AvonRisk
Bellville, Texas
Job Description Job Description Description: AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction-not increase volume-and create real career paths for professionals who want to grow their careers or move into leadership. At AvonRisk, you're part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed. Summary: Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. Essential Duties and Responsibilities: Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills to the BR supervisor. Communicates with clients and/or providers to clarify information. Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers. Ability to price hospital and surgery bills to applicable fee schedules. Ability to process reconsideration requests as assigned. May specialize in state specific or client specific areas of responsibility. May assist is answering provider calls. Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Location & Work Arrangement: Candidates should be based in Texas but are able to work fully remote. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Knowledge Skills: Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers' compensation regulations and have good comprehension of company software system process. Math Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Computer Skills: To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software. Certificates and Licenses: Must have Medical Bill Reviewer Designation - 40 hour initial certification plus continuing education hours of 16 hours every 2 years. Supervisory Responsibilities: This job has no supervisory responsibilities. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work and eight-hour shift, sit for long periods during the day, type or work at a keyboard most of the day, and read a video display terminal for long periods of time. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Requirements: Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickl Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Salary Range: The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate's experience, qualifications, skill set, and work location. Benefits: We take care of our people so they can take care of their work and their teams. AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including: Comprehensive medical, dental, and vision benefits Company contributions to HSA and FSA plans Employer paid life and disability insurance 401(k) with company match Paid time off (PTO) and company paid holidays Learning and development opportunities that support real career advancement Employee assistance resources and a supportive culture that values balance and wellbeing We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.
Job Description Job Description Description: AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction-not increase volume-and create real career paths for professionals who want to grow their careers or move into leadership. At AvonRisk, you're part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed. Summary: Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. Essential Duties and Responsibilities: Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills to the BR supervisor. Communicates with clients and/or providers to clarify information. Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers. Ability to price hospital and surgery bills to applicable fee schedules. Ability to process reconsideration requests as assigned. May specialize in state specific or client specific areas of responsibility. May assist is answering provider calls. Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Location & Work Arrangement: Candidates should be based in Texas but are able to work fully remote. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Knowledge Skills: Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers' compensation regulations and have good comprehension of company software system process. Math Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Computer Skills: To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software. Certificates and Licenses: Must have Medical Bill Reviewer Designation - 40 hour initial certification plus continuing education hours of 16 hours every 2 years. Supervisory Responsibilities: This job has no supervisory responsibilities. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work and eight-hour shift, sit for long periods during the day, type or work at a keyboard most of the day, and read a video display terminal for long periods of time. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Requirements: Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickl Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Salary Range: The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate's experience, qualifications, skill set, and work location. Benefits: We take care of our people so they can take care of their work and their teams. AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including: Comprehensive medical, dental, and vision benefits Company contributions to HSA and FSA plans Employer paid life and disability insurance 401(k) with company match Paid time off (PTO) and company paid holidays Learning and development opportunities that support real career advancement Employee assistance resources and a supportive culture that values balance and wellbeing We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.
Paul Davis Restoration, Inc.
Jacksonville, Florida
Job Description Job Description Benefits: Medical, Dental, & Vision Benefits Opportunity for advancement Training & development Wellness resources 401(k) matching Do YOU want to make an Impact in your community in a diverse and inclusive company, working in a dynamic and growing industry, while supporting your personal and professional journey in your career? Come and join the Paul Davis Team! Our company's mission is to provide opportunities for great people to deliver best-in-classresults. Are you looking to leverage your expertise to grow in a role that offers varied and challenging work? Our company, a leading parent organization that owns and operates 340+ franchise locations across North America, seeks a new REVIEW TEAM MANAGER! FLEXIBLE POSITION - REMOTE OR HYBRID ROLE REPORTS TO: Director of Estimate Reviews SALARY RANGE: $65,000 - $75,000 annually Position Summary This Review Team Manager will serve as a member of the Claims Force team (formerly known as Quality Assurance). The primary responsibility of the Review Team Manager is to lead a team of staff estimate reviewers in performance management, SMART goal creation, and team meetings with collaboration between other departments within the franchisor, designed to strategically place Paul Davis at the top of each carrier's score card. Work standards for the Manager and the team are focused on accuracy, speed, customer service, and similar supporting metrics. The Review Team Manager will