Personal Injury Examiner
Claim Processor Job In Arlington, TX
We are looking for Personal Injury Protection (PIP) Claims Examiners in Dallas TX to deliver our promise to be there and assist our customers throughout the often-complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S.As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Salary per hour
Dallas $24.82-$31.27
*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, responsibilities of the role, candidate's work experience, education and training, and the work location as well as market and business considerations*
Qualifications & Skills:
Bachelor's degree preferred, but not required
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
Must be able to speak in a clear, empathic and professional manner by telephone.
- Must be able to document files in a clear, concise, professional written manner, to be understood by customers, clients, co-workers and other employees of the organization.
-Must attain and maintain the required licenses issued by the state insurance department.
- Must be able to handle heavy call volume, pending claim files and stressful situation.
- Must be able to follow complex instructions, resolve conflicts or facilitate conflict resolution, and have strong organization/priority setting, multi-tasking skills.
- Must be able to learn and apply large amounts of technical and procedural information
#geico300
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
Benefits:
As an Associate, you'll enjoy our Total Rewards Program* to help secure your financial future and preserve your health and well-being, including:
Premier Medical, Dental and Vision Insurance with no waiting period**
Paid Vacation, Sick and Parental Leave
401(k) Plan
Tuition Assistance
Paid Training and Licensures
*Benefits may be different by location. Benefit eligibility requirements vary and may include length of service.
**Coverage begins on the date of hire. Must enroll in New Hire Benefits within 30 days of the date of hire for coverage to take effect.
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.
Lease Processor
Claim Processor Job 43 miles from Arlington
MD7, a leading provider of innovative solutions for mobile network technology is seeking a passionate and detail-oriented Lease Processor to expand the team.
Are accuracy and attention to detail very important to you?
Do you have a clear goal that you work toward each day?
Does supporting teammates and clients in a high energy, fast paced office excite you?
Do you have an interest in being an integral part of the company's growth?
If you answered yes to these questions, please read on. As our organization continues to evolve and grow, we find ourselves looking for a new team member to assist us in delivering a high-quality experience to every client, every time.
Job Summary
The Lease Processor (LP) prepares complex lease agreements and lease amendments on behalf of cellular phone operators. The LP will utilize multiple software systems for document generation, workflow management, tracking progress, and escalating issues. The LP works closely with customers, project managers, and lease negotiators in a high energy, fast-paced environment.
Major goals and responsibilities
Drafting lease documents in high volume for landlord and customer review
Ensure accuracy of all documents and participate in quality control
Coordinate, route and review final lease packages for execution
Essential activities
Preparing Lease Documents: includes reviewing existing lease documents, new negotiated terms, confirming operator and landlord information.
Coordinate Lease Packages: incudes preparing documents for execution, routing to multiple parties for signature and scanning/loading executed contracts into various document management systems.
Customer Interface: includes working with customer project teams and legal team to review proposed deal terms and obtain client approval.
Internal Team Interface: includes working with project managers and lease negotiators to manage a high volume of accurate contracts on a daily basis.
Utilize Computer Systems: includes using multiple software and data management systems.
Key Characteristics to be Successful in this Role
Skills
Strong written and verbal communication
Ability follow guidelines and process in workflow management software
Ability to adjust to changing workload and priorities
Strong computer skills with Outlook, Excel, and Word are required
Experience
Knowledge of real estate principles and contract drafting preferred
College degree, paralegal certificate or equivalent work experience
MD7 Core Values
Our Vision and Core Values are both foundational and aspirational at the same time. We never quit striving to improve. We're always looking to recruit exceptional talent that share in these values as well.
Respect for the Individual
Extreme Service
Balanced Life
Integrity
Giving Back
Continuous Improvement
We want to be able to continuously innovate to empower success. That's why, in addition to exciting career opportunities throughout the world, we also provide the best training in the industry.
Additional information
*This position not eligible to be performed from Colorado, New York or New Jersey.
Explore our Benefits
Disclaimer: 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.
MD7 is an Equal Opportunity Employer. If you need assistance or an accommodation due to a disability, please contact us at ******************.
Disability Claims Examiner
Claim Processor Job 34 miles from Arlington
Job Purpose: Under supervision, this position is responsible for examining and processing all claim types including short term or long term disability, life, waiver of premium, critical illness, accident insurance and other claim type for various policies. May perform a variety of related duties or travel to client sites to discuss / resolve claim issues.
Job Responsibilities:
* Proactively communicate and respond to claim inquiries from insureds, beneficiaries, policyholders and internal stakeholders; resolve issues through effective verbal and written communication by involving appropriate people within, or outside the department or company; effectively and professionally represent the company in all interactions.
* Investigate, research, verify and diligently obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability or incident.
* Adjudicate claims in accordance with established policies and procedures.
* Adhere to quality, production, service and departmental guidelines to process claims.
* Provide professional, prompt and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling various claim types.
* Approve or deny claims within policy limits; recommend approval, denial, rescission or settlement of disputed claims.
* Examine and analyze life claim information and makes benefit decisions .
Additional Skills & Qualifications
Must have experience with adjudicating Accidental, Critical, Hospital or Short term Disability claims
Required Job Qualifications:
* Bachelor degree or 4 years of experience.
* 2 years of claims experience.
* Problem solving and research skills.
* PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes.
* Knowledge of state regulations, statutes, and ERISA.
* Detailed oriented.
Hybrid role can sit in Alburquerque, NM ; Amarillo, TX ; Richardson , TX; Helena, Montana ; Tulso, OK or Lombard, IL
Pay and Benefits
The pay range for this position is $21.00 - $25.00
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a hybrid position in Richardson,TX.
