Adjudicator Job Description Samples

Results for the star of Adjudicator

Security Adjudicator Analyst

Requisition/Vacancy No.

156360BR Position Title

Security Adjudicator Analyst Job Category Security / Force Protection

Business Line

Government

Country

United States of America State/Province/Region USA - Virginia

City

Reston Why Choose AECOM? AECOM is a premier, fully integrated professional and technical services firm positioned to design, build, finance and operate infrastructure assets around the world for public- and private-sector clients. With nearly 100,000 employees — including architects, engineers, designers, planners, scientists and management and construction services professionals — serving clients in over 150 countries around the world, AECOM is ranked as the #1 engineering design firm by revenue in Engineering News-Record magazine’s annual industry rankings, and has been recognized by Fortune magazine as a World’s Most Admired Company. The firm is a leader in all of the key markets that it serves, including transportation, facilities, environmental, energy, oil and gas, water, high-rise buildings and government. AECOM provides a blend of global reach, local knowledge, innovation and technical excellence in delivering customized and creative solutions that meet the needs of clients’ projects. A Fortune 500 firm, AECOM companies, including URS Corporation and Hunt Construction Group, have annual revenue of approximately $19 billion. More information on AECOM and its services can be found at www.aecom.com.

About the Business Line

Government AECOM works with national and local governments around the world to manage and support critical programs in the areas of defense, security and intelligence; energy and climate change; environmental cleanup and waste management; infrastructure development, protection and resilience; and international development. Our global operations and connected expertise enable us to provide cutting-edge, relevant and cost-effective solutions that help our clients safeguard and enrich society and the world we live in.

Job Summary AECOM is seeking a Security Analyst in Virginia. Must have ACTIVE TS/SCI w/FS Poly Duties/Tasks and Responsibilities  Dependent on assignment, security analyst assistants provide a diverse range of adjudicative functions. The below list reflects some, but not necessarily all of the required daily activities and support.

  • Reviews a case file to determine what additional security processing, if any, needs to be performed.

  • Creates written products documenting case processing, such as Memorandum for the Record an E-mail.

  • Advises the Sponsor of the need for additional security processing in order to render adjudicative decision and schedule or conduct additional processing at the direction of the Sponsor.

  • Reviews the results of all security processing to glean necessary facts and data relevant to the final recommendation.

  • Interviews the subject in person, by telephone, or through written correspondence to elicit clarifying information after consultation and approval of the Sponsor.

  • Discusses with the Senior Case Manager (SCM), Expert Adjudicators, Adjudications Board members, Polygraph Examiners, Background Investigators, Case Processing Personnel, Managers, Office of Medical Services, Customers, and other as needed to resolve information discrepancies or gaps.

  • Analyzes the information and indicate a nexus between the behavior of the subject and the ICD 704 issues sufficient to support a final recommendation.

  • Provides a final written recommendation, in sufficient detail to permit the Sponsor to make an informed, independent decision to grant, disapprove or revoke a security clearance or approval.

  • Maintains each security file by purging duplicate copied of SF86, unofficial notes, page flags, and other extraneous materials prior to forwarding file to the SCM. Information contained on handwritten notes shall be formalized in a Memorandum for the Record and included in the file; the information is pertinent to the adjudication, prior to removal of the handwritten note. This may require that the adjudicator accurately upload official documents into electronic file records.

  • Makes oral presentations to SCMs, Program Mangers, Adjudication Boards, and/or other Senior Agency officials as required.

  • Administers notification to the customer, identify and recommend codes of conduct issues for the Sponsor to address, input of closing information in the Office of Security (OS) data base or other tracking software/applications as needed, and/or perform other follow-up actions resulting from the disposition of the case. Protects all information and data acquired during the preparation of the analysis from unauthorized release, employing the “need to know” principle, and return all adjudicative notes to the Sponsor.

  • Returns to the contractor’s point of contact cases that may give rise to an actual or potential conflict of interest, organizational or otherwise.

  • Responds in a timely manner to inquiries from the Sponsor on the status of pending cases or any other information pertaining to adjudicative support tasks.

