Insurance Claims Coordinator jobs in Charleston, WV

Insurance Claims Coordinator is responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of insurance claims for an organization. Acts as a liaison between the organization, its insurance provider and agents, claimants, and policy holders regarding the status and eligibility for coverage for all relevant claims. Being an Insurance Claims Coordinator reviews claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries, and makes recommendations for resolution. Typically requires an associate degree or its equivalent. Additionally, Insurance Claims Coordinator typically reports to a manager. The Insurance Claims Coordinator gains or has attained full proficiency in a specific area of discipline. Works under moderate supervision. To be an Insurance Claims Coordinator typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)

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Technical Coordinator, Claims Systems and Analytics
  • Encova Insurance
  • Charleston, WV FULL_TIME
  • The salary range for this job posting is $75,561.00 - $120,899.00 annually bonus benefits

    The above represents the salary range for this job requisition. Ultimately, in determining your pay, we'll consider your location, education, experience, and other job-related factors. Your recruiter can share more information about the specific salary range during the hiring process.

    This position may either work remote in our listed states or a hybrid schedule in the Charleston, West Virginia office. The position will report to the Director, Claims Systems and Analytics.

    JOB OBJECTIVE:

    The Technical Coordinator, Claims Systems and Analytics develops and performs statistical analyses using company data for the purpose of measuring claims outcomes. Utilizes industry standard reporting tools to establish claims dashboards and tools for the purpose of determining strategy and focus. Develops and implements predictive modeling tools and resources to assist the claims disciplines in early identification of red flags and strategy recommendations. Develops and assists in the implementation of new business requirements for new products, systems, and jurisdictions. This position serves as the administrator of the claims quality review system; and provides quarterly and annual analytics for the purposes of identifying areas that need improvement on the individual and team level. Ensures our products and systems are in regulatory compliance, efficient for the end user, and produces accurate calculations. This position utilizes expert knowledge of regulatory and jurisdictional requirements combined with innovative thinking to build systemic processes and effective claims management tools. This position analyzes quantitative and qualitative business indicators, makes recommendations for continuous improvement, and makes technical decisions in accordance with delegated authority.

    ESSENTIAL FUNCTIONS:

    • Develop claims expertise to regional business teams and other staff in areas such as policy, strategies, technical approaches, development of products and services, rules, filings, processes and workflows (including automation and business rules), regulatory compliance, and market conduct matters.
    • Collaboratively manage system and data-related projects - including business requirements and timelines - that impact process, procedure, and best practices.
    • Provide direction in the development of claims related tools and systems.
    • Participate in the development and implementation of strategic and tactical product and system development initiatives based on trend monitoring, feedback from internal and external stakeholders.
    • Present to and train internal and external stakeholders on product and service introductions, enhancements, and associated processes. Must demonstrate a solid understanding of the impact to internal and external stakeholders. Assist in the development of appropriate supporting materials.
    • Gather and analyze our internal products, service product and service trends/results (internal) and make recommendations for new and revised products, and processes.
    • Create innovative solutions using trend analysis; work with other disciplines to gather input regarding product and service changes and ideas.
    • Effectively develop and utilize available data to make appropriate product and service development decisions and recommendations.
    • Assist in the development of guidelines, policies and procedures that address identified business needs and support the achievement of business results. Determine system impacts resulting from process introductions or changes.
    • Bring a solid understanding of compliance issues and regulatory environment in all project development and implementation.
    • Identify and investigate compliance/regulatory issues and concerns. Develop and recommend appropriate business solutions and/or strategies based on those issues and analytical outcomes.
    • Create and maintain other necessary claims administrative instructions and policy.

    OTHER FUNCTIONS:

    • Other duties as assigned.

    KNOWLEDGE, SKILLS AND ABILITIES:

    • Bachelor's degree in Actuarial Science, Mathematics, Statistics, Business or related studies preferred.
    • A minimum of one year of actuarial or analytical experience is preferred.
    • Proficiency in Tableau or similar data tools preferred.
    • Spreadsheet and database proficiency desired.
    • Proficiency in SAS or SQL preferred.
    • The preferred candidate has an ongoing pursuit of actuary or analytical credentials.
    • Excellent written and oral communication skills needed.
    • A minimum of five years full-time or equivalent part-time paid experience with an insurance carrier or equivalent program is preferred.
    • Project management experience preferred.
    • Ability to analyze data to form general rules or conclusions.
    • Ability to understand and communicate regulatory requirements and develop claims best practices.
    • Ability to use relevant information and sound judgment to determine whether processes or decisions comply with regulations or standards.
    • Ability to work, coach, and mentor effectively in a team environment.
    • Ability to establish and maintain effective working relationships with others.
    • Ability to use logic and reasoning to identify problems, review related information and to analyze and compare alternative solutions, conclusions, or approaches, and to implement solutions and/or make improvements.
    • Ability to learn and understand the form and content of insurance policies.
    • Exceptional written and oral communication skills for use in internal team interaction and in collaboration with other business units for information gathering, reporting results, training, etc.
    • Excellent analytical, research, and documentation skills.
    • Ability to read, interpret, train and systematically apply regulatory requirements for a multi-state book of business.
    • Ability to read and interpret financial statements.
    • Ability to analyze and evaluate specific complaints and inquiries regarding claim-related issues such as benefit rates, medical authorization decisions, claims regulatory compliance, and timeliness of claim-related decisions.
    • Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
    • Ability to become knowledgeable in the design, implementation and interfaces of systems and applications.
    • Ability to apply confidentiality when appropriate.
    • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
    • Ability to work effectively in a paperless environment.


