Claim Processor jobs at Berkshire Hathaway Specialty Insurance - 534 jobs

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage: complex investigations coverage determinations liability assessments bodily injury claim resolutions-through both settlement and litigation. This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims. If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors: Ownership: You take responsibility for outcomes in all scenarios. Adaptability: You navigate dynamic environments with creativity and resilience. Leading People: You empower individuals and teams to achieve their best. Collaboration: You build and strengthen partnerships across organizational lines. Driving Value: You use data-driven insights to align actions with strategic goals. What You'll Do: Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust. Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims. Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations. Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention. Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service. Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence. Collaborate with leadership and cross-functional teams to identify and implement process improvements. Serve as a resource for team members on insurance-related questions providing mentorship and training to build their industry knowledge. What We're Looking For: Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases. Active Adjuster license (required) Expertise in Casualty claims, including knowledge of industry regulations and best practices Strong ability to assess needs and guide associates in negotiating claim settlements as needed Experienced in the use of various claims tools with ability to assist associates Strong adherence to compliance and regulatory requirements Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment Strong results orientation, with a history of meeting or exceeding performance goals Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations Ability to analyze data and metrics to inform decision-making and improve customer outcomes Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence Why Join GEICO? Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction. Inclusive Culture: Join a company that values diversity, collaboration, and innovation. Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit. Professional Growth: Access GEICO's industry-leading training programs and development opportunities: Licensing and continuing education at no cost to you. Leadership development programs and hundreds of eLearning courses to enhance your skills. Increased Earnings Potential: Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually. Incentives and Recognition: Corporate wide bonus programs are in place to reward top performers. Beware of scams! As a recruiter, I will only contact you through a @geico.com email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ***********************. keywords: litigation, auto liability, liability claims#geico300#LI-AL2 At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. Personal Injury Protection Claims Examiner - Richardson, TX Salary: $25.44 - $32.05 per hour / $51,261.60 - $64,580.75 annually What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Richardson, TX office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S. As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment. This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination. Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today! Qualifications: Prior insurance claims experience preferred, but not required Personal injury, bodily injury or workers' compensation experience preferred Solid analytical, customer service and multi-tasking skills Strong attention to detail, time management and decision-making skills #geico200 At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

Introduction At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they're free to grow, lead, and innovate. You'll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you're not just improving clients' risk profiles, you're building trust. You'll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you're ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you'll be joining a team that's passionate about helping individuals and organizations thrive. The Senior Claims Examiner will administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. This is a remote position located in California. How you'll make an impact Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. About You Required: High school diploma and 5 years related claims experience required. Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements. Extensive knowledge of accepted industry standards and practices. Computer experience with related claims and business software. Preferred: Bachelor's degree preferred. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses. Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation. Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you'll get, depending on your job level these benefits may improve: Medical/dental/vision plans, which start from day one! Life and accident insurance 401(K) and Roth options Tax-advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include: Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Introduction At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they're free to grow, lead, and innovate. You'll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you're not just improving clients' risk profiles, you're building trust. You'll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you're ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you'll be joining a team that's passionate about helping individuals and organizations thrive. The Senior Claims Examiner will administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. This is a remote position located in California. How you'll make an impact Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. About You Required: High school diploma and 5 years related claims experience required. Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements. Extensive knowledge of accepted industry standards and practices. Computer experience with related claims and business software. Preferred: Bachelor's degree preferred. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses. Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation. Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you'll get, depending on your job level these benefits may improve: Medical/dental/vision plans, which start from day one! Life and accident insurance 401(K) and Roth options Tax-advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include: Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