  • Manages case load effectively to meet the productivity standards set by the Sponsor.

  • Meets the adjudicative quality standards established by the Sponsor

  • Attends meetings required for all adjudicative personnel and mandatory training courses required by the Sponsor for individuals with staff-like access. IND-ICS

Minimum Requirements Minimum Qualifications Experience:  Experience applying principles of the ICD 704 –Personnel Security Standards and Procedures Governing Eligibility for Access to Sensitive Compartmented Information and Other Controlled Access Program Information as mandated through the issuance of the Presidents Executive Order (EO) 13467 Reforming Processes Relating to Suitability for Government Employment, Fitness for Contractor Employees and Eligibility for Access to Classified National Security Information and endorsed by Director of National Intelligence “Knowledge and experience may include verifiable experience in conducting background investigations, consolidating and/or processing investigative inputs, creating a comprehensive applicant profile, and/or preparing an adjudicative analysis and recommendation for the USG, or on behalf of a USG customer. While all of the above examples of ICD 704 experience are relevant, the strongest candidates will be those with prior adjudicative experience.” A minimum of 3 years of adjudicative experience in a Federal or Contractor role with the Federal Government or equivalent year(s) of experience in a related field or internship as delineated below  Equivalent experience in a related field may include, but is not limited to the following:

  • Experience analyzing, interpreting and applying personnel security policies, standards, procedures or regulations

  • Examining the accuracy, completeness and quality of final reports in compliance with ICD 704 requirements and guidelines and providing targeted insights to others in their write ups

  • Demonstrated experience in conducting pre-employment security interviews or background investigations for Federal Government job applicants, contractors and employees

  • Successful completion of additional training (coaching, On the job training, training courses) to develop, enhance and/or mature personal analytical and critical thinking skill sets

  • Successful academic record that reflects demonstrated analytical and critical thinking skills (see Education requirements section below)

  • Demonstrated experience conducting interviews and subsequently summarizing and verbally presenting results to senior audiences

  • Will be required to complete the ODNI Intro to National Security Adjudications Course within 30 days of deployment Education:  High school diploma or GED.  (Advanced degree may be substituted for upwards of six months of experience) An associates or B.A./B.S. degree in English or related field of study (Degree examples include, but are not limited to Criminal Sciences, Cybersecurity, Behavioral Sciences, Management, Financial or Auditing, etc…) which has a central theme/focus related to writing in a clear, concise manner and ability to articulate and defend a logical well-reasoned conclusion based on available and/or discovered/developed information. In summary, any formally approved B.A./B.S. course of study with a related emphasis which demonstrates well developed and honed critical thinking and analysis skills.

Preferred Qualifications N/A

What We Offer AECOM is a place where you can put your innovative thinking and business skills into high gear and work alongside other highly intelligent and motivated people. It's a place where you can apply your skills to some of the world's most challenging, interesting, and meaningful projects worldwide. It's a place that values the diversity of our areas of practice and our people. It's what makes AECOM a great place to work and grow. AECOM is an equal opportunity employer and Minorities, Females, Veterans, and Disabled persons are encouraged to apply. For further information, please click here at http://www.aecom.com/content/wp-content/uploads/2016/01/EEO-is-the-Law-poster-supplement.pdf to view the EEO Is The Law poster. NOTICE TO THIRD PARTY AGENCIES:Please note that AECOM does not accept unsolicited resumes from recruiters or employment agencies. In the absence of a signed Recruitment Fee Agreement, AECOM will not consider or agree to payment of any referral compensation or recruiter fee. In the event a recruiter or agency submits a resume or candidate without a previously signed agreement, AECOM explicitly reserves the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of AECOM.


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Adjudicator

Job Description: Reviews and analyzes information gathered during background investigations 1.

Analyzes, summarizes and verifies information gathered during background investigations 2. Using various databases conducts searches on information needed to determinate if an individual qualifies for a clearance 3. Reviews derogatory or conflicting information and seeks additional information to clarify questionable information and discrepancies 4.

If necessary, interviews Subject in person, by phone, or through written correspondence 5. Provides final recommendation for security clearance eligibility 6. Updates and maintains appropriate security records following government's requirements 7.

