Claim processor jobs in Alameda, CA - 108 jobs

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor's degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM. Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims. Duties and Responsibilities Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards. Prepare accurate and timely issuance of benefits notices and required reports within statutory limits. Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits. Ensure timely payment of benefits, bills and appropriate caseload and performance goals. Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data. Monitor, report, and assign claims for fraud potential and subrogation possibilities. Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws. Prepare and present claims summaries to clients during file reviews. Train and direct Claims Assistants to meet goals and deadlines. Review and approve priority payments and other documents from Claims Assistants. Performs other duties as assigned Knowledge, Skills, and Abilities Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions. Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits. Strong skills with use of general office administration technology, including Microsoft Office Suite and related software Excellent verbal and written communication skills Excellent interpersonal and conflict resolution skills Excellent organizational skills and attention to detail Excellent interpersonal, negotiation, and conflict resolution skills Strong analytical and problem-solving skills Ability to act with integrity, professionalism, and confidentiality, at all times The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits. #J-18808-Ljbffr

About the Company For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss. About the Role The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports. This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role. Key Responsibilities Case Management & Communication Receive, review, and manage assigned cases from start to completion. Communicate professionally with clients, claimants, witnesses, and other involved parties. Provide timely case updates and correspondence in accordance with company guidelines via CaseLink. Maintain objectivity and professionalism in all interactions. Investigative Field Work Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings. Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires. Perform scene and neighborhood canvasses, including walking on varied terrain. Meet with treating physicians and medical offices as required. Travel to designated locations, including overnight stays when necessary. Respond to rush cases within business hours when required. Documentation & Reporting Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis. Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired. Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements. Prepare and submit comprehensive investigative reports within 72 hours of final update submission. Evidence & Records Handling Retrieve records from agencies and entities both in-person and remotely. Take clear photographs and video when necessary and label all electronic files accurately. Securely collect, store, and maintain custody of evidence when required. Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure. Additional Responsibilities Identify and recommend additional investigative services outside the scope of the original assignment when appropriate. Work overtime as needed to meet case demands and deadlines. Maintain an efficient, safe, and organized telecommuter workspace. Physical & Work Environment Requirements Ability to sit for extended periods performing computer-based work and report writing. Ability to stand for extended periods while conducting interviews and canvasses. Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment). Ability to operate digital audio recording equipment. Qualifications Experience with workers' compensation claims and investigative processes. Strong written and verbal communication skills. Ability to work independently, manage time effectively, and meet strict deadlines. Willingness and ability to travel up to (but not limited to) 150 miles per assignment. Possession of a personal credit card with available balance for reimbursable business expenses. Proficiency with case management systems; CaseLink experience preferred. Access to a personal scanner for document upload and record handling. Preferred Qualifications Prior experience conducting recorded statements and field investigations. Experience with process service assignments. Familiarity with evidence handling and documentation standards. Background in insurance investigations or a related field.

WHAT WE'RE LOOKING FORAre you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Are you a Spanish speaker looking to apply those skills in a professional environment? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster. Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity. RESPONSIBILITIES Completes classroom training introducing workers' compensation claims handling strategies, medical terminology, and legal concepts. Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records. Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls. Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines. Develops and updates a plan of action for the successful resolution of each claim. Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently. Reduces fraud through early identification and escalation. Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers. Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims. Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim. WHAT YOU'D BRING TO THE ROLE Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred Exceptional interpersonal and customer service skills Ability to manage and prioritize multiple assignments in a fast-paced environment Strong organization skills to ensure tasks are completed within hard deadlines Basic mathematical skills to calculate monetary reserves To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications and be proficient, or able to become proficient, on applicable databases, systems, and vendor software programs. WHY YOU SHOULD APPLY Unparalleled financial strength and stability Fantastic growth and advancement opportunities WFH Hybrid schedule Free gym in building Generous Paid Time Off and Holidays Excellent Benefits (Medical, Dental, Vision, 401k, etc) Health and Wellness Reimbursement Tuition Assistance Reimbursement Discounts across companies such as GEICO, See's Candies, etc. In accordance with the California Equal Pay Act, the starting hourly wage for this job is $32.6924. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.

Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good! Grow Your Skills, Grow Your Potential Responsibilities Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accident and weather-related claims for homeowners, commercial properties, and large losses. We are looking for an experienced and highly skilled professional to contribute to our dynamic team. You will be the first point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process while providing Remarkable service. Key Responsibilities: Conduct on-site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions Provide exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally Gather necessary evidence, document findings, and prepare detailed reports to support the claims handling process Investigate and adjust both personal and commercial property claims with exposures up to $500,000 Evaluate coverage and policy terms to determine the validity of claims and ensure compliance with local regulations Negotiate and settle claims within the authorized limits, considering policy provisions, industry standards, and company guidelines Where you'll work: This position is located in East Bay Area, CA. Competitive candidates should reside within one of the listed zip codes and will service this same territory: 94501, 94502, 94505, 94506, 94507, 94509, 94511, 94513, 94514, 94516, 94517, 94518, 94519, 94520, 94521, 94523, 94525, 94526, 94528, 94530, 94531, 94541, 94542, 94546, 94547, 94548, 94549, 94553, 94556, 94561, 94563, 94564, 94565, 94569, 94572, 94575, 94577, 94578, 94579, 94580, 94583, 94595, 94596, 94597, 94598, 94601, 94602, 94603, 94605, 94606, 94607, 94608, 94609, 94610, 94611, 94612, 94613, 94618, 94619, 94621, 94702, 94703, 94704, 94705, 94706, 94707, 94708, 94709, 94710, 94720, 94801, 94803, 94804, 94805, 94806, 94850, 95202, 95203, 95204, 95205, 95206, 95211, 95219, 95231, 95330. This is a Remote-Field position in which you will work from home and utilize a mobile office/vehicle for in-person appointments. Although the primary work location is in the field, with a commutable distance from home, there will be opportunities for virtual work to be completed at home. Additionally, there may be occasions where you will be required to travel outside your assigned area to assist in other territories. Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible schedules and may be asked to work overtime and/or irregular hours. Qualifications Competitive candidates must demonstrate: Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims Strong knowledge of property insurance policies, coverage and claim handling practices Knowledge of both residential and commercial building construction Familiarity with local regulations and compliance requirements in your assigned territory Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus Proven ability to assess damages, estimate repair costs, and negotiate settlements Detail-oriented with strong organizational and analytical skills Proficient in using claims management software and other relevant tools Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces May be required to complete Rope and Harness Safety Training. A valid driver's license is required Preferred: Bachelor's Degree in a related field or equivalent work experience Experience in handling complex or high-value claims Construction background Water mitigation inspection experience Xactimate, XactContents Additional Details: Employees must successfully complete all required training, including applicable licensing exam(s) and background checks required of various state(s). State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing For San Francisco candidates: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Our Benefits Because work-life balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! Potential starting salary range: $73,824.56 - $118,245.00 / annually Starting salary will be based on skills, background, and experience High end of the range limited to applicants with significant relevant experience Potential yearly incentive pay up to 15% of base salary At State Farm, we offer more than just a paycheck. Check out our suite of benefits designed to give you the flexibility you need to take care of you and your family! Get Paid! On top of our competitive pay, you are eligible for an annual raise and bonus. Stay Well! Focus on you and your family's health with our robust health and wellbeing programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare plan options, including a high deductible plan. All medical plans provide 100% coverage for in-network preventative care, AND you and your family have access to vision, dental, telemedicine, 24/7 mental health professionals, and much more! Develop and Grow! Take advantage of educational benefits like industry leading training programs, top-notch tuition assistance programs, employee resource groups, and mentoring. Plan Ahead! Plan for those big moments in life with benefits like fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and more. You can also start a savings account or consider financing through our State Farm Federal Credit Union! Take a Little “You” Time! You will have access to our generous time off policies designed so you can plan around holidays, family events, volunteering, or just to take a relaxing day off. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! Give Back! We offer several ways to give back through our Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund. Finish Strong! Plan for retirement using free financial advisors and a 401(k) plan with company contributions of up to 7% of your salary. Visit our State Farm Careers page for more information on our benefits, locations, and the hiring process of joining the State Farm team! #LI-DS3 PandoLogic. Category:Insurance, Keywords:Insurance Examiner, Location:San Leandro, CA-94577

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