support the team with claim management escalations, performance accountability, and general oversight. Essential Duties/Responsibilities Recruits, onboards, and trains new Claims Force team members Completes monthly meetings with team members for performance coaching and management Completes monthly Goal Setting & Review (GS&R) Meetings with team members focusing on continuous improvement Supports team members' growth with creation of SMART Goals and development paths Facilitates and conducts team calibration meetings Supports assignment-level success through control points that include but are not limited to: Scorecard support, pre-estimate upload SLAs, estimate reviews, centralized remote estimate creation, and post-QA Approval managed repair Provides direct support for any function within the team during claim spikes to help with coordination of claims, catastrophe events, team member absences or shortages, and as requested based on organizational demands Communicates effectively with direct reports, supervisor, franchisees, and insurance carrier partners, and all stakeholders within the organization Communicates effectively with direct reports, supervisor, franchisees, insurance carrier partners, and all stakeholders within the organization Communication expectations include inbound and outbound phone calls, Validate, CMS, claim management system notes, email, MS Teams, and other potential software/communication applications Coach franchises on opportunities to improve their estimating and documentation performance Provide assistance to franchises on estimating requirements and claim expectations, based on carrier guidelines; and support technical claim inquiries across the estimating/claim management platforms Identify and communicate trends to Directors, Team Managers, Account Managers, Regional Business Coaches, and other organizational stakeholders Provides trend analysis of internal performance to supervisor and participates in problem-solving sessions to address gaps Provides support to the Director of Claims Force and other leaders in the onboarding process of new team members and those in new positions, acting as a key support role in organizational and departmental success Creates opportunities for team building through engaging meetings and events, strengthening the cohesiveness of the team and creating the opportunity for a high level of support to the network Approves timecards for direct reports Approves expense reports for direct reports Other projects or duties as assigned Competency - Knowledge, Skills and Abilities: Proficient use of a laptop and operating accessories Proficient use of Microsoft Office applications (Outlook, Teams, OneDrive, SharePoint, Forms, PowerPoint, Word, Excel) Subject matter expert-level knowledge and performance excellence within the insurance industry, including but not limited to mitigation, contents, and reconstruction concepts, operational practices, and verbiage Ability to lead and manage a team to move through reviews of varying job types, estimate severity, and complexity Assertive, professional communication skills - adaptive communication based on the context of the information being conveyed, both verbal and written Ability to assertively embrace the continuous improvement model and provide feedback necessary to move the business forward Proficient use of technology applications, including the creation of new documents Ability to independently problem solve, resolve conflict, and manage priorities Ability to learn and implement new processes related to our industry and the specific duties and responsibilities required to be successful in this role Ability to review and write estimates for water mitigation, mold, fire mitigation, temporary repairs, contents, reconstruction, and other job-type estimates in an accurate and timely manner Ability to complete multiple reviews or estimates within a given time frame Knowledge of estimating platforms; Xactware Products, Symbility, and other estimating software Knowledge of estimating principles for the insurance industry Ability to learn and operate our primary operating systems Ability to successfully pass required industry and company certifications on first attempt Ability to answer and communicate with PDRI, Independent franchises, and PDP offices via phone and email Ability to work in our main operating systems Ability to work independently Ability to pass and maintain a satisfactory background check Ability to maintain a high level of confidentiality Required Education and Experience High School Diploma or GED Bachelor's Degree or equivalent experience in insurance claims or related field 1 plus years' experience with estimation principles for the insurance industry 2 plus years' experience with contracting and/or field work for a given trade 3 plus years' experience with personnel management or coaching Preferred Education and Experience Experience serving in a customer service role. 5 plus years' experience in the restoration industry regarding water mitigation, mold remediation, lead and asbestos abatement, contents cleaning, contents packing, structure cleaning, and reconstruction. 5 plus years' personnel management or coaching experience Physical Requirement The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is occasionally required to sit, climb or balance, stoop or kneel. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Must be able to stay in a stationary position up to 100% of the time The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Constantly operates a computer and other office productivity machinery, such as a calculator, fax machine, copy machine, and computer printer. Must be able to observe and perceive information on a computer and documents Must be able to communicate and converse with customers over the phone Occasionally will lift up to 10lbs Ability to safely operate a company vehicle Work Environment The employee will be working indoors. The employee will be exposed to air conditioning and heat. The employee will be exposed to normal noises throughout the office. Travel This position may require up to 20% travel. This position may require travel to franchise locations, training, client/partner meetings, and team meetings. Reasonable Accommodation for Disability Any applicant or employee who believes that a reasonable accommodation is required for purposes of federal or state disability law is required to contact Human Resources to begin the interactive exchange process. The ADA defines "reasonable accommodation" as a change or adjustment to a job or work environment that allows a qualified individual with a disability to satisfactorily perform the essential functions of a particular job and does not cause an undue hardship for the employer. Disclaimer Paul Davis Restoration is an equal opportunityemployer. Paul Davis Restoration provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Flexible work from home options available.
