Insurance

• Lead and develop a high-performing Insurance and Claims Advocacy team
• Own program strategy, service delivery standards, and key performance indicators across insurance navigation and claims resolution
• Oversee resolution of complex medical billing and insurance issues
• Guide proactive insurance navigation
• Build and optimize scalable workflows
• Ensure accurate, audit-ready documentation and adherence to SOPs, regulations, and quality standards
• Partner cross-functionally to implement improvements, support growth, and elevate the member experience

Senior Manager, Insurance and Claims Advocacy

• Analyze payer payments to identify underpayments and reimbursement discrepancies by comparing paid amounts to contracted rates, fee schedules, and expected reimbursement
• Interpret and apply payer contract terms, guidelines, and reimbursement methodologies to ensure accurate payment outcomes
• Conduct detailed account analysis using strong analytical skills and persistence to resolve complex denials and payment variances
• Review accounts for credit balances and denials, determine root cause, and take appropriate corrective action (refund, adjustment, rebill, or appeal)
• Review and resolve credit balances across all payers, with priority on regulatory accounts (e.g., Medicare credit balance reporting)
• Submit timely, accurate appeals and process credit resolutions in alignment with payer and regulatory guidelines (including Medicare credit balance requirements)
• Ensure all account activity supports forward movement toward resolution with a one-touch mindset
• Maintain thorough, audit-ready documentation and accurate account notes
• Meet established productivity (APH) and quality standards while prioritizing high-risk, high-dollar, and timely filing accounts
• Collaborate cross-functionally to resolve issues and prevent recurrence
• Identify trends and escalate systemic issues, providing feedback for process improvement
• Initiate and track refunds, adjustments, and reapplications accurately and timely

Insurance Specialist – Credit Resolution

• Review self-pay accounts to verify insurance coverage.
• Analyze and resolve unpaid claims.
• Contact insurance carriers for claim status and payments.
• Research claims using online tools.
• Gather and submit supporting documentation to insurance carriers.
• Submit appeals when necessary.
• Review and apply contractual terms.
• Communicate with patients/guarantors to expedite claims.
• Assist with special projects and additional duties as needed.
• Ensure compliance with information security policies.
• Monitor inventory and provide reporting on open claims.
• Report security risks as per procedures.

Team Lead – Prior Auths, Insurance Verification

• Assessing the design and operating effectiveness of ITGC within SAP environments
• Evaluating the design and operational effectiveness of business process controls (BPC) within SAP applications
• Identifying control deficiencies, gaps, and areas for improvement within SAP systems
• Communicating audit findings, observations, and recommendations to client management
• Collaborating with client personnel to address questions, concerns, and recommendations related to SAP ITGC and BPC controls
• Staying abreast of emerging trends, technologies, and regulatory requirements related to SAP systems

IT Audit, Experienced Associate

• Join a growing network of independent agents
• Manage your own book of business
• Leverage extensive carrier relationships, training programs, technology platforms, and support teams

Licensed Health Insurance Agent

• Credit Controller on Collections for facultative, excess of loss and Pro Rata
• Liaising with Brokers to Chase up Cash
• Monthly Financial Reconciliations between different Hiscox Entities
• Update internal Systems with signings
• Assist in XOL and FAC processing
• Premiums & Claims Reporting – internal and external
• Assist with system developments

Reinsurance Technician

• Service on-going client needs
• Advise on insurance matters
• Conduct needs assessment
• Recommend solutions
• Answer inquiries
• Conduct care calls and process renewals
• Sell new policies/write new business to existing or new clients
• Retain existing book of business
• Quote new business through outbound call initiatives
• Contact Underwriters and Adjusters to discuss guidelines and policy
• Prepare documentation for insurers
• Complete applications for clients
• Issue insurance certificates
• Process changes and review renewals
• Keep current on underwriting rules and workflow processes
• Actively participate in training initiatives
• Process Account Receivable activities

Personal Insurance Advisor

• Perform and supervise larger, more complex assurance projects, including audits, reviews, and compilations
• Address complex accounting issues such as consolidations, deferred tax calculations, and going concern assessments
• Apply thorough knowledge of GAAP, GAAS, and other financial reporting frameworks to audit procedures
• Train, supervise, and delegate work to associates and interns to foster efficiency and team growth
• Review workpapers prepared by associates/interns, provide constructive feedback, and ensure conclusions are appropriate
• Customize audit strategies based on identified risks and ensure audit issues are addressed during planning and performance
• Analyze financial statements and disclosures for errors or omissions
• Prepare client correspondence, perform internal control walkthroughs, and handle client inquiries
• Contribute to engagement budgets and monitor performance against budgets
• Communicate effectively with team members and clients to address audit-related issues and project statuses
• Participate in department-wide training and independent learning to maintain and expand technical knowledge
• Demonstrate strong time management skills to meet deadlines and prioritize multiple engagements
• Perform other duties and display flexibility to take on a variety of responsibilities assigned by firm leadership
• Meet annual billable hour and other targets to fulfill individual performance and overall firm productivity

Senior Assurance Associate

• Make first contact with policy holder on the farm or ranch that has just experienced a loss
• Complete field inspections, read maps and aerial photos, measure fields and storage bins, collecting production records of farm commodities
• Assess damage or loss
• Stick with each claim for each grower until the work is done and the claim is settled
• Report to the Area Claims Supervisor and work regularly in the field on the farms
• Climb grain bins, walk over rough terrain for long distances
• Apply good judgment, common sense and understanding of ProAg's adjusting guidelines and policy provisions for a variety of Multi-Peril Crop Insurance, Crop Hail, and Named Peril policies
• Travel up to 75%, occasionally beyond your assigned territory

See all jobs on JobTailor

Senior Manager, Insurance and Claims Advocacy

Insurance Specialist – Credit Resolution

Team Lead – Prior Auths, Insurance Verification

Insurance Specialist – Credit Resolution

IT Audit, Experienced Associate

Licensed Health Insurance Agent

Reinsurance Technician

Personal Insurance Advisor

Senior Assurance Associate

Crop Insurance Adjuster