Are you ready to make a real difference in healthcare? MIEC is searching for a dynamic Claims professional to join our passionate team and play a pivotal role in protecting medical professionals and advancing patient safety! Whether you step into the role of Claims Analyst or take on the expanded responsibilities of Claims & Patient Safety Specialist, you'll be at the heart of our mission-opening, investigating, managing, and resolving incident and claim files for our valued policyholders. But that's just the beginning! As an Analyst or Specialist in our Claims Department, you'll go beyond claims management, partnering directly with groups and individual policyholders to deliver innovative Patient Safety & Risk Management services. You'll help shape safer healthcare environments, drive impactful change, and become a trusted advisor to those who count on us most. Join MIEC and be part of a team that's redefining excellence in claims and patient safety-where your expertise, initiative, and commitment truly matter. Get a sneak peek into MIEC's mission-driven, collaborative culture by following this link. LOCATION: This position is remote, with a preference for candidates located in Southern California, with limited travel to our main office in Oakland, CA. This position requires some travel from time to time, including overnight stays. COMPENSATION: The hiring salary range of $73,050 to $149,484 will be based on role, experience, and location. Priority will be given to candidates in Southern California, but see hiring ranges below for all locations: * Hiring range for Claims Analyst role: * San Francisco Bay Area and Hawaii: $84,519 to $112,691 * All other locations: $73,050 to $97,400 * Hiring range for Claims & Patient Safety Specialist role: * San Francisco Bay Area and Hawaii: $112,113 to $149,484 * All other locations: $96,900 to $129,200 MIEC offers competitive compensation, commensurate with experience and a comprehensive benefits package. MIEC is an EEO employer; we enjoy diversity in our staff, policyholders and business partners. BENEFITS: * 401(K) + Pension Plan * Health Insurance * Vision and Dental Insurance * Generous Paid Time Off Plans WHAT YOU'LL DO: Whether hired as a Claims Analyst or a Claims & Patient Safety Specialist, your primary duties will be in Claims, where you will: * Respond to first notice of potential claims from policyholders and handle advice calls, gathering preliminary information and providing appropriate advice for action. * Collaborate with the Claims team to identify and evaluate insurance coverage issues, and to develop, prepare and implement appropriate negotiation/case resolution strategies. * Obtain and review records, interrogatories, depositions, consultant reports, and attorney reports; coordinate discovery with defense counsel; monitor file status, reserves, legal landmarks and billings. * Prepare documentation, reports, and correspondence with policyholders, claimants and attorneys. * Submit incident, claim and suit files for opening; manage and close files in a timely manner. * Exercise strong judgment in settling cases within authority and develop indemnity and expense reserve recommendations above defined authority level. * Study trends and current developments within the medical malpractice industry in the states in which MIEC operates, and nationally. Proactively share information within the department about the trends and current developments, including relevant court cases. * Participate in seminars, trainings, meetings, and Board meetings, when requested. If hired as a Claims & Patient Safety Specialist, you will also: * Collaborate with MIEC's Patient Safety & Risk Management (PSRM) staff to provide specialized internal and external services addressing existing member groups and new business, including large medical groups and hospitals. * Apply principles of healthcare risk management, such as incident reporting and investigation, risk analyses, and policies/procedures, to further develop PSRM services which can be applied in all healthcare settings. * Collect, analyze, and compare MIEC data to present evidence-based information to members, utilizing data from various healthcare and medical malpractice claims sources including Candello - Solutions by CRICO, the MPL Association Data Sharing Project, and Preverity. * Coordinate and conduct Claims Prevention Surveys for policyholders. * Manage active matters involving unanticipated patient harm through MIEC's RESTORE communication and resolution program; work with MIEC policyholders to support effective patient communication, disclosure, and/or apology discussions. * Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials. * Participate in the conception and completion of special projects. Requirements WHO YOU ARE: * An experienced team member with a demonstrated expertise in the handling of medical malpractice claims and a solid understanding of Patient Safety Risk Management (PSRM) services and products, and the ability to address general PSRM questions or refer to the appropriate discipline. * A flexible collaborator who has a demonstrated customer service focus with all levels of internal and external stakeholders. * An enthusiastic and self-directed contributor who is skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines. * An inquisitive analytical thinker with good judgement, professional initiative, and strong research skills. * An excellent communicator, with strong written, verbal, and interpersonal communication skills and ideally with proficiency in medical terminology. Additionally, a candidate hired for the Claims & Patient Safety Specialist role would need: * An understanding of clinical systems. * Knowledge of hospital policies and procedures, and governmental healthcare regulations. * Ability to analyze medical records and quality issues. WHAT YOU'LL BRING: Education: * A Bachelor's degree (BA/BS) is