At Plymouth Rock Assurance, our Claims team embodies the traits of Understanding, Engaging, and Energetic, serving as the first point of contact for our policyholders who have experienced an automobile incident. As a Claims Representative, you will become part of a fast paced, rewarding, and diverse team that appreciates the importance of a healthy work/life balance. We are looking for high potential individuals to join our fast-track claims unit with an in-depth training program, so no prior insurance experience is needed for this role. Many of our Claims Representatives have benefited from internal growth opportunities and have secured more senior Claims or Supervisor level roles within our company. Apply now and start your career at Plymouth Rock! We are currently a Hybrid work environment- 4 days in the Boston office and 1 day work from home. Here Is What You Will Do Customer-centric employee: Conveying a calm, caring attitude, you will provide best-in-class service to customers while processing new claims. Understanding and providing Empathy is key to this role. Collaborative partner: Working with internal and external partners, you'll support policyholders while their claims are being processed. Energetic worker: In our fast-paced environment, you will handle customers' needs-quickly, effectively and in a friendly, caring manner. Problem solver: No day is predictable; you'll utilize out-of-the-box, creative thinking to resolve a wide variety of claims challenges and customer issues. Clear communicator: You'll provide policyholders with the information they need by clearly setting expectations and outlining next steps. Accessibility: Being available for customers via email, text, or phone to walk them step-by-step through the auto claim process and explain existing coverage. Here Is What You Will Bring To The Table A history of working customer service facing roles, hospitality, or retail, with previous call center experience a plus. Being on the phone consistently throughout the day is a requirement of the role. Excellent organizational and time management skills. Being able to pivot through different applications throughout the day. Prioritizing your day and staying organized is key. An associate or bachelor's degree preferred. Willingness to continue learning about products, procedures, and technical systems as you grow in this role. Why work for us Grow personally and professionally through our collaborative team environment Gain support and guidance to expedite proficiency through our mentor program 4 weeks accrued paid time off + 9 paid national holidays per year Onsite Free Parking LinkedIn Learning Courses 12-week Training Program Tuition Reimbursement Low cost and excellent coverage health insurance options (medical, dental, vision) Robust health and wellness program and fitness reimbursements Auto and home insurance discounts 2:1 Matching gift opportunities Annual 401(k) Employer Contribution (up to 7.5% of your base salary) Company sponsored social events Various Paid Family leave options including Paid Parental Leave Salary Range: The pay range for this position is $45,000 to $50,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. About The Company The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

Introduction At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they're free to grow, lead, and innovate. You'll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you're not just improving clients' risk profiles, you're building trust. You'll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you're ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you'll be joining a team that's passionate about helping individuals and organizations thrive. The Senior Claims Examiner will administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. This is a remote position located in California. How you'll make an impact Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. About You Required: High school diploma and 5 years related claims experience required. Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements. Extensive knowledge of accepted industry standards and practices. Computer experience with related claims and business software. Preferred: Bachelor's degree preferred. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses. Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation. Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you'll get, depending on your job level these benefits may improve: Medical/dental/vision plans, which start from day one! Life and accident insurance 401(K) and Roth options Tax-advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include: Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

FCE Benefit Administrators, Inc. is seeking a detail-oriented and motivated Medical Claims Processor to join our dynamic and growing team. The ideal candidate will be responsible for the accurate and timely processing of a wide range of claims while ensuring compliance with company standards and regulatory requirements. This role requires strong attention to detail, effective communication skills, and the ability to work efficiently in a fast-paced environment. Key Responsibilities Accurately process a variety of claim types, including Medical, Vision, Dental, HRA, Critical Illness, and Accident claims. Manage the entire claim lifecycle, including adjustments, voids, and payment reissues. Conduct audits on processed claims to ensure accuracy and compliance with policies. Serve as a point of contact for claim-related inquiries from members, providers, and internal AE (Account Executive) and CS (Customer Service) teams. Handle escalated client questions and issues via phone and email with professionalism and urgency. Participate in special projects and organizational initiatives as assigned. Assist with training and mentoring team members (for more experienced candidates). Education High school diploma or equivalent required. Associate's degree or vocational training in a related field (e.g., Medical Billing & Coding, Business Administration) preferred. Experience 1-3 years of experience in medical claims processing, data entry, customer service, or a general administrative role required. Technical Skills Proficiency in Microsoft Office Suite (Excel, Word, Outlook). Strong data entry capabilities and 10-key proficiency. Familiarity with claims management platforms or Electronic Health Record (EHR) systems preferred. Soft Skills Exceptional attention to detail and strong organizational abilities. Clear written and verbal communication skills. Strong problem-solving and critical thinking abilities. Ability to work independently while managing a high volume of tasks in a fast-paced environment. Commitment to maintaining confidentiality and handling sensitive information with integrity. Working Conditions Standard office environment. Prolonged periods of sitting and computer use may be required. Ability to lift up to 20 lbs occasionally (e.g., handling physical records or mail). Benefits Offered We understand that top talent is attracted to organizations offering competitive compensation, comprehensive benefits, and opportunities for professional growth. FCE offers a robust benefits package including: Medical, Dental, and Vision Coverage Disability Insurance 401(k) with Company Match Flexible Spending Accounts (FSA) Health Savings Account (HSA) Contributions Fitness Membership Discounts Company-paid Life Insurance Tuition/Professional Development Reimbursement Employee Assistance Programs Paid Time Off (PTO) About FCE Benefit Administrators, Inc. With nearly 30 years of experience, FCE Benefit Administrators, Inc. has helped hundreds of For-Profit and Not-For-Profit organizations achieve full compliance under the Service Contract Act (SCA), Davis-Bacon Act (DBA), Javits-Wagner-O'Day (JWOD), and related federal legislation. As trusted experts in government contracts, we specialize in the administration of bona-fide fringe benefit plans through an irrevocable funding arrangement, ensuring full compliance with SCA requirements. Equal Opportunity Employer FCE is an equal opportunity employer and is committed to creating an inclusive and diverse workplace.

