WVU Medicine

Claims Specialist

🌐
Worldwide
Post a Job
Affiliates
❌ Jobs You've Hidden
⭐️ Saved Jobs
✅ Applied Jobs
Account
This job opening is no longer available.
Similar Jobs
Commercial Property Claims Examiner III

🕒 March 7

California FAIR Plan Association

51 - 200

Website
LinkedIn
All Job Openings

Commercial Property Claims Examiner managing and authorizing complex commercial insurance claims investigated by independent adjusters. Focusing on claims over $500,000 with a detailed examination process.

🇺🇸 United States – Remote

💵 $95k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Field Property Claims Adjuster

🕒 March 5

Federated Insurance

1001 - 5000

Website
LinkedIn
All Job Openings

Field Property Claims Adjuster investigating, negotiating, and resolving property claims for clients affected by disasters. Role involves supporting clients remotely and requires frequent travel to major airports.

🇺🇸 United States – Remote

💵 $70.2k - $85.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Healthcare Claims Specialist

🕒 March 4

Evry Health

51 - 200

⚕️ Healthcare Insurance

🤝 B2B

🧘 Wellness

Website
LinkedIn
All Job Openings

Claims Specialist responsible for end-to-end claims adjudication for a health insurance company. Verifying claims and ensuring compliance with regulations in a remote capacity.

🇺🇸 United States – Remote

💵 $55k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Claims Analyst

🕒 March 4

Compre Group

51 - 200

Website
LinkedIn
All Job Openings

Claims Analyst managing direct insurance claims for Compre, a global specialty reinsurance company. Responsibilities include oversight of complex claims and exposure to coverage analysis.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Claims Examiner, Bodily Injury, Lit Required, Auto

🕒 March 4

Sedgwick

10,000+ employees

🏢 Enterprise

📋 Compliance

Website
LinkedIn
All Job Openings

Claims Examiner managing complex auto bodily injury claims for Sedgwick. Analyzing coverage, liability, and damages with vendor coordination for investigations.

🇺🇸 United States – Remote

💵 $75k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

Search More Claims Specialist Jobs
🌐
Worldwide
Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com
Search
Search Jobs by country
Search jobs by city
Search jobs by job title
Search entry-level jobs
Search junior-level jobs
Search senior-level jobs
Search jobs by tech stack
Search jobs by contract type
Search remote internships
Search remote part-time jobs
Remote jobs Anywhere in the World
Companies Hiring Anywhere in the World
Companies Hiring Sales People Anywhere in the World
Companies Hiring Software Engineers Anywhere in the World
Resources
Advice
Tips for finding remote jobs
Interview questions and answers
Resume examples
Cover letter examples
Post a job
Affiliates
Privacy policy
Terms of service
Job board SEO course
AI Apply Copilot
OpenClaw job finder
Jobs by Country
Remote jobs anywhere in the world (Worldwide remote jobs)
Remote jobs United States
Remote jobs Australia
Remote jobs Brazil
Remote jobs Canada
Remote jobs France
Remote jobs Ireland
Remote jobs Germany
Remote jobs Netherlands
Remote jobs Spain
Remote jobs UK
Popular Jobs
Remote data analyst jobs
Remote customer support jobs
Remote executive assistant jobs
Remote marketing jobs
Remote product designer jobs
Remote product manager jobs
Remote project manager jobs
Remote recruiter jobs
Remote sales jobs
Remote software engineer jobs
Jobs by Type
Remote full-time jobs
Remote part-time jobs
Remote contract jobs
Remote internship jobs
Remote entry-level jobs
Remote jobs with no experience required
Remote junior jobs (1-3 years of experience)
Digital nomad jobs
Remote jobs with no degree required
Freelance remote jobs
Temporary remote jobs
Remote jobs hiring now
Stay at home mom jobs

Senior Insurance Claims Specialist

Human Resources

• Responsible for maintaining positive and effective employee/labor relations practices and support with assigned departments
• Develops, coordinates, and maintains policies, programs and training regarding all Human Resources functions with emphasis in employee/labor relations
• Assists and advises hospital and management staff on employee and labor relations issues
• Develops and recommends employee relations practices to maintain positive employer/employee working relationships
• Investigates employee issues/problems utilizing sound judgment consistent with organization policies
• Receives and reviews grievance statements and written responses
• Serves as the HR representative on the Harassment Committee

