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Commercial Auto & General Liability Claims Examiner III
Tristar Insurance 4.0
Remote casualty claims supervisor job
Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Must work EST core hours. Must pass the NYS Adjuster license exam within 60 days of hire.
Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.
DUTIES AND RESPONSIBILITIES:
Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto, Auto Med Pay, and/or General Liability Casualty Claims.
Oversee and direct outside investigative service providers and work closely with the client and client counsel, and investigative services to advance the claim to conclusion.
Maintain an ongoing diary.
Continually assess exposure and evaluate for accurate reserves and settlement recommendations.
Prepare Loss Reports providing a thorough analysis of coverage, liability, and damages.
Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
Document all correspondence, reports, discussions, and decisions in the claim file record.
Provide outstanding service to the client.
Position is remote/working from home.
Qualifications
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required; bachelor's degree in related field (preferred) and two years auto and general liability casualty and or No Fault/PIP related experience; or equivalent combination of advanced education and experience.
Special Requirements:
At least two years of Automobile and General Liability claims experience required.
Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge.
Demonstrated verbal and written communications skills.
Demonstrated advanced analytical, decision-making and negotiation skills.
Computer proficiency.
Preferred Skills:
Ability to communicate effectively and clearly, both orally and in writing.
Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.
Excellent customer service skills.
An understanding of the litigation process and case valuation in multiple jurisdictions.
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
Time management skills, organizational skills, and ability to prioritize issues and tasks.
Ability to effectively operate computer equipment and applications.
Independence, flexibility, and creativity.
Other Qualifications:
Candidate must have adjuster licenses and be willing to obtain the NY license if they do not already have one.
Candidate must be willing to work Pacific Time core hours.
Here are some of the benefits you can enjoy in this role:
Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.
Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements
MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects
Visual requirements necessary to perform the job:
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
2. PHYSICAL EFFORT (cont.)
FREQUENCY
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
X Kneeling: Bending legs at knee to come to a rest on knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Frequently
Occasionally
2. PHYSICAL EFFORT (cont.)
FREQUENCY
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.
Frequently
Frequently
Frequently
3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
WORKING CONDITION
ENVIRONMENTAL
FACTOR
NATURE/REASON
OF EXPOSURE
FREQUENCY
Dirt/Dust
Noise
Temperature extremes
Dampness
Vibrations
Equipment movement hazard
Chemicals/solvents
Electrical shock
Significant work pace/pressure
Odors/Fumes
$50k-76k yearly est. 18d ago
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Sr DI Claims Examiner
Ameritas 4.7
Remote casualty claims supervisor job
is remote (within the U.S.A.) and does not require regular in-office presence.
What you do:
Evaluates and authorizes disposition of complex claims.
Obtains and analyzes medical records and financial documents.
Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews.
Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer.
Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments.
Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates.
Assists with recoveries from reinsurance carriers.
Performs all claims processing support functions.
What you bring:
Bachelor's degree or equivalent experience is required.
1-3 years of related experience is required.
What we offer:
A meaningful mission. Great benefits. A vibrant culture
Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life.
At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't:
Ameritas Benefits
For your money:
• 401(k) Retirement Plan with company match and quarterly contribution.
• Tuition Reimbursement and Assistance.
• Incentive Program Bonuses.
• Competitive Pay.
For your time:
• Flexible Hybrid work.
• Thrive Days - Personal time off.
• Paid time off (PTO).
For your health and well-being:
• Health Benefits: Medical, Dental, Vision.
• Health Savings Account (HSA) with employer contribution.
• Well-being programs with financial rewards.
• Employee assistance program (EAP).
For your professional growth:
• Professional development programs.
• Leadership development programs.
• Employee resource groups.
• StrengthsFinder Program.
For your community:
• Matching donations program.
• Paid volunteer time- 8 hours per month.
For your family:
• Generous paid maternity leave and paternity leave.
• Fertility, surrogacy, and adoption assistance.
• Backup child, elder and pet care support.
An Equal Opportunity Employer
Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law.
Application Deadline
This position will be open for a minimum of 3 business days or until filled.
This position is not open to individuals who are temporarily authorized to work in the U.S.
$65k-97k yearly est. 1d ago
Director of Claims Audits
All Care To You
Remote casualty claims supervisor job
About Us
All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available.
Job purpose
The Director of Claims Audits is responsible for post and pre auditing institutional and professional claims according to established line of business guidelines, policies and procedures. This job includes achieving 95% or higher claims compliance. Process improvement of the claims process to achieve quality claims adjudication within CMS, DHCS and DMHC timeliness guidelines.
Duties and responsibilities
Institutional Claims Review for accuracy and timeliness using HP audit tools to capture Root Cause, Remediation and QA monitoring.
Professional Claims Review for accuracy and timeliness using HP audit tools to capture Root Cause, Remediation and QA monitoring.