Application Deadline
This position will be accepting applications until Jan 23, 2025.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Claims Specialist Lead
Claim Processor Job 22 miles from Arlington
Job Details Pearl Street Dental Management - Dallas, TXDescription
Do you have 5+ years of dental office administrative experience with an emphasis on Insurance Billing, Collections, and Revenue Cycle Management? We are seeking an experienced Insurance Billing/Collections Specialist lead from a dental office to join our support team in Dallas, TX.
This position will require phone contact with insurance company representatives and dental practices.
Specific Job Skills and Responsibilities
Must have knowledge of Insurance Billing, Collections, and Revenue Cycle Management in a dental office
Employ measures to expedite claim adjudication by resolving issues that may delay processing
Expert knowledge of outgoing and incoming insurance processes and insurance follow-up
Demonstrates continuous effort to improve operations, decrease turnaround times, streamline work processes, and works cooperatively and jointly to provide quality seamless customer service
Follow up with insurance carriers on special insurance billings and claims
Knowledge of CDT coding and terminology is a plus
Must be detail-oriented, organized, and work with little supervision
Knowledge of dental/medical industry and insurance plans
Ability to read and write in a clear and concise manner
Ability to multi-task effectively under stress, prioritize and meet deadlines with strong attention paid to detail of work produced
Pleasant and professional phone etiquette
Must have knowledge of computer programs and operations (Word, Excel, PowerPoint, Outlook)
Knowledge and experience working with public and private insurance companies
Ability to maintain client and patient confidentiality
Open Dental knowledge is a plus
Essential Functions and Lead Responsibilities:
Mentors guide and provide oversight assistance to the team.
Identifying areas where technical solutions would improve business performance.
Identify team members' strengths and opportunities and report findings to supervisors
Coach others on how to navigate through systems to find information needed for calls
Training and development of team members to ensure Pearl Streets policy and protocol are being followed.
Identify trends and root causes related to inaccurate insurance billing, and report to the manager while resolving account errors.
Competency, Skills, and Abilities:
Decision Making
Strong analytical and problem-solving skills with attention to detail
Excellent customer service skills
Ability to prioritize and manage multiple projects
Solid ability to learn new technologies and possess the technical aptitude required to understand the flow of data through systems as well as system interaction
Education and/or Experience
Associate's or Bachelor's degree;
Or two-five years related experience or equivalent combination of education and experience in the dental insurance billing processing environment.
Dental experience is required
In addition to full medical, dental, and vision we provide life insurance, paid vacation, standard holidays, and 401K.
About Pearl Street
Pearl Street is a small group of partner dentists with dental practices throughout Texas. We are working to empower the dentists in our group with the best tools for their practice. Additionally, we have a centralized business team that handles many of the non-clinical services, including Human Resources, Operations, Billing, Training, Finance & Bookkeeping, Credentialing, Facilities Support, IT, and Marketing.
Pearl Street is reimagining group dentistry and preserving the private practice! We are bringing a fresh perspective and providing exceptional dental care. We are passionate about creating extraordinary experiences for our dental providers, our loyal team members, and our patients.
Job Type: Full-time
Benefits:
401(k)
401(k) matching
Dental insurance
Employee discount
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
Monday to Friday
Experience:
Dental: 5 years (Preferred)
Dental RCM: 5 years (Preferred)
Work Location: In person
Qualifications
Experience:
Dental: 2 years (Preferred)
Dental RCM: 2 years (Preferred)
Work Location: In person
Claims Examiner - Auto
Claim Processor Job 22 miles from Arlington
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Claims Examiner - Auto
**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Processes complex auto commercial and personal line 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.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**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 personal and commercial line auto policies, coverage's, principles, and laws.
**Skills & Knowledge**
+ In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
+ Knowledge of medical terminology for claim evaluation and Medicare compliance
+ Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
+ Strong oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Strong organizational skills
+ Strong interpersonal skills
+ Good negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Service Expectations
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical:** Computer keyboarding, travel as required
**Auditory/Visual:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
at any time.
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.**
**Taking care of people is at the heart of everything we do. Caring counts**
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)
Claims Representative - North Richland Hills, TX
Claim Processor Job 15 miles from Arlington
Who is Federated Insurance? At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own.
Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values.
What Will You Do?
Customer-focused, source of knowledge and comfort, desire to help, professional - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss.
No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients.
This is an in-office position that will work out of our North Richland Hills, TX office, located at 9001 Airport Freeway. A work from home option is not available.
Responsibilities
* Work with policyholders, physicians, attorneys, contractors and others to ensure claims are resolved in a prompt, fair and courteous way.
* Explain policy coverage to policyholders and third parties.
* Complete thorough investigations and document facts relating to claims.
* Determine the value of damaged items or accurately pay medical and wage loss benefits.
* Negotiate settlements with policyholders and third parties.
* Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars.
Minimum Qualifications
* Current pursuing, or have obtained a four-year degree
* Experience in a customer service role in industries such as retail, hospitality, logistics, banking, automotive dealerships, vehicle rental, sales or similar fields
* Ability to make confident decisions based on available information
* Strong analytical, computer, and time management skills
* Excellent written and verbal communication skills
* Leadership experience is a plus
Salary Range: $61,700 - $75,400
Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. More information can be discussed with a with a member of the Recruiting team.
What We Offer
We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You.
Employment Practices
All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization.
If California Resident, please review Federated's enhanced Privacy Policy.
Claims Processor
Claim Processor Job 34 miles from Arlington
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Claims Processor
Type: Temporary/Contract
Length: Up to 90 days (Note: Could be less or could be extended depending on weather events and amount of claims/work to be processed)
Hours: Must be flexible to work 7 days a week: Monday through Friday, 7:00 a.m. to 7:00 p.m.; Saturday and Sunday, 8:00 a.m. to 5:00 p.m.
