Claim processor jobs in Bluffton, SC

Responsible for the accurate and timely processing of claims. Logistics: PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. This role is located on-site at 17 Technology Cir., Columbia, SC, 29203. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You'll Do: Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. To Qualify for This Position, You'll Need the Following: Required Education: High School Diploma or equivalent Required Skills and Abilities: Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills. Required Software and Tools: Basic office equipment. We Prefer That You Have the Following: Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment. Preferred Skills and Abilities: Ability to use complex mathematical calculations. Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Company Details At Berkley Alliance Managers, we offer innovative coverage and risk management solutions for our brokers and policyholders. We have a passion for offering fresh ideas and relevant insurance products and services. Our business consists of four target markets - Design Professionals, Construction Professionals, Accounting Professionals and Miscellaneous Service Professionals. Our focus allows us to tailor coverage and create comprehensive risk management programs that enhance profitability and reduce susceptibility to loss. Company URL: ******************************* Responsibilities The Claims Examiner position is a junior level claims handling position. Under close supervision, the Claims Examiner I is responsible for handling all aspects of claims related to professional liability lower-level or entry level (non-complex) claims. The Claims Examiner will handle potential claims/notice of circumstances and lower-level claims. This position is intended to be an introduction to the claims handling process as the Claims Examiner I begins to interact with clients, attorneys, and outside vendors for various reasons, including but not limited to, claims and coverage analysis, liability and damages analysis, reserve recommendations and setting, and departmental reporting. Some limited travel may be required for mediations and meetings. The role manages outside defense counsel that are assigned on claim or pre-claim files, including cost containment and litigation management. The Claims Examiner I will actively engage in and embraces the company's continued learning and innovation culture, including participation in innovation groups to identify solutions for enhancement and change. Key functions include but are not limited to: Adjusting all aspects of claims and loss notices, including but not limited to setting up claims, coverage analysis, liability and damages analysis, reserve setting, and departmental reporting. Issues coverage letters when needed. Attend mediations, settlement conferences, and other claims-related travel as needed or required. Maintain adjuster's licenses in all states requiring licenses, or as requested. Business-related travel as required or needed. Active engagement in the company's innovation culture and group. Continued and self-driven learning. Qualifications 4-year college degree required. Adjuster licenses in required states + CA. 1 to 3 years claims-related, adjusting experience. Strong written and verbal communication skills, attention to detail and deadline structures. Ability to work both independently and collaboratively with all levels of staff. Proficient with MS Office software and PC applications and systems. 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 which for this role include: • Base Salary Range: $48,000 - $72,000 • Eligible to participate in annual discretionary bonus. • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.

Job Summary:The Claims Examiner I is responsible for adjudicating individual and group voluntary benefits claims, including Critical Illness, Accident, Hospital Indemnity, Short Term Disability, Short Term Care, and Life products. This role ensures the accurate entry of claims data while conducting thorough reviews and analyses to determine eligibility. As an entry-level position, the Claims Examiner I works closely with more senior examiners to ensure the accurate and timely processing of claims. This role supports the company's mission by maintaining high standards of accuracy and efficiency in claims adjudication.Key Responsibilities: Deliver exceptional service to claimants, internal teams, and external customers, aligning with company values. Process and adjudicate routine claims for Critical Illness, Accident, Hospital Indemnity, Short Term Disability, Short Term Care, and Life products under direct supervision. Investigate, resolve, and make decisions on less complex claims, ensuring full compliance with company policies and industry regulations. Ensure claims are processed in compliance with company policies and industry regulations. Meet or exceed minimum production averages and accuracy targets for payment, procedure, and financial goals. Participate in the development and implementation of policies and procedures to improve claim handling processes. Assist in enhancing claims processes to boost operational efficiency while maintaining compliance. Consistently meet production and accuracy targets, including payment, procedure, and financial goals. Collaborate with team members and other departments to ensure seamless claims handling and customer service. Day-to-Day Activities: Review and enter claims data accurately. Conduct thorough reviews and analyses to determine eligibility. Communicate with claimants and other stakeholders to gather necessary information and provide updates. Research and resolve discrepancies in claims data. Participate in team meetings and training sessions to stay updated on policies and procedures. Contribute to various claims-related projects and process improvement initiatives. Qualifications: High school diploma or equivalent required; Bachelor's degree preferred. Minimum of 1 year of claims experience preferred, with exposure to group and/or individual products. Basic understanding of claims processing and settlement practices. Strong communication and interpersonal skills. Ability to manage multiple priorities and meet deadlines. Basic knowledge of regulatory standards and compliance requirements. Skills: Analytical Skills: Ability to review claim details, medical records, and policy provisions to make informed decisions. Claims examiners must analyze information to determine coverage and benefits accurately. Attention to Detail: Precision in reviewing documentation, identifying discrepancies, and ensuring all required information