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Claims Processor I Pgba Jobs in Virginia (NOW HIRING)

Brookfield

Senior Claims Assistant

Richmond, VA · On-site

$18.50 - $23.50/hr

Coordinate Escheatment process. * Review of outstanding checks for various claim systems and review ... Must have good business acumen (i.e. understand how an insurance company works and makes money ...

Brookfield

Senior Claims Assistant

Richmond, VA · On-site

$18.50 - $23.50/hr

Coordinate Escheatment process. * Review of outstanding checks for various claim systems and review ... Must have good business acumen (i.e. understand how an insurance company works and makes money ...

Brookfield

Senior Claims Specialist

Richmond, VA · On-site

Processing mail and prioritizing workload. * Completing telephone calls and written correspondence ... Must have good business acumen (i.e. understand how an insurance company works and makes money ...

USAA

Sr. Injury Claims Adjuster

Chesapeake, VA · On-site +1

$63K - $121K/yr

Prioritizes and manages assigned claims workload to keep members and other involved parties ... i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for ...

USAA

Sr. Injury Claims Adjuster

Chesapeake, VA · On-site +1

$63K - $121K/yr

Prioritizes and manages assigned claims workload to keep members and other involved parties ... i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for ...

USAA

Injury Claims Examiner (East Region)

Chesapeake, VA · On-site

$85K - $162K/yr

The Opportunity As a dedicated Injury Claims Examiner (East Region), you will be responsible to ... i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for ...

USAA

Injury Claims Examiner (East Region)

Chesapeake, VA · On-site

$85K - $162K/yr

The Opportunity As a dedicated Injury Claims Examiner (East Region), you will be responsible to ... i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for ...

USAA

Injury Claims Adjuster

Chesapeake, VA · Hybrid

$57K - $103K/yr

Identifies, confirms, and makes coverage decisions on soft tissue claims. * Investigates loss ... i.e., H-1B, TN, STEM OPT Training Plans, etc.) Compensation: USAA has an effective process for ...

USAA

Injury Claims Adjuster

Chesapeake, VA · Hybrid

$57K - $103K/yr

Identifies, confirms, and makes coverage decisions on soft tissue claims. * Investigates loss ... i.e., H-1B, TN, STEM OPT Training Plans, etc.) Compensation: USAA has an effective process for ...

Brookfield

Garage Bodily Injury Claims Adjuster

Richmond, VA · On-site

$49K - $63K/yr

Processing mail and prioritizing workload. * Completing telephone calls and written correspondence ... Must have good business acumen (i.e.understand how an insurance company works and makes money ...

AlphaStaffHCM

Senior Property Adjuster

Chesapeake, VA · Remote

$63K - $114K/yr

Maintains accurate, thorough, and current claim file documentation throughout the claims process ... Experience handling large loss complex claims (i.e., water, vandalism, malicious mischief ...

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Claims Processor I Pgba information

What does a Claims Processor I PGBA do?

A Claims Processor I PGBA is responsible for reviewing, processing, and adjudicating insurance claims in accordance with company policies and industry regulations. They verify the accuracy of information, determine eligibility, and ensure claims are processed efficiently and correctly. This entry-level position often involves communicating with policyholders, healthcare providers, and other stakeholders to resolve discrepancies or gather additional information. Attention to detail and knowledge of insurance procedures are essential for success in this role.

What are the key skills and qualifications needed to thrive as a Claims Processor I PGBA?

To thrive as a Claims Processor I PGBA, you need strong attention to detail, analytical skills, and a high school diploma or equivalent. Familiarity with claims processing software, data entry systems, and knowledge of insurance or healthcare terminology are typically required. Exceptional organizational skills, time management, and effective communication set top performers apart. These abilities ensure accurate and timely processing of claims, reducing errors and supporting customer satisfaction in a high-volume environment.

What are some common challenges faced by a Claims Processor I PGBA, and how can they be successfully managed?

Claims Processors at PGBA often encounter challenges such as high volumes of claims, strict accuracy requirements, and tight deadlines. Successfully managing these involves strong attention to detail, effective time management, and familiarity with claims processing software. Collaboration with team members and clear communication with supervisors can help resolve complex cases efficiently. Continuous learning about updated policies and procedures also plays a key role in overcoming daily obstacles.

What is the difference between Claims Processor I Pgba vs Claims Processor II?

AspectClaims Processor I PgbaClaims Processor II
Required CredentialsHigh school diploma or equivalent; basic insurance knowledgeHigh school diploma; some experience or certification preferred
Work EnvironmentEntry-level, clerical setting within insurance companiesMore complex claims processing, possibly supervisory tasks
Employer & Industry UsageCommon in insurance companies, healthcare providersUsed in similar settings, often with increased responsibilities

The main difference between Claims Processor I Pgba and Claims Processor II lies in experience and responsibilities. Claims Processor II typically handles more complex claims and may assist or supervise Claims Processor I Pgba roles. Both positions require similar credentials but differ in scope and expertise.

What are popular job titles related to Claims Processor I Pgba jobs in Virginia?

For Claims Processor I Pgba jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Claims Processor I Pgba jobs in Virginia look for?

The top searched job categories for Claims Processor I Pgba jobs in Virginia are:

What cities in Virginia are hiring for Claims Processor I Pgba jobs?

Cities in Virginia with the most Claims Processor I Pgba job openings:

Claims Processor I Pgba jobs near you
Infographic showing various Claims Processor I Pgba job openings in Virginia as of August 2026, with employment types broken down into 1% Internship, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 82% Physical, 5% Hybrid, and 13% Remote job distribution.

Claims Consultant

Tata Consultancy Service Limited

Henrico, VA • On-site

$48K - $55K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 11 days ago

Job description

Responsibilities:
To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
Approval or denial on FMLA claims as per Insurance carrier, and employers guidelines
Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
Refers cases as appropriate to team lead and clinical case management
Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
Provide ideas to management on continuous improvement and service level management
Performs other duties or participates in special projects as assigned
Requirements:
1+ year of Disability/FMLA/PFL claims or insurance claims experience
Experience working with FINEOS
Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
Excellent oral and written communication, including presentation skills
Strong Analytical, decision making, problem solving, and people management skills
Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
Willingness to embrace change in a fast paced work environment
A strong desire to continuously learn and improve
Identify escalated cases and work with Team Leader to develop a plan to address key issues.
TCS Employee Benefits Summary:
• Discretionary Annual Incentive.
• Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
• Family Support: Maternal & Parental Leaves.
• Insurance Options: Auto & Home Insurance, Identity Theft Protection.
• Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement.
• Time Off: Vacation, Time Off, Sick Leave & Holidays.
• Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
Salary Ran ge: $48,000 - $55,000 per year

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