The Total Loss Unit within our Auto Claims Organization is responsible for identifying, negotiating and settling total losses with both insureds and claimants. The Total Loss Claims Representative processes payments and is responsible for the documentation of assigned claims as well as coordinating disposition of the total loss salvage vehicle. He or she is responsible for controlling total loss expenses and salvage recoveries on all total losses assigned. Perks: 4 weeks accrued paid time off + 9 paid national holidays per year Robust wellness & health and fitness reimbursement programs 401(k) bonus program Tuition reimbursement Auto and home insurance discounts Volunteer opportunities 2:1 donation matching program Company-paid life and disability insurance plans Optional medical, dental, vision, legal, pet insurance, FSA and identity theft protection plans Responsibilities: Negotiates and communicates all total loss and diminished value settlements per company and state guidelines. Multi jurisdictions, including MA, NH, CT, NY, and others as required Understands the total loss evaluation methodology processes with the ability to effectively communicate these to vehicle owners. Has a basic understanding of vehicle financing / leasing. Reviews damage estimates to confirm vehicles are total losses. Documents all settlements and actions in the claim file system. Works directly with salvage vendor to move vehicles and obtains salvage bids where necessary Negotiates and settles claims within his/her individual authority. Submits claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate. Escalates claims to supervisor that are not moving in a positive direction. Maintains an effective diary system on pending files. Prioritize and handle multiple tasks simultaneously. Quickly adjusts to fluctuating workload and responsibilities. Keeps involved parties and agents updated on the status of the claim and emerging issues. Ensures that service, loss and expense control are maintained at all times. Adheres to privacy guidelines, law and regulations pertaining to claims handling. Prepares payments to vehicle owners, banks and lease companies. This role will report in person to our Boston office, located directly across from South Station. Knowledge/Skills: Property and casualty claims handling experience desired Ability to work independently and in a team environment Excellent oral and written communication skills Excellent organizational skills Solid problem solving skills Proficient in Word, Excel, MS Outlook Educational Requirements: Bachelor's degree from four-year college or university or commensurate work experience preferred Previous auto claims handling State Adjusting licenses or the ability to obtain them within 6 months of employment Salary Range: The pay range for this position is $50,000 to $73,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. The Plymouth Rock Company and its affiliated group of companies write and manage over $2.2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 2,000 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

