Claims Examiner Series - Law
Claim processor job in New York, NY
at MABSTOA
Claim Examiner / Senior Claim ExaminerFirst date of Posting: 03/18/2025 Last date of filing: Until Completed Authority: TA/OA Department: Law Division/Unit: Torts Work Location: 130 LivingstonHours of Work: As required Compensation
Claim Examiner: Min: $50,468 - Max: $71,659 (New Hire Rate: $43,866)
Senior Claim Examiner: Min: $56,971 - Max: $86,426 (New Hire Rate: $49,543)
Supervising Claim Examiner: Min: $77,342 - Max: $95,975 (New Hire Rate: $67,257) SummaryThis position involves all aspects of investigation, assessment, and resolution of personal injury and/or property damage claims. The incumbent must manage a high-volume caseload and timely and accurately assess liability and damages, prepare written reports, be ready and able to investigate and document emergency situations, and may conduct statutory hearings. Strong computer skills and excellent problem-solving abilities are required. The incumbent must also demonstrate independent initiative and sound judgment, settle claims and suits directly with claimants or their counsel, prioritize assignments, prepare files for independent investigators, and may appear in court to aid defense counsel.Responsibilities• Investigate accidents with an eye toward developing effective litigation strategies and liability theories to defeat suits brought against MTA and its agencies and prepare files for trial, coordinating with staff attorneys and outside counsel for any litigation preparation or investigation required.• Review pending cases and prepare reports summarizing the case, liability and damages exposures, reserve recommendations, settlement value, potential subrogation opportunities and identify allegations or information that warrant further investigation.• Prepare to settle claims and suits with claimants and/or their counsel within approved settlement authority limits.• Consult with management on outstanding discovery for heavy-exposure cases and will assist staff attorneys and outside counsel in obtaining documents.• Communicate with outside counsel, preparing files for assignment to them and may conduct statutory hearings, may conduct up investigation on "Quick Response" accidents and may appear in court to assist staff attorneys and outside counsel with trial.Education and ExperienceClaim ExaminerA baccalaureate degree from an accredited college; orA four-year high school diploma or its equivalent and four years of full-time experience investigating and settling liability claims; or Senior Claim ExaminerOne (1) year of permanent service in the title of Claim Examiner.A baccalaureate degree from an accredited college and four years of paid experience in claims adjusting work from a common carrier or other transportation company, insurance company, governmental agency or law office, at least one (1) year of which shall have been in a responsible supervisory capacity; or A four-year high school diploma and seven (7) years of satisfactory, full-time paid experience as described in above, at least two (2) years of which shall have been in a responsible supervisory capacity; or a satisfactory equivalent.Desired Skills
Proven ability to assess and prioritize a large volume of work.
General computer proficiency.
Computer research proficiency using internet and other computer resources.
Microsoft Office Suite, including Word and Outlook.
Excellent interpersonal communication.
Excellent oral and written communication.
Prior claims handling experience required strongly desired.
Other InformationPursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the “Commission”).Equal Employment OpportunityMTA and its subsidiary and affiliated agencies are Equal Opportunity Employers, including with respect to veteran status and individuals with disabilities. The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.
Auto-ApplyComplex Claims Examiner -FAIRCO
Claim processor job in New York, NY
For a description, see PDF at: ************ transre. com/wp-content/uploads/2025/10/FAIRCO-Complex-Claims-Examiner.
pdf
Personal Injury Claims Examiner
Claim processor job in Marlton, NJ
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Personal Injury Protection Claims Examiner - Marlton, NJ
Salary: $27.47 per hour / $55,350 annually
What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Marlton, NJ office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S.
As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.
Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Qualifications & Skills:
Bachelor's degree preferred
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
#geico200
Annual Salary
$27.47 - $42.73
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Auto-ApplyClaims Examiner
Claim processor job in New York, NY
Job Description
Jones Jones LLC is a trusted leader in workers' compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. Our firm values growth, integrity, and excellence across every level of our organization.