    This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.

    Ready to join our team?
    At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities.

    Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential.

    What you can expect from us
    Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations.

    Encova Insurance is an EOE/E-Verify employer.

     

  • 1 Month Ago

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Independent Insurance Claims Adjuster in Moundsville, West Virginia
  • MileHigh Adjusters Houston Inc
  • Moundsville, WV FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 1 Month Ago

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Independent Insurance Claims Adjuster in Beckley, West Virginia
  • MileHigh Adjusters Houston Inc
  • Beckley, WV FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 1 Month Ago

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Independent Insurance Claims Adjuster in Hurricane, West Virginia
  • MileHigh Adjusters Houston Inc
  • Hurricane, WV FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 1 Month Ago

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Independent Insurance Claims Adjuster in Saint Albans, West Virginia
  • MileHigh Adjusters Houston Inc
  • Saint Albans, WV FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 1 Month Ago

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Medical Biller - Beckley WV
  • Priority Medical Claims
  • Beckley, WV FULL_TIME
  • About usPriority Medical Claims is a medical billing company focused on EMS and Ambulance claim processing. We are looking for a full time medical biller with strong skills in the claim follow up area...
  • 4 Days Ago

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0 Insurance Claims Coordinator jobs found in Charleston, WV area

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Senior Life Insurance Agent - Virtual
  • Pope Insurance Group (A Security National Life Insurance Company Agency)
  • Charleston, WV
  • **THIS POSITON REQUIRES THAT YOU HOLD A LIFE INSURANCE PRODUCERS LICENSE** We are actively hiring licensed agents who ha...
  • 3/28/2024 12:00:00 AM

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INSURANCE AGENT - REMOTE
  • The Gardner Agency Group
  • Charleston, WV
  • Are you looking to take your career in a new direction or are you already a licensed insurance agent? At The Gardner Age...
  • 3/28/2024 12:00:00 AM

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Licensed WV Life Insurance Agent for Security National
  • Pope Insurance Group (A Security National Life Insurance Company Agency)
  • Huntington, WV
  • *This position of for currently licensed agents only. No Exceptions* Do not apply if you do not have an insurance produc...
  • 3/28/2024 12:00:00 AM

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Remote Insurance Sales - LICENSED AGENT
  • MBB CONSULTING, INC (SFG)
  • Huntington, WV
  • MBB Consulting is a dynamic and growing insurance company that values its employees and invests in their success. With a...
  • 3/28/2024 12:00:00 AM

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Customer Service Representative
  • Qonten
  • Huntington, WV
  • **Customer Service Representative** - | Fri, 04 Mar 2022 22:20:29 GMT In the process, youll develop experience with a br...
  • 3/27/2024 12:00:00 AM

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Life Insurance Sales Agent Remote
  • Lagniappe Agency (Symmetry Financial Group)
  • Charleston, WV
  • Organization Description: No Cold Calling. Unique Sales and Ownership Opportunity. Commission Only Position Are you some...
  • 3/25/2024 12:00:00 AM

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Remote Insurance Agent
  • Dorr Agency
  • Huntington, WV
  • Looking for your last career stop? Interested in an industry change? Seeking work-life balance? The Dorr Agency is seeki...
  • 3/25/2024 12:00:00 AM

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Scheduler (Guam)
  • Planate Management Group
  • Charleston, WV
  • Planate Management Group (PMG) is a Service-Disabled Veteran-Owned Small Business (SDVOSB) headquartered in Alexandria, ...
  • 3/24/2024 12:00:00 AM

Charleston is the most populous city in, and the capital of, the U.S. state of West Virginia. Located at the confluence of the Elk and Kanawha rivers, the population during the 2017 Census Estimate was 47,929. The Charleston metropolitan area as a whole had 214,406 residents. Charleston is the center of government, commerce, and industry for Kanawha County, of which it is the county seat. Early industries important to Charleston included salt and the first natural gas well. Later, coal became central to economic prosperity in the city and the surrounding area. Today, trade, utilities, governm...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Insurance Claims Coordinator jobs
$45,021 to $68,363
Charleston, West Virginia area prices
were up 1.2% from a year ago

Insurance Claims Coordinator in Wilmington, DE
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December 22, 2019
Insurance Claims Coordinator in New Orleans, LA
Resource Solutions are recruiting for two Claim Technicians to work for a insurance provider in their office in Chelmsford.
February 10, 2020
Insurance Claims Coordinator in Bellingham, WA
This individual will review all claims and make coverage decision.
January 31, 2020