required. Licenses/Certification: * A valid driver's license is required. * A Certified Professional in Healthcare Risk Management (CPHRM) designation is preferred. Experience: The ideal Claims & Patient Safety Specialist candidate will join us with a minimum of seven (7) years of experience as a medical professional liability claims representative, risk manager or similar experience in defense of medical professional liability or risk management/patient safety field required. The ideal Claims Analyst candidate will join us with a minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry. Digital Skillsets: Our ideal candidate will be a digitally fluent contributor, comfortable in a range of virtual environments and proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs. About MIEC: MIEC was founded in 1975 in the depths of the malpractice crisis by physicians and their medical societies when insurance was largely unavailable to the healthcare community. As the West's first truly physician-owned medical professional liability insurer, MIEC has always been guided by the desire to protect physicians and other healthcare professionals from malpractice risks and committed to a long-term philosophy of business conduct that ensures such a crisis never happens again. We exist to foster enduring partnerships within the healthcare community by serving members through a philosophy of vigorous protection and high value, delivered by people who care. As a member-owned exchange Headquartered in Oakland, CA, MIEC now insures more than 7,400 physicians and other healthcare professionals in 4 states, with regional claims offices in Idaho, Alaska, and Hawaii. MIEC has consistently adapted to meet the changing needs of healthcare delivery and continually seeks to reinvent medical professional liability through effective partnership, innovative insights, and dynamic risk solutions.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Auto - Commercial Trucking Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze and process complex auto claims for a large commercial trucking account by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Processes complex auto commercial claims, including bodily injury and ensures claim files are properly documented and coded correctly. * Responsible for litigation process on litigated claims. * Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. * Reports large claims to excess carrier(s). * Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. * Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. * Communicates claim action/processing with insured, client, and agent or broker when appropriate. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. Experience Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of commercial line auto policies, coverage's, principles, and laws. TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000-$90,000 annually. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Responsibilities Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report. Routes claims to appropriate PHC departments and internal staff for additional review. Follows up and completes claims once response to request has been received. Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. Generates claims correspondence as needed. Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor. Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame. Supports Claims Department's needs for resolving all pended claim types. Participates in special projects and assignments as required. Other duties as assigned. Qualifications Education and Experience High school diploma or equivalent; prior experience examining claims in an automated environment; or equivalent combination of education and experience. Special Skills, Licenses and Certifications Effective written and oral communication skills. Good organization skills. Performance Based Competencies Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines. Work Environment And Physical Demands Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $ 28.94 - $ 34.00 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Workers' Compensation Claim Supervisor Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 adjusters Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a Workers' Compensation Claim Supervisor with California jurisdiction expertise to remotely lead a team of adjusters out of our Las Vegas, NV branch. This role is critical in ensuring claims are handled accurately, efficiently, and in compliance with client and regulatory requirements. You'll provide clear guidance and direction throughout the lifecycle of each claim, while mentoring and developing your team for long-term success. Responsibilities • Oversee proper handling of WC claims to protect the interests of the adjuster, client, and carrier • Review claim files regularly and provide direction on complex or litigated matters • Assist with reserve accuracy and compliance with client handling instructions • Participate in claim reviews and ensure adherence to jurisdictional laws and best practices • Recruit, train, and mentor staff; conduct performance reviews and manage PIPs • Address personnel issues and manage administrative responsibilities • Ensure compliance with carrier/state reporting requirements Qualifications What You'll Bring Required: • 10+ years of WC claims experience (California jurisdiction) • Prior experience adjusting WC claims from start to resolution • CA SIP designation or CA Claims Certificate (or ability to obtain within 60 days) • Strong leadership, communication, and organizational skills Preferred: • 3+ years of supervisory experience • Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required. • Proficiency in Microsoft Office and claims systems Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