Participates in review panels and meetings to address specific security cases with senior adjudicators and security officials 8. Assists in the development of new or changing adjudication-related policies and procedures 9. Participates in special projects as required Education Bachelor's Degree in Business Administration or a related business discipline, or the equivalent combination of education, professional training or work experience.

Qualifications 2-5 years of related experience in facility or industrial security administration, preferably in the government contracting industry. As a trusted systems integrator for more than 50 years, General Dynamics Information Technology provides information technology (IT), systems engineering, professional services and simulation and training to customers in the defense, federal civilian government, health, homeland security, intelligence, state and local government and commercial sectors.With approximately 32,000 professionals worldwide, the company delivers IT enterprise solutions, manages large-scale, mission-critical IT programs and provides mission support services.GDIT is an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Protected Veterans/Individuals with Disabilities.



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Adjudicator -Full Performance

Supporting the Most Exciting and Meaningful Missions in the World

Adjudicator -Full Performance

Responsibilities:

Provide adjudicative support services to assist in meeting the mission requirements of customers throughout the organization.

Requires full performance knowledge and experience of Federal-level adjudicative processes. Security Analyst Assistants at the Full Performance level shall provide a diverse range of adjudicative functions to include but not limited to:

  • review case files to determine needed security processing actions

  • create written products documenting case processing

  • advise the customer of the need for additional security processing to render an adjudicative decision

  • review results of all security processing relevant to the final adjudicative recommendation

  • conduct interviews of candidates in person, via telephone or through written correspondence

  • discuss and present cases to supervisors and subject matter experts as needed

  • provide a final written recommendation with sufficient detail to permit the sponsor to make an informed decision to regarding security clearance approval or denial

  • perform file maintenance to include removing duplicate copies of documents, unofficial notes, etc

  • responds to status inquiries in a timely manner • meets quality standards established by the customer

  • manages case load effectively to meet productivity standards established by the customer

Qualifications:

  • Must be a US citizen possessing TS/SCI clearance with a polygraph at time of application.

  • Minimum three years Adjudicative experience at the Federal level or extensive analyst experience; investigative experience is desired by not required.

  • High School diploma or GED.

  • Must possess demonstrated analytical ability and the ability to handle a large complex workload

  • Must demonstrate a high level of personal integrity and the ability to discreetly handle sensitive, personal and classified case information

  • Must have excellent writing skills with ability to comprehend complex and multi-source data into succinct and supportable final reports

  • Must possess strong organizational skills and good judgment

  • Must be able to operate various corporate and customer specific automated systems for case tracking and status reporting

  • Must have a thorough understanding of the federal rules and regulations that encompass the clearance process

  • Demonstrated ability to produce analytic documents that require minimal editing, utilize software tools (MS Word/Excel/Power Point)

  • Ability and skill to elicit information during an interview with minimal direction and work effectively with a variety of individuals

  • Ability to provide excellent customer service

  • Ability to work well with various client personnel and stakeholders

  • Strong briefing and presentation skills

An Equal Opportunity Employer. PAE's hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran's status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.

EEO is the Law Poster


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Bilingual Unemployment Insurance Adjudicator

Bilingual Unemployment Insurance Adjudicator Salary $16.63 Hourly Location Grand Island, NE Job Type PERM FULL TIME Department Department of Labor Job Number 60010243 Closing 6/7/2017 11:59 PM Central + Description

  • Benefits Description Under general supervision, interviews claimants, employers and other interested parties to determine claimants past, present and future unemployment insurance eligibility and employer's charging. Evaluates facts, reconciles conflicting employment information and issues formal, written appealable determinations by applying appropriate federal and State Employment Security laws and/or regulations.

    Hours: 8-5, Monday - Friday. Job location is 203 E Stolley Park Road. Examples of Work Analyzes benefit claims to obtain the necessary information to write legal formal determinations of benefits eligibility.

    Processes appeals from claimants and employers, explains procedures, assists in completion of appeal, completes necessary documents, and data entry of transactions. Testifies on behalf of Commissioner of Labor as necessary in appeal hearings. Investigates wage records through access to wage/tax files to determine employer liability, establishes correct reporting wages through the UI 417 wage investigation processes.