P&C Claims Lead Full Time Oakbrook Terrace, IL, US Salary Range:$107,000.00 To $134,000.00 Annually BCS Financial is seeking an experienced claims leader to oversee Specialty Risk Solutions claim operations and strategy for Agent E&O, commercial cyber, excess cyber, and other complex products. This role is responsible for managing day-to-day claims functions, driving process improvement, and collaborating across departments to ensure optimal claim outcomes and compliance. Essential Elements Adjudicate claims from end to end including assessing coverage, establishing reserves, communicating with Insureds, TPAs, coverage counsel and reinsurers, establishing reserves and negotiating settlements. Establish and maintain early warning system to track and monitor Open claims (high-dollar, high risk exposure situations) Facilitate Claims Committee, consisting of cross-functional areas with shared responsibility for positive claim outcomes and accurate financial reporting Establish and report on key metrics (KPI and SLA performance management) Analyze and report significant claim trends across programs (insourced and outsourced programs) Coordinate and lead interdepartmental workflows and resources related to continuous process improvement efforts Collaborate with underwriters to support policy construction and drafting, reporting claim trends, data analysis, and risk assessments Participate and/or facilitate TPA audits, identify risks and work closely with Enterprise Risk Management and other internal teams to mitigate risks Monitor reserves Ensure great customer service experience for our Insureds Perform similar work-related duties as assigned Requirements Education and Certifications Bachelor's degree required; advanced degree or industry certifications (AIC, CPCU, RPLU) preferred. Experience 10+ years of claims handling experience, with a focus on Agent E&O and Commercial Cyber claims. Strong analytical, organizational, and process improvement skills. Excellent verbal and written communication; able to present to senior management and in group settings. Experience with claims management systems (e.g., Guidewire, ClaimCenter), data analytics, and reporting tools. Knowledge of insurance industry claims process, legal/regulatory environment, and litigation/arbitration/trial processes. Collaborative mindset and ability to influence others. Travel Required Local travel to main office

Claims Clerk Full TimeSME/Specialist Oakbrook Terrace, IL, US Salary Range:$50,500.00 To $57,500.00 Annually The Claims Clerk will be responsible for accurate, timely screening and distribution of incoming electronic claims correspondence. This role will aid the Analysts in timely processing of the claims and help secure a manageable turnaround time for the entire Claims Department. This position will report to the Claims Manager. Essential Elements Manage the Secure File Transfer Portal (SFTP) site ensure all reporting received is processed in a timely manner Download and pivot reports from Power BI, to locate all possible medical and prescription claims. Identify and review claims data ensuring data integrity Distributing claim requests for processing Convert the PDF claims received into an Excel Template for the Claims Analyst to upload and process Additional duties as assigned Requirements Education and Certifications Associates degree or commensurate experience required Experience Excel, Microsoft Office Suite, Power BI, Clerical functions Travel Required May need to travel to the home office quarterly Hybrid workplace

Safety Insurance is proud to be one of the leading property and casualty insurance providers in Massachusetts. We are committed to supporting independent agents and their customers through our unwavering dedication to excellence. Our success is built on a simple philosophy: deliver the highest quality insurance products at competitive rates while providing exceptional service at every step. At Safety Insurance, we don't just offer jobs - we offer careers that are challenging, fulfilling, and designed to grow with you. Our people are our greatest asset. A diverse workforce makes us stronger, more innovative, and better equipped to serve our customers. At Safety, we empower our employees to be their best by fostering an inclusive environment and offering resources that support their careers, education, and families. We also understand the importance of work-life balance. That's why we offer hybrid work options, flexible schedules, and a 37.5-hour workweek. Conveniently located in the heart of Boston's financial district, our downtown office is a positive space where employees can stay connected to both each other and the pulse of the city. Safety's benefits go beyond the basics. In addition to competitive salaries, our comprehensive benefits package includes: * 3 weeks accrued paid time off + 11 paid holidays per year * Health insurance (medical, dental, vision) * Annual 401(k) Employer Contribution (up to 8% of your base salary) * 100% tuition reimbursement * Free on-site fitness center * Complimentary coffee and breakfast service * Hybrid work schedules * Working Advantage Discount Program * Employee Assistance Program * …and much more! Join Safety Insurance and discover a career that's built to support your success - both personally and professionally.

Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs. Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district. Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!