Claims system quality improvement collaboration (all departments that touch a claim)
Collaborative Claims team training on items found during audits for process improvement
Claims workflow monitoring (all departments that touch a claim)
Other requests as needed
Qualifications
10+ years or more experience in processing HMO claims in a managed care environment.
Proficient in rate application for all payments methods by lines of business. (Medicare, Commercial, Medi-Cal). Including but not limited to, NCCI/CCI edits, CMS Medicare, Medi-Cal, RNC, outpatient PPS & Inpatient DRG facility, ASC, APC, Interim Rate Payment
Expert with all regulatory requirements including CMS, DMHC and DHS.
Proficient with all Federal and state requirements in claim processing.
Knowledge of medical terminology and coding.
Recognize the difference between Shared Risk and Full Risk claims.
Proficient in applying Division of Financial Responsibility.
Knowledgeable in applying Health Plan Benefit Matrices.
Proficient understanding of AB1324.
Proficient understanding of AB1455 Claims Settlement Practice & Dispute and Resolution regulations.
Medical Record Coding Review as it pertains to administrative billing and coding.
Excellent communication skills including reports, correspondence, and verbal communications.
Demonstrated proficiency with Microsoft Word and Excel.
$90k-162k yearly est. 60d+ ago
Claims Supervisor
Aspire General Insurance Company
Remote casualty claims supervisor job
Job DescriptionDescription:
Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service.
Our company values can best be described with ABLE: to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success.
What You'll Do
Under moderate supervision of Management, the ClaimsSupervisor performs the essential functions of the position, which includes but is not limited to supervising a team of Claims Representatives and Claims Support Specialists. Ensure that the team meets service standards and performs essential functions at or above the quality and service standards of Aspire General Insurance Company.
DUTIES AND RESPONSIBILITIES:
· Review of automobile claim investigations.
· Make handling recommendations and provide directions to subordinates.
· Ensure ongoing adjudication of claims within company standards and industry best practices and regulations.
· Determine, recommend and grant authority for settlement and payment processes.
· Responsible for overall file handling and work product quality of subordinates.
· Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation.
· Assist in the operations of the claims department, including making recommendations and implementing an organizational structure adequate for achieving the department's goals and objectives.
· Maintain a documented system of claims policies, systems, procedures and workflows to ensure smooth operations.
· Provide feedback to Management on process and system improvement initiatives for the department.
· Report to Management as soon as there is an awareness of any issues or concerns which may be detrimental to the department or Company; recommend policies and procedures to Management regarding quality issues that may arise.
· Staff Training-Foster a highly focused training and development environment within the Claims Department.
· Complies with state and federal laws, Department of Insurance criteria, insurance carrier criteria and follows and enforces Aspire General Insurance Company and partner's policies, procedure and work rules.
· Communicate and provide timely notification to the Human Resources Department for all things related to employee attendance, punctuality or possible leave related situations.
· Provide timely and thorough documentation for all things related to employee performance, training, recognition and/or coaching.
· Evaluate subordinates' performance and administer personnel actions as required in coordination with human resources department.
Ensure the Department has adequate scheduling, including time-off requests, work shift management, etc
Assist to identify, recruit, hire and develop top talent.
· Ability to achieve targeted performance goals
Maintain that sensitive information regarding employees and the Company is kept confidential
Regular and predictable punctuality and attendance.
· Other duties as necessary.
Requirements:
· Three plus years' experience in Property and Casualty insurance industry.
· Must have a clear understanding of insurance industry practices, standards and terminology.
· Experience in handling subrogation, property damage and injury claims required.
· Must be able to pass a background check.
· Must have the ability to work in a high volume, fast-paced environment while managing multiple priorities.
· Must have a disciplined approach to all job-related activities.
· Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills.
· Must have strong keyboard skills as well as proficiency in Windows and MS Office products.
INTER-RELATIONSHIP COMPONENT:
Ability to develop excellent working relationships with Staff, Partners, Clients and outside agencies.
Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of goodwill, indicative of a professional environment and atmosphere.
Ability to be a team player and work cohesively with other Aspire General Insurance and Partner Companies' staff to achieve company goals.
Able to represent the Company in a professional manner and contribute to the corporate image.
Able to consistently provide excellent service.
WORKING CONDITIONS:
This is an exempt position which complies with an alternative work schedule when applicable.
This work environment is fast-paced, and accuracy is essential to successful task completion.
The office is that of a highly technical company supporting a paperless environment.
Travel may be required.
Requires extended periods of computer use and sitting.
This is a remote position.
Benefits: Medical, Dental, Vision, HSA*, PTO, 401k, Company observed Holidays
Individuals seeking employment at Aspire General Insurance Services LLC are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation in accordance with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
*Dependent on plan selected
Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, location, etc.
$70k-126k yearly est. 28d ago
Supervisor, Claims | California
Employers Holdings, Inc.