    Collaborates with UI Tax representatives to determine legal standing of employers accounts and misreported or unreported wages, establishes to benefit records the accurate wages for purpose of UI eligibility. Answers verbal and written inquiries from claimants, employers and other agencies to explain legal requirements and procedures pertinent to the Unemployment Insurance program and general information. Assists Benefits Special Programs Unit with Approved Training applications and adjudication.

    Adheres to State, Department of Labor, and UI Division policies and procedures. Other duties as assigned by management personnel. Qualifications / Requirements REQUIREMENTS:

    Spanish/English bilingual skills required. Post high school coursework/training in social/behavioral sciences, public or business administration, accounting or related field OR experience in personnel, unemployment insurance, employment services, insurance, accounting or human services with responsibility for employment interviewing, referral or placement, credit investigation, analyzing and/or evaluating financial data and/or evaluating and determining eligibility for services and/or benefits. PREFERRED: Six months' work experience in unemployment insurance, specifically, wage investigations and/or adjudication.

    Knowledge, Skills and Abilities Knowledge of: the Nebraska Employment Security law. Skill in: interviewing clients, employers and other parties of interest to collect and elicit essential information; use of computer. Ability to: effectively communicate with others.

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Adjudicator -Full Performance

Supporting the Most Exciting and Meaningful Missions in the World Adjudicator -Full Performance Responsibilities: Provide adjudicative support services to assist in meeting the mission requirements of customers throughout the organization. Requires full performance knowledge and experience of Federal-level adjudicative processes. Security Analyst Assistants at the Full Performance level shall provide a diverse range of adjudicative functions to include but not limited to:

  • review case files to determine needed security processing actions + create written products documenting case processing + advise the customer of the need for additional security processing to render an adjudicative decision

  • review results of all security processing relevant to the final adjudicative recommendation

  • conduct interviews of candidates in person, via telephone or through written correspondence + discuss and present cases to supervisors and subject matter experts as needed + provide a final written recommendation with sufficient detail to permit the sponsor to make an informed decision to regarding security clearance approval or denial + perform file maintenance to include removing duplicate copies of documents, unofficial notes, etc + responds to status inquiries in a timely manner • meets quality standards established by the customer + manages case load effectively to meet productivity standards established by the customer Qualifications:

  • Must be a US citizen possessing TS/SCI clearance with a polygraph at time of application.

  • Minimum three years Adjudicative experience at the Federal level or extensive analyst experience; investigative experience is desired by not required.

  • High School diploma or GED.

  • Must possess demonstrated analytical ability and the ability to handle a large complex workload

  • Must demonstrate a high level of personal integrity and the ability to discreetly handle sensitive, personal and classified case information

  • Must have excellent writing skills with ability to comprehend complex and multi-source data into succinct and supportable final reports

  • Must possess strong organizational skills and good judgment

  • Must be able to operate various corporate and customer specific automated systems for case tracking and status reporting

  • Must have a thorough understanding of the federal rules and regulations that encompass the clearance process + Demonstrated ability to produce analytic documents that require minimal editing, utilize software tools (MS Word/Excel/Power Point) + Ability and skill to elicit information during an interview with minimal direction and work effectively with a variety of individuals + Ability to provide excellent customer service + Ability to work well with various client personnel and stakeholders + Strong briefing and presentation skills An Equal Opportunity Employer. PAE’s hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran’s status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law. EEO is the Law Poster at http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf JOIN OUR TALENT NETWORK at http://www.jobs.net/jobs/pae/join PAE is a leading provider of enduring support for the essential missions of the U.S. government, its allied partners and international organizations. With over 60 years of experience, PAE supports the execution of complex and critical missions by providing global logistics and stability operations, technical services and national security solutions to customers around the world. PAE has a workforce of approximately 15,000 people in over 60 countries on all seven continents and is headquartered in Arlington, VA. In compliance with the ADA Amendments Act (ADAAA), should you have a disability and would like to request an accommodation in order to apply for a currently open position with PAE, please call Recruiting at (703) 656-6064 or email jobs@pae.com with "Disability Assistance" in the subject line.

