Case Manager jobs at AMERISAFE - 281 jobs

This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking an experienced Workers Compensation Field Case Manager to join our team in the Cincinnati-North Dayton-Columbus, OH area. This is a remote, contracted role. Job Summary The Field Case Manager is responsible for assisting our clients injured workers with case management and return to work services. Essential Duties and Responsibilities Provide field case management services for our clients injured workers, including onsite attendance at doctor's appointments Perform case assessments and develop action plans to support recovery and timely return to work Coordinate timely access to needed medical services and maintain proactive communications Cultivate excellent relationships with all parties (AE's, IWs, providers, clients) Provide written reports on case status and updates (post, physician visit/weekly/monthly) and submits timely monthly billing to billing specialist. Contracted CM Requirements Prior Field Case Management - workers' compensation experience preferred Active Registered nurse (R.N. License and possess the ability to be licensed as a registered nurse in multiple states without restrictions) Understanding and working knowledge of ODG Guidelines Seasoned professional nurse with clinical nursing experience and at least 2-years case management experience with injured workers Understanding of case management processes Excellent interpersonal communication skills - both oral and written Professional certifications such as: CDMS, CRRN, COHN, or CCM are a plus Values At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration. AAP/EEO Statement Here at Charles Taylor we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation. Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor.

Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking an experienced Workers Compensation Field Case Manager to join our team in the Cincinnati-North Dayton-Columbus, OH area. This is a remote, contracted role. Job Summary The Field Case Manager is responsible for assisting our clients injured workers with case management and return to work services. Essential Duties and Responsibilities * Provide field case management services for our clients injured workers, including onsite attendance at doctor's appointments * Perform case assessments and develop action plans to support recovery and timely return to work * Coordinate timely access to needed medical services and maintain proactive communications * Cultivate excellent relationships with all parties (AE's, IWs, providers, clients) * Provide written reports on case status and updates (post, physician visit/weekly/monthly) and submits timely monthly billing to billing specialist. Contracted CM Requirements * Prior Field Case Management - workers' compensation experience preferred * Active Registered nurse (R.N. License and possess the ability to be licensed as a registered nurse in multiple states without restrictions) * Understanding and working knowledge of ODG Guidelines * Seasoned professional nurse with clinical nursing experience and at least 2-years case management experience with injured workers * Understanding of case management processes * Excellent interpersonal communication skills - both oral and written * Professional certifications such as: CDMS, CRRN, COHN, or CCM are a plus Values At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration. AAP/EEO Statement Here at Charles Taylor we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation. Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor.

Now Hiring: RN Case Manager - Lubbock, TX Region Work from home + local field travel Salary: Competitive & commensurate with experience Quarterly Bonus Opportunities Free CEUs for licenses & certificates License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! RN degree required National Certification preferred (CCM, CRC, COHN, CRRC) Workers' Comp Case Management experience a plus Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Lubbock community!

🚨 Now Hiring: RN Case Manager - Lubbock, TX Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the Lubbock community! Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