About Stand Stand is a new technology and insurance company revolutionizing how society assesses, mitigates, and adapts to climate risks. Our leadership team has extensive experience in insurance, technology, and climate science: building billions in market value at prior ventures. At Stand, we are rethinking how insurance enables proactive, science-driven resilience. Existing insurance models often rely on broad exclusions, leaving homeowners without options. At Stand, we leverage advanced deterministic models and cutting-edge analytics to provide personalized risk assessments-helping homeowners secure coverage and take proactive steps toward resilience. Why Join Stand: At Stand, you'll join a mission-driven team redefining insurance through the lens of climate resilience, building a transformative, data-driven insurance model with real-world impact for homeowners and communities on the front lines of climate change Location: This role is onsite at either or Tampa, FL office or our San Francisco, HQ. Both are options. Role Summary: As Head of Claims at Stand Insurance, you will be responsible for managing the Claims lifecycle, end-to-end in conjunction with third party partners and the Operations team. Unlike many Claims roles, however, this role is unique in that it also provides an opportunity to be part of the solution in avoiding claims before they happen by working with mitigation and retrofitting vendors. By being involved in the building process before, during, and after a claim, you will be able to ensure we are fulfilling our promise of security to insureds in every facet. This role is great for a high energy, execution focused individual with experience in the most challenging property catastrophe markets. Core Responsibilities: Implement catastrophe response program and strategy for various catastrophe perils in conjunction with TPA partners Build core networks for programs such as water remediation, salvage and subrogation, legal defense, and other approved/recommended contractors that can provide high quality repairs for insureds while managing claim expense Maintain Claims compliance in all states and in all functional areas, such as claims handling practices, reporting, OFAC and CMS Medicare compliance, etc. Develop internal and external staffing, partnerships, and scaling Claims department for expansion of states and products Collaborate with cross-functional teams, including underwriting, product, and actuarial, to collaborate on policy language, underwriting guidelines, and claim reserving practices Help develop best in class wind mitigation vendor networks to help support insureds securing appropriate retrofitting quickly and affordably Work with Product and Technology teams to enhance technology for streamlined claim handling processes and create a seamless and transparent claim experience for insureds Must-Haves 15+ years of property claims experience, predominantly in the personal lines space High-value Homeowners experience Experience in the Florida marketplace is strongly preferred, but generally shall have experience in one or more CATs in a leadership role Comfort working cross-functionally in a fast-paced, entrepreneurial environment Nice-to-Haves Wildfire catastrophe experience Technical competencies and background in designing/working with teams to develop Claims Management software Compensation: The annual base salary range for full-time employees in this position is $150,000 to $210,000+ meaningful Equity Grant. Compensation decisions are dependent on several factors including, but not limited to, an individual's qualifications, location where the role is to be performed, internal equity, and alignment with market data. Additional Benefits: Comprehensive benefits including above-market Health, Dental, Vision Weekly lunch stipend Flexible time off 1-day a week WFH flexibility 401k plan Equal Opportunity Employment Stand is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status. We believe that diversity enriches the workplace, and we are committed to growing our team with the most talented and passionate people from every community. We are committed to providing reasonable accommodations for qualified individuals. If you require assistance Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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

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

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. About GEICO The Government Employees Insurance Company (GEICO) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. GEICO is a wholly owned subsidiary of Berkshire Hathaway and is the third largest auto insurer in the United States. In 2023, GEICO earned premiums worth over $40 billion U.S. dollars. GEICO is going through a massive digital transformation to re-platform the Insurance industry, removing friction across Customers, Partners, Marketplace, Segments, Channels, and Experiences as we grow our reach and market share. About The Role GEICO is hiring a Innovation Analyst to join their Claims Innovation team. As an Innovation Analyst, you will support GEICO's Claims Innovation team in identifying, analyzing, and implementing opportunities to improve processes and technology. This role partners with cross-functional teams to deliver innovative solutions that enhance efficiency, accuracy, and customer experience. Responsibilities: * Evaluate and analyze existing claims processes, data, and performance metrics to identify areas of opportunity for efficiency, effectiveness, or accuracy * Gather and analyze data to provide insights into claims processes and performance metrics * Support the development of actionable strategies and assist in implementing process and technology enhancements. * Assist the Director, Claims Innovation in establishing priorities, goals, and objectives * Collaborate with Operations, Product, AI/ML, and Engineering teams to define and prioritize requirements. * Prepare reports and presentations summarizing