Job Description Job Description Benefits: Medical, Dental, & Vision Benefits Opportunity for advancement Training & development Wellness resources 401(k) matching Do YOU want to make an Impact in your community in a diverse and inclusive company, working in a dynamic and growing industry, while supporting your personal and professional journey in your career? Come and join the Paul Davis Team! Our company's mission is to provide opportunities for great people to deliver best-in-classresults. Are you looking to leverage your expertise to grow in a role that offers varied and challenging work? Our company, a leading parent organization that owns and operates 340+ franchise locations across North America, seeks a new REVIEW TEAM MANAGER! FLEXIBLE POSITION - REMOTE OR HYBRID ROLE REPORTS TO: Director of Estimate Reviews SALARY RANGE: $65,000 - $75,000 annually Position Summary This Review Team Manager will serve as a member of the Claims Force team (formerly known as Quality Assurance). The primary responsibility of the Review Team Manager is to lead a team of staff estimate reviewers in performance management, SMART goal creation, and team meetings with collaboration between other departments within the franchisor, designed to strategically place Paul Davis at the top of each carrier's score card. Work standards for the Manager and the team are focused on accuracy, speed, customer service, and similar supporting metrics. The Review Team Manager will support the team with claim management escalations, performance accountability, and general oversight. Essential Duties/Responsibilities Recruits, onboards, and trains new Claims Force team members Completes monthly meetings with team members for performance coaching and management Completes monthly Goal Setting & Review (GS&R) Meetings with team members focusing on continuous improvement Supports team members' growth with creation of SMART Goals and development paths Facilitates and conducts team calibration meetings Supports assignment-level success through control points that include but are not limited to: Scorecard support, pre-estimate upload SLAs, estimate reviews, centralized remote estimate creation, and post-QA Approval managed repair Provides direct support for any function within the team during claim spikes to help with coordination of claims, catastrophe events, team member absences or shortages, and as requested based on organizational demands Communicates effectively with direct reports, supervisor, franchisees, and insurance carrier partners, and all stakeholders within the organization Communicates effectively with direct reports, supervisor, franchisees, insurance carrier partners, and all stakeholders within the organization Communication expectations include inbound and outbound phone calls, Validate, CMS, claim management system notes, email, MS Teams, and other potential software/communication applications Coach franchises on opportunities to improve their estimating and documentation performance Provide assistance to franchises on estimating requirements and claim expectations, based on carrier guidelines; and support technical claim inquiries across the estimating/claim management platforms Identify and communicate trends to Directors, Team Managers, Account Managers, Regional Business Coaches, and other organizational stakeholders Provides trend analysis of internal performance to supervisor and participates in problem-solving sessions to address gaps Provides support to the Director of Claims Force and other leaders in the onboarding process of new team members and those in new positions, acting as a key support role in organizational and departmental success Creates opportunities for team building through engaging meetings and events, strengthening the cohesiveness of the team and creating the opportunity for a high level of support to the network Approves timecards for direct reports Approves expense reports for direct reports Other projects or duties as assigned Competency - Knowledge, Skills and Abilities: Proficient use of a laptop and operating accessories Proficient use of Microsoft Office applications (Outlook, Teams, OneDrive, SharePoint, Forms, PowerPoint, Word, Excel) Subject matter expert-level knowledge and performance excellence within the insurance industry, including but not limited to mitigation, contents, and reconstruction concepts, operational practices, and verbiage Ability to lead and manage a team to move through reviews of varying job types, estimate severity, and complexity Assertive, professional communication skills - adaptive communication based on the context of the information being conveyed, both verbal and written Ability to assertively embrace the continuous improvement model and provide feedback necessary to move the business forward Proficient use of technology applications, including the creation of new documents Ability to independently problem solve, resolve conflict, and manage priorities Ability to learn and implement new processes related to our industry and the specific duties and responsibilities required to be successful in this role Ability to review and write estimates for water mitigation, mold, fire mitigation, temporary repairs, contents, reconstruction, and other job-type estimates in an accurate and timely manner Ability to complete multiple reviews or estimates within a given time frame Knowledge of estimating platforms; Xactware Products, Symbility, and other estimating software Knowledge of estimating principles for the insurance industry Ability to learn and operate our primary operating systems Ability to successfully pass required industry and company certifications on first attempt Ability to answer and communicate with PDRI, Independent franchises, and PDP offices via phone and email Ability to work in our main operating systems Ability to work independently Ability to pass and maintain a satisfactory background check Ability to maintain a high level of confidentiality Required Education and Experience High School Diploma or GED Bachelor's Degree or equivalent experience in insurance claims or related field 1 plus years' experience with estimation principles for the insurance industry 2 plus years' experience with contracting and/or field work for a given trade 3 plus years' experience with personnel management or coaching Preferred Education and Experience Experience serving in a customer service role. 5 plus years' experience in the restoration industry regarding water mitigation, mold remediation, lead and asbestos abatement, contents cleaning, contents packing, structure cleaning, and reconstruction. 5 plus years' personnel management or coaching experience Physical Requirement The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is occasionally required to sit, climb or balance, stoop or kneel. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Must be able to stay in a stationary position up to 100% of the time The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Constantly operates a computer and other office productivity machinery, such as a calculator, fax machine, copy machine, and computer printer. Must be able to observe and perceive information on a computer and documents Must be able to communicate and converse with customers over the phone Occasionally will lift up to 10lbs Ability to safely operate a company vehicle Work Environment The employee will be working indoors. The employee will be exposed to air conditioning and heat. The employee will be exposed to normal noises throughout the office. Travel This position may require up to 20% travel. This position may require travel to franchise locations, training, client/partner meetings, and team meetings. Reasonable Accommodation for Disability Any applicant or employee who believes that a reasonable accommodation is required for purposes of federal or state disability law is required to contact Human Resources to begin the interactive exchange process. The ADA defines "reasonable accommodation" as a change or adjustment to a job or work environment that allows a qualified individual with a disability to satisfactorily perform the essential functions of a particular job and does not cause an undue hardship for the employer. Disclaimer Paul Davis Restoration is an equal opportunityemployer. Paul Davis Restoration provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Flexible work from home options available.