We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow within a premier workers' compensation firm.
The Firm is located at 5 Hanover Square, New York, NY and this is a hybrid position.
Essential Functions
1. Claims Adjusting Work (NYTIC / Emerald):
Perform intake and coverage verification via WCB employer coverage search
Initiate three-point contact (employer/clamant/provider) within 24 hours
Conduct compensability analysis and develop action plans
Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement
Calculate AWW and benefit rates; set and review reserves at key milestones
Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections
Route medical bills to bill review and ensure fee schedule compliance
Prepare for hearings and maintain eCase updates
Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices
2. Licensing & Compliance (Jones Jones):
Collaborate with the Compliance team on licensing forms and regulatory filings
Review TPA scorecards and ensure compliance with WCB standards
Track and invoice licensing fees and renewals
Support examiner training and respond to licensing-related inquiries
3. ADR (MRM):
Manage intake, eligibility, and notices under the collectively bargained ADR program
Coordinate and schedule mediations
Draft case summaries and settlement proposals
Ensure adherence to Medical Network protocols and document variances
Prepare and route settlement paperwork, including Section 32 agreements
Maintain dashboards of ADR cycle times and outcomes for annual reporting
Obtain loss runs from wrap-up sponsors
4. MMG
Evaluate Independent Medical Examination (IME) reports for accuracy and compliance
Assist with administrative tasks such as schedule coordination and provider panel management
Competencies
Excellent and professional verbal and written communication skills
Strong understanding of workers' compensation best practices
Exceptional organizational skills and attention to detail
Excellent time management skills with a proven ability to meet deadlines
Strong analytical and problem-solving skills
Ability to perform well in a fast-paced, dynamic environment
Ability to maintain confidentiality and exercise discretion and sound judgment
Proficient with Microsoft Office Suite or related software
Qualifications
Bachelor's degree in business administration or related field
Active Independent Adjuster License (required)
2- 5 years of claims management experience
Apply today to join a firm with over a century of success and a future focused on innovation. Jones Jones LLC is an equal employment opportunity employer.
Complex Claims Examiner
Claim processor job in New York, NY
About Us
Since 1977 we have delivered first class solutions to insurers worldwide, by combining global reach with local decision making. We have built customer & broker relationships on years of trust, experience and execution. Through our people, our products and our partnerships, we deliver the capacity and expertise necessary to contribute to the sustainable growth of prosperous communities worldwide. To do so, our colleagues work with:
Integrity Work honestly, to enhance TransRe's reputation
Respect Value all colleagues. Collaborate actively.
Performance We reward excellence. Be accountable, manage risk and deliver TransRe's strengths
Entrepreneurship Seize opportunities. Innovate for and with customers.
Customer Focus Anticipate their priorities. Exceed their expectations.
We have the following job opportunity in our New York City office:
Description
We seek an experienced claims professional to join our growing FAIRCO team in our New York City office. FAIRCO is a subsidiary of TransRe Holdings, a Berkshire Hathaway company. As a member of FAIRCO, the Complex Claims Examiner will be responsible for adjusting Professional & Management Liability claims, with opportunities for experiences with other FAIRCO programs. Responsibilities will include but not be limited to:
Managing and adjusting primary and excess Professional & Management Liability claims, including private and public company, Directors and Officers, lawyers liability, accountants liability, financial institutions, cyber, employment practices and miscellaneous professional liability.
Proactively handling claims throughout the entire claim lifecycle from inception to resolution.
Analyzing policy coverage and drafting coverage analyses based on contract terms and claim details.
Evaluating liability and damages to determine the level of exposure to the insured and the policy.
Directing and closely monitoring assignments to defense counsel and experts in accordance with relevant guidelines.
Collaborating with underwriters, brokers, program partners, and insureds to ensure seamless claims resolution.
Traveling to and attending claims mediations, as required.
Developing and implementing claims handling strategies to mitigate risk and reduce claim expenses.
