Claims Director jobs in North Dakota

Claims Director directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements. Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Claims Director is responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Additionally, Claims Director provides expert guidance and consultation to staff on the most complex claims. Requires a bachelor's degree. Typically reports to top management. The Claims Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Claims Processor
  • Highmark Health
  • ND, ND FULL_TIME
  • Description

    JOB SUMMARY

    This job is responsible for screening, reviewing, evaluating online entry, correcting errors and / or performing quality control review and final adjudication of paper / electronic claims.

    Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information;

    may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal / external audits, member / provider phone calls, other insurance information received, appeals, and system changes, etc.

    provides technical assistance in researching and resolving inquiries.

    ESSENTIAL RESPONSIBILITIES

    • Receives and processes claims to include entering / verifying claims data; determines if claim information is complete and correct.
    • Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment levels to arrive at final payment determination.
    • Elevates issues to next level of supervision as appropriate and ensures a professional line of communication is maintained with internal and external customers.
    • Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff / management.

    Maintains accurate records, including timekeeping records and attends all required training classes.

    Other duties as assigned or requested.

    EDUCATION

    Required

    High School Diploma / GED

    Substitutions

    None

    Preferred

    None

    EXPERIENCE

    Required

    1 year of related experience

    Preferred

    • 1 year of claims processing experience
    • Inquiry resolution system, OCWA, Oscar, Outlook experience

    LICENSES or CERTIFICATIONS

    Required

    None

    Preferred

    None

    SKILLS

    • Strong verbal and written communication skills.
    • Ability to take direction and to navigate through multiple systems simultaneously.
    • Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
    • Ability to use mathematics to adjudicate claims.
    • Ability to solve problems within pre-defined methods and guidelines.
    • Knowledge of operating systems specific to claim processing.
    • Ability to review claims and analyze critical data.
    • Reading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims.
    • Researches and finalizes claims, adjustments, inquiries and reports as required.

    Language (Other than English) :

    None

    Travel Requirement : 0% - 25%

    0% - 25%

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office-based

    Teaches / trains others regularly

    Never

    Travel regularly from the office to various work sites or from site-to-site

    Never

    Works primarily out-of-the office selling products / services (sales employees)

    Never

    Physical work site required

    Lifting : up to 10 pounds

    Constantly

    Lifting : 10 to 25 pounds

    Occasionally

    Lifting : 25 to 50 pounds

    Never

    Pay Range Minimum : $16.50

    $16.50

    Pay Range Maximum : $22.20

    $22.20

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation / gender identity or any other category protected by applicable federal, state or local law.

    Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation / gender identity, protected veteran status or disability.

    EEO is The Law

    Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()

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    For accommodation requests, please contact HR Services Online at

    Less than 1 hour ago
  • 21 Days Ago

C
Claims Representative
  • CPKC
  • Enderlin, ND FULL_TIME
  • Canadian Pacific (CP) and Kansas City Southern (KCS) are now CPKC. As the only truly North American railway, we are making big moves Drawing on our strong foundations and heritage, CPKC moves essentia...
  • 2 Days Ago

C
Claims Representative
  • Canadian Pacific Kansas City
  • Enderlin, ND FULL_TIME
  • PURPOSE OF THE POSITION:Provide 24-hour emergency response to and investigate incidents involving employee injuries or third party injuries and/or property damage. Manage claims resulting from these i...
  • 8 Days Ago

F
Claims Adjuster
  • Farmers Mutual Insurance Company of Nebraska
  • Fargo, ND FULL_TIME
  • Farmers Mutual of Nebraska is seeking a Claims Adjuster in North Dakota - an exceptional individual who is intuitive, motivated, and skilled. We’re experiencing incredible growth and are on the search...
  • 9 Days Ago

C
Claims Investigator - Part Time
  • CoventBridge Group
  • Bismarck, ND PART_TIME
  • Overview Claims Investigator (Part-Time) Bismark, ND area Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it contin...
  • 22 Days Ago

C
Claims Investigator - Part Time
  • CoventBridge Group
  • Fargo, ND PART_TIME
  • Overview Claims Investigator (Part-Time) Fargo, ND area Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continue...
  • 23 Days Ago

A
Claim Director - Complex Specialty
  • Axis
  • New York, NY
  • This is your opportunity to join AXIS Capital a trusted global provider of specialty lines insurance and reinsurance. We...
  • 3/29/2024 12:00:00 AM

C
Claim Director-Westchester Casualty
  • Chubb
  • Jersey City, NJ
  • Job Description Scope The Westchester Casualty Claims Director is responsible for investigating and settling high exposu...
  • 3/29/2024 12:00:00 AM

S
Insurance Claims Director
  • Strategic Logistics
  • Goldsboro, NC
  • Job Description Job Description Express is now hiring for the below position. This will be a direct hire position. Start...
  • 3/28/2024 12:00:00 AM

B
Claims Director
  • Berkley
  • New York, NY
  • Company Details: Berkley Professional was founded in October 2008 as an operating unit of W. R. Berkley Corporation, one...
  • 3/27/2024 12:00:00 AM

C
Claim Director-Environmental
  • Chubb
  • Jersey City, NJ
  • Job Description Chubb is seeking a Claim Director on the Environmental Claims team on a 3/2 hybrid work model. The Envir...
  • 3/27/2024 12:00:00 AM

C
Sr. Claim Director - Aerospace
  • Chubb
  • Chicago, IL
  • Chubb seeks a Senior Claim Director on the Aerospace Casualty claims team that provides specialized claim handling on be...
  • 3/27/2024 12:00:00 AM

C
Claim Director - Life Sciences (Hybrid)
  • Chubb
  • Chicago, IL
  • Job Description Chubb is seeking a Claim Director for our Life Sciences Claims team. The Life Sciences Claims Team provi...
  • 3/27/2024 12:00:00 AM

C
Claim Director - Field Property Adjuster
  • Chubb
  • Austin, TX
  • Job Description We are currently looking for a Claim Director to handle property claims in the United States. The positi...
  • 3/25/2024 12:00:00 AM

North Dakota is a Midwestern state of the United States. It borders Canada and lies at the center of the North American continent. The geographic center of North America is near the town of Rugby. Bismarck is the capital of North Dakota, and Fargo is the largest city. Soil is North Dakota's most precious resource. It is the base of the state's great agricultural wealth. But North Dakota also has enormous mineral resources. These mineral resources include billions of tons of lignite coal. In addition, North Dakota has large oil reserves. Petroleum was discovered in the state in 1951 and quickly...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Director jobs
$176,086 to $254,659

Claims Director in Columbus, OH
McGinley, co-director of the Workplace Law Program at UNLV.
January 08, 2020
Claims Director in Port Arthur, TX
Work closely with Corporate leadership by providing guidance and assistance in all claims-related matters.
February 10, 2020
Claims Director in Benton Harbor, MI
Claims Process Manager ASI/Progressive Home is growing and we're looking for talented people to join our staff in our Claims Dept.
February 11, 2020