Pay Rate: $15.00 per hour
Location: Richardson, TX
Qualifications
High school/GED
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Workers Compensation Claims Specialist, West
Claim Processor Job 37 miles from Arlington
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 commercial claims with moderate to high complexity and exposure for a specific line of business. 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-AR1
#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 ***************************.
Claims Litigation Specialist
Claim Processor Job 19 miles from Arlington
Company Details
Berkley Southwest offers commercial property and casualty products and services through independent agents in Arizona, Arkansas, New Mexico, Oklahoma and Texas. We maintain a strong local presence in each of our markets, keeping underwriting and support close to the customer.
Now more than ever, financial strength is critical to a successful, long term insurance relationship. Berkley Southwest is a member company of W. R. Berkley Corporation, a Fortune 500 company, whose insurance company subsidiaries are rated A+ (Superior) by A.M. Best.
This role will be based in our Irving, TX office. We offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.
The Company is an equal employment opportunity employer. #LI-AV1 #LI-HYBRID
Responsibilities
As a Claims Litigation Specialist, you'll have both the autonomy and support to primarily handle lawsuits, large exposure claims, and more complicated claims involving Construction Defect Litigation. You will provide prompt, fair and effective claims service for insureds and claimants.
What you can expect:
Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
Internal mobility opportunities
Visibility to senior leaders and partnership with cross functional teams
Opportunity to impact change
Benefits - competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education
We'll count on you for the:
Investigation of lawsuits and other larger exposure claims made by insureds and claimants including but not limited to:
proper coverage determination,
direction of defense attorneys,
litigation management,
taking of recorded statements,
arranging for outside appraisal of damage if warranted,
evaluate and negotiate settlements,
deny claims and lawsuits not covered,
where no liability exists, deny liability,
defend and/or negotiate costs of defense settlements,
Obtain proper discovery, forms and documents.
Establishing and maintaining proper reserving throughout the life of the claim file. Maintain appropriate diary schedules of all claims in the care of custody of the Litigation Specialist.
Evaluation of damage appraisals and bills for proper documentation and accuracy for establishing claim values.
Completing all necessary reporting forms and litigation management forms according to procedures on a daily basis.
Entry of proper claim reserves and claim payments and maintaining in appropriate file notes on the system.
Initiating subrogation and contribution and dispose of salvage according to established procedures.
Informing the proper Underwriting Department of risks hazards discovered through the investigation of the claim, Advise supervisor immediately of all claims of a severe nature or exceeding settlement authority.
Attending mediations, settlement conferences, litigation conferences and trials when warranted.
Assuming full responsibility for all phases of account management for accounts as assigned and inform management of any unfavorable trends.
Acting as an Advisor and coach for other litigation handlers and claims representatives within designated claims area or claim region by conducting claim reviews.
Assisting Claims Manager/Claims Supervisor as directed in supervisory functions (technical direction) and maintain and implement litigation logs and records and other claims related logs and records.
Keeping Claims Manager/Claims Supervisor informed on all high exposure and complex or unusual claims.
Qualifications
What you need to have:
Bachelor's degree in business insurance or related field.
Minimum of 5 years adjusting experience including:
Basic understanding in construction and the duties of various trade groups within the construction industry
Understanding contracts
Writing reservation of rights letters
Developing cost share agreements, and work out time on risk indemnity arrangements with other carriers
Casualty adjusters license in Texas and New Mexico.
What makes you stand out:
Ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
Ability to project a warm and friendly manner in all business contacts and maintain a professional relationship with fellow workers, insureds, and the general public.
Ability to consistently demonstrate the WRBC Core Competencies and Innovation Behaviors.
Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees.
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 #constructiondefect #constructiondefectclaims Sponsorship Details Sponsorship not Offered for this Role
Logistics Claim Specialist (EM6869)
Claim Processor Job 37 miles from Arlington
**On-site** SL Division Full time 24-6869-1 Plano, Texas, United States **Description** Samsung SDS plays a leading role in the global logistics market with unique logistics services. With its innovative IT technology, SDS developed the integrated logistics solution called “Cello” in 2010, started its logistics business in 2012 and expanded its logistics business with Business Process Outsourcing.
As Korea's no.1 IT service provider, Samsung SDS has completed a number of SCM/logistics consulting and system development projects for the last 30 years. Based on the extensive experience and expertise it built over the years, Samsung SDS started to provide tech-based logistics services in 2012 and has now grown into a global top-level third-party logistics company.
Logistics Claims Specialist (“Claims Operator”) will be a part of Operation Group and work closely with Account Group and its Settlement subpart as well as the company's Management/Finance Group. Claims Specialist will work on a resolution of logistics claims, including warehouse and transportation, and develop and maintain SOPs for logistics processes. The position handles and resolves complex claims with customers, shippers, consignees, and carriers relating to cargo loss incidents. This requires understanding of the logistics and supply chain, ability to establish priorities and plan functions accordingly, experience reporting and analysis, and collaborating with other business units within and outside the organization.
To learn more about Samsung SDS America, Inc. please visit
**Responsibilities:**
* Lead person in charge (PIC) of claim recovery.
* Report and monitor daily registration progress to the control tower and management.
* Develop strategy to improve performance and present plan to management.
* Implement action plan based on the approved improvement strategy.
* Provide additional training and development to increase recovery ratio.
* Track and be familiar with contract information for all available carriers.
* Communicate and build relationships with partner carriers to streamline claim processing.
* Monitor claims sent to Cello to ensure the correct process is being followed, as well as accuracy.
* Ensure recovery is completed within 60-90 days of receipt.
* Prioritize registration of claims close to the 9 month filing deadline to prevent timebarred claims.