Employee & Labor Relations Consultant

Director

• Ensure licensure is completed within 100 days of hire
• Engage in responsibilities that necessitate a pharmacist's license once full licensure is obtained
• Oversee pharmacy administration duties in a health-system environment
• Collaborate with healthcare professionals to ensure quality pharmacy services
• Manage compliance with accreditation standards

Director of Pharmacy

Analyst

• Responsible for the technical EPIC HB contract build and modeling functions including the Hyperdrive, Text, and Data Courier environments.
• Responsible for design, development and testing of reports using innovative techniques, analyzing data from various sources and systems.
• Prepare accurate data analysis in order to communicate with regulatory agencies, contracted payers and internal leadership.
• Build and maintain advanced Microsoft Excel contract models in order to meet the functional needs of staff and streamline process flow.
• Recommend and implement technical solutions to assist in planning, streamlining and decision making.
• Maximize reimbursement by analyzing contract variances, new technology, denial trending, payment variance trending and regulatory changes.
• Use of performance improvement, project management and technology skills.

Systems and Contracts Analyst

Medical Billing and Coding

• Serves as lead responsible for monitoring, maintaining and coordinating work assignments.
• Performs ongoing audits of select inpatients and outpatient accounts.
• Provides training to ensure optimum reimbursement and hospital coding compliance.
• Ensures accurate and appropriate information is documented, coded, and entered into the system(s).
• Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment.

Lead Coding Specialist

Accountant

• Performs a wide range of professional accounting functions in accordance with Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP) to support the month-end financial statement process of Peak Health entities.
• Completes documentation and schedules during month-end, budget preparation, and external audit.
• Prepare quarterly and annual statutory reporting, filings, and compliance tasks.
• Provides financial guidance to department managers to help control costs and provide organization-wide efficiencies.
• Aid in the planning and build out of statutory quarterly and annual financial statements.
• This may include the coordination and preparation of all footnote disclosures, management discussion and analysis, and internal controls.
• Tracking, managing, and submitting all U.S. (State based and NAIC) Finance related regulatory fees and filings.
• Making, recording, and reconciling government business capitated payments.
• Prepare and file State-Specific Finance Forms and supplements including various schedules.
• Monitor due dates and ensure timely compliance with state filing deadlines pertaining to Finance filings.
• Track and submit renewals, fees, and changes in company information to each state regulator.
• Coordinate with regulatory reporting function to ensure Finance accountabilities align with overall regulatory filing calendar.
• Corresponding with regulators proactively as needed.
• Partner with applicable parties to ensure proper support of general ledger data/applications supporting external statutory accounting and financial reporting.
• Reconcile and explain GAAP vs STAT differences, particularly in areas like loss reserves and premium recognition.
• Manage risk-based capital (RBC) calculations, asset admissibility, and premium deficiency testing.
• Oversee reinsurance accounting, including ceded/assumed premiums and recoverables.
• Support loss reserve development, including IBNR estimation and actuarial collaboration.
• Respond to state regulatory inquiries to support routine financial inquiries.
• Analyze underwriting results and trends impacting statutory profitability.
• Reconcile cash accounts associated with claim disbursements associated with government products.
• Accountable for ensuring governmental products premium billing process is accurate.
• Reconciling Medicare Advantage Prescription Drug payable and receivables, including cost sharing programs and rebates.
• Assist in accounting and treasury management of the investment portfolio.
• Coordinate with the tax department in accounting for and transacting various regulatory taxes.
• Supporting the accounting classification of expenses between Medical and Administrative.
• Supporting the development of regulatory rate setting, by assisting in the provision of administrative expense actual and projections.
• Support the filing of various regulatory financial schedules and attestations, including but not limited to MLR filings, Medicare DIR filings, etc.
• Coordinate with the Actuarial and Operational Analytic functions to maintain risk adjustment accruals.
• Develop strong relationships with Department managers to help coordinate and monitor financial controls over the organization’s cost centers according to approved budget guidelines.
• Coordinate accounting and financial processes to maximize efficiency in the daily accounting operations. Ensure that internal control measures are being followed.
• Maintain general ledgers to complete and submit accurate financial data during month-end process according to predetermined deadlines.
• Lead and coordinate month end variance analysis.
• Oversee and review month end general ledger reconciliations.
• Directly supervise the work and development of assigned Accounting Department staff.
• Coordinate other staff duties to accomplish department goals and objectives. Delegate projects/duties, as necessary.
• Develop and submit analytical financial data as needed by department director/manager.
• Assist in completing and compiling financial support documentation for budget and external audit purposes.
• Assist in coordination of the budget and external audit review.
• Train new personnel and monitor their progress.
• Participate in educational opportunities as provided by Peak Health to enhance skill related abilities.
• Complete other duties as assigned by manager.
• Support performance improvement and quality assurance initiatives.