Requirements
The ideal candidate will possess the following knowledge, skills and abilities:
Extensive experience litigating or handling issues pertaining to complex Professional & Management Liability issues, with a focus on Directors and Officers coverage.
Experience leading mediations for Professional & Management Liability claims.
Experience evaluating coverage under various types of policies, drafting coverage correspondence, and participating in claims investigations.
Track record of effectively managing defense counsel and legal spend, assessing liability and financial exposure, and effectively negotiating cost effective, good faith claims resolutions.
Juris Doctorate preferred.
Willingness to travel up to 25% of the time for mediations, industry conferences, and client meetings.
Possession of, or willingness to obtain, a New York and other state adjuster's licenses.
Work Schedule
TransRe is supportive of an agile work schedule, which may differ based on individual roles, your local office's practices and preferences, marketplace trends, and TransRe's business objectives. This position is eligible for a hybrid work schedule with 3 days in the office per week, and 2 days remote.
Compensation
In addition to base salary, for this position, TransRe offers a comprehensive benefits package, paid time off, and incentive pay opportunity. The anticipated annual base salary range in New York for this position, exclusive of benefits, paid time off, and incentive pay opportunity is $140,000 - $180,000. This range is an estimate, and the actual base salary offered for this position will be determined based on certain factors, including the applicant's specific skill set and level of experience.
We are an Equal Opportunity Employer (EOE) and we support diversity in the workforce.
Auto-ApplyAssociate Claims Examiner
Claim processor job in New York, NY
With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠.
This position is intended for a candidate seeking growth opportunity in a dynamic organization. The Associate Claims Examiner will join a specific business unit, as assigned, and will receive ongoing on-the-job training in their line of business. The Associate also will be part of the company's Early Career Program. The Early Career Program Claims Track is a one-year training program geared toward ambitious college graduates looking to launch a high-performing career in claims with a world-wide insurance leader. During the one-year program, associates receive specialized training that can position them for career advancement and valuable industry certifications.
About This Role
As the Associate develops skill and gains experience, on-the-job responsibilities will include but are not limited to:
* Manage Claims on behalf of Arch Customers.
* Receive exposure to other areas within the Administration and Operations of Claim handling, including but not limited to Special Investigations Unit, Analytics, Subrogation.
* Perform claim handling responsibilities included but not limited to: Coverage analysis, Exposure analysis, Resolution strategies, Claims review, and Customer Service.
Desired Skills
* Actively completing or recently completed an area of study in Insurance & Risk Management, Business, Liberal Arts, Communications, Psychology, Linguistics, or relevant degree.
* Minimum 3.0 GPA or higher.
* Highly proficient with Microsoft Office tools including Word, Excel, and Outlook.
* Exemplary oral and written communication skills.
* Analytical, with keen ability to evaluate complex issues.
* Proactive; able to organize and prioritize to meet multiple demands and commitments.
* Demonstrates a strong work ethic, collaborative mindset, and potential for leadership.
Location & Work Arrangement
* The Early Careers Program (ECP) begins July 2026. A new hire for this role would start between January - June 2026.
* This position is classified as a hybrid position. You will work 2 days onsite and 3 days from home.
* This position can be located in Morristown, NJ, Jersey City, NJ, New York City, NY, or Philadelphia, PA.
* Relocation and housing assistance is not provided for this role.
#LI-AM2
#Hybrid
For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.
$60,000 - $65,000/year
* Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.
* Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits.
Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team.
14400 Arch Insurance Group Inc.
Auto-ApplyCommercial Auto Bodily Injury Claims Examiner
Claim processor job in New York, NY
Job DescriptionOur client is actively seeking a seasoned Commercial Auto Bodily Injury Claims Adjuster to join their growing NYC team. This person will be responsible for managing a portfolio of moderate to complex claims involving commercial auto exposures, often including litigated files. From first notice to final resolution, you'll drive the claims process with precision, ensuring timely outcomes and outstanding service. Key Responsibilities:
Conduct thorough investigations and evaluations of commercial auto bodily injury claims, exercising sound judgment within designated authority limits to ensure prompt and fair resolution.