**Requirements**
* Bachelor's degree in Statistics, Accounting, Business, Analytics, or equivalent experience preferred (High School Diploma Required)
* 2+ years of Logistics Freight Claims Processing experience required.
* Excellent verbal and written communication skills; people skills; ability to communicate information in a clear and understandable manner
* Ability to read, interpret, and simplify complex information from various sources to create clarity and ease of understanding.
* Strong critical thinking and planning ability; balancing accountabilities; flexibility to work in a fast-paced, team environment
* Proficient with in Microsoft Office products including Excel, and with web-based applications, claims database software and the ability to produce reports to support findings
* Great attention to detail, organization, cross-group collaboration, and project management skills
* Ability to lead a group towards a common goal and to delegate workload to maximize efficiency.
* Transportation/Logistics Freight claims processing experience preferred.
* Required to work on-site in Plano, TX
* Work Schedule: in the office 8:00 am - 5:00 pm
* Ability to travel up to 10 % in the U.S.
**Benefits**
**Samsung SDSA offers a comprehensive suite of programs to support our employees:**
* **Top-notch medical, dental, vision and prescription coverage**
* **Wellness program**
* **Parental leave**
* **401K match and savings plan**
* **Flexible spending accounts**
* **Life insurance**
* **Paid Holidays**
* **Paid Time off**
* **Additional benefits**
**Samsung SDS America supports your professional development and growth in your future career.**
**Your base pay is one part of our total compensation package and is determined within a range. This allows you to progress as you grow and develop within the position. Your base pay will depend on your skills, education, qualifications, experience, and location.**
**Samsung SDS America, Inc. is an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, status as a protected veteran, marital status, genetic information, medical condition, or any other characteristic protected by law.**
Auto Physical Damage Claim Representative
Claim Processor Job 22 miles from Arlington
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$53,700.00 - $88,600.00Target Openings1What Is the Opportunity?This position is responsible for handling low to moderate Personal and Business Insurance Auto Damage claims from the first notice of loss through resolution/settlement and payment process. This may include applying laws and statutes for multiple state jurisdictions. Claim types include multi-vehicle (2 or more cars) auto damage with unclear liability and no injuries. Will also handle more complex Auto Damage claims such as non-owned vehicles, fire/theft, and potential fraud as well as non-auto, property related damage. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
Travelers offers a hybrid work location model that is designed to support flexibility.What Will You Do?
Customer Contacts/Experience:
Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follows-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC).
Coverage Analysis:
Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for Auto Damage only claims in assigned jurisdictions. Addresses proper application of any deductibles and verifies benefits available and coverage limits that will apply. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration other issues relevant to the jurisdiction.
Investigation/Evaluation:
Investigates each claim to obtain relevant facts necessary to determine coverage, causation, extent of liability/establishment of negligence, damages, contribution potential and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g.. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, etc.) Takes recorded statements as necessary.
Recognizes and requests appropriate inspection type based on the details of the loss and coordinates the appraisal process. Maintains oversight of the repair process and ensures appropriate expense handling.
Refers claims beyond authority as appropriate based on exposure and established guidelines. Recognizes and forwards appropriate files to subject matter experts (i.e., Subrogation, SIU, Property, Adverse Subrogation, etc.).
Reserving:
Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
Negotiation/Resolution:
Determines settlement amounts based upon appraisal estimate, negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants.
May provide support to other parts of Auto Line of Business (e.g. Total Loss, Salvage, etc.) when needed.
Insurance License:
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's degree preferred.
Demonstrated ownership attitude and customer centric response to all assigned tasks
Ability to work in a high volume, fast paced environment managing multiple priorities
Attention to detail ensuring accuracy
Keyboard skills and Windows proficiency, including Excel and Word - Intermediate
Verbal and written communication skills - Intermediate
Analytical Thinking- Intermediate
Judgment/Decision Making- Intermediate
Negotiation- Intermediate
Insurance Contract Knowledge-
Basic
Principles of Investigation- Intermediate
Value Determination- Basic
Settlement Techniques- Basic
What is a Must Have?
High School Diploma or GED required.
A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is required.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Commercial Claims Specialist - Bodily Injury
Claim Processor Job 37 miles from Arlington
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.
Description
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 for a Claims Specialist within our Commercial Lines Shared Economy team!
The Claims Specialist II, Rideshare works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; Westborough, MA; or Weatogue, CT. Please note this policy is subject to change.
We are open to fill this position as a Claims Specialist II, Senior Claims Specialist I or Senior Claims Specialist II, depending on candidate experience. Salary listed is for the entire country and may vary based on candidate location.
Responsibilities:
* Manages an inventory of claims to evaluate compensability/liability.
* Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
* Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
* Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
* Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
* Performs other duties as assigned.
We will focus on candidates who have the following experience:
* Attorney represented claimants for Bodily Injury claims in Shared Economy, Rideshare, Delivery Network Company or large Commercial Casualty losses.
* At least one year of recent litigation management experience.
Qualifications
* BS/BA degree or equivalent work experience.
* Minimum of 2 years experience in claims adjustment, general insurance or formal claims training.
* Required to obtain and maintain all applicable licenses.
* Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
* Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.
About Us
This position may have in-office requirements depending on candidate location.
At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That's why we provide an environment focused on openness, inclusion, trust and respect. Here, you'll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession.
Liberty Mutual has proudly been recognized as a "Great Place to Work" by Great Place to Work US for the past several years. We were also selected as one of the "100 Best Places to Work in IT" on IDG's Insider Pro and Computerworld's 2020 list. For many years running, we have been named by Forbes as one of America's Best Employers for Women and one of America's Best Employers for New Graduates as well as one of America's Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: *******************************************************
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
* San Francisco
* Los Angeles
* Philadelphia
ESIS Claims Specialist, AGL (Hybrid)
Claim Processor Job 22 miles from Arlington
The AGL Claims Specialist: Under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.
