by twochickswithasidehustle | Sep 16, 2025 | Uncategorized
Company Description:
This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer service or customer facing position. This is a data entry position where you will be processing medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level. You will work independently with the assistance of knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.
Job Description:
What you will be doing as a Claims Examiner:
- Work independently, processing claims via data entry for 90% of your day.
- Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
- Follow up on claims needing additional information
- Refer problem claims to a Lead and/or auditor for additional review
- Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
- Work with specific software
- May be assigned special projects
When you join us, you’ll enjoy:
- Pay rate of $13.50/hour with the opportunity to bonus an additional $1500 a month.
- Medical, dental, and vision plans.
- Paid training and PTO (be sure to ask about our Global Flexible Vacation Policy).
- Company-provided equipment.
- Advancement opportunities – 80% of our frontline leaders have been promoted from within.
- Monthly rewards & recognition programs.
- Employee Discounts.
- EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
- Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.
Qualifications:
Skills
- Data entry
- Time management
- Attention to detail
- Analytical
Required Qualifications
- High School Diploma or equivalent
- Excellent Internet Connectivity:
- Internet access speed of 2 Mbps upload and 10 Mbps download – the faster the better.
- house network, and a hard-wired internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (Wireless and/or satellite Internet Service Providers are not compatible with our systems)
- A quiet and distraction-free, secure place to work
- Effective verbal and written communication skills
- Strong typing and analytical abilities
- Multi-tasking skills with a strong attention to detail
- Computer knowledge
- Minimum 40 words per minute on typing test
- Must have and maintain a clean and paper free work environment to meet our company policies.
- Medical Billing and Coding degree/certification.
- Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
- Knowledge of Medical terminology
Additional Information:
All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
by twochickswithasidehustle | Sep 12, 2025 | Uncategorized
General information
Job Posting Title
Quality Control / Quality Assurance Team Lead
Date
Wednesday, September 3, 2025
City
Remote
Country
United States
Working time
Full-time
Description & Requirements
Maximus is looking for a Quality Control / Quality Assurance Team Lead to support our DMCS program under our Department of Education portfolio. The Quality Control / Quality Assurance Team Lead will provide quality control reviews for functions supporting the Debt Management Collection Services (DMCS) program.
DMCS Contact Center Quality team is an essential part of the DMCS program. Its objective is to utilize operational techniques and activities to satisfy quality requirements. Quality includes activities aimed at the detection and correction of errors, faults, discrepancies and/or defects in products or services prior to delivery. QC activities generate testing or review results of work efforts and provide feedback that supports Quality Assurance (QA) and drives continuous improvement.
This is a Limited Service position. This position is temporary with an expected date of 12/31/2025.
Essential Duties and Responsibilities:
– Works on assignments that are moderately difficult, requiring judgement in resolving issues.
– Follow procedures and directions to assess the quality of service provided through monitoring incoming calls and other work types which focusing on the quality of customer service, accuracy of information provided, and adherence to established policies and procedures.
– Conduct call monitoring sessions to ensure workers are performing in accordance with established quality and performance standards.
– Provide feedback on call monitoring results.
– Evaluate recorded and/or transcribed interactions of a complex nature between the caller/chatter/correspondent and the worker, and provide appropriate context of ratings.
Additional Duties and Responsibilities:
– Assist the Quality processors in resolving questions concerning audits and Quality processes
– Ensure work is distributed to staff to ensure Performance Metric standards and Service Level Agreements are met
– Track daily completions and outstanding work balances and provide the data to Quality Supervisor
– Respond to data requests by providing supporting documentation and responding to disputes within specified timeframe
– Assist in creating and providing reporting and trending data to Business Operation and Training management to provide effective tools that allow departments to understand variances and make effective decisions around resource allocation and training needs
– Work with external auditors during periodic reviews and audits, assisting in preparation of annual audit schedules
– Monitor and evaluate correspondence and phone activities and complete scorecards to assess each item according to guidance provided and provide a constructive assessment.
– Maintain and update databases, score cards, reports, and documents with high degree of accuracy.
– Identify accounts requiring escalation, escalating immediately if warranted.
– Utilize the feedback tool to give and receive constructive feedback on call quality and department tasks.
– Preform administrative functions that support the process of reports and appeals.