Remote casualty claims supervisor job
Supervisor, Claims - California| 100% Remote (WFH) Opportunity The Workers' Compensation ClaimsSupervisor is responsible for leading a team to successfully and proactively analyze and manage work comp claims assigned to the unit. The supervisor monitors and directs team effectiveness, guiding compliance with work comp state statutes within best practices to ensure claims move efficiently to closure. Participates in establishing team goals and objectives, participates in strategic and budgetary planning; monitors team effectiveness and supervises personnel and provides direct oversight on issues exceeding their authority. Successfully supports, coordinates and delegates objectives that support the company's mission and financial success.
Preference given to those candidates with experience in the California
Essential Duties and Responsibilities
* Leads, supervises and manages a Workers' Compensation claims team to achieve company objectives and department goals by promoting and ensuring compliance with Company procedures and guidelines.
* Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and supports and respects all team and company staff members, internal and external customers, and vendors.
* Responsible for managing, developing, coaching, and motivating your work comp claims team. Conducts regular performance reviews.
* Communicates effectively and assists with the interpretation and practical implementation of processes, workflows and systems. Provides technical and jurisdictional guidance to the team.
* Responsible for monitoring the quality and quantity of work produced and coaching towards improved performance.
* Fosters inter-departmental collaboration to build relationships throughout the organization to help drive success through partnership. Works closely with Corporate Claims and Quality Assurance for compliance.
* Participates in the recruitment, selection and hiring of team members and facilitates training of new hires.
* Exemplifies excellent customer service and models this for the team. Conduct business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality.
* Participates in conference calls, meetings with adjusters, insureds, and agents.
* Provides superior customer service by addressing inquiries from agents and policyholders.
* Reviews and approves reserves, settlements, payments and other assigned tasks within level of authority.
* Performs regular claim reviews based upon best practices, procedures and guidelines. Collaborates with the team for proactive claims management.
* Other duties as assigned.
Requirements
* Must have a minimum of 10 years of technical claims experience in Workers' Compensation to include claim, coverage and compensability investigation, claim reserving, settlement negotiation and litigation management, regulatory compliance, and mentoring, training and developing adjusters.
* At least two years of which must have been in a supervisory capacity.
* Demonstrated business knowledge including effective communication, customer focus, the ability to collect and analyze information, problem solving and decision making in accordance with policies and regulations.
* Demonstrated computer proficiency and comfortable using an internet-based claims system, reports, spreadsheets and databases.
* Strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, customers, and other departments within the company.
* Previous formal presentation experience.
* Demonstrated technical PC skills to include MS Word, Excel, PowerPoint, and Windows, strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, clients, and other departments within the company.
Certification
* Active, current California Adjuster license
* Insurance designation preferred (WCCP, ARM, AIC, CPCU, etc.) preferred.
Education
* Bachelor's Degree preferred or equivalent industry experience
Work Environment:
* Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship.
* It requires a suitable space that provides a private and quiet workplace.
* Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
* Travel: May be required to travel to off-site location(s) to attend meetings, as necessary
Salary Range: $80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details! *********************************************************
About EMPLOYERS
As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!
We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS!
Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.
We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!
At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As "America's small business insurance specialist", we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote
$80k-120k yearly 38d ago
Supervisor, Claims | California
EIG Services
Remote casualty claims supervisor job
Supervisor, Claims - California| 100% Remote (WFH) Opportunity
The Workers' Compensation ClaimsSupervisor is responsible for leading a team to successfully and proactively analyze and manage work comp claims assigned to the unit. The supervisor monitors and directs team effectiveness, guiding compliance with work comp state statutes within best practices to ensure claims move efficiently to closure. Participates in establishing team goals and objectives, participates in strategic and budgetary planning; monitors team effectiveness and supervises personnel and provides direct oversight on issues exceeding their authority. Successfully supports, coordinates and delegates objectives that support the company's mission and financial success.
Preference given to those candidates with experience in the California
Essential Duties and Responsibilities
Leads, supervises and manages a Workers' Compensation claims team to achieve company objectives and department goals by promoting and ensuring compliance with Company procedures and guidelines.
Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and supports and respects all team and company staff members, internal and external customers, and vendors.
Responsible for managing, developing, coaching, and motivating your work comp claims team. Conducts regular performance reviews.
Communicates effectively and assists with the interpretation and practical implementation of processes, workflows and systems. Provides technical and jurisdictional guidance to the team.
Responsible for monitoring the quality and quantity of work produced and coaching towards improved performance.
Fosters inter-departmental collaboration to build relationships throughout the organization to help drive success through partnership. Works closely with Corporate Claims and Quality Assurance for compliance.
Participates in the recruitment, selection and hiring of team members and facilitates training of new hires.
Exemplifies excellent customer service and models this for the team. Conduct business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality.
Participates in conference calls, meetings with adjusters, insureds, and agents.
Provides superior customer service by addressing inquiries from agents and policyholders.