Why Saybrus? We strive to help employees lead fulfilling professional lives. Excellence is expected and rewarded. We believe in straightforward communication and encourage employees to share opinions and ideas. Our salaries, incentive awards and comprehensive benefits provide a highly competitive total reward package based on individual and company performance. Many of our employees work from their homes, while others are based in our Hartford, CT headquarters. Job Summary Saybrus Partners is looking for a self-motivated individual for the role of Case Manager, a critical role in the success of Saybrus' life insurance distribution strategy. Case Managers provide new business support to key business partners. They must independently manage cases by creatively resolving issues, negotiating underwriting offers (where applicable) while leveraging contacts and resources to ensure a desired outcome. Candidates must possess a strong knowledge of the life insurance process and be able to troubleshoot problems causing cycle time delays. Responsibilities also include timely communications, assistance in gathering outstanding requirements and overall superior customer service. Case Managers are expected to utilize strong communication skills (verbal and written) to ensure cases move through the new business process in a timely manner. Case managers must work well in a team environment. This role has a direct correlation to the success of the account.Job Description Principal Duties and Responsibilities Proactively follow up and provide communication to support advisor/distributor satisfaction and understanding; ensure cases progress from submission to placement in a timely/efficient manner with superior service. Manage daily workload with emphasis on time management and quality standards. Review and assess requirements, as needed. Serve as a single point of contact to customers. Receive and resolve complex and/or sensitive customer service inquiries, complaints and problems with quality, accuracy, and in a timely manner. Proactively resolve any issues and inquiries. Manage the necessary components for the new business process, identifying cases that need special handling. Accept ownership and suggest innovative solutions to meet branch/client needs while undertaking new and different requests. Explore opportunities to add value. Use expertise in life insurance process, terminology, technology to support and enhance daily operations. Negotiate underwriting offers with the underwriting teams of our Product Partners as appropriate to provide best opportunity for placement. Provide continuous scheduled telephone coverage as business needs dictate. May be responsible for employee training and mentoring. Perform other duties as assigned Knowledge, Skills and Abilities Knowledge of the life insurance process (permanent and term products), including key impairments Working knowledge of desktop applications such as Outlook, Word and Excel. Knowledge of Smart Office and Salesforce.com a plus. Critical thinking skills with the ability to identify and troubleshoot problems, and comfort with cases involving a high degree of complexity. Excellent verbal and written communication skills; clear and effective Excellent interpersonal and relationship building skills to interact with internal and external clients Discretion while handling confidential matters (e.g., medical records) Ability to work independently in a fast-paced, multi-faceted environment while focusing on critical deliverables Comfortable in a team environment and supportive of corporate change

AMERISAFE is seeking a detail-oriented, productivity driven professional to add to our Illinois based Workers Compensation Claims Team. In this position, you will conduct on-site and in-person investigations, determine compensability, establish reserves, document decision making, issue benefit payments, and make notifications to the State administrative authority. You will work with injured workers, employers, medical and legal professionals to ensure the appropriate benefits are provided to injured workers under the appropriate Workers' Compensation Laws. In addition to the benefits listed on our careers page, other benefits of this position include: * Salaried position based on location and experience ($50,000 to $95,000) * Auto reimbursement program * Reimbursement for cell phone and internet * Target Case Load of 60 claims Upon an offer and acceptance of employment with AMERISAFE, you will be required to complete our pre-employment screening, which includes a criminal background check, a 10-panel drug test and, if applicable, a review of your motor vehicle report. A 10-panel drug test includes amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine metabolite (BZE), marijuana metabolite (THCA), methadone, methaqualone, codeine/morphine, phencyclidine, propoxyphene. Qualifications * Claims experience highly preferred. * Bachelor's degree or related professional business experience acceptable. * State license to handle Workers' Compensation claims if required. * Professional written and verbal communication skills required. * World class customer service attitude required. * Ability to learn and use proprietary software and Microsoft Office products is necessary. * The ability to be self-directed. This is a remote position. * Valid driver's license, acceptable driving record and acceptable vehicle required. * Frequent travel within a designated territory required, but rarely is overnight travel required.

