stock purchase plan
Investigator II – Special Investigations Unit ( Tennessee, North Carolina, Kentucky, Virginia )
West Bend Insurance Company —Remote
- $68,000 - $90,000 a year
- Full-time
- Remote
- Research
- Mid-level
- Driver's License
- Health savings account
- Disability insurance
7d
SIU Investigator
Allstate —Remote
- $53,500 - $104,100 a year
- Remote
- Research
- Mid-level
- Analysis skills
- Work from home
10h
Safety & Claims Manager – Transportation & Warehouse
Confidential —Holtsville, NY
- $90,000 - $115,000 a year
- Full-time
- CDL A
- 3 years
- Case management
- Paid holidays
- Health insurance
Quick Apply
Pre-Litigation Attorney
Rubenstein Law, P.A. —Woodbridge, NJ
- $90,000 a year
- Full-time
- Customer service
- Mid-level
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
10d
Property and Casualty Field Adjuster Investigator
CUSTARD INSURANCE ADJUSTERS —Portland, ME
- $50,000 - $100,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Paralegal - Insurance Defense
Roberts, Reynolds, Bedard & Tuzzio, PLLC —Coral Springs, FL
- From $60,000 a year
- Full-time
- Writing skills
- Mid-level
- In-person
- Health savings account
- AD&D insurance
Quick Apply
Remote Personal Injury Associate Attorney - Wisconsin
10xLaw —Wisconsin
- From $100,000 a year
- Full-time
- Remote
- Mid-level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
Property and Casualty Field Adjuster/Investigator
CUSTARD INSURANCE ADJUSTERS —Attleboro, MA
- $55,000 - $75,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Liability Claims Examiner - NY
GREATER NEW YORK MUTUAL INSURANCE COMPANY —Manhattan, NY
- $69,100 - $124,400 a year
- Writing skills
- Mid-level
- Analysis skills

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Claims Specialist

Blue Cross and Blue Shield of Kansas -
Topeka, KS

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Job Details

Contract
$27.08 - $33.85 an hour
8 days ago

Benefits

Paid parental leave
Caregiver leave
AD&D insurance
Disability insurance
Dental insurance
Tuition reimbursement
Adoption assistance
Parental leave
Vision insurance
401(k) matching
Gym membership

Qualifications

Contract documentation review
Contract review
Medical office experience
Basic math
Contract interpretation
High school diploma or GED

Full Job Description

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
Professional Growth Opportunities: Advance your career with ongoing training and development programs.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP)
Health/Vision/Dental insurance
6 weeks paid parental leave for new mothers and fathers
Fertility/Adoption assistance
2 weeks paid caregiver leave
401(k) plan matching up to 5%
Tuition reimbursement
Health & fitness benefits, discounts and resources

Job Summary

The AICK Claims Specialist will administer, review, and approve or deny all types of claims, for the products marketed by AICK, to include Waiver of Premium, Term Life, Accidental Death & Dismemberment, Short Term Disability, Long Term Disability, Living Benefit Rider, Ordinary Life, Yearly Renewable Term, all Voluntary Life and Accidental Death & Dismemberment coverage. This position also plays a part in helping develop new products, answering questions regarding how the provisions of a policy are administered and serving on Ad Hoc teams representing AICK as needed.

"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

Review, investigate, and adjudicate all claims (approval or denial) by verifying eligibility, coverage, and contract provisions, including obtaining additional information from employers, hospitals, reinsurers, and other external partners.
Ensure claim handling complies with all regulatory requirements, including ERISA, NAIC unfair claims practices, and applicable state regulations, and that claims are processed within statutory timeframes with appropriate documentation.
Interpret and apply policy provisions, reinsurance treaties, and group contracts to determine claim payability, reinsurer liability, and continuation of liability; partner with reinsurers to confirm determinations.
Conduct in-depth investigations on complex or questionable claims, including coordinating with investigators or rehabilitation specialists and preparing documentation for potential legal proceedings when required.
Manage disability claims lifecycle, including review and processing of continuance requests, evaluation of treatment plans, and assessment of rehabilitation or return-to-work options.
Communicate claim decisions and policy provisions clearly to claimants, employers, attorneys, and regulatory bodies via phone and written correspondence, including responses to denials and inquiries.
Manage overpayment recoveries and collections, including establishing and monitoring repayment arrangements with claimants.
Maintain accuracy of claim accounts and systems by verifying reports, reconciling balances, making necessary adjustments, and approving claims for payment per guidelines.
Research and respond to State Insurance Department complaints, implement corrective actions as needed, and maintain required complaint logs in compliance with regulatory standards.
Support contract updates and product development initiatives by collaborating across departments, participating in Ad Hoc teams, and identifying operational or compliance improvement opportunities.
Compile and report required financial and operational data, including Schedule F for the Annual Statement, management reports (e.g., claim processing time, paid claims, closed claims), and other required reporting (FICA, W-2/W-3).
Participate in system testing for claims payment platforms, including validation of new releases and defect fixes.

What you need

Knowledge/Skills/Abilities

Ability to analyze detailed contract provisions and make decisions based on a set of facts or criteria.
Excellent written and verbal communication skills.
Extensive knowledge of ERISA/FICA regulations preferred.
High aptitude for math.

Education and Experience:

High school diploma or equivalent required.
Licensed Practical Nurse, Certified Nurses Aid or Certified Medical Aid license required
Minimum of 2 years experience in a professional, clinical, or as a medical office coordinator with billing experience required.
Minimum of 1 years' experience working with Kansas Department of Insurance regulations for life and/or disability products preferred.

Physical Requirements

Ability to lift and carry up to 25 pounds.
Ability to stand or sit for extended periods.
Ability to look at a computer screen for prolonged periods.
Occasional walking, bending, or reaching within the office environment.
Ability to bend, kneel, stoop, or reach.
Ability to perform repetitive tasks.

Compensation

$27.08 - $33.85 hourly

Non - Exempt Grade 13

Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Apply Now

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