Reviews and approves reserves, settlements, payments and other assigned tasks within level of authority.
Performs regular claim reviews based upon best practices, procedures and guidelines. Collaborates with the team for proactive claims management.
Other duties as assigned.
Requirements
Must have a minimum of 10 years of technical claims experience in Workers' Compensation to include claim, coverage and compensability investigation, claim reserving, settlement negotiation and litigation management, regulatory compliance, and mentoring, training and developing adjusters.
At least two years of which must have been in a supervisory capacity.
Demonstrated business knowledge including effective communication, customer focus, the ability to collect and analyze information, problem solving and decision making in accordance with policies and regulations.
Demonstrated computer proficiency and comfortable using an internet-based claims system, reports, spreadsheets and databases.
Strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, customers, and other departments within the company.
Previous formal presentation experience.
Demonstrated technical PC skills to include MS Word, Excel, PowerPoint, and Windows, strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, clients, and other departments within the company.
Certification
Active, current California Adjuster license
Insurance designation preferred (WCCP, ARM, AIC, CPCU, etc.) preferred.
Education
Bachelor's Degree preferred or equivalent industry experience
Work Environment:
Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship.
It requires a suitable space that provides a private and quiet workplace.
Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
Travel: May be required to travel to off-site location(s) to attend meetings, as necessary
Salary Range: $80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details! *********************************************************
About EMPLOYERS
As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!
We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS!
Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.
We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!
At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote
$80k-120k yearly 37d ago
Claims Manager - Professional Liability
Counterpart International 4.3
Remote casualty claims supervisor job
Claims Manager (Professional Liability)
Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk .
As a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider for our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share.
YOU WILL
Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes.
Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you.
Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution.
Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters).
Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards.
Support our data collection efforts and models by effectively using our Agentic Claim Experience (ACE) system to fully and accurately capture critical details about each claim assigned to you.
Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments.
Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems.
Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision.
YOU HAVE
At least 10 years of professional experience, with at least 5 years of experience litigating or managing professional liability claims. Previous carrier experience is a plus.
Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred.
Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire.
Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed.
High level of personal initiative and leadership skills.
Exceptional time management, problem solving and organizational skills.
Comfort and skill operating in a paperless claims environment. Familiarity with Google Workplace is preferred, but not required.
Willingness to quickly adapt to change and use creative thinking and data-driven insights to overcome obstacles to resolution.
Strong communication skills, both verbal and written.
Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%).
WHO YOU WILL WORK WITH
Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group.
Jaclyn Vogt, Senior Claims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College.
Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims.
WHAT WE OFFER
Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan.
Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members.
401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement.
Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay.
Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it.
Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year.
Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories.
Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.)
Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests.
Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise.
No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones.
Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart.
COUNTERPART'S VALUES
Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others.
Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met.
Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal.
Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected.
Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there.
Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life.
Our estimated pay range for this role is $150,000 to $180,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience.
We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives.
We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.
Cottingham & Butler Claims Services (CBCS) was built upon driven, ambitious people like yourself. “Better Every Day” is not just a slogan, it is a promise we make to ourselves and our clients. We are looking to hire an experienced Southeast Work Comp ClaimsSupervisor to our team. We are looking for someone who is eager to motivate and develop adjusters of all levels. If you're ready to make a significant impact and drive excellence, we want to hear from you!
Key Expectations for the ClaimsSupervisor Role:
Accountability and Feedback: Ensure that the team receives regular, high-quality feedback to drive accountability.
Team Metrics: Maintain weekly metrics in the green. If a team member is not meeting expectations, develop and document plans with the Claims Manager to improve performance.
Quality Service Review (QSR) Scores: Achieve monthly QSR scores of 90%+ for the team and address any underperformance with actionable plans.
Monthly Meetings: Arrange monthly meetings with the team to align on goals, discuss challenges, provide training, and foster collaboration.
Customer Service Survey Scores: Maintain an average score of 1.30 or less. Use survey results as coaching opportunities and ensure follow-up discussions.
Mentorship and Teammate Development: Act as a mentor and actively contribute to developing your team of adjusters.
Experience Requirements:
The ideal candidate must have substantial experience in the Southeast region and possess a strong background in achieving results. We are looking for a critical thinker who is eager to collaborate with other like-minded professionals to drive growth and strengthen our business. A minimum of 1-5 years of claims supervision is required.
Do you think this might be a fit for you? Send us your resume - we'd love to talk!
Pay & Benefits
Salary - Flexible based on your experience level.
Most Benefits start Day 1
Medical, Dental, Vision Insurance
Flex Spending or HSA
401(k) with company match
Profit-Sharing/ Defined Contribution (1-year waiting period)
PTO/ Paid Holidays
Company-paid ST and LT Disability
Maternity Leave/ Parental Leave
Company-paid Term Life/ Accidental Death Insurance
About the company
At Cottingham & Butler Claims Services, we sell a promise to help our clients through life's toughest moments. To ensure we keep that promise, we hold ourselves to a set of principles that we believe position our clients and our company for long-term success. Our Guiding Principles are not just words on paper, they are a promise we make to ourselves and our clients.