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L&I Workers' Compensation Adjudicator 4, Unit Lead Wage Specialist, Self-Insurance

Description The chosen candidate for this position will act as a wage and claim subject matter expert and technical advisor to the Claims Unit Supervisor, Unit Adjudicators, the Self-Insurance Program, and the Self-Insured Community. Some of what you'll do * Calculate and provide oversight on complex wages.

  • Adjudicate claims, review and analyze complex formal protests made by injured workers, employers, physicians, and their attorneys or lay representatives. Resolve contested cases by telephone, correspondence and in person, to reduce litigation on workers' compensation cases.

  • Manage and adjudicate a small claim caseload of varying complexity.

  • Provide mentoring and coaching to unit staff, ensuring consistent interpretation of policies and laws. Act as a technical resource to the Claim Unit Supervisor and other adjudicative staff.

  • Participate in the development of strategies and address issues identified through quality assurance. Complete quality assurance reviews at the direction of the unit supervisor.

    Provide supervisor with input for evaluation of claims staff as well as progress reports. Provide coverage for supervisor in their absence on non-personnel related issues

  • Draft responses for Direct and Suggested Reply assignments from the Director's office. Prepare briefing papers for the Director to make discretionary decisions, including requests for Accident Fund benefits on over-seven re-openings and requests for waiver of overpayments.

Who should apply L&I; employees skilled in calculating wages and adjudicating time-loss payments under Title 51 with a minimum of one-year of experience managing complex claims at the WCA 3 level.

What we are looking for * Collaborative and approachable leader, coach and mentor; actively works with co-workers to provide information, instruction, feedback and encouragement to maximize success on the job.

  • Excellent verbal and written communications skills, ability to develop professional correspondence, present, and communicate ideas clearly and concisely.

  • Proactive problem solver with demonstrated conflict management skill.

  • Able to independently manage time and prioritize workload for maximum efficiency.

  • Intermediate/expert level computer skills, skilled including Microsoft Office applications (Outlook, Excel, Word). * Respond and address difficult, stressful or sensitive situations with tact and diplomacy.

  • Strong consultation skills, ability to employ expertise and credibility to help identify, evaluate and resolve sensitive issues, problems and service needs. Dependability, punctuality and good attendance are essential to this job.

    Supplemental Information This job announcement may be used to fill multiple vacancies. Application review starts immediately and the hiring authority reserves the right to offer the job at any time. It's to your advantage to apply quickly.

    Employees driving on state business must have a valid driver's license. Employees driving a privately owned vehicle on state business must have liability insurance on the privately owned vehicle. Prior to any new hire into L&I;, a background check, including criminal record history, will be conducted. To apply, follow the "Apply" link above

Jobs advertised as Open Continuous will be closed without notice. Apply quickly! We're looking for evidence that you have what we're looking for.

Your application materials will be used for deciding who'll be selected for interview. For more information about the Department of Labor & Industries visit: http://www.lni.wa.gov/ OR Contact us at: Jobs@Lni.wa.gov L&I; strives to attract and retain a high-performing and diverse workforce in which our differences are respected and valued to better meet the needs of the diverse customers we serve. L&I; fosters an inclusive environment that promotes safety, collaboration, flexibility and fairness so that all employees can participate and contribute to their full potential.

Persons with a disability, who need assistance in the application process, or those needing this announcement in an alternative format, may call (360) 902-5700. Applicants that are deaf or hard of hearing may call through the Washington Relay Service at 7-1-1. The State of Washington is an Equal Opportunity Employer

If you have specific questions regarding this position, please contact Trish Lamb at 360.902.5709 or email atLAMW235@lni.wa.gov. Please do not contact to inquire about the status of your application.Salary: $3,907.00 - $5,126.00 Monthly Location: Thurston County – Tumwater, WA Job Type: Agency Internal - Permanent Job Number: 2017-03915 Department: Dept. of Labor & Industries Closing: 5/30/2017 11:59 PM Pacific Agency: State of Washington Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504. Website: http://www.careers.wa.gov