Purpose: The Regional Patient Case Manager - Long Term Care (RPCM-LTC) is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding patient-specific programs, referral status or escalation, benefits verification and financial assistance counseling. The RPCM-LTC acts as a single point of contact for communication and coordination among all participants of the LTC facility health care team to ensure that the services are provided. The RPCM-LTC is responsible for providing professional, concise internal and external communication regarding case status updates, next steps in prescription processing, shipment set ups, and communication of reimbursement issues. The RPCM-LTC oversees the provision of extended, ongoing services to residents of long-term care facilities. Also, provides intensive case management in a collaborative process that includes therapy initiation, referrals to Specialty Distributors, and triages to Specialty Pharmacy or Long-Term Care Pharmacies. Responsibilities: Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities. Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups. Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures. Review and add LTC profile data to capture the key information related to LTC facilities and customers. Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support. Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey. Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable. Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate. Apply defined business rules to qualify patients for manufacturer supported programs. Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls. Provide support, education and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups. Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution. Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention. Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance. Refer patients to third-party or other foundation programs per program business rules. Manage case triage to Specialty Pharmacy or Long Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison. Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates. Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility. Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules. Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately. Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers and payers. Utilizes outbound faxes, email alerts, and mailings per program guidelines. Strong compliance mindset, demonstrating clear understanding of patient privacy laws. Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity. Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed. This position may require flexibility in scheduling, with shifts occurring between 8:00AM and 8:00PM EST, Monday through Friday. Employees should be prepared to work within this timeframe as needed. Other duties as assigned. Required Qualifications: High school diploma plus 2+ years recent case management experience Previous 3+ years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care Advanced knowledge and experience in healthcare setting Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction Empathy, drive and commitment to exceptional service Ability to build productive internal/external working relationships Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables Preferred Qualifications: Undergraduate degree and/or equivalent work experience Certified Pharmacy Technician (CPhT) or Case Management Experience Long-term care reimbursement/case management experience is a major plus Bilingual Spanish speaking and writing is plus Strong analytical and organizational skills with meticulous attention to detail Experience with benefit investigation and verification of prescription benefits Working knowledge of Third-Party and other Foundation programs a major plus Understanding of plan types - Government, Commercial, Medicaid, VA, Fed Knowledge of insurance structure (ex PBM's, major medical plans, co-pay assistance /cards) Ability to proficiently use Microsoft Teams, Excel, Outlook and Word Work Environment RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee's teleworking space should be separate and distinct from their “home space” and allow for privacy. Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

Purpose: The Regional Patient Case Manager - Long Term Care (RPCM-LTC) is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding patient-specific programs, referral status or escalation, benefits verification and financial assistance counseling. The RPCM-LTC acts as a single point of contact for communication and coordination among all participants of the LTC facility health care team to ensure that the services are provided. The RPCM-LTC is responsible for providing professional, concise internal and external communication regarding case status updates, next steps in prescription processing, shipment set ups, and communication of reimbursement issues. The RPCM-LTC oversees the provision of extended, ongoing services to residents of long-term care facilities. Also, provides intensive case management in a collaborative process that includes therapy initiation, referrals to Specialty Distributors, and triages to Specialty Pharmacy or Long-Term Care Pharmacies. Responsibilities: Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities. Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups. Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures. Review and add LTC profile data to capture the key information related to LTC facilities and customers. Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support. Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey. Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable. Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate. Apply defined business rules to qualify patients for manufacturer supported programs. Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls. Provide support, education and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups. Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution. Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention. Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance. Refer patients to third-party or other foundation programs per program business rules. Manage case triage to Specialty Pharmacy or Long Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison. Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates. Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility. Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules. Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately. Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers and payers. Utilizes outbound faxes, email alerts, and mailings per program guidelines. Strong compliance mindset, demonstrating clear understanding of patient privacy laws. Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity. Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed. This position may require flexibility in scheduling, with shifts occurring between 8:00AM and 8:00PM EST, Monday through Friday. Employees should be prepared to work within this timeframe as needed. Other duties as assigned. Required Qualifications: High school diploma plus 2+ years recent case management experience Previous 3+ years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care Advanced knowledge and experience in healthcare setting Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction Empathy, drive and commitment to exceptional service Ability to build productive internal/external working relationships Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables Preferred Qualifications: Undergraduate degree and/or equivalent work experience Certified Pharmacy Technician (CPhT) or Case Management Experience Long-term care reimbursement/case management experience is a major plus Bilingual Spanish speaking and writing is plus Strong analytical and organizational skills with meticulous attention to detail Experience with benefit investigation and verification of prescription benefits Working knowledge of Third-Party and other Foundation programs a major plus Understanding of plan types - Government, Commercial, Medicaid, VA, Fed Knowledge of insurance structure (ex PBM's, major medical plans, co-pay assistance /cards) Ability to proficiently use Microsoft Teams, Excel, Outlook and Word Work Environment RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee's teleworking space should be separate and distinct from their “home space” and allow for privacy. Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