Manage a caseload consisting of 100 - 110 Commercial Auto files with bodily injury exposures.
Collaborate with claimants, legal representatives, and other stakeholders to negotiate settlements, issue payments, and bring claims to closure effectively.
Maintain accurate documentation and prepare detailed claim status reports to support transparency and compliance throughout the claims lifecycle.
Requirements:
5 to 7+ years of experience handling Litigated Commercial Auto Bodily Injury claims.
Strong analytical thinking and attention to detail to assess coverage, liability, and damages accurately.
Excellent negotiation and communication skills, with the ability to manage complex interactions confidently.
Proficiency in modern claims management software and related technologies.
Active adjusters license, highly preferred.
Salary & Benefits:
Competitive base salary ranging from $95,000 to $110,000, depending on experience.
Comprehensive benefits package, including health, dental, and vision insurance.
Generous PTO and paid holidays.
Clear pathways for career advancement.
401(k) plan with competitive employer matching.
Sr. Claims Analyst, Environmental Casualty
Claim processor job in New York, NY
Investigate, evaluate, and resolve claims asserted against the Company's environmental policies. Engage in collaborative projects in support of other areas of the company, including underwriting, finance and accounting, actuarial, operations, and technology. Provide superior service to all customers, whether internal or external.
Job Responsibilities:
· Efficiently manage a vigorous load of claims involving a broad spectrum of accounts and coverages. Promptly analyze coverage, draft accurate and timely coverage positions, and manage litigation by effectively interacting with insureds, brokers, defense counsel, underwriters and other parties as required. Establish timely and appropriate reserves and regularly report claim developments and trends to claims and underwriting management. Represent Company in the resolution of claims and participate in legal proceedings, including mediations.
· Work with other areas of the Company including underwriting, finance and accounting, actuarial, operations and technology on projects as requested. Prepare claim summaries and other reports as necessary for management. Prepare Executive Claim reports and present on a quarterly basis to senior executives.
· Meet with existing or prospective clients and brokers. Attend relevant industry conferences/meetings.
Compensation
The below annualized base pay range is a broad range based on analysis of similar positions in the market. The actual base pay for the position may be above or below he listed range and determined by a number of considerations, including but now limited to complexity, location, and scope of the role, along with experience, skills, education, training, and other conditions of employment. Base salary represents one compensation of Allied World comprehensive total reward package, which may also include annual incentive compensation rewards. The salary range is flexible and will be determined according to the candidate's experience.
$105,000 - $113,000
Qualifications:
· Minimum of 2 years' experience handling claims.
· Four-year college degree is required.
Knowledge of claims, legal and coverage issues in all U.S. jurisdictions. Excellent negotiation and communication skills. Strong technical skills and writing experience. Proficient with Microsoft Office products, internet research.
Ability to accurately and timely analyze coverage, draft coverage position letters and interact and collaborate with counsel regarding litigation and coverage strategies, negotiate and resolve claims and otherwise act within the scope of delegated authority.
Compliance with multi-state adjuster licensing requirements.
Some travel required.
About Fairfax
Fairfax is a holding company which, through its subsidiaries, is engaged in property and casualty insurance and reinsurance and investment management.
About Allied World
Allied World Assurance Company Holdings, Ltd, through its subsidiaries, is a global provider of insurance and reinsurance solutions. We operate under the brand Allied World and have supported clients, cedents and trading partners with thoughtful service and meaningful coverages since 2001. We are a subsidiary of Fairfax Financial Holdings, Limited and benefit from a strong capital base and a worldwide network of affiliated entities that allow us to think and respond in non-traditional ways.
Our generous benefits package includes Health, Dental and Disability Insurance, a company match 401k plan, and Group Term Life Insurance. Allied World is an Equal Opportunity Employer. All qualified applicants will be considered for employment without consideration of any disability, veteran status or any other characteristic protected by law.