findings, recommendations, and project progress. * Contribute to and/or lead pilot programs, POC's, or A/B testing and reporting on performance and progress * Participate in innovation workshops, ideation sessions, and design sprints. * Monitor project risks, benefits, and performance metrics; escalate issues as needed. * Stay informed on industry trends, emerging technologies, and best practices. About You Skills & experiences: * 3+ years of experience in business process optimization, business analysis, consulting, innovation, or process engineering. * Leadership experience in P&C insurance claims * Bachelor's degree in Business, Finance, Economics, Statistics, or related field. * Knowledge of innovation methodologies, processes, and principles * Strong analytical skills and ability to interpret data for decision-making. * Effective communicator with strong collaboration skills. * Demonstrated ability to adapt and learn in a fast-paced environment. * Commitment to diversity, equity, and inclusion. Leadership qualities: * Leads from the front and isn't shy about using their voice * Ability to lead and influence with empathy and humility * Ability to navigate and lead through complexity * Curiosity, critical thinking skills; a lifelong learner who sees situations through multiple lenses * Exceptional character and an ability to instill confidence and build trust. Someone who possesses high emotional intelligence, and is an attentive, empathetic listener Location: Remote, or available office #LI-HB1 Annual Salary $82,000.00 - $172,200.00 The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations. At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. * Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. * Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. * Access to additional benefits like mental healthcare as well as fertility and adoption assistance. * Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

The MSO Claims Examiner is responsible for the daily review, audit, examination, investigation and adjudication of hospital and professional claims. Must exceed qualitative standard and meet quantitative production standard. Responsible to prepare files and documents for the annual health plan delegation oversight audits, assist Claims Supervisor with MSO management reports, and other special projects as needed. ESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted hospital and professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Responsible for the daily review of complex pre-payment claims reports. Identify processing errors and make corrections prior to the weekly FFS payment cycle. Identify claims payment errors and perform claims revision/correct activities for repayment or deduction per Physician and/or Vendor Contract terms. Must meet quantitative production standard of 750 claims per week. Provides feedback on testing system upgrades and enhancements. Respond to complex provider inquiries related to claims adjudication, denial, and payment status and handle member billed issues when arise. Respond to first level provider inquiries related to claims adjudication, denial, and payment status and handle member billed issues when arise (when necessary). Responsible to prepare, review, and submit claims files and evidence documents for the annual delegation oversight audit(s) performed by Health Plan(s). Provide recommendations to Claims Manager on updating claims policies and procedures to meet turn-around-time and/or CMS/DHCS/MCP regulatory requirement. Assist in training the entry level Claims Examiner for claims auditing and adjudication activities, and other MSO staff with general claims information. Identify system configuration errors and flaws during day-to-day operation, report to department supervisor, manager and MSO System Configuration team to correct/resolve them. Identify auditing errors and/or training-related opportunities that will improve operational efficiencies and results. Provides information in response to the requests of patient, physician, insurance company or co-worker as appropriate. Prepares and interprets appropriate statistical reports. Performs other job duties as required by manager/supervisor and NEMS Management Team. Qualifications QUALIFICATIONS: Completion of a 2-year degree from an accredited University, may be substituted with relevant work experience in healthcare medical claims processing and examination field. Minimum 3-4 years of experience in health insurance claims processing, examination, adjudication, and auditing. Strong knowledge of managed care and/or healthcare claim reimbursement or medical billing in Medi-Cal and Medicare Advantage program required. Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, and ICE standards), particularly DHCS/Medi-Cal and CMS/Medicare guidelines required. Working knowledge of medical terminology, standard code sets including CPT, HCPCS, ICD, POS, and claim forms. Strong English communication skills with strong analytical and problem solving skills. Ability to self-manage in a detail oriented environment. Ability to operate PC based software programs or automated database management systems preferred. Good organization and prioritization skills, outstanding in time management LANGUAGE: Must be able to fluently speak, read and write English. Fluent in other languages are an asset. STATUS: This is an FLSA NON-exempt position. This is not an OSHA high-risk position. This is a Full Time position. NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