These principles have become a driving force of our culture and share many common themes with the values of our clients. First, we hire and develop amazing people that have an insatiable desire to succeed, are committed to learning, and thrive on challenges. Secondly, we pride ourselves on serving our clients' best interests through quality service, innovative solutions, and constantly evaluating our performance. Third, we have embraced and are guided by the theme of "better every day" constantly pushing ourselves to be better than yesterday. Ultimately, we get more energy from the future we are creating for our people, our clients, and our company than from our past success.
As an organization, we are very optimistic about the future and have incredibly high expectations for our people and our performance. We also understand that our growth is fueled by becoming better, not bigger - growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.
$64k-98k yearly est. Auto-Apply 9d ago
Claims Resolution Supervisor
Allied Benefit Systems 4.2
Remote casualty claims supervisor job
The Claims Resolution Supervisor (Supervisor, Rapid Response Team (RRT)) and Refund is responsible for the timely assisting the management team with monitoring and management of the daily work and other functions within the RRT and Refund Departments. Provides guidance and direction to team members. Develops and implements workflows as needed. The supervisor is the primary contact for handling and prioritizing any questions and issues from other departments.
ESSENTIAL FUNCTIONS
Oversees work activities and monitors workflow to ensure systems and procedures are documented, training material is developed and maintained, and reports are generated to meet business needs.
Motivates team members to ensure efficient and effective operational outcomes.
Leadership responsibilities include training staff, planning, assigning and directing work, appraising performance, rewarding and counseling employees, addressing complaints, and resolving problems.
Monitor inventory and turn-around times.
Conducts weekly meetings with team to ensure tasks and projects are completed timely.
Work with various departments to handle issues that arise in a timely manner.
Supporting other duties and projects as assigned by management.
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Performs other related duties as assigned.
EDUCATION
Bachelor's Degree or equivalent work experience required.
EXPERIENCE AND SKILLS
At least 5 years claims processing experience, preferably on the QicLink claims processing system required.
Minimum of 5 years of group health insurance and benefits experience required.
Must possess demonstrated leadership potential
Must be proficient in Microsoft Word, and Excel and have the ability to learn Microsoft Access.
Must have excellent written and verbal communication skills.
Must have strong analytical skills.
Must have knowledge of CPT and ICD-10 coding terminology.
POSITION COMPETENCIES
Accountability
Communication
Action Oriented
Timely Decision Making
Building Relationships/Shaping Culture
Customer Focus
PHYSICAL DEMANDS
This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT:
Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Protect Yourself from Hiring Scams
Important Notice About Our Hiring Process
To keep your experience safe and transparent, please note:
All interviews are conducted via video.
No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager.
If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process.
For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems
Your security matters to us-thank you for helping us maintain a fair and trustworthy process!
$70k-90k yearly est. 7d ago
Remote Claims Supervisor
Jobgether
Remote casualty claims supervisor job
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Remote Claims Manager. In this role, you will have a significant impact on the operation of the claims department, supervising multiple teams to ensure the successful execution of client and corporate commitments. You will manage daily operations, providing support to team members and addressing complex issues. Your leadership will guide the team towards achieving high-quality service and production goals while fostering professional development. This role offers the opportunity to implement processes that enhance efficiency and client satisfaction.Accountabilities
Supervise and manage the day-to-day operations of the claims team and outsourced vendor staff.
Ensure successful achievement of quality, production, and service expectations.
Facilitate staff development and the successful integration of new clients.
Address complex claims or customer service inquiries.
Provide guidance to team members on claims processing procedures.
Manage relationships with outsourced vendors and clients.
Drive continued process improvements within the department.
Requirements
High School Diploma or GED equivalent.
3-5 years of claim processing experience.
Previous supervisory or management experience.
Strong self-direction and ability to work with minimal supervision.
Excellent verbal and written communication skills.
Proven leadership, organizational, and interpersonal skills.
Ability to work effectively with various stakeholders.
Problem-solving skills to deal with varying situations.
Proficiency in reading and interpreting documents and SPDs.
Flexibility and openness to process improvements.
Experience with MS Excel/Word and ability to learn new systems.
Benefits
Flexible remote work arrangement.
Opportunity for professional development and growth.
Access to health and wellness benefits.
401(k) savings and pension plans.
Paid time off and parental leave.
Disability insurance and supplemental life insurance.
Employee assistance program.
Tuition reimbursement and other incentives.
Annual incentive bonus plan.
Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.#LI-CL1
$55k-94k yearly est. Auto-Apply 17h ago
(Remote) Senior Claims Examiner
Your Journey Starts Here
Remote casualty claims supervisor job
Who We Are
Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
Review newly reported claims and log them on the pending claims log.
Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
Handle and log specific State and NAIC policy locator searches.
Mentor and support third-party claims administration staff.
Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
Work on special projects and other duties as assigned by the Claims Manager.
Perform quarterly claim audits focusing on third-party claim handling.
Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
Handle Department of Insurance claim complaints or requests in a timely and professional manner.
Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
Support M&A activity, if applicable
Qualifications:
5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
Ability to meet deadlines while performing multiple functions.
Proficient in MS Office applications and the Internet.
Ability to proactively analyze and resolve problems.
Attention to detail.
Flexibility and willingness to adapt to changing responsibilities.
Excellent written communication, interpersonal and verbal skills.
Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
Proactive and outside-the-box thinker.
Independent and organized work style.
Ability to maintain strong performance while working remotely and independently, if applicable.
Strong judgment and discretion when handling highly confidential business, employee, and customer information.
Team player and creative, critical thinker highly desired.
Licenses + Certifications:
Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
Legal or Paralegal Certifications optional but useful
Essential Functions:
This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
Salary Range: $70,720 - $91,520
Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
Dental Insurance: Coverage for preventive, basic, and major dental services.
Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
PTO and Sick Time accrue each pay period: Take time off when you need it
Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 50d ago
(Remote) Senior Claims Examiner
Efinancial 4.7
Remote casualty claims supervisor job
Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
* Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
* Review newly reported claims and log them on the pending claims log.
* Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
* Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
* Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
* On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
* Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
* Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
* Handle and log specific State and NAIC policy locator searches.
* Mentor and support third-party claims administration staff.
* Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
* Work on special projects and other duties as assigned by the Claims Manager.
* Perform quarterly claim audits focusing on third-party claim handling.
* Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
* Handle Department of Insurance claim complaints or requests in a timely and professional manner.
* Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
* Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
* Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
* Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
* Support M&A activity, if applicable
Qualifications:
* 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
* Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
* Ability to meet deadlines while performing multiple functions.
* Proficient in MS Office applications and the Internet.
* Ability to proactively analyze and resolve problems.
* Attention to detail.
* Flexibility and willingness to adapt to changing responsibilities.
* Excellent written communication, interpersonal and verbal skills.
* Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
* Proactive and outside-the-box thinker.
* Independent and organized work style.
* Ability to maintain strong performance while working remotely and independently, if applicable.
* Strong judgment and discretion when handling highly confidential business, employee, and customer information.
* Team player and creative, critical thinker highly desired.
Licenses + Certifications:
* Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
* Legal or Paralegal Certifications optional but useful
Essential Functions:
* This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
* Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
* Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
* Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
* When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
* Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
* Salary Range: $70,720 - $91,520
* Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
* Dental Insurance: Coverage for preventive, basic, and major dental services.
* Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
* Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
* Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
* 401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
* PTO and Sick Time accrue each pay period: Take time off when you need it
* Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 52d ago
Senior Claims Representative
Liberty Mutual 4.5
Remote casualty claims supervisor job
Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As a Commercial Insurance Claims Representative, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual.
The preference is for the candidates to be located close to a hub and be in the office a minimum of 2 days/week (Hubs: Plano, TX, Suwanee, GA, Westborough, MA, Hoffman Estates, IL, Indianapolis, IN and Eugene. OR, and Phoenix, AZ) although candidates from any location will be considered. Please note this policy is subject to change.
Responsibilities:
Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
Determines and negotiates settlement amount for damages claimed within assigned authority limits.
Writes simple to moderately complex property damage estimates or review auto damage estimates.
Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed.
Qualifications
Bachelor's Degree preferred. High school diploma or equivalent required.
1-2 years of experience. Claims handling skills preferred.
Strong customer service and technology skills.
Able to navigate multiple systems, strong organizational and communication skills.
License may be required in multiple states by state law.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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$69k-113k yearly est. Auto-Apply 1d ago
Senior Claims Examiner (remote)
Switch'd
Remote casualty claims supervisor job
*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
$80k-94k yearly 60d+ ago
Sr. Claims Representative - California Workers' Compensation
Berkley 4.3
Remote casualty claims supervisor job
Company Details
BerkleyNet is an innovative workers compensation insurance provider that does all of our business online. Our Goal? To make doing business “Ridiculously Fast. Amazingly Easy.”
Responsibilities
Investigate workers' compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
Record and code injured worker demographics, job information and accident information in company's claims management system and files necessary forms with state regulatory agencies
Issue timely payments to injured workers, medical providers and service vendors
Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
Negotiate settlements of claims within designated authority with injured workers and attorneys
Serve as the team's subject matter expert of the Workers' Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
Manage the claims litigation process to ensure timely and cost-effective claims resolution
Monitor the expenses and effectiveness of managed care and investigation vendors
Periodically travel to attend hearings, conferences and training sessions
Attend and participate in claim file reviews with management and defense attorneys
Coordinate and lead special projects or processes as assigned by management
Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
Support management with training and staff development
Support management with vendor management activities
Continuously strives to improve our product and business results through innovation
Obtain and maintain adjuster license(s) in assigned jurisdictions
For highly qualified and experienced candidates, we are open to considering remote work arrangements for individuals who can travel as needed.