Title: Customer Service Claims Processor Department: Customer Service Union: OPEIU 29 Grade: 17 The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Title: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16 Non-Exempt Hours per Week: 40 The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Possesses a strong work ethic and team player mentality. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third-party administrator. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $25.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Job Title: Claims Processor - Casualty FLSA Status: Non-Exempt Job Family: Claims Department: Casualty Claims Responsible for effectively analyzing and resolving assigned minor casualty claims consistent with claims department standards and company objectives. POSITION ESSENTIAL FUNCTIONS AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Identify and investigate coverage, damage and reserve adequacy issues on assigned claims. Apply statutes, common law, and other applicable legal concepts. Identify liability issues and communicate this to supervisor for possible file transfer. Communicate with policyholders, agents, claimants, medical providers and other persons as needed. Direct independent adjusters, appraisers, and other support service providers to ensure effective and efficient claims resolution. Acquire, record and maintain all essential file documentation in accordance with established guidelines. Provide timely status reports regarding assigned claims to management and others. Identify and pursue cost containment/loss mitigation opportunities. Negotiate and resolve all assigned claims within established settlement authority in a prompt, fair and equitable manner. Participate and provide input in regularly scheduled departmental meetings involving collective decision making. Travel as needed to attend training programs and to conduct investigation relating to claims resolution. Further the attainment of overall claims department objectives by assisting other claims personnel as requested. Complete other projects as assigned. KNOWLEDGE, SKILLS, AND ABILITIES The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to effectively communicate with others (both oral and written). Must be able to make independent decisions. Must have strong interpersonal and organizational skills. Must have the ability to handle confrontational situations in a productive manner. Experience in investigation, customer service, and/or negotiation would be beneficial. Insurance, legal and/or medical knowledge would be of benefit. Should be able to sit for prolonged periods of time. Effectively interface with external contacts, Brotherhood employees, managers, and department staff members. EDUCATION AND/OR EXPERIENCE List Degree Requirement, Years' Experience, and Certifications Must have a high school diploma or equivalent. Must fulfill required adjuster licensing requirements. Bachelor's degree or equivalent related work experience desired. Insurance related course work would be of benefit. Terms and Conditions This description is intended to describe the general content of and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements. Because the company's niche is the church and related ministries market, and because effective service requires a thorough understanding of this market, persons in this position must be familiar with church operations and must conduct themselves in a manner that will neither alienate nor offend persons within this target niche. Brotherhood Mutual Insurance Company reserves the right to modify, interpret, or apply this position description in any way the company desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. This position description is not an employment contract, implied or otherwise. The employment relationship remains “at-will”.

DETAILS Assistant Claims Examiner - Flex Department: Workers' Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 6 Career Ladder: Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers' Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. Answer questions over the phone from medical providers regarding bills Contact treating physician for disability status Contact employer for return-to-work status or availability of modified work. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators Complete preparation of documents for overnight delivery Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners Contact with clients, injured workers, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required 2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferred Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses Administrators Certificate from Self-Insurance Plans preferred Knowledge of workers compensation laws, policies, and procedures Understanding of medical and legal terminology Must demonstrate accuracy and thoroughness in work product Ability to sit for prolonged periods of time Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