Now Hiring: RN Case Manager - Oklahoma City, OK Region Work from home + local field travel Salary: Competitive & commensurate with experience Quarterly Bonus Opportunities Free CEUs for licenses & certificates License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! RN degree required National Certification preferred (CCM, CRC, COHN, CRRC) Workers' Comp Case Management experience a plus Location Requirement Candidates must be based in Oklahoma City or cities along the corridor up to Tulsa (including Edmond, Norman, Moore, Stillwater, and surrounding areas) Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Oklahoma City community!

🚨 Now Hiring: RN Case Manager - Oklahoma City, OK Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus 📍 Location Requirement Candidates must be based in Oklahoma City or cities along the corridor up to Tulsa (including Edmond, Norman, Moore, Stillwater, and surrounding areas) ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the Oklahoma City community! Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence. #LI-RG1 Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

Now Hiring: RN Sr Case Manager - San Antonio, TX Region Work from home + local field travel Salary: Competitive & commensurate with experience Quarterly Bonus Opportunities Free CEUs for licenses & certificates License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! RN degree required National Certification preferred (CCM, CRC, COHN, CRRC) Workers' Comp Case Management experience a plus Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the San Antonio community!

🚨 Now Hiring: RN Sr Case Manager - San Antonio, TX Region 🚨 💻 Work from home + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We're looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRC) ✨ Workers' Comp Case Management experience a plus ✅ Your Impact: You'll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the San Antonio community! Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted. Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity. Demonstrated ability to handle complex assignments and ability to work independently is required. Effective oral and written communication skills are required. Thorough understanding of jurisdictional WC statutes. Advanced knowledge to exert positive influence in all areas of case management. Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned. Highly skilled at promoting all managed care products and services internally and externally. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Minimum of 1 nationally recognized Certification from the URAC list of approved certifications. Must be able to travel as required. Individuals who conduct initial clinical review possess an active, professional license or certification: To practice as a health professional in a state or territory of the U.S.; and With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. Must maintain a valid driver's license in state of residence. #LI-RG1 May assist supervisor/manager in review of reports, staff development. Reviews case records and reports, collects and analyzes data, evaluates client's medical and vocational status and defines needs and problems in order to provide proactive case management services. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, employer and physicians. May recommend and facilitate completion of peer reviews and IME's by obtaining and delivering medical records and diagnostic films notifying patients. Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation case management goals to include RTW. May review files for claims adjusters and supervisors. May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards. May obtain referrals from branch claims office or assist in fielding phone calls for management as needed. Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client. May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases. May meet with employers to review active files. Reviews cases with supervisor monthly to evaluate file and obtain direction. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem resolution by appropriate use of research and resources. May perform other related duties as assigned.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The opportunity Short-Term Disability insurance provides an income to employees who cannot work due to an illness or injury. As a Case Specialist, you will review claims for Short-Term Disability and decide if the person applying for benefits are eligible to receive them. Some claims are easy, some are more complex. But all claims give you the opportunity to interact and make a difference for our Clients daily. How you will contribute * Review claim forms to make sure the person applying for benefits meets all the requirements to receive benefits, including their medical condition, the recommendations of their health care providers, and the details of the short-term disability contract. * Approve the benefits if the person meets all these requirements. * Process these claims in a timely manner with accuracy. * Serve our clients in a caring and empathetic manner, communicating clearly with them the decisions you make. * Reach out to employees, employers, health care providers, attorneys, and anyone else as needed to get the paperwork or information you need to make a decision. * Make sure all your claim decisions match the insurance contract and follow all laws, regulations, and procedures. What you will bring with you * Passion for helping people, especially in times of need due to illness or injury. * Your desire and ability to provide superior service and build positive relationships. * Independent thinking and decision-making skills to support payment of benefits. * Your energy to thrive in a fast-paced environment. * Drive to continuously learn, build, and grow professionally. * The ability to adapts well to change and execute on new concepts. * Insurance claims experience is not a requirement. Salary Range: $49,400 - $66,700 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 29/01/2026