Note: This is a hybrid position requiring 3 days in the Dallas office and 2 days working from home.
Duties may include but are not limited to:
Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.
Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract.
Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
Sets reserves within authority limits and recommends reserve changes to Team Leader.
Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
Settles claims promptly and equitably.
Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
Informs claimants, insureds/customers or attorney of denial of claim when applicable.
May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
Refers claims to subrogation as appropriate. May arrange for salvage disposition or other recovery proceedings as necessary by line of business.
May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current exposure and future risks
Establishes and maintains strong customer relations
Depending on line of business, other duties may include:
Maintaining system logs
Investigating compensability and benefit entitlement
Reviewing and approving medical bill payments
Managing vocational rehabilitation
College degree or 5+ years' experience handling claims in a relevant line of business.
Basic knowledge of claims handling and familiarity with claims terminologies
Effective negotiation skills
Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses.
Ability to self-motivate and work independently
Knowledge of company products, services, coverage's and policy limits, along with awareness of the company's claims best practices
Knowledge of applicable state and local laws and ability to obtain necessary license
An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
The pay range for the role is $71,500 to $115,000. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.
ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.
Claims Specialist (Workers' Compensation)
Claim Processor Job 22 miles from Arlington
Who We Are
Revantage, a Blackstone Real Estate portfolio company, is a global provider of corporate services.
With a corporate purpose of ‘In Pursuit of Better,' Revantage delivers value-added services and world-class talent for Blackstone Real Estate portfolio companies, spanning diverse asset classes, including residential, logistics, office, hospitality and retail sectors. Headquartered in Chicago, the company's footprint extends across North America, Europe and Asia Pacific.
Rooted in a commitment to collaboration and inclusivity, Revantage goes beyond traditional corporate services and acts as a trusted partner. Across offerings that include finance, technology, human resources and operations, Revantage proactively anticipates stakeholder needs, recruits exceptional talent and enables its business partners to thrive.
What We Value: Our Culture
Our people are our most important asset, enabling Blackstone portfolio companies and investments to scale and thrive. Together, we foster a workplace where everyone can be themselves, enabling them to do their best work.
At Revantage, we have exceptional people who live our values and help us pursue better every day. We offer dynamic and meaningful work, competitive compensation, benefits and flexibility. We listen and take action to ensure our organization evolves to reflect our employees' voices and support an inclusive culture.
Our demonstrated commitment to our people and collaborative culture have earned us numerous awards as a top employer.
Our culture is built on our shared core values and commitment to be:
Learners - We learn from our challenges and successes
Leaders - We commit to continuous improvement
Enthusiasts - We face challenges with optimism and believe anything is possible
Achievers - We expect high standards for ourselves and enable the success of our teams
Partners - We deliver value and positive impact to our partners
Grow your career with us. As a member of our team, you'll gain hands-on experience in the real estate industry and benefit from a supportive environment that fosters personal and professional growth.
Why This Role Is Valuable
This position will support the Insurance and Alternative Solutions (IAS) department in the management of liability claims across North America. In addition to claims management, the candidate will utilize the Risk Management Information System (RMIS) to create meaningful metrics for various portfolio companies. As an integral part of the team, the Claims Associate will work with all facets of the Risk Management department.
How You Add Value
Assist in claim reporting and management to achieve the most positive claim outcome possible.
Assist in the oversight of carrier/TPA management of all claims - monitor, evaluate, and address technical and financial performance issues.
Receive and review incident reports in RMIS to ensure the claim was properly reported and determine if escalation to supervisor and/or legal department is necessary.
Act as a liaison between third-party property managers and insurers to resolve claims, track payments, and understand lender requirements.
Ensure claim reporting processes and procedures are followed by the portfolio companies and reinforce claim reporting instructions when necessary, including regular training to portfolio companies on claim reporting.
Participate in quarterly claim reviews, tailoring the review to each portfolio company's needs.
Provide loss history when requested from various portfolio companies.
Assist with historical claim closure efforts.
WHAT YOU BRING TO THIS ROLE
Required:
Bachelor's degree from an accredited college.
Minimum of 8 years of workers compensation and general liability claim handling experience.
Strong quantitative skills in insurance and finance.
First-class interpersonal skills, including relationship building & maintenance.
Excellent communication (verbal & written), numerical, presentation & organizational skills.
Demonstrate strong teamwork skills.
Effective reasoning and decision-making skills.
Strong negotiation and investigation skills.
Ability to meet deadlines and follow up in a timely manner.
Self-motivated with the ability to work effectively as part of a team in a fast-paced, dynamic environment where superior time-management and prioritization skills are essential.
Proficient working knowledge of Microsoft Office systems, particularly Excel.
Preferred:
Workers' Compensation expertise with active or prior licensure in TX, FL, NY, and CA.
Brokerage and large carrier experience in Workers' Compensation.
Strong background in Workers' Compensation Claims Review.
Familiarity with multifamily and commercial premises environments.
Base Salary Range: $88,165.00-$125,000.00. This represents the presently-anticipated low and high end of the Company's base salary range for this position. Actual base salary range may vary based on various factors, including but not limited to location and experience.
Total Direct Compensation: This job is also eligible for discretionary bonus and incentive compensation on an annual basis.
Benefits: The Company provides a variety of benefits to employees, including health insurance coverage, retirement savings plan, paid holidays and paid time off (PTO).
The additional total direct compensation and benefits described above are subject to the terms and conditions of any governing plans, policies, practices, agreements, or other materials or documents as in effect from time to time, including but not limited to terms and conditions regarding eligibility.