is present before making a decision. This skill is crucial for accurate claim adjudication. Communication Skills: Strong written and verbal communication abilities to clearly explain claim decisions to stakeholders. Claims examiners must also effectively communicate with internal teams. Time Management: Efficient handling of multiple claims and tasks, ensuring timely adjudication within set deadlines. Time management is vital for managing high workloads and meeting service-level agreements. Problem-Solving: Capacity to address complex claims scenarios, interpret policy language, and find solutions to claims issues. Claims examiners need to resolve questions or disputes related to coverage. Knowledge of Policy Provisions: Deep understanding of policy terms, conditions, and exclusions for accident indemnity, hospital indemnity, short-term care, critical illness, and disability coverage. This is necessary for accurate application of benefits. Regulatory Compliance Awareness: Knowledge of relevant insurance laws and regulations to ensure all claims are handled in compliance with legal and regulatory requirements. Work Environment / Physical Requirements:The work environment is a standard office setting with typical office equipment. This role involves professional collaboration with colleagues and clients. Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.

This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department's performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting staff as required for continually improved file handling. · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel. · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures. · Complete research pertaining to complex coverage issues, industry trends, and related topics. · May assist with targeted audits of a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management re-audits to verify calibration and accuracy of the first level reviews completed. · Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling Job Qualifications Formal Education & Certification Bachelor's degree or equivalent work experience Knowledge & Experience · A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty claims with high complexity. · Prior claims management experience and/or auditing preferred. Skills & Competencies · Communication and analytical ability at a level to interact with associates, managers, agents and vendors. · Demonstrated team building and coordination skills. · Must possess strong interpersonal skills and the ability to present critical information to Senior Management. · Ability to manage multiple priorities and work independently. · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts. · Must be able to work in a fast-paced automated production environment and possess solid planning and organizational skills including time management, prioritization, and attention to detail. · Must meet company guidelines for attendance and punctuality and professional appearance/decorum. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role We are seeking a skilled Auto Delivery & Rideshare Bodily Injury Litigation Resolution Specialist to manage litigated files. The successful candidate will: Investigate all aspects related to assigned claims Evaluate coverage, liability and damages Negotiate and resolve claims Manage litigation related to auto accident claim disputes The Bodily Injury Litigation Resolution Specialist will also be responsible for maintaining electronic files, working with defense counsel's to drive performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Managing all aspects of litigated cases, including evaluation of the resolution process Analyzing auto claims to identify areas of dispute, investigating and gathering all necessary information and documentation, evaluating liability and damages and negotiating and resolving claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, communicating regularly with clients, attorneys, vendors and other stakeholders Reviewing legal documents and ensuring compliance with initial suit-handling plan of action. Analyzing policy language and reaching appropriate coverage decisions. Directing and controlling the activities and costs of outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Ride Share/TNC/Livery litigation is required. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical causation knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 60 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Responsible for the accurate and timely processing of claims. Logistics: PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. This role is located on-site at 17 Technology Cir., Columbia, SC, 29203. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You'll Do: Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. To Qualify for This Position, You'll Need the Following: Required Education: High School Diploma or equivalent Required Skills and Abilities: Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills. Required Software and Tools: Basic office equipment. We Prefer That You Have the Following: Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment. Preferred Skills and Abilities: Ability to use complex mathematical calculations. Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

+ Responsible for the accurate and timely processing of claims. + Research and processes claims according to business regulation, internal standards and processing guidelines. **Responsibilities:** + Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. + Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. **Skills:** + **Required Skills and Abilities:** Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math. + **Required Software and Tools:** Proficient in word processing and spreadsheet applications. Proficient in database software. **Education:** + **Required Education Level and Degree Type** : High School Diploma or equivalent + Required Work Experience: Experience processing, researching and adjudicating claims **Experience:** + Experience processing, researching and adjudicating claims **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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, self-motivated - 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 Atlanta, GA office, located at 5607 Glenridge Drive. A work from home option is not available. Responsibilities * Work with policyholders, 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 first party property loss benefits. * 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, equipment dealerships, equipment 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.