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $104,000.00 - $171,700.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign on bonus up to $20,000. Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Major Case Specialist, you are responsible for investigating, evaluating, reserving, negotiating, and resolving complex, serious and severe claims typically with full damage value for average claim $500,000 to over a multi-million dollar value. You will serve as an expert technical resource to claim professionals, business partners, customers, and other stakeholders. What Will You Do? * Oversee major General Liability claims from initiation to resolution, ensuring compliance with company policies and industry regulations. * Conduct detailed investigations to gather evidence, assess liability and determine extent of damages. * Evaluate claim information and documentation to make informed decisions regarding coverage and settlement. * Engage in negotiations with claimants, legal representatives, and other parties to achieve fair and equitable settlements. * Maintain comprehensive and accurate records of all claim activities, communications, and decisions. * Prepare and present detailed reports on claim status, trends and outcomes to senior management. * Work closely with legal, underwriting, and other departments to ensure coordinated claim handling. * Apply litigation management strategies through the selection of counsel and evaluation. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. What Will Our Ideal Candidate Have? * Bachelor's Degree. * Ten years of experience in handling major General Liability claims and managing litigation and complex negotiations. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of management. * Thorough understanding of business line products, policy language, exclusions, and ISO forms. * Demonstrated ability of strategic claims handling practices. * Strong written and verbal communication skills with the ability to understand, synthesize, interpret, and convey information in a simplified manner. * Familiarity with industry regulations and legal requirements specific to XX insurance. * Ability to work independently and manage multiple high-value claims simultaneously. What is a Must Have? * High School Degree or GED required with a minimum of 4 years bodily injury litigation claim handling or comparable claim litigation experience. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $104,000.00 - $171,700.00 Target Openings 2 What Is the Opportunity? This role is eligible for a sign on bonus up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff. What Will You Do? * Directly handle assigned severe claims. * Full damage value for average claim (without regard to coverage or liability defenses): $500,000 to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value. * Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Work with Manager on use of Claim Coverage Counsel as needed. * Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. * Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Complete outside investigation as needed per case specifics. * Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts. * Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Maintain claim files and document claim file activities in accordance with established procedures. * Develop and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiate disposition of claims with insureds and claimants or their legal representatives. * Recognize and implement alternate means of resolution. * Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Utilize evaluation documentation tools in accordance with department guidelines. * Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. * Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure. * Establish and maintain proper indemnity and expense reserves. * Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims. * Recommend appropriate cases for discussion at roundtable. * Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others. * Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance. * Apply litigation management through the selection of counsel, evaluation. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred. * 10+ years claim handling experience with 5-7 years experience handling serious injury and complex liability claims preferred. * Extensive working level knowledge and skill in various business line products. * Excellent negotiation and customer service skills. * Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills. * Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others and actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices. * Demonstrated strong coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced * Judgment/Decision Making - Advanced * Communication - Advanced * Negotiation - Advanced * Insurance Contract Knowledge - Advanced * Principles of Investigation - Advanced * Value Determination - Advanced * Settlement Techniques - Advanced * Litigation Management - Advanced * Medical Terminology and Procedural Knowledge - Advanced What is a Must Have? * 10+ years claim handling experience or related experience with 3-5 years experience handling serious injury and complex liability claims. High School Degree or GED required; In order to perform the essential job functions of this job, acquisition and maintenance of Property/Causalty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The opportunity Short-Term Disability insurance provides an income to employees who cannot work due to an illness or injury. As a Case Specialist, you will review claims for Short-Term Disability and decide if the person applying for benefits are eligible to receive them. Some claims are easy, some are more complex. But all claims give you the opportunity to interact and make a difference for our Clients daily. How you will contribute * Review claim forms to make sure the person applying for benefits meets all the requirements to receive benefits, including their medical condition, the recommendations of their health care providers, and the details of the short-term disability contract. * Approve the benefits if the person meets all these requirements. * Process these claims in a timely manner with accuracy. * Serve our clients in a caring and empathetic manner, communicating clearly with them the decisions you make. * Reach out to employees, employers, health care providers, attorneys, and anyone else as needed to get the paperwork or information you need to make a decision. * Make sure all your claim decisions match the insurance contract and follow all laws, regulations, and procedures. What you will bring with you * Passion for helping people, especially in times of need due to illness or injury. * Your desire and ability to provide superior service and build positive relationships. * Independent thinking and decision-making skills to support payment of benefits. * Your energy to thrive in a fast-paced environment. * Drive to continuously learn, build, and grow professionally. * The ability to adapts well to change and execute on new concepts. * Insurance claims experience is not a requirement. Salary Range: $49,400 - $66,700 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 29/01/2026