Base Salary Range:
Total Direct Compensation: This job is also eligible for discretionary bonus and incentive compensation on an annual basis.
Benefits: The Company provides a variety of benefits to employees, including health insurance coverage, retirement savings plan, paid holidays and paid time off (PTO).
The additional total direct compensation and benefits described above are subject to the terms and conditions of any governing plans, policies, practices, agreements, or other materials or documents as in effect from time to time, including but not limited to terms and conditions regarding eligibility.
EEO Statement
Revantage is an equal opportunity employer. In accordance with applicable law, we prohibit discrimination against any applicant, employee, or other covered person based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, caste, immigration status, religion, religious creed (including religious dress and grooming practices), sex, gender, gender expression, gender identity, marital status, sexual orientation, pregnancy (including childbirth, lactation or related medical conditions), age, national origin or ancestry, citizenship, physical or mental disability, genetic information (including testing and characteristics), protected leave status, domestic violence victim status, or any other consideration protected by federal, state or local law. We are committed to providing reasonable accommodations, if you need an accommodation to complete the application process, please email
********************
Please review the job applicant privacy notice here.
Workers Compensation Claims Representative, DBA
Claim Processor Job 37 miles from Arlington
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 direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for Defense Based Act (DBA) Workers' Compensation. Experience in DBA is not required, however a plus. 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 low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit.
Contributes to customer satisfaction 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, estimating potential claim valuation, and following company's claim handling protocols.
Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim.
Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes.
Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
Developing ability to manage expenses 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 Claim, 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 perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
Developing basic knowledge of the commercial insurance industry, products and claim practices.
Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service.
Ability to develop collaborative business relationships with both internal and external work partners.
Able to exercise independent judgement, solve basic problems and make sound business decisions.
Analytical mindset with critical thinking skills.
Strong work ethic, with demonstrated time management and organizational skills.
Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
Knowledge of Microsoft Office Suite and ability to learn business-related software.
Adaptable to a changing environment
Ability to value diverse opinions and ideas
Education & Experience:
High school Diploma required. Associates or Bachelor's Degree preferred.
Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
Prior claim handling, or business experience in the insurance industry and/or customer service is preferred.
#LI-AR1
#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,
t
he national base pay range for this job level is $47,000 to $78,000 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 ***************************.
Auto Physical Damage Claim Representative
Claim Processor Job 34 miles from Arlington
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$53,700.00 - $88,600.00
Target Openings
1
What Is the Opportunity?
This position is responsible for handling low to moderate Personal and Business Insurance Auto Damage claims from the first notice of loss through resolution/settlement and payment process. This may include applying laws and statutes for multiple state jurisdictions. Claim types include multi-vehicle (2 or more cars) auto damage with unclear liability and no injuries. Will also handle more complex Auto Damage claims such as non-owned vehicles, fire/theft, and potential fraud as well as non-auto, property related damage. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
Travelers offers a hybrid work location model that is designed to support flexibility.
What Will You Do?
Customer Contacts/Experience:
* Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follows-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC).
Coverage Analysis:
* Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for Auto Damage only claims in assigned jurisdictions. Addresses proper application of any deductibles and verifies benefits available and coverage limits that will apply. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration other issues relevant to the jurisdiction.
Investigation/Evaluation:
* Investigates each claim to obtain relevant facts necessary to determine coverage, causation, extent of liability/establishment of negligence, damages, contribution potential and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g.. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, etc.) Takes recorded statements as necessary.
* Recognizes and requests appropriate inspection type based on the details of the loss and coordinates the appraisal process. Maintains oversight of the repair process and ensures appropriate expense handling.
* Refers claims beyond authority as appropriate based on exposure and established guidelines. Recognizes and forwards appropriate files to subject matter experts (i.e., Subrogation, SIU, Property, Adverse Subrogation, etc.).
Reserving:
* Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner.
* Negotiation/Resolution:
* Determines settlement amounts based upon appraisal estimate, negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants.
* May provide support to other parts of Auto Line of Business (e.g. Total Loss, Salvage, etc.) when needed.
Insurance License:
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's degree preferred.
* Demonstrated ownership attitude and customer centric response to all assigned tasks
* Ability to work in a high volume, fast paced environment managing multiple priorities
* Attention to detail ensuring accuracy
* Keyboard skills and Windows proficiency, including Excel and Word - Intermediate
* Verbal and written communication skills - Intermediate
* Analytical Thinking- Intermediate
* Judgment/Decision Making- Intermediate
* Negotiation- Intermediate
* Insurance Contract Knowledge-
* Basic
* Principles of Investigation- Intermediate
* Value Determination- Basic
* Settlement Techniques- Basic
What is a Must Have?
* High School Diploma or GED required.
* A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is required.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Claims Specialist
Claim Processor Job 22 miles from Arlington
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.
Primary Purpose
* This position is responsible for Workers' Compensation and/or liability and Insurance Claims Administration
* Workers' Compensation responsibilities include Claims Adjusting, Workplace Safety Coordination, Coordinating the Workers' Compensation Labor Pool, Transitional Work Assignments, Report Development, and various compliance issues related to the Texas Department of Insurance to ensure effective operations.
* Liability and Insurance Claims include Administration of Claims, Adjusting, Legal Coordination, Insurance Coordination, Claimant Communication and Record Keeping.
Minimum Specifications
Education
* Bachelor's Degree in Risk Management, Business Administration, Organizational Development, or a related field of study preferred.
Experience
* 3 plus years of experience in a Workers' Compensation or Claims administrative environment.
Equivalent Education and/or Experience
* May have an equivalent combination of education and experience to substitute for both the education and experience requirements.