Under the supervision of the Risk Manager, the Claims Specialist will assist in managing the claims process, including collaborating with all departments to help mitigate accidents, injuries, and property damage involving both employees and customers. ESSENTIAL DUTIES AND RESPONSIBILITIES Responsibilities: Will assist with the management process of claims for all lines of insurance to include property, general liability, auto, unemployment, and workers' compensation. Utilizes skills and trend-tracking to assist in reducing accidents, and occupational injuries. Coordinates claim notification with the insurance carriers and serves as a point of contact for all assigned claims with the insurance carriers. Contacts employees and customers with potential claims to assist in mitigating potential loss and further injuries. Assist with all Parker's Workers' Compensation (WC) Claims, Unemployment Claims, General Liability Claims, and all other from initial notification through to claim closure, including reviewing, analyzing, and approving authority amounts. Case management can include scheduling of appointments, obtaining current medical information, assisting managers with the transition of injured employees back to work, and assisting the injured employee. Ensure continued communication with injured parties to include customers, workers and leaders of the injured worker. May act as Parker's representative for depositions, informal conferences, mediations, and/or hearings pertaining to claims, working with assigned attorneys as necessary. Prepares Parker's written responses to unemployment claims based upon a summary of facts compiled from files, personnel records and interviews. May prepare cases for and represents Parker's at unemployment claim appeal hearings. Provides personnel employment information and verification, questions witnesses and claimant to ascertain facts of separation and presents a closing summary statement of the employer's position to the hearing officer. Prepares client witnesses for hearing appearances. Case preparation for hearings involves document gathering and organization, unemployment law research, and defense strategies. Maintains frequent telephone contact with management and leaders, gathering facts necessary to determine if unemployment claims are disputable and explaining unemployment rules, regulations, decisions and options. Refers information ascertained during investigations to the Claims team, Operations, and/or Human Resources, as necessary, when possible EEOC charges, wrongful discharge, or threatened litigation facts may have been uncovered. Other similar duties as required. Knowledge, Skills, and Abilities: Strong attention to detail Advanced skills in the use of Windows-based office software: Microsoft Office, Word, Excel, and PowerPoint and G-Suite products Must possess strong analytical and problem-solving skills Able to manage multiple priorities Able to research, collect, and analyze data and prepare written and oral reports Knowledge of claims processing techniques Able to analyze, classify, and rate risks, exposure, and loss expectancies Knowledge of workers' compensation laws and requirements, safety, loss control, and risk management principles Principles, practices, and procedures of general business including knowledge of the unemployment compensation system, filing appropriate unemployment responses, and personnel administration including legal aspects of hiring and firing; and the relationship of the Federal Unemployment Tax Act and the various state acts; knowledge of state and federal unemployment laws, rules and regulations. Highly organized and able to track a project from initial contact through the end of the project Ability to effectively communicate information and ideas in written and verbal format EDUCATION AND REQUIREMENTS Required: Associate or Bachelor's degree or equivalent experience 1-2 years' experience processing workers' compensation, general liability, and/or unemployment claims Experience in creating reports Preferred: ARM, CRM or similar designation 4+ years' experience processing workers' compensation, general liability, and/or unemployment claims TRAVEL As required PHYSICAL REQUIREMENTS Prolonged periods sitting/standing at a desk and working on a computer

Claims Specialist Program Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance! Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes. The details When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault. You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case. You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual. Qualifications What you've got * You have 0-2 years of professional experience. * A strong academic record with a cumulative 3.0 GPA preferred * You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism. * You possess strong negotiation and analytical skills. * You are detail-oriented and thrive in a fast-paced work environment. * You must have permanent work authorization in the United States. What we offer * Competitive compensation package * Pension and 401(k) savings plans * Comprehensive health and wellness plans * Dental, Vision, and Disability insurance * Flexible work arrangements * Individualized career mobility and development plans * Tuition reimbursement * Employee Resource Groups * Paid leave; maternity and paternity leaves * Commuter benefits, employee discounts, and more Learn more about benefits at ************************** A little about us As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow. We were recognized as a '2018 Great Place to Work' by Great Place to Work US, and were named by Forbes as one of the best employers in the country for new graduates and women-as well as for diversity. 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. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