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Adjudicator

Adjudicator

Description

SAVA services and solutions help our federal clients provide for national security, improve communications and collaboration, secure the integrity of information systems and networks, enhance data collection and analysis, and increase efficiency and mission effectiveness. We’re at the forefront of the communications breakthroughs that bring federal, state, local and international organizations together for leading edge collaborative solutions in our fight against global crime and terrorism. Careers@savasolutions.com

Job Description: We are seeking a professional, well organized, and enthusiastic individuals to provide support for the US Capitol Police applicant processing effort:

  • The individual selected will be working closely with key stakeholders and handling high volume, confidential and time sensitive materials.

  • The investigator shall examine case files which contain the applicant’s Personal History Statement (PHS).

  • The investigator shall initiate multiple background checks, conduct interviews, evaluate the results and adjudicate cases in order to determine eligibility for employment with the United States Capitol Police.

  • The investigator serves as interface with insurance companies, legal professionals, medical professionals, financial institutions, government and regulatory agencies, and vendors.

  • The investigator shall provide customer service and will be in communication with insurance companies’ claim services, claimants, policyholders, agents, counterparts in other firms, external legal professionals, external medical professionals, financial institutions, government/regulatory agencies, potential customers and vendors and suppliers Qualifications

BASIC QUALIFICATIONS: + Minimum Education: Associates Degree in Criminal Justice or Military related training + Must be trained by an approved or recognized training program (e.g. Federal Background Investigator Training Program (FBITP), local law enforcement training, Reid School) and have no less than two years of experience as a Background Investigator, Criminal Investigator, Security Specialist, or Adjudicator with a Federal Agency, Police Department, or recognized private contractor specializing in background investigations; + 5 years general background investigation experience; + Working knowledge about all applicable fraud statutes: local, state and federal, to ensure duties and assignments are carried out within the requirements of applicable law and client expectations; + Must maintain the highest degree of integrity and confidentiality when handling information that is considered personal and confidential; + Working ability to conduct investigatory interviews and to conduct investigations requiring a high degree of skill for varied personnel security investigations and work to ensure suitability for employment; + Must be able to determine the information or evidence required to reach a judgment, and best approach to obtain that information; + Must be able to gather background data, includes initiation of credit and criminal checks, and draft a report of findings for investigative cases; and + Must be able to prepare a wide variety of complex documents, memorandums and/or reports that summarizes the evidence which We wish to thank all applicants for their interest and effort in applying for the position; however, only candidates selected for interviews will be contacted.

AN EQUAL OPPORTUNITY EMPLOYER We are Equal Opportunity Employers. Prospective employees will receive consideration without discrimination because of race, color, religion, creed, gender, national origin, age, disability, marital status, veteran status, sexual orientation, or any other legally protected status. We are committed to Equal Employment Opportunity and providing reasonable accommodations to applicants with physical and/or mental disabilities.If you have a physical and/or mental disability and are interested in applying for employment and need special accommodations to use our website to apply for a position please contact, Recruiting Services at job-assist@akima.com or 571-353-7053.The dedicated email and telephonic options above are reserved only for individuals with disabilities needing accessibility assistance.Please do not use the dedicated phone number above to call on the status of your job application if you do not require accessibility assistance or an accommodation.Reasonable accommodation requests are considered on a case-by-case basis. In order for our company to stay compliant with government regulations, please apply on line. Please DO NOT email resumes or call in lieu of applying online unless you have a physical and/or mental disability and need assistance with the online application.

Job:

Security, Intelligence & Defense Analysis

Primary Location: US-DC-Washington

Schedule: Full-time

Shift:

Day Job

Req ID: SAV03060


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Claims Adjudicator

Paramount Claims Department is currently recruiting for a Claims Adjudicator. The Claims Adjudicator perform adjudication and adjustments as assigned on claims that require multiple pend code resolution, application of manual pricing methods for hospital, medical and/or ancillary services for all product lines to ensure superior quality and member and provider satisfaction. Success in this position will be based on the individual's ability to effectively prioritize work, identify and resolve complex concerns in a professional manner, and work in a team environment to achieve a common goal.

