Claims Director jobs in Danbury, CT

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

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Claims Analyst
  • STAFFORD COMMUNICATIONS GROUP
  • Danbury, CT FULL_TIME
  • Description

    Job Title: Claims Analyst


    Stafford Communications is uniquely different. Stafford Communications, a division of Premier BPO specializes in customer service, compliance and marketing in support of many prestigious brands in in pharmaceutical, healthcare, food, consumer packaged goods and beauty care companies – ensuring their customer service initiatives are aligned to their marketing programs.


    Job Summary:

    The Production Claims Analyst is responsible for the review, investigation, decision making, and processing of production claim types, and all related claim functions and activities. Production claims are those claims under $5,000.


    Essential Duties and Responsibilities:

    • Review and adjudicate all types of claims designated as “production claims”, meeting production and quality goals.
    • Review, investigate, and apply all necessary criteria to determine validity of claim.
    • Understand the Anthem JAA workflow and apply JAA processing procedures, rules, and guidelines to adjudicate JAA claims.
    • Apply benefit plan rules and processing guidelines to pay, pend, or deny claims.
    • Manage and follow up timely on all pending claims and correspondence, including review of patient claim history.
    • Prepare and generate accurate claim EOB messages and correspondence.
    • Review and determine eligibility and coverage for specific group/plan.
    • Research claim problems and take necessary actions to resolve.
    • Utilize training and on-line documentation to keep up to date on processing guidelines, insurance principles, DOL rules and regulations, and benefit plan rules.
    • Update claims system with applicable claim/and patient notes.
    • Perform COB, No-fault, Pre-existing, and other claim investigations.
    • Contact employers, providers, participants, as necessary.
    • Identify correct providers, PPOs, and ensure that appropriate pricing is obtained.
    • Perform non-complex claim adjustments, including handling of customer service referrals and take appropriate steps to initiate adjustments on JAA claims.
    • Troubleshoot utilization review and medical necessity related issues utilizing AMM or other UR vendor’s website information, and route claims for review accordingly.
    • Utilize Claim Workflow system for work assignments, routing, and follow up.
    • Handle other claim-related duties, projects, and assignments as assigned, including the handling of claim exceptions and provider not found claims.

    Education and/or Experience:

    • One to two years of college or equivalent experience.
    • Minimum one years’ claims experience.
    • Familiarity with Eldorado Software is a plus.
    • Medical billing and/or AMA coding experience preferred.
    • Data Entry experience or equivalent type work using keyboard/PC.

    Knowledge and skills:

    • Knowledge of insurance and medical terminology.

    • High level of keyboard/PC skills.

    • Excellent oral and written communication skills.

    • Good judgment and decision-making abilities.

    • Good analytical and math skills.

    • Good interpersonal skills and willingness to assist others.

    • Basic knowledge of Word and Excel.

    Pay, benefits and more:

    We are eager to attract the best, so we offer competitive compensation and a generous benefits package, including full health insurance (medical, dental and vision), 401(k), life insurance, disability and more.

  • 5 Days Ago

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Medical Claims Analyst
  • STAFFORD COMMUNICATIONS GROUP
  • Danbury, CT FULL_TIME
  • DescriptionJob Title: Medical Claims AnalystStafford Communications is uniquely different. Stafford Communications, a division of Premier BPO specializes in customer service, compliance and marketing ...
  • 5 Days Ago

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Auto Damage Claims Adjuster
  • Progressive Insurance
  • Danbury, CT FULL_TIME
  • Join Forbes' 2023 Best Employer for Diversity! As an auto damage claims adjuster, you’ll serve as Progressive’s point of contact with customers – directing and making decisions regarding the repair pr...
  • 28 Days Ago

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

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

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

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0 Claims Director jobs found in Danbury, CT area

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Assistant Director, Reinsurance Accounting
  • American International Group
  • Wilton, CT
  • Assistant Director - Reinsurance Accounting Who we are American International Group, Inc. (AIG) is a leading global insu...
  • 3/28/2024 12:00:00 AM

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EHS Regional Manager - Hubbell Site Flexible
  • Hubbell Power Systems
  • Shelton, CT
  • EHS Regional Manager - Hubbell Site Flexible Apply now Date: Mar 11, 2024 Location: Shelton, CT, US, 06484-4300 Company:...
  • 3/28/2024 12:00:00 AM

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Maintenance Director
  • Health Care
  • Fishkill, NY
  • Job Description Job Description Manage, advise, and schedule trade mechanics in implementing a comprehensive preventativ...
  • 3/28/2024 12:00:00 AM

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Office Assistant - Medical Claims
  • Madison Approach
  • Ossining, NY
  • Job Description Job Description #zr Position Title: Medical Claims Office Assistant Job Summary: We are seeking a dynami...
  • 3/28/2024 12:00:00 AM

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Business Policy & Governance Director
  • Equiniti
  • Bridgeport, CT
  • Management Level EQ US is a leading provider of ownership data management, analytics and advisory services to public and...
  • 3/27/2024 12:00:00 AM

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Director of Operations and Human Resources
  • Saxe Doernberger & Vita, P.C.
  • Trumbull, CT
  • Saxe, Doernberger, & Vita P.C, a boutique insurance litigation law firm, with locations in Trumbull, CT, Naples, FL, and...
  • 3/26/2024 12:00:00 AM

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Commercial Casualty Claims Adjuster (The Mutual Group) - Remote Opportunity
  • GuideOne Insurance
  • New Haven, CT
  • The Mutual Group (TMG) is a comprehensive, integrated insurance operations platform dedicated to helping mutual insuranc...
  • 3/26/2024 12:00:00 AM

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Commercial Litigation Associate (Hybrid Schedule)
  • Oak Ridge Legal Search LLC
  • Stamford, CT
  • Job Description: Unpublished Opportunity for a Commercial Litigation Associate in Stamford, CT - Our client offers a uni...
  • 3/25/2024 12:00:00 AM

Danbury is a city in Fairfield County, Connecticut, United States, located approximately 50 miles (80 km) northeast of New York City making it part of the New York metropolitan area. Danbury's population at the 2010 census was 80,893. Danbury is the fourth most populous city in Fairfield County, and seventh among Connecticut cities. The city is within the New York combined statistical area and Bridgeport metropolitan area. The city is named for Danbury in Essex, England. It is nicknamed the "Hat City" because for a period in the nineteenth and early twentieth centuries it was the center of the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Director jobs
$203,586 to $294,431
Danbury, Connecticut area prices
were up 1.7% from a year ago

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Conducts audits of the claims process to include coverage analysis, investigation, valuation, scope, estimate, reserving and the accurate disposition of claims.
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