Job Details Corporate Headquarters - Atlanta, GA HybridDescription Integrity. Care. Trust. Compassion. Expertise. Do these words resonate with you? These values of Builders culture create success in all we do. We strive to provide deeply supportive partnerships to our customers, agents, and each other. Builders is proud to be named among the Great Places to Work. Our award-winning culture has earned top marks in Company Direction, Employee Appreciation, Work-Life Balance, Leadership, and Compensation and Benefits. Our strong culture keeps us Built Strong in a forever-changing world, and our AM Best A Rating is evidence of our financial strength. Position Summary The General Liability Claims Specialist is responsible for the investigation, evaluation and settlement of complex General Liability claims and management of Commercial Auto Liability and Commercial Auto Physical Damage claims. The Specialist upholds standards of excellence in technical proficiency and consistently delivers exceptional customer service. Responsibilities Manage caseload of Property and Casualty claims inclusive of general liability, construction defect particularly small to mid-sized residential contractors, and commercial automobile liability and physical damage losses in multiple jurisdictions through effective claim management Investigate and analyze coverage; make coverage determinations; draft coverage correspondence; effectively communicate coverage determinations to policyholders and other stakeholders with minimal supervision or oversight. Conduct investigation throughout all aspects of the claims process. Establish timely reserves within authority and re-evaluate throughout the life of the claim Determine liability, evaluate exposure, and negotiate claims to resolution. Identify and pursue risk transfer opportunities, whether contractual indemnity, contribution or additional insured opportunities and obligations. Maintain accurate documentation/information in claim file. Proactively drive litigation toward resolution. Prepare timely, concise reports including Large Loss and Reinsurance Reports Control costs involving vendor utilization Negotiate and settle claims within authority Foster a professional rapport with clients and claimants to effectively resolve issues Effectively communicate and collaborate with internal and external partners Meet expected quality performance guidelines As required, attend mediations, pre-trial conferences, trials, etc. Qualifications Bachelor's degree from an accredited college or university; or equivalent education and experience in Insurance or other related fields Minimum of 5 years handling general liability and commercial auto liability and physical damage claims. Current P&C adjuster License, ability to be licensed in GA, FL, SC, CO, and TX SCLA, CPCU or other insurance related designations a plus Proficient in understanding of Construction Defect and commercial auto liability laws, principals, rules and regulations Proficient in both verbal and written communication with the ability and commitment to maintain confidentiality Skill in interpersonal interactions, with the ability to collaborate effectively with individuals at all organizational levels and with external stakeholders; skill in customer service and problem-solving Capacity to work autonomously while ensuring transparent communication with internal leadership Skill in analysis, time management, prioritization, negotiation and project management; ability to multi-task effectively while paying attention to detail Proficient with Microsoft Office Suite and function specific software applications Let's talk benefits! Competitive Salary Bonus Structure Profit Sharing Medical, Dental, Vision Insurance Employer Paid Short Term Disability Employer Paid Long Term Disability Employer Paid Life Insurance Voluntary Life Insurance 401K with Company Match PTO About Builders Builders is a mid-sized mutual with remarkable strengths. Rated A by AM Best, Builders has forged rock-solid financial strength and a reputation for reliability and fairness in fulfilling our promises to customers. Kind, collaborative, and customer-centric, our experienced and passionate teams foster a rewarding atmosphere of excellence, trust, and mutual respect, meriting the “Culture Excellence” honors from Top Workplaces. Flexible and highly personal, our experts leverage deeply supportive partnerships with knowledgeable independent agencies to drive better services and protection for policyholders. Our financial excellence, amazing people, and powerful partnerships build outstanding outcomes and peace of mind for our agents and their clients. This is what we mean by Insurance Built Strong . Builders Insurance Group is an Equal Opportunity Employer. We welcome applicants from all walks of life and don't discriminate based on any protected status. Join us in creating a diverse and inclusive workplace! If, during the application process you need assistance, or an accommodation due to a disability, please contact *******************.

Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law This position is not eligible for employment based sponsorship. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. PRIMARY DUTIES: * Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. * Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. * Translates medical policies into reimbursement rules. * Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. * Coordinates research and responds to system inquiries and appeals. * Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. * Perform pre-adjudication claims reviews to ensure proper coding was used. * Prepares correspondence to providers regarding coding and fee schedule updates. * Trains customer service staff on system issues. * Works with providers contracting staff when new/modified reimbursement contracts are needed. Minimum Requirements: Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. Preferred Skills, Capabilities and Experience: * CEMC, RHIT, CCS, CCS-P certifications preferred. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Job Type: Permanent Build a brilliant future with Hiscox Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist! Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations: West Hartford, CT (preferred) Atlanta, GA Boston, MA Chicago, IL Los Angeles, CA Manhattan, NY About the Hiscox Claims team: The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners. The role: The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible. What you'll be doing as the Complex Claims Specialist: Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to: Reviewing and analyzing claim documentation and legal filings Drafting coverage analyses for tech E&O, first and third party cyber claims Strategizing and maximizing early resolution opportunities Monitoring litigation and managing local defense and breach counsel Attending mediations and/or settlement conferences, either in person or by phone as appropriate Smartly managing and tracking third-party vendor and service provider spend Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager Liaising directly on daily basis with insureds and brokers Maintaining timely and accurate file documentation/information in our claims management system Our must-haves: 5+ years of professional lines claims handling experience A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred What Hiscox USA Offers Competitive salary and bonus (based on personal & company performance) Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care) Company paid group term life, short-term disability and long-term disability coverage 401(k) with competitive company matching 24 Paid time off days with 2 Hiscox Days 10 Paid Holidays plus 1 paid floating holiday Ability to purchase 5 additional PTO days Paid parental leave 4 week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox USA Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range $140,000 - $155,000 (Boston, Manhattan, West Hartford) Salary range $125,000-$135,000 (Chicago, Atlanta) 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. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-AJ1 Work with amazing people and be part of a unique culture

Claims Specialist Program Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance! Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes. The details When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault. You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case. You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual. Qualifications What you've got You have 0-2 years of professional experience. A strong academic record with a cumulative 3.0 GPA preferred You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism. You possess strong negotiation and analytical skills. You are detail-oriented and thrive in a fast-paced work environment. You must have permanent work authorization in the United States. What we offer Competitive compensation package Pension and 401(k) savings plans Comprehensive health and wellness plans Dental, Vision, and Disability insurance Flexible work arrangements Individualized career mobility and development plans Tuition reimbursement Employee Resource Groups Paid leave; maternity and paternity leaves Commuter benefits, employee discounts, and more Learn more about benefits at ************************** A little about us As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow. We were recognized as a ‘2018 Great Place to Work' by Great Place to Work US, and were named by Forbes as one of the best employers in the country for new graduates and women-as well as for diversity. 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. We can recommend jobs specifically for you! Click here to get started.