  • Promptly adjudicate claims from assigned workflow queues, as well as working "pended to desk top" claims within established thresholds to ensure Plan and regulatory standards are met;

  • Production 150 - 160 claims per day

  • Pended claims - no more than 2% over 30 days

  • Promptly and accurately apply bundling logic as determined by the current software programs to ensure appropriate payment avoidance.

  • Accurately adjudicate claims per established QA thresholds;

  • Demonstrates a thorough knowledge of the Plan's published claims processing procedures on the company's intranet.

  • Proficient with core applications of the current claims processing system and front-end imaging.

Thank you for inquiring about a position with Paramount. We are a NCQA accredited managed care plan, which is part of ProMedica's integrated healthcare system with offices in Maumee, Columbus, Cleveland, and Cincinnati. Paramount provides health insurance coverage for Medicare, Medicaid, and Commercial members. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

Our mission is to improve your health and well-being. So we're committed to your wellness with various initiatives, such as preventive services, online knowledge, health risk assessments, our Steps2Health disease management programs, health fairs, and more.

Job Requirements

  • High School Diploma

  • Two to three years experience of claims processing in a health insurance environment strongly preferred.

  • Two to three years experience in customer service; provider unit desirable.

  • COB processing and/or investigation methods a plus.

  • Demonstrated experience in all lines of business; HMO, PPO, Medicare, Medicaid, etc.

  • Knowledge of ICD, CPT, and DRG coding, and medical terminology strongly preferred.

  • Ability to prioritize and handle large volumes of work.

  • Ability to work in a production environment that can be stressful.

  • Maintain a high level of motivation, initiative, and accountability.

  • Demonstrated excellent written and oral communication skills.

  • Ability to maintain confidential information.

  • Maintains respectful and professional behavior.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace

Employee Exemption Type

Non-Exempt

Job Type

Full-time

Budgeted Hours / Pay Period

80

Shift Type

Days

Shift Hours

Weekends

On-call Requirements

Additional Schedule Details


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Claims Adjudicator

Description

Mercer is a global consulting leader in talent, health, retirement and investments. Mercer helps clients around the world advance the health, wealth and performance of their most vital asset – their people. Mercer's 20,000 employees are based in more than 40 countries. If you thrive on challenge, are passionate about ideas, love solving problems and truly enjoy connecting with people, we encourage you to explore the hundreds of job opportunities available through Mercer. Our core strengths place Mercer in a unique position to help our clients achieve the extraordinary - and extraordinary results require extraordinary people. Mercer is a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), a global team of professional services companies offering clients advice and solutions in the areas of risk, strategy and human capital.

The purpose of this position is to process basic claims and correspond with insured and providers in a prompt, informative, and courteous way. The incumbent in this role also interacts with other departments in order to obtain information needed to process claims. The position works within established procedures applying basic understanding of a body of knowledge.

  • Claims Processing.

  • Reviews claim requests to determine eligibility for processing and escalate to management as necessary.

  • Makes appropriate system entries and verifies accuracy.

  • Ensures utilization of most up to date processes and procedures to update claims.

  • Identifies process improvements, offers solutions to claim problems, and communicates recommendations to management.

  • Manages tasks according to company guidelines.

  • Client Inquiries.

  • Responds within company standards to inquiries by telephone and written communication.

  • Works with colleagues across the organization to research inquiries in a prompt, courteous, and accurate manner.

Qualifications

  • High school diploma or equivalent required.

  • Claims processing and/or medical office experience preferred. No claims experience required.

  • Excellent written and verbal communication skills to effectively interact with customers on the telephone.

  • Excellent organizational and time-management skills to handle multiple tasks.

  • Detail oriented to ensure accuracy.

  • Analytical skills and the ability to make appropriate decisions independently.

  • Basic computer skills and the ability to navigate through multiple systems without assistance.

  • Proficient in Microsoft Office.

  • Appropriate license must be obtained if necessary for position.