Job DescriptionGENERAL OVERVIEW OF KEY ROLES & RESPONSIBILITIES: The individual occupying this position will perforn work in the community that supports establishing and building relationships with local CRC's, Inpatient Psychiatric Facilities, and other community providers and neighborhood associations in addition to, short- and long-term residential providers. services. These functions are directed at specific outcomes for program growth and participant support. I. Participates in planning and implementation of special events and community outreach. 2. Marketing/Outreach Implementation 3. Liaison with community supporters, agencies/ organizations in public and non-profit sectors. ESSENTIAL & CORE FUNCTIONS: Duties and Responsibilities • Assess the needs of individuals, families, or c0Ill1nw1ities to identify the necessary resources and services. • Connect clients with appropriate community resources, and or refer clients to community services to help them in recovery. • Advocate and assist clients in navigating social service systems. • Organize and promote community outreach programs and workshops to educate the community on available resources and services. • Collaborate with other social workers, healthcare professionals, and community leaders to address larger community issues. • Document and maintain records of clients' cases, including services provided, assessments, and progress. • Provide crisis intervention and counseling in situations requiring immediate social service attention. • Develop community programs to assist with social issues such as homelessness, substance abuse, and domestic violence. • Work with other social workers, counselors, and health professionals to provide the best care for clients. • Advocate and assist clients in navigating social systems. • Monitor and evaluate clients' progress and modify treatment plans as needed. • Document and maintain records of clients' cases to or see the quality and timeliness of assessment, tracking and reporting accurate referral information. • Provide support to admin staff and volunteers, students. • Attends community resource and networking events. • Participate in community and home visits to established members in program. • Perform presentations and distribute information to community providers. • Duties may include but are not limited to establishing goals and objectives for OMY intake unit. Clinical/Rehabilitations Roles and Responsibilities. Provides support for transitioning clients into services. • Follow up with clients to ensure that their needs are met and to evaluate the effectiveness of their service plans. • Provide crisis intervention and counseling in situations requiring immediate social service attention. Work with individuals, families or groups to improve their circumstances and capacity to manage social and personal issues. • Coordinate services v.rith referral sources and other community resources to ensure timeliness of treatment services. Attends and participates in meetings, coordinating information and care requirements with other care providers. Knowledge of Federal, State, and local laws and regulations. Ex. (HIPPA, State regulations, County Mental Health regulations)) Assess daily admission and discharges program status. Monitor the volume of referrals to ensure that referrals are processed in a timely manner. Improve professional skills through continuing education, peer supervision, and individual supervision as needed. • Refer clients and/or family members to community resources, as necessary. Requirements Prerequisites and Qualifications for The Position: 1. Bachelor's degree in social work (BSW), psychology or a related field master's degree in social work (MSW) Psychology or a Social Science Degree and have a minimum of (1) years of experience in Community Work with nonprofit/ profit groups, organizations, and Volunteerism (Preferred) 2. Counseling experience with adults and or families diagnosed with mental i1lness and/or substance use. 3. Valid FBI clearance, criminal history check and child abuse history clearance required. 4. Participation in and completion of all CBH mandatory in-services (must be completed with three (3) months of hire and then annually from the date of the initial training). 5. Valid Pennsylvania Diiver's License. Benefits Health Care Plan (Medical, Dental & Vision) Retirement Plan (401k, IRA) Life Insurance (Basic, Voluntary & AD&D) Paid Time Off (Vacation, Sick & Public Holidays) Family Leave (Maternity, Paternity) Short Term & Long Term Disability