Researches and resolves escalated, complex, and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include, but not limited to provider enrollment, medical review, appeals and/or finance. Completes research efficiently and accurately to ensure the departmental goals are achieved. Description Location: This position is full-time (40-hours/week) Monday-Friday-Hourly). This role is Hybrid. What You'll Do: Researches and resolves high profile claims issues. Ensures claims processing errors are corrected according to the appropriate provider reimbursement contract. May also research and resolve high profile issues including, but not limited to provider enrollment, medical review, appeals and/or finance, which may be received via written or telephone correspondence. Serves as Point of Contact for various providers (professional and facility) to resolve all claims payment errors. Conducts weekly conference calls with assigned providers to ensure open communication pertaining to all current issues. Communicates/educates providers on proper coding of claims, claims filing, pricing concerns, contract questions, benefit/system updates, etc. Determines if claims payment errors are the result of system issues. Troubleshoots, and/or coordinates the resolution/correction of the system processing error. Verifies disbursement requests to ensure the request is valid and appropriately documented. Researches rejected, transition, and paid status claims for validity and escalate as appropriate. Uses the various systems of the department/company to complete research. Monitors inventory reports to ensure claims are resolved accordingly. Provides documentation as requested for audit purposes. May provide written or telephone correspondence to resolve claims issues. To Qualify For This Position, You'll Need The Following: Required Education: High School Diploma or equivalent Required Work Experience: 5 years of combined claims and provider service experience in a healthcare environment. 3 years of experience with claims systems (may be concurrent). Required Skills and Abilities: Comprehensive knowledge of claims payment policies and refund policies. Working knowledge of related claims software systems. Knowledge of medical terminology and coding as appropriate. Strong analytical skills and the ability to retrieve and research automated reports. Strong time management skills and adaptable to change. Strong communication (verbal and written) communication skills. Required Software and Tools: Standard office equipment. We Prefer That You Have The Following: Preferred Education: Bachelor's degree-in Business, Computer Science, Healthcare Administration, or a related field. Preferred Skills and Abilities: Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.

Here are the job details for your review: Job Title: Claims Specialist Pay Rate: $22/hr on W2, Duration: 12 Months Job Location: REMOTE Notes: Position is 100% remote, 40 hours/week. Seeking candidates who have proficient SAP and excel knowledge/skills Job Description: • Supervise the transportation claims inbox and work with the vendors, customers and internal partners to ensure that KC is recovering the appropriate funds o Assist with end-to-end task completion • Maintain daily contact with key client contacts and perform data entry / order processing within specified system. • Document and report on status of pending inquiries regarding account problems, plus some outgoing phone calls. • Intermediate position that requires a Bachelors degree or 8+ years of equivalent experience. • Work with freight payment team to ensure any disputes with transportation carriers are solved timely • Communication with carriers to ensure that there are no gaps in information required • End to end management of freight claims inclusive of assisting KC in creating a new procedure in how to file claims • Assistance to returns and refusals inbox which will require associate to coordinate with carriers, distribution facilities and customer service to determine if loads need to be cancelled, re-scheduled or re-worked

Job Description At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply. Work Schedule Remote Monday through Friday, 8:30 AM to 5:00 PM EST Must be able to work 8am - 5pm Eastern Standard Time Responsibilities Claims Review and Processing Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. Critical Analysis Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. Timely Processing Ensure prompt claims processing to meet client standards and regulatory requirements. Identify and resolve any barriers using effective problem-solving strategies. Issue Resolution Collaborate with internal departments to proactively resolve discrepancies and issues. Use analytical skills to identify root causes and implement solutions. Confidentiality Maintenance Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. Detailed Record Keeping Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. Trend Monitoring Analyze and report trends in claim issues or irregularities to management. Assist Team Leads with reporting to contribute to continuous process improvements. Audit Participation Engage in audits and compliance reviews to ensure adherence to internal and external regulations. Critically evaluate and recommend process improvements when necessary. Mentoring Mentor and train new claims processors as needed. Requirements High school diploma or equivalent. Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. Billing experience doesn't count towards years of experience qualification Familiarity with ICD-10, CPT, and HCPCS coding systems. Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker's compensation claims is a plus). Strong attention to detail and accuracy. Ability to interpret and apply insurance program policies and government regulations effectively. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Ability to work independently and collaboratively within a team environment. Commitment to ongoing education and staying current with industry standards and technology advancements. Experience with claim denial resolution and the appeals process. Ability to manage a high volume of claims efficiently. Strong problem-solving capabilities and a customer service-oriented mindset. Flexibility to adjust to the evolving needs of the client and program changes. Benefits 401(k) with employer matching Health insurance Dental insurance Vision insurance Life insurance Flexible Paid Time Off (PTO) Paid Holidays What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Job Description The Nuclear Company is the fastest growing startup in the nuclear and energy space creating a never before seen fleet-scale approach to building nuclear reactors. Through its design-once, build-many approach and coalition building across communities, regulators, and financial stakeholders, The Nuclear Company is committed to delivering safe and reliable electricity at the lowest cost, while catalyzing the nuclear industry toward rapid development in America and globally. About the role The Nuclear Company is looking for an experienced Claims Mitigation & Management Specialist to support the deployment of major nuclear reactor projects. This role will focus on contract formation, administration, and proactive claims prevention. You will work closely with project teams, contract managers, and leadership to identify and address potential risks, respond to claims, and ensure contractual compliance across complex, utility-scale nuclear energy projects. Responsibilities Proactively identify potential claims and disputes on projects. Develop and implement strategies for early claims identification and mitigation. Provide guidance to project teams on contract administration and documentation. Conduct detailed forensic analysis of project documentation for claims assessment. Quantify cost and schedule impacts of potential claims, including delay and disruption. Prepare comprehensive claims position papers and reports. Support the negotiation process for claims and disputes. Assist in preparing for and participating in dispute resolution forums (e.g., mediation, arbitration). Develop and maintain a robust claims log, tracking all active and potential claims. Ensure all claims-related documentation is meticulously organized. Prepare regular reports on claims status, liabilities, and resolution progress. Work closely with Project Controls, Contracts, and Legal teams on claims management. Participate in project reviews to provide insights on claims trends. Experience Bachelor's degree in Engineering, Construction Management, Quantity Surveying, Law, or a related field. 8+ years of progressive experience in claims management, dispute resolution, or contract administration. 3+ years of focused claims management experience. Experience on energy mega-projects (utility-scale, high capital, high complexity). Experience on nuclear energy projects is highly valued. Demonstrated expertise in contract formation, negotiation, and administration. Exceptional analytical, critical thinking, and problem-solving skills. Excellent written and verbal communication and negotiation skills. Proficiency in project management software, scheduling tools, and advanced Excel. Ability to work effectively under pressure and manage multiple priorities. Knowledge of construction law and dispute resolution processes. Benefits Competitive compensation packages 401k with company match Medical, dental, vision plans Generous vacation policy, plus holidays Estimated Starting Salary Range The estimated starting salary range for this role is $121,000 - $143,000 annually less applicable withholdings and deductions, paid on a bi-weekly basis. The actual salary offered may vary based on relevant factors as determined in the Company's discretion, which may include experience, qualifications, tenure, skill set, availability of qualified candidates, geographic location, certifications held, and other criteria deemed pertinent to the particular role. EEO Statement The Nuclear Company is an equal opportunity employer committed to fostering an environment of inclusion in the workplace. We provide equal employment opportunities to all qualified applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic. We prohibit discrimination in all aspects of employment, including hiring, promotion, demotion, transfer, compensation, and termination. Export Control Certain positions at The Nuclear Company may involve access to information and technology subject to export controls under U.S. law. Compliance with these export controls may result in The Nuclear Company limiting its consideration of certain applicants.