  • Core competencies include:

  • Critical Thinking and Problem Solving

  • Professional/Technical Knowledge

  • Communicating with Impact

  • May need New York Adjustor's license (only need 3 licensed for state of New York)

Marsh & McLennan Companies offers competitive salaries and comprehensive benefits and programs including: health and welfare, tuition assistance, pension and 401K, employee assistance program, domestic partnership benefits, career mobility, employee network groups, volunteer opportunities, and other programs. For more information about our company, please visit us at: www.mmc.com. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. For more information, please visit us at: www.mmc.com/diversity.

MMCRSR


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Facilities Project Manager - Active And Current DHS Background Investigation And Adjudication Preferred”

Facilities Project Manager - Active and Current DHS background investigation and adjudication preferred” Location: Euless, Texas, United States Requisition #: 40507 Post Date:

FACILITIES PROJECT MANAGERDallas, Texas Active and Current DHS background investigation and adjudication preferred.Please, click here at https://news.clearancejobs.com/2013/08/06/getting-a-security-clearance-with-the-department-of-homeland-security/ for DHS investigation and adjudication information. Please, be advised this position is not allocated for relocation assistance.

OPPORTUNITY : The

Facilities

Project Manager in our

government services division oversees the development and execution of programs, and is accountable for the quality and the timely delivery of contractual items under the contract terms and conditions. Serves as point of contact with client, and performs day-to-day management of contract execution, possibly involving multiple tasks and groups of personnel at multiple locations, on a single project.

Establishes and maintains technical and financial reports demonstrating project progress and delegates responsibilities to subordinates and oversees successful contract/task order completion. Ensures senior level management, within the client organization, is aware of overall program status, including all relevant projects and their potential impact on higher level organizational strategic vision.

SPECIFIC RESPONSIBILITIES: This includes monitoring contractor activities in accordance with government procurement procedures, and policy, review or develop scope of work, and contract specifications using the existing Building Operations, Maintenance and Repair (BOMR) contracts and pricing structure. The Facilities Project Manager will monitor and review written or oral customer requests for engineering service, complaints, and other issues and will coordinate appropriate action or resolution with the government Contracting Officer Representative (COR) and/or BOMR contractor(s). The Facilities Project Manager will investigate, determine, and coordinate the need for repairs or enhancement projects, and will assist in the development of the related cost and schedule estimates.

This includes developing and maintaining annual and advance year financial maintenance execution plans for assigned region and facilities. Working closely with the Program Manager and Directors to ensure accurate and consistent financial reporting, revenue recognition, and project billing. Tracking/logging of work requests and preparation of recurring status reports are part of the duties of the Facilities Project Manager.

Prepare contract reports as designated by the COR. Perform other duties related to program management support. Maintain facility and equipment records in accordance with agency directives utilizing established data base and systems.

Facility Project Managers budget for custodial and mechanical workloads, contract cost escalations, utility rate increases, the cost of minor repairs and agency moves, security support, procurement of supplies and material, travel, administrative salaries, and equipment requirements. Proficient use of Microsoft Office to prepare and maintain documents; Power Point Presentations, Excel and word documents. General experience using programs such as Computerized Maintenance Management Systems and Facility Portfolio management systems.

REQUIREMENTS : + BS or BAdegree is required.

  • Minimum10years of relatedwork experience is required.

  • Incumbent should have a broad general technical and business background.

  • Incumbent is required to obtain a DHS clearance.

  • Active and CurrentDHS clearance is preferred SKILLS/COMPETENCIES: Proven ability to perform in a management capacity, excellent written and oral communications skills, and a thorough knowledge of industry practices and regulations are also required. In addition, must be knowledgeable of current technology and how it can be effectively utilized on the project.

    Parsons is a technology-driven engineering services firm with more than 70 years of experience in the engineering, construction, technical, and professional services industries. The corporation is a leader in many diversified markets with a focus on infrastructure, defense, and construction. Parsons delivers design/design-build, program/construction management, systems design/engineering, cyber/converged security, and other professional services packaged in innovative alternative delivery methods to federal, regional, and local government agencies, as well as to private industrial customers worldwide.

    All across the world, at every time of day, Parsons is keeping people moving toward a brighter, safer world. For more about Parsons, please visit www.parsons.com at http://www.parsons.com/ .

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