Qualifications
3 - 5 years of experience handling workers' compensation claims
Experience with California workers' compensation claims
Excellent written and verbal communication skills
Strong interpersonal and relationship building skills
Exceptional time management and organization skills
Strong analytical and critical thinking skills
Ability to work independently and strategically problem solve
Ability to diplomatically manage conflict
Ability to develop relationships within the organization and work effectively across departments
Strong discretion and integrity in dealing with highly confidential and sensitive information
Detail oriented
Education
Bachelors' degree or equivalent insurance industry work experience
AIC, ARM, CCP, or CPCU insurance designation preferred
Additional Company Details The Company is an equal employment opportunity employer.
We do not accept any unsolicited resumes from external recruiting firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees.
Base salary range: 75k-100k
Benefits include: Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans.
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. Additional Requirements • Low level of domestic U.S. travel required (up to 5% - 10% of time) Not ready to apply? Connect with us for general consideration.
Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues-not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).
Primary Responsibilities:
Claims Management:
- Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid.
- Determine what was paid, what was denied, and why.
- Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc.
Payer Interaction:
- Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard.
- Understand and navigate multiple contracts.
- Utilize BCBS portal to follow up and resolve outstanding claim issues.
Analytical Review:
- Differentiate between pricing errors vs. payment errors.
- Accurately price claims based on contract terms and identify variances.
Scope of Work:
- Outpatient facility claims ONLY
- Technical denials ONLY
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: ****************************************************
Skills and Requirements
- High school diploma or equivalent
- Outpatient hospital billing experience
- 5+ years Experience with facility claims follow-up & appeals handling
o Experience with UB04 forms
o This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.)
- Strong experience working with BlueCross BlueShield CareFirst and/or BlueCard
o Familiarity using payer portal, their escalation process, how to read and interpret contracts
- Experience meeting a productivity standard of following up on ~80 claims per day with 98% accuracy.
- Knowledgeable of ICD + CPT Codes
- Attention to Detail:
o Must be able to spot errors and inconsistencies in claims and contracts.
- Analytical Thinking:
o Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly.
- Independent & Fast Learner
- Tech Savvy (Excel, Teams, etc.) and experience working fully remotely - Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic
$33k-65k yearly est. 14d ago
Sr Claims Examiner- MSI
The Baldwin Group 3.9
Remote casualty claims supervisor job
Why MSI? We thrive on solving challenges.
As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs.
We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners.
Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle.
Bring on your challenges and let us show you how we build insurance better.
The Sr Claims Examiner is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision
PRIMARY RESPONSIBILITIES:
• Analyzes insurance policies and other documents to determine insurance coverage.
• Investigates and analyzes claim information to determine extent of liability.
• Handles claims 1st Party Property Claims with complex to major severity.
• Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
• Sets timely, adequate reserves in compliance with the company's reserving philosophy.
• Engages experts to assist in the evaluation of the claim.
• Monitors vendor performance and controls expense costs.
• Evaluates, negotiates and determines settlement values.
• Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
• Handles all claims in accordance with Best Practices.
• Responsible for monitoring and completing assigned claims inventory.
• Acquire and maintain a state adjuster's license and meet state continuing education requirements.
• Provides Best-In-Class customer service for insureds and agents.
• Develops and maintains relationships with external and internal stakeholders.
• Acts as a mentor for less experienced Claims Examiners.
• Updates and maintains the claim file.
• Identifies opportunities for subrogation and ensures recovery interests are protected.
• Identifies fraud indicators and refers files to SIU for further investigation.
• Participates in claims audits, internal and external.
• Provides oversight of TPAs
• Assists with special projects
KNOWLEDGE, SKILLS & ABILITIES:
EDUCATION & EXPERIENCE:
High School/GED
10+ year's experience in claims
Must have Property & Casualty Insurance License
#LI-BM1
#LI-REMOTE
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The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
About the Role
At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859.
Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
· Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
· Communication via telephone, email, and text with employees, employers, attorneys, and others
· Review and interpret medical records, utilizing resources as appropriate
· Complete financial calculations
· Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
· Apply contract/policy provisions to ensure accurate eligibility and liability decisions
· Demonstrate and apply analytical and critical thinking skills
· Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
· Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
· Leverage a broad spectrum of resources, materials, and tools to render claims decisions
· Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
· Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
· Work independently as well as within a team structure
· Deliver refresher trainings as appropriate to the claim team
· Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
· Prepare reports for management on claim outcomes and performance metrics.
· Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
· Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits\: Equitable Total Rewards Program
What You Will Bring
· Bachelor's degree or equivalent work experience
· 3+ disability claims administration experience
· Prior leadership experience as a team lead or manager
· Exceptional customer service skills
· Maintains positive and effective interaction with challenging customers
· Strong knowledge of disability and leave laws and regulations
· Ability to handle sensitive information with confidentiality and professionalism
· Group Disability Claims experience
· Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
· Experience working with the Fineos Claim Management System
· Exceptional written and oral communication skills demonstrated in previous work experience
· Excellent organizational and time management skills with ability to multitask and prioritize deadlines
· Ability to manage multiple and changing priorities
· Detail oriented; able to analyze and research contract information
· Demonstrated ability to operate with a sense of urgency
· Experience in effectively meeting/ exceeding individual professional expectations and team goals
· Demonstrated analytical and math skills
· Ability to exercise critical thinking skills, risk management skills and sound judgment
· Ability to adapt, problem solve quickly and communicate effective solutions
· High level of flexibility to adapt to the changing needs of the organization
· Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
· Continuous improvement mindset
· A commitment to support a work environment that fosters diversity and inclusion.
· Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
**********
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE\: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
* Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
* Communication via telephone, email, and text with employees, employers, attorneys, and others
* Review and interpret medical records, utilizing resources as appropriate
* Complete financial calculations
* Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
* Apply contract/policy provisions to ensure accurate eligibility and liability decisions
* Demonstrate and apply analytical and critical thinking skills
* Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
* Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
* Leverage a broad spectrum of resources, materials, and tools to render claims decisions
* Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
* Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
* Work independently as well as within a team structure
* Deliver refresher trainings as appropriate to the claim team
* Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
* Prepare reports for management on claim outcomes and performance metrics.
* Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
* Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
What You Will Bring
* Bachelor's degree or equivalent work experience
* 3 disability claims administration experience
* Prior leadership experience as a team lead or manager
* Exceptional customer service skills
* Maintains positive and effective interaction with challenging customers
* Strong knowledge of disability and leave laws and regulations
* Ability to handle sensitive information with confidentiality and professionalism
* Group Disability Claims experience
* Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
* Experience working with the Fineos Claim Management System
* Exceptional written and oral communication skills demonstrated in previous work experience
* Excellent organizational and time management skills with ability to multitask and prioritize deadlines
* Ability to manage multiple and changing priorities
* Detail oriented; able to analyze and research contract information
* Demonstrated ability to operate with a sense of urgency
* Experience in effectively meeting/ exceeding individual professional expectations and team goals
* Demonstrated analytical and math skills
* Ability to exercise critical thinking skills, risk management skills and sound judgment
* Ability to adapt, problem solve quickly and communicate effective solutions
* High level of flexibility to adapt to the changing needs of the organization
* Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
* Continuous improvement mindset
* A commitment to support a work environment that fosters diversity and inclusion.
* Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
$60k-65k yearly 60d+ ago
Commercial Property Claims Supervisor | Remote
King's Insurance Staffing 3.4
Remote casualty claims supervisor job
Our client, a leading A-rated Insurance Carrier, is seeking to add a Commercial Property ClaimsSupervisor to oversee a team of Inside Commercial Property Claims Examiners. This individual will be responsible for supervising daily claim operations, providing technical guidance, supporting adjuster development, and ensuring high-quality handling of mid-to-complex Commercial Property losses. The Supervisor will also assist with escalated files, conduct quality audits, and ensure adherence to company best practices. Experience with Xactimate or Symbility is required. This is a remote position!
Supervise a team of Commercial Property Examiners handling mid-to-complex losses from inception to close.
Provide ongoing coaching, mentorship, and technical guidance to adjusters.
Review, analyze, and approve adjuster estimates, coverage recommendations, and settlement proposals.
Manage team performance, conduct file audits, and ensure compliance with department Best Practices.
Assist with escalated claims, complex coverage issues, and high-severity losses as needed.
Oversee workload distribution, monitor productivity, and ensure timely file handling.
Communicate effectively with policyholders, agents, contractors, and internal leadership.
Identify opportunities for cost containment, loss mitigation, and subrogation recovery.
Provide timely and accurate reporting to management regarding team performance and claim activity.
Consistently promote exceptional customer service and support a positive team culture.
Requirements:
7 to 10 years of Commercial Property claims experience
2 - 5+ years in a Team Lead / Supervisor capacity.
Must have experience working directly for an Insurance Carrier handling or overseeing Commercial Property claims.
Proficiency in Xactimate or Symbility.
Strong leadership, communication, organizational, and interpersonal skills.
Bachelor's Degree preferred but not required.
Salary/Benefits:
$110,000 to $150,000 annual base salary plus bonus up to 8 - 12%
Company vehicle provided (Truck/SUV)
Extremely competitive Medical, Dental, Vision, and Life plans
Employer matching 401(k) plan
Generous PTO policy
Clear opportunities for advancement within a growing organization