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Claims examiner Jobs in Arlington, TX

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Claims examiner • arlington tx

Last updated: 1 day ago

Claims Auditor Lead

Elevance HealthGrand Prairie, TX, United States
Full-time

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.This... Show more

Risk Manager

TradeJobsWorkforce76002 Arlington, TX, US
Full-time

Risk Manager job responsibilities: Leads the identification, communication, measurement, and management o... Show more

 • Promoted

Registered Dental Assistant

Pleasant DentalEuless, TX, US
$20.00 hourly
Full-time

We are seeking a dynamic and organized Office Manager to join in our General Dental office.The ideal candidate will be responsible for overseeing the daily operations of our office, ensuring effici... Show more

Account Associate - State Farm Agent Team Member

Rodolfo Perez - State Farm AgentArlington, TX, US
$45,000.00 yearly
Full-time

As Account Associate - State Farm Agent Team Member for Rodolfo Perez - State Farm Agent, you are vital to our daily business operations and customers’ success.You grow our agency through meaningfu... Show more

Claims and Risk Manager

Quanta ServicesGrand Prairie, TX, United States
Full-time

NorthStar Energy Solutions is hiring! The Claims & Risk Manager is responsible for leading NorthStar Energy Solutions' incident-to-claim lifecycle, working directly with the Safety and Regional Ris... Show more

Claims Research Specialist - State National

MarkelBedford, TX, United States
Full-time

Join Us And Play Your Part In Something Special.The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community o... Show more

Remote Insurance Experts - AI Trainer ($50-$60 per hour)

MercorHurst, Texas, US
Remote
Full-time

Role Overview** - Mercor is seeking senior insurance professionals to build evaluation tasks for AI systems operating in Fortune 500 enterprise insurance and risk contexts.The workflows are calibra... Show more

Human Resources Generalist

Professional Packaging SystemsGrand Prairie, TX, US
$65,000.00–$70,000.00 yearly
Full-time

Professional Packaging Systems (Pro Pac) is looking for individuals who have a strong professional ethic, are passionate about innovating for positive change, and are collaborative team players.We ... Show more

Sr Claims Specialist | Liability Bodily Injury

Great West Casualty CompanyArlington, TX, United States
Full-time

Liability Claims Adjuster - Bodily Injury.Liability Claims Adjuster, with a focus on being a litigation specialist for the region, you will investigate, evaluate, negotiate, and resolve complex bod... Show more

Arbitrator I

TPI Global (formerly Tech Providers, Inc.)Euless, TX, US
Full-time
Quick Apply

Job Location: Euless, TX/ Matteson, IL/ Hybrid.Project Duration: 6 months with possible extension.Hybrid Schedule: Monday & Friday REMOTE, Euless office Tuesday - Thursday.Initial training may ... Show more

Life Insurance Position - State Farm Agent Team Member

Elitha Moses - State Farm AgentArlington, TX, US
$45,000.00 yearly
Full-time

Elitha Moses - State Farm Agent is seeking a qualified and empathetic professional for the role of Life Insurance Position - State Farm Agent Team Member.As a customer-oriented expert, you will mar... Show more

Construction Scheduler

Polk MechanicalGrand Prairie, TX, United States
Full-time

Develop, maintain, and update detailed project schedules (baseline and updates) using Primavera.Monitor schedule progress, identify critical path activities, and recommend corrective or recovery ac... Show more

Customer Service Representative

The Reeves AgencyBedford, TX, US
$36,000.00–$50,000.00 yearly
Full-time

Insurance Customer Service Representative.This role involves addressing inquiries, resolving issues, and offering support on a variety of insurance-related matters.Establish customer relationships ... Show more

Risk Manager

TradeJobsWorkForce76096 Arlington, TX, US
Full-time

Risk Manager Job Duties: Leads the identification, communication, measurement, and manag... Show more

 • Promoted

General Liability and Auto Liability Adjuster II

AS&G Claims AdministrationArlington, TX, United States
$70,000.00–$75,000.00 yearly
Full-time

Experienced Liability Adjuster.AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, manage... Show more

Account Associate - State Farm Agent Team Member

Reinhardt State Farm AgencyBedford, TX, US
$65,000.00 yearly
Full-time

As Account Associate - State Farm Agent Team Member for Reinhardt State Farm Agency, you are vital to our daily business operations and customers’ success.You grow our agency through meaningful cus... Show more

Sr. Program Client Services Analyst (Accounting/Finance) - State National

Markel Service Inc.Bedford TX
Full-time

What part will you play? If you’re looking for a place where you can make a meaningful difference, you’ve found it.The work we do at Markel gives people the confidence to move forward and seize opp... Show more

Insurance Account Position - State Farm Agent Team Member

Alejandra Palomera - State Farm AgentArlington, TX, US
$35,000.00 yearly
Full-time

Producer who can recognize opportunities and strategically turn leads into long-lasting customer relationships.As our sales representative, your knowledge of insurance products and industry trends ... Show more

Claims Coordinator/Receptionist

ServiceMaster Restore 6717 - North Richland HillsRichland Hills, TX, US
$17.00–$20.00 hourly
Full-time +1

ServiceMasterTEAM – Water, Fire & Smoke Damage Restoration; FULL SERVICE RESTORATION.Backed by a nationally recognized brand and industry-leading standards, we deliver compliant, high-quality r... Show more

Claims and Risk Manager

AmpacityGrand Prairie, TX, United States
Full-time

NorthStar Energy Solutions is hiring! The Claims & Risk Manager is responsible for leading NorthStar Energy Solutions' incident-to-claim lifecycle, working directly with the Safety and Regional Ris... Show more

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The cities near Arlington, TX that boast the highest number of claims examiner jobs are:
Claims Auditor Lead

Claims Auditor Lead

Elevance HealthGrand Prairie, TX, United States
1 day ago
Job type
  • Full-time
Job description

Claims Auditor Lead

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit.

Primary duties may include, but are not limited to:

  • Responsible for all team training including but not limited to new hires, cross training, new product and system enhancements.
  • Conducts audits for new hires and/or any team member learning a new skill.
  • Reviews, interprets and maintains records of quality and productivity for entire team.
  • Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized correctly.
  • Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.
  • Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.
  • Independently analyzes and makes decisions on complex claim audit issues.
  • Serves as subject matter expert on policy, workflow and technical questions.
  • Interfaces with all levels of support including but not limited to production support, medical management, provider/vendor contracting and other audit teams.
  • Partners with Management on complex claims reviews and resolution.
  • Responsible for reviewing and resolving shared mailbox issues.
  • Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.
  • Manages projects as assigned and may work across different platforms or lines of business.
  • Reviews and responds to external audit requests.
  • Performs audit reviews of and may adjudicate complex high dollar claims by completing an end to end audit with final approval authority.

Minimum Requirements:

Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.

Preferred Requirements:

  • Proficiency in Microsoft Office Suite is highly preferred.
  • Commercial Claims experience is highly preferred
  • CI&W and WGS experience is highly preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: CLM > Claims Support