Adjudicator Job Description Samples

Results for the star of Adjudicator

Senior Adjudicator - Ts/Sci Required

Job Description: Position requires an in-scope TS/SCI clearance. Adjudicator tasks shall include: 1. Work on personnel security cases assigned by the Government.

Each case will vary in the total tasks, time and effort required to provide the deliverable, which is a written recommendation to grant, suspend, disapprove, or revoke sensitive security accesses; 2. Review and analyze assigned case files to determine if additional security processing needs to be performed in order to render an adjudicative decision. If additional security processing is necessary, the Contractor shall recommend to the Government as to what additional processing requirements should be conducted; 3.

Review the results of all security processing to glean facts and data relevant to the final recommendation; 4. Interview Subjects in person, by telephone, or through written correspondence to elicit clarifying information; 5. Discuss cases with senior adjudicators, Team Chiefs, Branch management, Adjudications Board members, Polygraph Examiners, Background Investigators, Case Processing Personnel, Managers, and Customers to resolve information discrepancies or gaps; 6.

Sufficiently analyze case information in order to show a nexus between the behavior of the case subject and the lCD 704 issues sufficient to support a final recommendation; 7. Provide final written recommendations using Government formats that provide sufficient detail to enable the Government to make informed, independent decisions to grant, disapprove or revoke a Subject's security access; 8. Maintain security files and ensure that duplicate copies of the SF86, unofficial notes, page flags, and other extraneous materials are purged with approval by USG prior to forwarding files to Branch managers or returning case files to the file room; 9.

Deliver oral presentations to Branch and/or Division management, the Adjudications Board, and/or other senior organization officials as required; 10. Administer notifications to customers as approved by the USG, update information in the customer data management system, and perform other follow-up actions resulting from the disposition of cases; 11. Protect all information and data acquired during the preparation of the analysis from unauthorized release and return all adjudicative notes to the Government; 12.

Respond in a timely manner to inquiries from the Government on the status of pending cases or any other information pertaining to adjudicative support tasks under this SOW; 13. Provide a draft adjudicative recommendation to the Government for all cases worked. The Contractor shall subsequently provide a final recommendation to the Government that incorporates any Government comments provided in response to the draft recommendation that are complete, accurate, and free of spelling and grammatical errors.

For each case completed, a written recommendation whether to grant, disapprove or revoke a clearance/approval is required, in accordance with established timelines. 14. Complete cases as identified by the Government. 15. May be requested to perform 'spot' checks of previously closed adjudicative decisions to ensure they meet Government quality requirements; 16.

May also provide Adjudication training and briefings to USG and industry personnel, when approved by the USG. This could include limited TDY travel in CONUS. 17. Provide a monthly report on the number of cases opened, number of cases closed, number of board cases, number of personal interviews/telephonic interviews and the number of recommendations.

GDIT duties may also include: 1. Performs data collection, analysis, interpretation and management duties. 2. Develops rules and methodologies for data collection and analysis. 3.

Ensures the integrity of project data, including data extraction, storage, manipulation, processing and analysis. 4. Consults with the external clients and internal staff to determine data management needs and objectives. 5. May be responsible for database design, administration, security, and maintenance. 6.

Prepares presentations that reflect the results of the data analysis. 7. Develops and delivers data-related training programs. 8. Coordinates with scientists and other technical experts to design and develop statistical analyses methodologies. 9.

May provide guidance and work leadership to less-experienced Data Analysts. 10. Maintains current knowledge of relevant technologies as assigned. 11. Participates in special projects as required.

Education Bachelors Degree in a Computer Science, Statistics or a related technical discipline, or the equivalent combination of education, technical certifications or training, or work experience. Qualifications 5-8 years of related statistics/data analysis experience. Quals include: 1.

Experience performing Background Investigations, Counterintelligence, or Personnel Security for US Government clearances 2. Knowledge of lCD 704 and Executive Order 12968; 3. Knowledge and proficiency in the use of Microsoft Office Suite. 4.

Direct experience as an adjudicator with USG 5. Excellent elicitation skills, both oral and written 6. Exceptional organizational skills 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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Security Adjudicator Analyst

Business Line

Government Position Title Security Adjudicator Analyst United States of America

  • Virginia Reston

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.Job CategorySecurity / Force ProtectionCountryUnited States of AmericaPosition StatusFull-TimeRequisition/Vacancy No.156360BR


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Automotive Mechanical Warranty Claims Adjudicator

Are you a Technician or Service Advisor looking to get off the shop floor or out of the dealership? If YES, this is the perfect opportunity for you!