Job Description Consultant will provide Social Work services as assigned, to specific projects deemed necessary to facilitate quality services at Global Leadership Academy (GLA) Specifically Provide daily(5) days a week of social work services for minimum 6.5 hours (30 minutes unpaid lunch) daily Provide Individual Therapeutic sessions with identified student prioritizing IEP scholars with prescribed counseling services Facilitate group process and/or psycho education sessions with identified scholars Conduct school wide workshops/ Professional Development sessions as identified providing no more than 4 per school year Manage and follow through on the multi-agency services provided to students and their families, particularly as the needs and services impact the educational adjustment of scholars Serve as liaison between school and community agencies in respect to reporting child abuse/neglect and or crisis events Serve as subject matter expert for all social work-related school services, attending required meetings as necessary Document each service encounter within 24 hours of service delivery; Provide quantitative and qualitative data reports for groups, workshops and individual interventions monthly and/or as requested. Support attendance initiative by meeting with parents/guardians in school or-in community as needed. Provide consultation at the-system level to enhance classroom/school climate for· success, promote optimal learning, improve-interpersonal, and alleviate barriers to good adjustment Manage and follow through on the multi-agency services provided to students and their families, particularly as the needs and services impact the educational adjustment of students Maintain compliance with Consultant Guidelines included in this agreement. Consultant shill be available [5 days per week at 6 hours minimum per day], The six hours do not include breaks/lunch, Consultant agrees to perform the services specified herein during such hours as shall be necessary. In the absence of a special need for Consultant's services at a particular time or on a particular day, Consultant shall be free to determine the times when [he/she] will perform services consistent with recommendations from the Program Director. However, if the services are to be perform on GLA premises, WES has the right to require that the services be performed during the hours of normal business operation for GLA. Consultant is available to perform consulting services for persons or entities other than WES. However, Consultant warrants and represents that there is no conflict of interest between [his/her] performance of services under this Agreement and the performance of [his/her] services under other contracts for services or as an employee of other persons or entities and will ensure that no such conflict arises during the term of this Agreement. Execution of this Agreement by Consultant does not guarantee that WES will offer any additional assignments to Consultant. WES may elect to withhold payment to Consultant for services provided that are not authorized by the Program Director or until all contracted services and documentation of services have been submitted without error. Contract is contingent on WES maintaining a contract with GLA and GLA making regular on time payments to WES. Requirements The Consultant, at his/her own expense, shall be responsible for obtaining and maintaining the necessary qualifications and certifications/licenses needed to complete assignments: A Social Work Consultant must meet the following minimum qualifications and have the following documentation within their file: A licensed social worker or MSW or school guidance counselor and all of the following: 1. Current certificate of professional liability insurance 2. The ability and willingness to adjust work hours in accord with scholar needs. 3. For Licensed staff, complete the number of training hours every two years required to maintain the license, As well as the Mandated Reporter Training every five years, 4. Valid PA State Criminal History Report, PA Child Abuse Clearances, FBI Criminal History Report (fingerprinting). 5. Working knowledge of application federal, state and local law governing the proper handling of scholar information. Clinical Supervision The Consultant must attend weekly Team meetings with the WES Program Director