To learn more, visit awac.com, or follow us on Facebook at facebook.com/alliedworld and LinkedIn at linkedin.com/company/allied-world.
Auto-ApplyClaims And Encounter Analyst II
Claim processor job in New York, NY
JOB PURPOSE:
The Claims and Encounter Analyst enhances the efficiency and effectiveness of the claims department by analyzing data, refining processes, and ensuring compliance with State, CMS, and contractual guidelines. This role requires knowledge of Government Programs medical claims and authorization data analytics, encounter process, risk adjustment, and a strong focus on data-driven process improvement.
JOB RESPONSIBILITIES:
Medical Economics/ Claims Analysis:
Conduct in-depth claims analysis, root cause investigations, and identify process improvement opportunities.
Review and investigate claims to be adjudicated by the Third-Party Administrator (TPA), applying contractual provisions in accordance with provider contracts and authorizations.
Work with vendors to identify sources of opportunities to improve claims process for providers.
Evaluate and revise SLAs with the claims TPA to improve operational efficiency; track and monitor open tickets and configuration updates.
Leverage multiple data sources to develop scheduled and ad-hoc reports to enable process and trend analysis.
Encounter and Riks Adjustment Analysis:
Assist the Director with analytics to support Medicare risk adjustment process through advanced medical records review to identify and code all relevant diagnoses, including chronic conditions utilizing ICD-10 coding guidelines.
Assists improve the risk adjustment surveillance process.
Validate DRG grouping and pricing outcomes; possess basic knowledge of HCC and ICD-10.
Analyze claims data to identify risk-adjustable conditions and uncover opportunities to improve risk capture processes through data-driven insights and recommendations.
Review, validate, and reconcile claim and encounter data submissions for completeness, timeliness, and compliance.
Analyze trends in encounter rejections and denials; develop improvement plans.
Maintain the integrity of encounter data submission workflows and documentation to support audits.
Statutory and Regulatory Reporting, including support to Quality and Clinical Services departments:
Work with department heads and business owners, collect and prepare data for state, federal, and internal inquiries (e.g., HPMS, IPRO), ensuring accuracy and regulatory compliance.
Analyze and understand data from various source systems to validate data quality and ensure that business reporting needs are fulfilled through a formal, documented process.
Prepare quarterly utilization metrics to support the timely and accurate submission of miscellaneous state reporting, i.e. PACEOR, VBPTR, MLR.
Assist department heads and business owners in identifying and performing appropriate analyses to enable sound decision-making.
Work with business users, report writers, Data Warehouse team, and enterprise data architect to refine/adapt/maintain ETL mappings as business users needs change or the data environment changes.
Provider Scorecard Reporting:
Develop monthly provider scorecards to assess network provider performance and identify improvement areas.
Perform in-depth analytics on provider performance against the Quality Incentive Program to ensure adherence and accurate incentive payments based on contracts.
Coordinate with Finance on check runs, provider payments, and resolution of over/underpayments.
Develop and deliver business intelligence solutions and associated reporting using various Enterprise Data Warehouse (EDW) applications and BI tools (specifically using SQL Server, Tableau Server, Power BI, etc.); revise reporting dashboards as needed.
Other duties as assigned.
Schedule: 8:30AM - 5:30PM
Weekly Hours: 40
QUALIFICATIONS:
Education: Bachelor's degree is required; quantitative discipline is strongly preferred. Master's degree is preferred.
Experience:
Three to five (3-5) years of managed care (Medicaid and Medicare) data analytics is required.
Proficiency in data analytics, i.e. SAS, SQL, one or the other is required.
Claims adjudication and understanding of claims PPS is strongly preferred.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is strongly preferred.
Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS is preferred.
Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software is required.
Effective oral, written, and interpersonal communication skills are required.
Able to multitask efficiently, effectively, and timely.
Strong organizational skills and work ethic.
Detail-oriented, professional and collaborative, a great team player.
Physical Requirements
Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:
Standing - Duration of up to 6 hours a day.