Come and join a fun, motivated team of automotive professionals. Located in Strongsville, NAE/NWAN is looking for a skilled Automotive Mechanical Warranty Claims Adjudicator to be part of our claims team. Please note, this is a position that handles all claims via the phone. There is no travel involved.

This person must have automotive experience and ASE Certifications are a plus! Service Advisors, Technicians, and Experienced Claims Adjudicators meet the minimum level of experience necessary for the job.

The best candidate will be a person who has good personal relations, handles themselves well over the phone, enjoys multi-tasking, understands the processing of a warranty claim and has a great attitude. You must be comfortable navigating through multiple computer software programs including proficiency with Microsoft Office.

Due to growth of business on the west coast, potential candidates must have a flexible working schedule as we are looking to hire for the following shifts:

Tuesday-Friday 9AM-6PM

Monday-Friday 11AM-8PM

National Automotive Experts offers a complete compensation package including medical, dental, vision, 401(k) guaranteed benefit program, short and long term disability, life insurance, flexible spending accounts, paid time off, incentive opportunities, and an excellent work environment.

No phone inquiries please.

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Claims Adjudicator

JOB DESCRIPTION:

Responsible for the accurate and timely processing of claims. Must meet published quality and productivity standards. Also, responsible for adjustments to previously processed claims.

Key Functions/Responsibilities:

    • Reviews, evaluates and adjudicates claims not automatically adjudicated by the processing system according to productivity and quality standards.
    • Interprets and processes routine claims.
    • Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.
    • Alerts claims management to claims aging issues as well as provider billing problems.
    • Maintains current knowledge of BMCHP members' benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication.

Supervision Exercised:

    • None

Supervision Received:

    • Close supervision is received daily.

Qualifications:

Education:

    • High School degree or equivalent required.

Preferred/Desirable:

    • Some college coursework preferred.

Experience:

    • Two years or more years experience in managed care claims processing preferred.

Certification or Conditions of Employment:

    • Pre-employment background check

Competencies, Skills, and Attributes:

    • Working knowledge of medical terminology as well as CPT4, HCPCS and ICD9 coding sets and HIPAA regulations.
    • Knowledge of Microsoft Office and FACETS preferred.
    • Ability to maintain production level and quality goals.
    • Follow through on commitments and meets deadlines
  • Work is thorough, accurate, and effective.

    • Demonstrates ability to complete assigned work in a timely fashion.

Working Conditions and Physical Effort:

    • Ability to work OT during peak periods.
  • *Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

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Claims Adjudicator II

It’s Time For A Change… Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day.

We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely.

We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it. What You’ll Be Doing: We are looking for an experienced individual to fill our Claims Adjudicator II team position.

The successful candidate will have at minimum 3-5 years of experience adjudicating claims in a Claims Center environment. They will use their proven strong analytical skills to review claim rules and workflows. Additional essential functions would also be:

  • Experienced level adjudicator providing analytical ability to review claim rules and workflows + Responsible for adjudicating claims to maintain/comply with Service Level Agreements + Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures

  • Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.) + Research CMS1500 claim edits to determine appropriate benefit application utilizing established criteria + Apply physician contract pricing as needed

  • Ability to resolve claims that require adjustments and adjustment projects + Identify claim(s) with inaccurate data or claims that require review by appropriate team members + Maintain productivity goals, quality standards and aging timeframes + Contribute positively as a team player + Complete special projects as assigned + Comply with all departmental and company Policy and Procedures The Experience You’ll Need (Required): + Associate or Bachelor degree preferred.

  • Experience in health insurance claims processing with a minimum of 3 to 5 years adjudication experience.

  • HMO Claims or managed care environment preferred.

  • Ability to work in a team environment + Integrity and discretion to maintain confidentiality of members, employee and physician data + Knowledge of medical billing and coding + Knowledge of health insurance, HMO and managed care principles + Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products + Attention to detail + Excellent interpersonal, oral and written communication skills + Strong attention to detail and organization

  • Able to work independently; strong analytic skills + Strong computer skills Evolent Health is an Equal Opportunity/Affirmative Action Employer

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Billing Adjudicator

Position Summary: A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims. Key Responsibilities: • Review and research rejected Third-Party claims taking appropriate action to resolve. • Work backlog of denied claims for timely resubmission. • Manage assigned queues keeping up-to-date and current on all claims. • Workflow grid is cleared daily meet productivity criteria • Specific denials including new patient overrides • Follow all applicable government regulations including HIPAA. • Display behavior which exemplifies the Core Values. • Other duties as deemed necessary The work schedule will be Monday - Friday 11:30 am to 8:00 pm rotating weekends/holidays

Required Qualifications: • High school diploma • Entry-Level familiarity with Excel/Access • Perform multiple tasks effectively • Able to work both independently and as part of a team

Preferred Qualifications: • Pharmacy technician certification highly preferred • Experience in pharmacy, managed care, Medicaid and/or Medicare organizations

Education: • High school diploma

Business Overview: CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers.