We are looking for an experienced Insurance Claims Examiner to join our team on a contract basis in Oakland, California. In this role, you will analyze and process medical claims, ensuring accuracy and compliance with healthcare regulations. Ideal candidates will have a strong background in insurance claims management and coding, along with the ability to work independently in a fast-paced environment. Responsibilities: - Review and adjudicate medical claims for accuracy and compliance with Medi-Cal, Medicare, and other healthcare regulations. - Research and resolve claim discrepancies, ensuring proper payment and documentation. - Utilize coding systems such as ICD-10, CPT, and HCPCS to verify claim accuracy. - Maintain confidentiality while handling sensitive participant and family information. - Follow organizational policies and procedures to ensure compliance and attention to detail. - Exhibit consistent attendance and punctuality while meeting deadlines. - Communicate effectively with internal teams and external stakeholders to address claim issues. - Input accurate data into various computer systems and software programs. - Provide courteous and detail-oriented customer service to all stakeholders. - Perform additional duties as assigned to support claims processing activities. If you are interested in this role please apply now and call us at (510) 470-7450, it is an urgent need for our client. Requirements - Comprehensive understanding of medical coding systems, including ICD-10, CPT, and HCPCS. - Minimum of 3 years of claims processing experience in a Medicare/Medi-Cal environment. - Proficiency in computer applications such as Outlook, Excel, and Word. - Ability to work effectively in a multidisciplinary setting. - High school diploma required; bachelor's degree preferred. - Strong auditing, billing, and claim administration skills. - Familiarity with CMS platforms and 3M systems. - Excellent organizational and communication skills, with the ability to prioritize tasks and meet deadlines. TalentMatch Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use (https://www.roberthalf.com/us/en/terms) and Privacy Notice (https://www.roberthalf.com/us/en/privacy) .

Salary Range: $50.42 - $68.08 The Contracts and Legal Claims Specialist oversees contracts management the organization's system. and contract lifecycle, from drafting and preparation to execution; ensuring contractual accountability and duties are met by all parties involved. The role ensures effective administration of the full contract lifecycle, from drafting and review. to execution and compliance monitoring. The Contracts and Legal Claims Specialist is also responsible for coordinating claims and legal matter in collaboration with Vice President, outside legal counsel, insurance carriers and internal stakeholders. The Contracts and Legal Claims Specialist is also responsible for the following duties: Oversite and daily management Management System of the health system's Contract administrative function. Oversite and management of health system policies and numbered memorandums lifecycle with the collaboration stakeholders. on internal Subpoena intake and management for the healthcare system, ensuring timely and accurate response to subpoenas and related data requests and coordinating with legal counsel and internal departments and external vendor to manage the subpoena lifecycle Daily management of the health system's Public Record Request website and coordinate with the appropriate stake holders and legal counsel to ensure compliance with regulatory requirements for responding to requests. Supporting the Vice President and Chief Compliance & Risk Officer with management of litigation claims and other legal matter logistics. Facilitates the claims filing and adjudication process with malpractice carriers and collaborates malpractice carriers with legal counsel and to ensure timely coordination of the discovery process for litigation. Works with legal counsel to coordinate meetings, interviews depositions with and support. staff and medical staff and provides logistical In addition to performing the essential functions listed below, may also be assigned other duties as required. Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities * Benefit interpretation and analysis of EOCs across multiple health plans * Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans * Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories * Analysis of authorization rules and Division of Financial Responsibility (DOFR) * Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators * Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation * Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution * Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary * Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) * Assist with maintenance of benefit requirements and configuration decisions and policies and procedures * Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems * Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems * Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance * Other duties as assigned Requirements * 5+ years of experience in benefits and claims in Managed Care, delegated model setting * Experience with benefit analysis and/or quality assurance * College degree in healthcare (preferred) or equivalent experience/knowledge * Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding * Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. * Experience with Epic Tapestry (preferred) * Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs * Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities * Knowledge of how benefit configuration relates to claims adjudication and payment processes. * Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. * Experience with testing, reviewing, and validating benefit plans * Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. * Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. * Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. * Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage third party liability construction defect commercial claims with moderate to high complexity and exposure. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-KP1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.