Certification/Registration/Licensure
* Texas Department of Insurance Workers' Compensation Adjuster License is required within 90 days of hire or reclassification into the position - OR
* All Lines Adjuster license required within 90 days of hire or reclassification into the position.
Skills or Special Abilities
* Must be able to demonstrate a working knowledge of current State Department of Insurance requirements, and its accompanying laws, standards, and guidelines.
* Must have knowledge regarding claims adjusting and loss prevention.
* Must be able to plan, design, and implement cross-departmental reports and delegate their build.
* Must have good verbal and written communication skills to effectively communicate with the public, physicians, and all levels of staff.
* Must be detail oriented. Must have a working knowledge of database software including in-house and TPA claims management software.
* Must be able to organize information and draw logical conclusions.
* Must have knowledge of and working experience with the Family Medical Leave Act.
Responsibilities
* Reviews, investigates, and ensures proper reporting of all workers' compensation claims and/or liability and insurance claims. Conducts frequent and ongoing reviews of each case to ensure the file is reserved appropriately, documented timely, and that the insurance adjuster has implemented an aggressive action plan to resolve each claim in a timely and cost-efficient manner in applicable claims.
* Administrates the Return-to-Work Transitional Duty Process. Coordinates with employees' supervisors to ensure a smooth return to full duty. Ensure employee, supervisor, and the Office of Talent Management are all updated on changes.
* Works with internal and external legal counsel in determining compensability of claims.
* Create key strategic initiatives to improve the Claims program and procedures. Identify and execute upon opportunities for improved efficiencies and enhanced risk management.
* Serves as the point of contact for all internal and external stakeholders, including but not limited to Third Party Administrators, Provider Networks, Texas Department of Insurance, and attorneys, regarding the administration, management, rules and regulations, and requirements of claims.
* Audits Third Party Administrator's and legal firm's check register to ensure billing accuracy and validity. Research billing and payment issues between providers, medical facilities, and claims administrator. Serves as the point of contact for concerns regarding benefits and claim status.
* Reconciles actual to budget claims performance and determines cause of variance. Develops action plans to address significant variations.
* Develops key performance and key risk indicators to ensure efficient program management.
* Develops and delivers programs designed to minimize Parkland's overall exposure to claims and liabilities, which may include policy and procedure buildout, committee and/or workgroup coordination, and stakeholder communication.
* Responsible for Report Development activities which include initiating technical designs for trending reports to analyze injury causes for both internal and external customers. Creates and maintains reports and automates report distribution. Researches and implements new reporting and online technology.
Job Accountabilities
* Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
* Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
* Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.
Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth
Job Segment: Healthcare Administration, Patient Care, Program Manager, Healthcare, Management
Claims Specialist II, Excess BI and Property Damage
Claim Processor Job 37 miles from Arlington
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
This position will be responsible for the investigation and resolution of lower to medium complexity and lower to medium exposure claims. These claims will consist of non-litigated and litigated matters. Under general supervision, this position will be able to manage a full claim workload with minimal assistance and be responsible for making sound decisions within delegated authority. Adheres to Fair Claims Practices regulations as applicable in various states. Minimal travel required.
* Analyzes coverage and communicates coverage positions
* Conducts, coordinates, and directs investigation into loss facts and extent of damages
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims
* Drafts coverage position letters
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
* Handles claims in all jurisdictions
* Handles litigated and non-litigated property damage claims with values up to $250,000
* Handles non-litigated bodily injury claims with values up to $250,000 in all jurisdictions;
* Handles smaller product liability and/or construction defect claims.
* Identify losses which should be reported to SIU.
* Participates in special projects or assists other team members as requested
* Provides excellent and professional customer service to insureds while maintaining a high level of production.
* Represents Markel in mediations, as required
* Sets reserves within authority or makes recommendations concerning reserve changes to manager
Education
* Bachelor's degree or equivalent work experience
Certification
* Must have or be eligible to receive claims adjuster license
* Successful completion of basic insurance courses or achievement of industry designation (INS, IEA, AIC, ARM, SCLA, CPCU)
Work Experience
* Minimum of 2-3 years experience in commercial construction or equivalent combination of education and experience
* Knowledge of insurance industry or claims handling preferred.
#LI-MM1
US Work Authorization
* US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Pay information:
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The national average salary for the Claims Specialist II is $61,857 - $76,230 with 20% bonus potential.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
* We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
* All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
* We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
* Markel offers hybrid working schedules of 3 days in the office and 2 days remote.
Are you ready to play your part?
Choose 'Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
* All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
* All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Pharmacy Billing and Med D Claims Specialist
Claim Processor Job In Arlington, TX
Pharmacy Billing and Med D Claims Specialist A-Line Staffing is currently seeking an experienced Pharmacy Billing and Med D Claims Specialist. If you think you’re a GREAT candidate and would like to be considered for immediate consideration, call/text Day Green at +1 (469) 840-5624 or email Dgreen@alinestaffing.com. Job Description:
The Pharmacy Billing and Med D Claims Specialist serves as a key point of contact for the Clinical Hub and is responsible for communicating with Pharmacists, Facilities, Physicians, and Prescription Drug Plans (PDPs) regarding therapeutic interchanges, prior authorization requests, and payment denials. The role ensures accurate documentation and resolution of prior authorizations, supporting the completion of required forms with clinical justifications.
Responsibilities:
Act as a resource to facilities for obtaining information, completing necessary documentation, and following up on outstanding claims.
Proactively communicate with facilities, physicians, and plans to resolve prior authorization issues and denials.
Investigate claims and payment denials, providing detailed explanations to facilities.
Initiate and complete prior authorization forms, ensuring accuracy and attention to detail.
Provide clinical support to RxAllow team members for prior authorization concerns and submissions.
Collaborate with EMAR systems and other stakeholders to streamline the authorization process.