What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy.

Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law.

CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster:

EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/



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Sr. Security Adjudicator (Former 1811)

Description: JOB DESCRIPTION:Leidos has an opportunity for Sr. Investigative Analyst Consultants at the Federal Bureau of Investigation (FBI) in Washington, DC.

The candidates will support the FBI as Investigative Analyst Consultant (IAC) to assist the FBI Personnel Security Program with investigations and making suitability and/or trustworthiness security adjudications for FBI employees, contractors, law enforcement officials, and task force members. The candidates will be required to conduct security investigations of FBI employees, contractors, law enforcement officials and task force members where security concerns have been identified relative to maintaining a security clearance.

Qualifications: EDUCATION & EXPERIENCE: Requirements: • Minimum 15 years of 1811 federal law enforcement experience as a former agent. • Minimum five years directly-related analyzing investigations, record checks, and other information as necessary for the purpose of making a written record of the accuracy and completeness of the investigation and to enable an accurate security adjudication decision. • Candidates will have relevant experience conducting and evaluating Top Secret/Secret investigations with preferred experience in counterintelligence/espionage, counterterrorism, criminal matters, and personnel security investigations. • Candidates will analyze and investigate all necessary information for the purpose of determining the final decision on the adjudication of clearances. • Candidates will have experience performing Quality Assurance Reviews on Reports of Investigations or Security Background Investigations. • Candidate will have the necessary skills to resolve minor issues without supervision, working major issue cases through the due-process.

Candidate will render highly effective personnel security adjudications based on expert examination of the facts and supporting evidence; and conduct open source internet checks in support of investigations. Candidate will prepare and document all written findings and recommendations for the federal agency to make a determination that security adjudication creation. • Working knowledge of Microsoft Office software applications (Word, Excel, Outlook, PowerPoint) Leidos Overview: Leidos is a global science and technology solutions leader working to solve the world's toughest challenges in the defense, intelligence, homeland security, civil, and health markets. The company's 33,000 employees support vital missions for government and commercial customers.

Headquartered in Reston, Virginia, Leidos reported pro forma annual revenues of approximately $10 billion for the fiscal year ended January 1, 2016 after giving effect to the recently completed combination of Leidos with Lockheed Martin's Information Systems & Global Solutions business (IS&GS). For more information, visit www.Leidos.com. The company's diverse employees support vital missions for government and commercial customers. Qualified women, minorities, individuals with disabilities and protected veterans are encouraged to apply. Leidos is an Equal Opportunity Employer.



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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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HRA Claims Adjudicator

HRA Claims Adjudicator

Description The purpose of this position is to process more complex claims, take on more complex projects, and correspond with insured and providers in a prompt, informative, and courteous way, and interacts with other departments in order to obtain information needed to process claims. The position possesses a higher claim approval authority operating with a broad understanding and application of body of knowledge. This position acts as a mentor and provides feedback to more junior claims clerks and examiners. This position may also audit claims processing of colleagues.

Claims Processing + Reviews complex claim requests to determine eligibility for processing and escalate to management as necessary.

  • Audits claims processing of other colleagues.

  • Prepare for carrier audits as well as audit work of other colleagues.

  • Handles more complex claims; i.e. pre-existing conditions, other health insurance, high deductibles, etc.

  • Train new colleagues; mentor and provide feedback.

  • 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.

  • Minimum of one year claims experience.

  • Claims processing and/or medical office experience preferred.