The Claim Examiner Team Lead is a key resource for the Claim Examiner team, leveraging advanced expertise in claim adjudication, payment integrity and regulatory compliance. This position does not include direct supervisory responsibilities or formal performance reviews. Instead, the Team Lead provides support, coaching, and technical guidance to claim examiners, ensuring accuracy, efficiency, and adherence to CMS and company standards. Acting as a mentor, process improvement lead, and operational reviewer, the Team Lead drives continuous improvement, supports fraud, waste and abuse (FWA) prevention initiatives and collaborates with cross-functional teams to optimize claims processes and professional development. Key Responsibilities: Team Leadership and Enablement Provide direction, mentorship, and technical support for Claim Examiners, fostering a collaborative and high-performance environment. Act as the primary resource for escalated claims and technical questions, offering expert advice and facilitating team learning. Contribute to the development and delivery of training materials and workshops, supporting ongoing professional development. Lead and support onboarding of new Claim Examiners, ensuring effective orientation to claims processes, company policies, and regulatory requirements. Serve as a resource for new team members during their initial training period helping them integrate into the team and build foundation skills. Claim Adjudication and Payment Integrity Utilize in-depth knowledge of claims adjudication processes to ensure accurate and timely processing of Medicare Supplement claims. Review and analyze complex claims for proper application of policy provisions and regulatory requirements. Support payment integrity by verifying claims are processed correctly, assisting in identifying and correcting payment errors, and collaborating on payment integrity reviews. Fraud, Wast, and Abuse (FWA) Prevention Review claims for signs of fraudulent activity or proper hilling practices. Assist in enforcing policies and procedures to prevent, detect and address FWA in claims processing. Conduct investigations into suspected FWA activities and educate team members on prevention strategies. Regulatory Compliance and Quality Assurance Ensure claims processing complies with CMS guidelines, state regulations, and company policies. Conduct regular audits of claims to maintain high standards of quality and compliance. Stay informed about changes in Medicare regulations and communicate updates to the team. Claim Edit Logic Review and Collaboration Serve as an operational reviewer and subject matter expert for claim edit logic, providing input and feedback to technical, compliance, and analytics team. Participate in requirements gathering, validation, and documentation of logic changes, supporting audit readiness and continued improvement. Collaborate with IT and analytics teams on the implementation and optimization of claim edit logic, without direct responsibility for technical development or system configuration. Process Improvement and Operational Excellence Identify opportunities for process improvements and efficiencies in claim indexing, queue management and workflow. Lead or participate in process improvement initiatives, leveraging data analytics and trend analysis to drive operational enhancements. Prepare actionable insights for management review. Stakeholder Collaboration and Enablement Facilitate resolution of complex claims issues and drive alignment with CMS policies. Provide expert guidance and support to claim examiners and customer service representative regarding claim-related inquiries and escalations. Collorate with cross-functional teams (compliance, IT, analytics, customer service) to ensure seamless integration of new rules and system enhancements. Qualifications: Experience: 3+years of experience in healthcare claims analysis, medical coding, payment integrity or healthcare data analytics. Experience with Medicare payment methodologies and reimbursement rules preferred. Experience with clinical coding (CPT, HCPCS, ICD, NDC) and regulatory research preferred. Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or similar preferred credentials. Skills: Technical and Analytical: Advanced proficiency in SQL and Excel; experience with data visualization tools (Tableau, Power BI) and large datasets. Strong analytical, communication and problem-solving skills. Deep understanding of medical coding systems (CPT, HCPCS, ICD, DRG, NCD) and healthcare reimbursement methodologies. Communication and Collaboration: Excellent verbal and written communication skills; able to explain technical concepts to non-technical audiences and document logic/rationale for edits. Ability to work independently and collaboratively in cross-functional teams (technical, business operations, provider facing). Quality and Process Improvement Strong attention to detail and commitment to accuracy in edit development, testing, and documentation. Experience in quality assurance, UAT testing and continuous improvement of claims editing. Problem Solving and Initiative: Demonstrated ability to analyze root causes, troubleshoot issues and propose solutions for claims editing and payment integrity challenges. Proactive in identifying opportunities for edit optimization, regulatory compliance and operational efficiency. Work Environment / Physical Requirements: The work environment is a standard office setting with typical office equipment. This role involves professional collaboration with colleagues and clients. Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.