Senior Accountant – Statutory

• Develop strong relationship with Department managers to help coordinate and monitor financial controls over the organization’s cost centers according to approved budget guidelines.
• Coordinate accounting and financial processes to maximize efficiency in the daily accounting operations.
• Maintain general ledger in order to complete and submit accurate financial data during month-end process according to predetermined deadlines.
• Lead and coordinate month end variance analysis.
• Oversee and review month end general ledger reconciliations.
• Oversee the work and development of assigned Accounting Department staff.
• Coordinate other staff duties to accomplish department goals and objectives. Delegate projects/duties as necessary.
• Develop and submit analytical financial data as needed by department director/manager.
• Assist in completing and compiling financial support documentation for budget and external audit purposes.
• Assist in coordination of the budget and external audit review.
• Train new personnel and monitor their progress.
• Participate in educational opportunities as provided by the hospital to enhance skill related abilities.
• Support performance improvement and quality assurance initiatives.
• Ensure duties of specialty focus are completed accurately and timely (i.e., monthly financial statements, consolidated financial statements, bonds, cash flow projections, etc.)

Senior Accountant – SMG

Manager

• Oversees the denial and appeal processes for the health system
• Provides leadership to the clinical denial coordinators and assigned staff
• Prioritizes, analyzes, and develops process improvement initiatives to reduce risk of revenue loss
• Works in collaboration with the Clinical Financial Integration team to ensure appropriate revenue capture for the system

Manager, Clinical Denials

• Ensure accurate and appropriate coding classification to meet departmental, hospital and agency requirements.
• Obtain accurate documentation in the medical record for coding assignment.
• Code moderately complex patient classes (i.e. ED, observations, same day care).
• Review and accurately interpret medical record documentation to assign ICD-10, CPT, or modifier codes.
• Assure quality and timely coding, charging, and abstraction is completed for assigned areas.
• Maintain current coding knowledge through various educational methods.
• Contact physicians to obtain necessary information for coding assignments.

Coding Specialist II, Day Surgery

• Codes inpatient and/or IRAD 90% of current FTE status.
• Reviews and accurately interprets medical record documentation from all hospital accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10-CM, ICD-10-PCS, CPT, or modifier codes for each diagnosis and procedure that is identified (inpatient and IRAD).
• Ensures appropriate MS-DRG assignment based on accurate ICD-10-CM and ICD-10-PCS coding assignment and medical record documentation.
• Assigns hospital codes to a variety of patient classes (i.e. I/P, IRAD, etc.).
• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
• Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
• Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
• Contacts physicians or any persons necessary to obtain information required for to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.

Inpatient Hospital Coding Specialist III

• Support the operational efficiency of the Pharmacy Department by coordinating fiscal management activities.
• Perform data analysis and maintain departmental statistics and reports.
• Coordinate accounting and financial processes to maximize efficiency in daily operations.
• Review medication purchases, revenue, and contract pharmacy fees.
• Generate reports related to current expenses as the basis for the budget.
• Assist in completing financial documentation for budget and audits.

Pharmacy Analyst – 340B

Administration

• Manage all scheduling and timekeeping functions for WVU Medicine’s Staffing Solutions Program
• Receive and respond to communication outside of normal business hours
• Manage multiple commitments to hit payroll deadlines
• Handle timekeeping functions including obtaining, entering, and posting schedules
• Ensure all incentives are tracked, entered, and updated according to each facility’s offerings
• Maintain open lines of communication with staff to manage schedules and answer inquiries
• Collaborate with cross-functional teams and share documents efficiently

Scheduling & Timecard Administrator – Specialist

Operations

• Assists in most aspects of drug distribution under the supervision of a pharmacist
• Responsible for preparing unit-dose medications and delivering medications
• Reads physician orders/prescriptions and prepares medication for dispensing
• Communicates with patients or care givers regarding medication delivery and pick-up
• Maintains inventory and supplies in assigned pharmacy service areas
• Ensures that pharmacy service areas are clean and orderly

Community Pharmacy Operations Technician, Part-Time

• Assists in drug distribution under pharmacist supervision
• Prepares unit-dose medications and medication for dispensing
• Communicates with patients regarding medication and schedules
• Takes inventory and maintains supplies in pharmacy service areas