– Maintain up-to-date knowledge of federal regulations, policies, and procedures as they apply to student financial aid.
– Maintain current understanding of the processing procedures.
– Utilize available systems, knowledge-base and standard technology such as telephone, e-mail, and web browser to respond to inquiries and perform job duties.
– Identify trends in the information provided by agents to identify areas of improvement and areas that might require additional training.
– Organize, lead, or participate in calibration meetings including the selection of topics to be evaluated and discussed,
– Assist with new hire presentations, assignments, and certifications.
– Demonstrate and maintain appropriate judgment with confidential information.
– College courses or degree from an accredited college or university preferred
– Minimum 3 years of related experience required
– Accurate data entry skills
– Proficient in the use of Microsoft Office products
– Excellent organizational, written and verbal communication skills
– Ability to perform comfortably in a fast-paced, deadline-oriented work environment
– Ability to work as a team member, as well as independently
– Ability to write using proper grammar, punctuation, sentence structure and pass a written test
– Applicants will be required by contract to undergo program update training as student financial assistance programs change, as well as required employee training.
– May perform other functions as requested by management within scope of level or occasional support of lower-level functions as business/volume need require
Additional Requirements Per Client:
– High School Diploma or GED required
– Must reside in the U.S.
– Must be a U.S. citizen.
– Must be able to pass a Federal Background Check.
– Must not be delinquent or in default on any federal student loans.
Home Office Requirements:
– Private and Secure workspace from home
– Access to Wi-Fi, LAN (wired connection/ethernet) or both at home
– Internet provider that offers enough speed for multiple users without latency or lag? (i.e. housemate also WFH, kids playing video games or streaming shows, etc.)
– Internet download speed of 25mbps single/50mbps shared and 5mbps (10 preferred) upload or higher required (you can test this by going to www.speedtest.net)
Employment and continued employment are contingent upon obtaining and maintaining a favorable clearance. Final suitability determination is the sole discretion of the Department of Education..
Minimum Requirements
– High School diploma or equivalent with 2-4 years of experience.
– Associate degree preferred.
– May have training or education in area of specialization.
EEO Statement
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant’s salary history will not be used in determining compensation.
Minimum Salary
$
17.75
Maximum Salary
$
33.00
by twochickswithasidehustle | Sep 11, 2025 | Uncategorized
Job Details
Description
The Capture Center Specialist participates in all assigned activities pertaining to scanning, matching and attaching EOR and bill to be returned to the client and responding to phone calls from the providers. The participant will handle all incoming mail and faxes. The participant is also responsible for making sure that the bills are returned to the client within a timely manner and understanding how to communicate with the supervisor any delays that would prevent the work from being returned in a timely manner. The participants are responsible for working as a team and assisting each other when required to make sure the goals are met or achieved. To successfully accomplish these responsibilities the Capture Center Specialist will work closely with the analyst and supervisor.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Identifying and indexing all incoming faxes to the appropriate file, on a daily and timely basis
- Scans paper documents and completes imaging process
- Follows document destruction procedures
- Adheres to HIPPA and other sensitive data regulations, policies, and procedures
- Process information by compiling, coding, categorizing, and verifying information and data
- Photocopying of original two-sided documents to covert to one sided documents
- Opens and sorts incoming paper mail
- Identify and classify documents or other electronic content according to characteristics such as document type, function, or other classification
- Retrieves images
- Operates data capture equipment safely
- Operates data capture technology to import digitized documents into document management system
- Search electronic sources, such as databases or repositories, or manual sources for information
- Follow clearly established and defined procedures and know when to escalate for higher review
- Challenges include complete high volumes of work while meeting quality, productivity, and timeliness standards
- Additional duties as required
KNOWLEDGE & SKILLS:
- Excellent written and verbal communication
- Intermediate Microsoft Office suite skills
- Ability to work independently and in a team environment
- Attention to detail, organizational ability, and time management skills
- Learning agility: able to learn, adapt, unlearn, and relearn to keep up with changing conditions
EDUCATION & EXPERIENCE:
- High school diploma or GED
- Six months experience in a service type office or customer service preferred
- For Document Control department: valid driver’s license and clear DMV background check
- For Intracompany Services department: comfort making regular outbound business phone calls to administrative professionals for provider demographics verification
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $13.08 – $22.89 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
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