Make outgoing calls to Facilities, Plans, and Physician offices to obtain approvals.
Communicate effectively with Client Billing Service Offices, Pharmacy Directors, and prescription drug plans to resolve customer issues.
Achieve productivity goals such as calls/claims per hour, as determined by the Director and Clinical Hub Manager.
Adhere to Company’s Code of Business Conduct, policies, and applicable federal and state laws.
Develop expertise in claim adjudication, insurance verification, and back-end billing workflows.
Prioritize work to meet daily and competing deadlines.
Perform other tasks as assigned.
Competencies:
Interpersonal Skills: Maintains confidentiality, resolves conflicts constructively, and remains open to feedback.
Communication Skills: Writes and speaks clearly, listens actively, and presents information effectively.
Teamwork: Contributes to team success, fosters a positive environment, and supports group objectives.
Professionalism: Handles pressure tactfully, upholds ethical standards, and accepts responsibility.
Organizational Skills: Plans effectively, prioritizes efficiently, and develops actionable goals.
Adaptability: Adjusts to changes, manages competing demands, and remains flexible in dynamic environments.
Initiative: Proactively seeks growth opportunities and takes independent action when necessary.
Position Qualifications:
Education:
Required: High School Diploma or Associate Degree.
Desired: Certified Pharmacy Technician (CPhT) or Medical Assistant Certification.
Desired: Bachelor’s Degree.
Experience:
Required: Third-party medical billing experience.
Required: EMAR system knowledge.
Desired: 1-3 years of pharmacy experience.
Desired: 3 years of call center experience.
Skills:
Certified Pharmacy Technician.
Data Entry skills (40 WPM).
Research ability and Insurance experience.
Proficiency in Microsoft Excel.
Experience with Frameworks and LTC400 (preferred).
Technical Skills:
Proficiency in Microsoft Office programs.
Job Schedule & Location:
Monday - Friday, 9:00 am - 5:30 pm
Location: Arlington TX 76010 United States
Job Salary/Wage:
$19.00 per hour
If you think you’re a GREAT candidate and would like to be considered for immediate consideration, call/text Day Green at +1 (469) 840-5624 or email at Dgreen@alinestaffing.com.
Claims Specialist
Claim Processor Job 22 miles from Arlington
**Primary Purpose** * This position is responsible for Workers' Compensation and/or liability and Insurance Claims Administration * Workers' Compensation responsibilities include Claims Adjusting, Workplace Safety Coordination, Coordinating the Workers' Compensation Labor Pool, Transitional Work Assignments, Report Development, and various compliance issues related to the Texas Department of Insurance to ensure effective operations.
* Liability and Insurance Claims include Administration of Claims, Adjusting, Legal Coordination, Insurance Coordination, Claimant Communication and Record Keeping.
**Minimum Specifications**
**Education**
* Bachelor's Degree in Risk Management, Business Administration, Organizational Development, or a related field of study preferred.
**Experience**
* 3 plus years of experience in a Workers' Compensation or Claims administrative environment.
**Equivalent Education and/or Experience**
* May have an equivalent combination of education and experience to substitute for both the education and experience requirements.
**Certification/Registration/Licensure**
* Texas Department of Insurance Workers' Compensation Adjuster License is required within 90 days of hire or reclassification into the position - OR
* All Lines Adjuster license required within 90 days of hire or reclassification into the position.
**Skills or Special Abilities**
* Must be able to demonstrate a working knowledge of current State Department of Insurance requirements, and its accompanying laws, standards, and guidelines.
* Must have knowledge regarding claims adjusting and loss prevention.
* Must be able to plan, design, and implement cross-departmental reports and delegate their build.
* Must have good verbal and written communication skills to effectively communicate with the public, physicians, and all levels of staff.
* Must be detail oriented. Must have a working knowledge of database software including in-house and TPA claims management software.
* Must be able to organize information and draw logical conclusions.
* Must have knowledge of and working experience with the Family Medical Leave Act.
**Responsibilities**
- Reviews, investigates, and ensures proper reporting of all workers' compensation claims and/or liability and insurance claims. Conducts frequent and ongoing reviews of each case to ensure the file is reserved appropriately, documented timely, and that the insurance adjuster has implemented an aggressive action plan to resolve each claim in a timely and cost-efficient manner in applicable claims.
- Administrates the Return-to-Work Transitional Duty Process. Coordinates with employees' supervisors to ensure a smooth return to full duty. Ensure employee, supervisor, and the Office of Talent Management are all updated on changes.
- Works with internal and external legal counsel in determining compensability of claims.
- Create key strategic initiatives to improve the Claims program and procedures. Identify and execute upon opportunities for improved efficiencies and enhanced risk management.
- Serves as the point of contact for all internal and external stakeholders, including but not limited to Third Party Administrators, Provider Networks, Texas Department of Insurance, and attorneys, regarding the administration, management, rules and regulations, and requirements of claims.
- Audits Third Party Administrator's and legal firm's check register to ensure billing accuracy and validity. Research billing and payment issues between providers, medical facilities, and claims administrator. Serves as the point of contact for concerns regarding benefits and claim status.
- Reconciles actual to budget claims performance and determines cause of variance. Develops action plans to address significant variations.
- Develops key performance and key risk indicators to ensure efficient program management.
- Develops and delivers programs designed to minimize Parkland's overall exposure to claims and liabilities, which may include policy and procedure buildout, committee and/or workgroup coordination, and stakeholder communication.
- Responsible for Report Development activities which include initiating technical designs for trending reports to analyze injury causes for both internal and external customers. Creates and maintains reports and automates report distribution. Researches and implements new reporting and online technology.
**Job Accountabilities**
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
**Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.**