Applications to be submitted by January 05, 2026 Compensation Grade: P14 Compensation Details: Minimum: $53,357.00 - Maximum: $53,357.00 Annually Positions with a designated work location in New York City, Nassau, Rockland, Suffolk, or Westchester Counties will receive a $4,000 annual downstate adjustment (pro-rated for part-time positions). Department (OHEHR) AI - AIDS Institute Job Description: Responsibilities The New York State Department of Health, AIDS Institute has established eight Uninsured Care Programs, of which some of these programs have the most comprehensive drug and service coverage in the country. The programs provide access to medical services and medications for all New York State residents with or at risk of acquiring HIV/AIDS. The programs bridge the gap between Medicaid coverage and private insurance and serve as a transition to Medicaid by providing interim assistance to individuals eligible for but not yet enrolled in Medicaid or assistance in meeting spenddown requirements. The Insurance and Claims Specialist I will be responsible for APIC reimbursement processing; pharmacy, primary care, home care and APIC payment processing; handle complex fiscal hotline calls; assist providers and participants with the coordination of benefits; assist with staff training; other appropriate related duties. Minimum Qualifications Bachelor's degree in a related field; OR an Associate's degree in a related field and two years of general office, secretarial, or administrative experience; OR four years of such experience. Preferred Qualifications At least one year of experience in a health care program providing services to people living HIV/AIDS. At least two years of customer service experience in a financial or medical field. At least two years of medical claims or insurance experience. Knowledge of COBRA, HIPAA, and coordination of benefits. Conditions of Employment Grant funded position. Compliance with funding requirements such as time and effort reporting, grant deliverables, and contract deliverables, is required. Valid and unrestricted authorization to work in the U.S. is required. Visa sponsorship is not available for this position. Prior to hire, all HRI employees must reside within a reasonable commuting distance of their official work location and must also be located in, or willing to relocate to, one of the following states: New York, New Jersey, Connecticut, Vermont, or Massachusetts. Telecommuting will not be available. HRI participates in the E-Verify Program. Affirmative Action/Equal Opportunity Employer/Qualified Individuals with Disabilities/Qualified Protected Veterans ********************** About Health Research, Inc. Join us in our mission to make a difference in public health and advance scientific research! At Health Research, Inc. (HRI), your work will contribute to meaningful change and innovation in the communities we serve! At HRI, we are on a mission to transform the health and well-being of the people of New York State through innovative partnerships and cutting-edge public health initiatives. As a dynamic non-profit organization, HRI plays a crucial role in advancing the strategic goals of the New York State Department of Health (DOH), Roswell Park Comprehensive Cancer Center (RPCCC), and other health-related entities. HRI offers a robust, comprehensive benefits package to eligible employees, including: Health, dental and vision insurance - Several comprehensive health insurance plans to choose from; Flexible benefit accounts - Medical, dependent care, adoption assistance, parking and transit; Generous paid time off - Paid federal and state holidays, paid sick, vacation and personal leave; Tuition support - Assistance is available for individuals pursuing educational or training opportunities; Retirement Benefits - HRI is a participating employer in the New York State and Local Retirement System and offers optional enrollment in the New York State Deferred Compensation Plan. HRI provides a postretirement Health Benefits Plan for qualified retirees to use towards health insurance premiums and eligible medical expenses; Employee Assistance Program - Provides educational and wellness programs, training, and 24/7 confidential services to assist employees, both personally and professionally; And so much more!

Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character. We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world? Learn more about our unique culture and history. Job Opportunity: Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss Senior Claims Auditor with knowledge of employer group health insurance, managed care, and direct medical claims products. This position will work with our Third-Party Administrator's (TPA's) daily with interaction with several other areas in our Medical Stop-Loss Division. The position is preferably located in our Indianapolis or Plymouth Meeting, PA office. We are open to candidates who could work from out Atlanta or Boston office as well. Duties & Responsibilities: Audit specific and aggregate claims for assigned complex blocks of business Audit and process claim reimbursements Verify claims are paid in accordance with the plan document and reimbursable under the Stop Loss policy Verify participant and dependent eligibility Maintain and exceed targeted claims accuracy standards Maintain accurate and detailed information for each file Conduct implementation calls for newly sold groups Review and approve plan documents and plan amendments Initiate and further cost containment opportunities Audit program business claims across several lines within our Accident & Health Division Assist management with implementation calls for new business sold Set and adjust reserves Qualifications, Skills, and Experience: Minimum of 5+ years' experience examining and auditing medical stop loss claims Proficient with Microsoft Office Suite, especially Excel Knowledge of group insurance, managed care, and direct medical claims products Demonstrate excellent mathematical, communication and customer service skills Excellent problem-solving and critical-thinking skills Detail/results-oriented Strong analytical skills Excellent customer service Knowledge of COB, Medicare, HIPAA, CPT, ICD9/ICD10, and interpretation of employer group health plan benefits Ability to work independently with minimal supervision while meeting or exceeding established turn-around-time, production, and accuracy standards BHSI Offers: A competitive package and exciting growth opportunities for career-oriented teammates A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework Benefits that support your life and well-being, which include: Comprehensive Health, Dental and Vision benefits Disability Insurance (both short-term and long-term) Life Insurance (for you and your family) Accidental Death & Dismemberment Insurance (for you and your family) Flexible Spending Accounts Health Reimbursement Account Employee Assistance Program Retirement Savings 401(k) Plan with Company Match Generous holiday and Paid Time Off Tuition Reimbursement Paid Parental Leave NOTE: This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization. The base salary range for this position is from $70,000 - $80,000 along with annual bonus eligibility; a candidate's actual salary is commensurate with experience as determined by their relevant skills, experience, and geographical location. We value our teammates - both their capabilities and character - as demonstrated by our amazing culture.