  • 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). At Mercer, we make a difference in the lives of more than 110 million people every day by advancing their health, wealth, and careers. We’re in the business of creating more secure and rewarding futures for our clients and their employees — whether we’re designing affordable health plans, assuring income for retirement or aligning workers with workforce needs. Using analysis and insights as catalysts for change, we anticipate and understand the individual impact of business decisions, now and in the future. We see people’s current and future needs through a lens of innovation, and our holistic view, specialized expertise, and deep analytical rigor underpin each and every idea and solution we offer. For more than 70 years, we’ve turned our insights into actions, enabling people around the globe to live, work, and retire well. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. At Mercer, we say we Make Tomorrow, Today . Visit www.mercer.com for more information and follow us on LinkedIn and Twitter @Mercer. Mercer LLC and its separately incorporated operating entities around the world are part of Marsh & McLennan Companies, a publicly held company (ticker symbol: MMC). Marsh & McLennan Companies offers competitive salaries and comprehensive benefits. For more information about our company, please visit us at: http://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. Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.

Job

Customer Service

Primary Location US-MA-Norwood Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.

Req ID: NOR005M1


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L&I Workers' Compensation Adjudicator 3 In Training

Description This opportunity is open to current L&I; employees only.The WCA 3, in training is a 12-month program. During the first 20 weeks of the in-training plan, the trainee will attend 15 weeks of formal classroom training and 5 weeks of work experience on the claims floor.

Then an additional 6 – 7 months of work experience on the claims floor managing a level 3 caseload, focusing on policies and procedures unique to self-insurance, and receiving ongoing coaching and mentoring by training, the unit leads, and the unit supervisor. The trainee will be expected to prepare, take, and pass the Self-Insurance certification test by the 6th month of the in-training plan. As a WCA 3, you'll perform quality reviews of adjudicative actions to ensure action are based on laws.

Make legally binding decisions regarding workers benefit entitlement, including claim allowance or denial, reopening, time-loss, segregation, suspension and closure with or without permanent partial disability awards. You'll also resolve protests, disputes and recommend penalties when appropriate. Some of what you'll do: * Manage a caseload; reviews, adjudicates, and assures quality management of industrial insurance claims in accordance with the industrial insurance laws and case law.

  • Interpret facts and apply laws and rules in determining injured workers' entitlement to benefits.

  • Resolve disputes concerning authorization or denial of medical treatment, suspension, segregation, transfer of physician, and other claim issues.

  • Issue legal orders when appropriate.

  • Respond to telephone inquiries regarding claim information, department rules and regulations, and the Self-Insurance claim adjudication process.

Your success will look like this Achieve a minimum of 80% accuracy in the Critical Decision and Action. By the end of your first 9 months, you'll have successfully completed all formal training classes, meeting daily production expectations and be released from work checking in interlocutory, denials, allowances, time loss, wages and wage orders, closures, correspondences and PPD scheduled payments, disputes and protests, reopening's, board orders, complex validity and segregations.

At this time, you will move up to a WCA 3 portion of the in-training plan. By the end of 12 months, you'll have been released from all remaining work checking categories; complex closure, non-cooperation, and protests and have successfully completed the in training program and promote to a WCA 3. If the trainee completes the plan in a shorter period of time, the supervisor may recommend early advancement to management and the Office of Human Resources.

After the trainee successfully achieves the required classroom training, productivity, and work checking requirements, they will promote from a WCA 2 to a WCA 3 and serve a WCA 3 trail service period. The WCA will serve a six (6) month trial service review period at the WCA 3 level. Who should apply? Current L&I; employees who have achieved journey level status through the WCA 2 Apprenticeship Program. What we're looking for: * Motivated self-starters who take initiative and who continually develop and upgrade their knowledge, skills and abilities.

  • Demonstrated analytical thinking and decision-making skills and abilities.

  • Strong written and verbal communicators.

  • Individuals who can create and sustain a customer centered team and work environment. Cooperative, courteous and responsive in all interactions.

  • Trainees must work 5 days per week during instructor lead classroom training.

  • Organized, effectively prioritize and perform multiple tasks.

  • Meet productivity standards, deadlines and work schedules; working to be efficient in the use of resources, work time and equipment.

  • Professional, prompt, dependable, maintaining the highest levels of confidentiality and professionalism at all times. Note: In addition to your application, the process requires you to include a cover letter/letter of interest clearly addressing the above section of job announcement titled: "What we are looking for" to be including in your application package.

    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.Salary: $3,721.00 - $4,879.00 Monthly Location: Thurston County – Tumwater, WA Job Type: Agency Internal - Permanent Job Number: 2017-05363 Department: Dept. of Labor & Industries Closing: 7/5/2017 11:59 PM Pacific Agency: State of Washington Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504. Phone: View Posting for Agency Contact Website: http://www.careers.wa.gov



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