Sitting/Stationary Positions - Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
Lifting/Push/Pull - Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
Bending/Squatting - Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
Stairs/Steps/Walking/Climbing - Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
Sight/Visual Requirements - Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
Audio Hearing and Motor Skills (Language) Requirements - Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
Cognitive Ability - Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
Salary Range (Min-Max):$105,000.00 - $110,000.00
Auto-ApplyClaims Specialist - EPL
Claim processor job in Red Bank, NJ
This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.
About the Team
AXIS is a leading provider of specialty insurance and global reinsurance. The Employment Practices Liability team is an engaging team handling excess and primary claims for various AXIS policy forms. The strength of our team is grounded in our people and culture, encouraging collaboration, growth, and diversity.
How does this role contribute to our collective success?
The selected individual will collaborate with a team to investigate, analyze, and evaluate Third Party Liability claims, ensuring proper coverage determinations. Expertise will be developed in Employment Practices Liability while engaging with complex insureds on significant and dynamic disputes. This role offers meaningful opportunities to contribute to impactful case resolutions within specialized insurance sectors. The selected individual will also have exposure to Fiduciary Liability claims.
What Will You Do In This Role?
* Serving as a Claims Specialist focused on Employment Practices Liability Claims within AXIS' North America Claim team.
* Determining the appropriate valuation of complex claims, recommending settlement strategies, adhering to company policies, and collaborating with insureds, brokers, and partners effectively.
* Traveling to participate in mediations, observe trials, and strengthen relationships with vital AXIS partners.
* Escalating coverage concerns to internal teams and collaborating with external coverage attorneys when specific assignments necessitate their involvement.
* Developing claims and litigation strategies, delegating tasks, and overseeing the work of external legal advisors effectively.
* Assisting with underwriting inquiries while analyzing claim trends, conducting data analysis, and performing comprehensive risk assessments to support decision-making processes.
* Keeping precise records of claim activities and promptly updating systems with all relevant details ensuring accuracy and efficiency.
About You
We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals.
What We're Looking For
* Seek candidates who bring unique perspectives and diverse skills to the team.
* Contribute actively to the success of a growing and dynamic team by bringing energy and a positive attitude.
* Hold a Juris Doctorate.
* Operate efficiently in settings with high visibility, shifting deadlines, and evolving expectations while staying focused and achieving outcomes.
* Demonstrate organizational abilities and solve problems effectively.
* Exhibit outstanding skill in verbal communication and written expression.
* Showcase skill as a litigator or litigation manager, well-versed in dispute resolution.
* Write coverage letters independently with precision and attention to detail, ensuring accuracy in all aspects of the work.
Role Factors
Travel is associated with this role. The role requires you to be in office 3 days per week and adhere to AXIS licensing requirements.
What We Offer
For this position, we currently expect to offer a base salary in the range of $85,000 - $145,000. Your salary offer will be based on an assessment of a variety of factors including your specific experience and work location.
In addition, you will be offered competitive target incentive compensation, with awards based on overall corporate and individual performance. On top of this, you will be eligible for a comprehensive and competitive benefits package which includes medical plans for you and your family, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and much more.
Where this role is based in the United States of America, this role is Exempt for FLSA purposes.
About Axis
This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.
AXIS Persona
AXIS Capital seeks professionals who thrive in a dynamic, high-performing environment grounded in humility and mutual respect. We employ those who exemplify our core values of People, Excellence, Decisiveness, and Stronger Together.
We are a team characterized by integrity and self-discipline, striving for continuous improvement and driven to achieve ambitious results. Our focus is on hiring, developing, retaining, and rewarding individuals who excel in:
Purposeful Action: Delivering top-tier work with a data-driven approach and operating at AXIS speed.
Collaborative Decision-Making: Valuing input from all relevant groups and being open to debate. Able to leave their ego at the door and be committed to achieving results through teamwork, fully supporting decisions once made.
Measuring Outcomes: Consistently evaluating performance against established expectations.
The AXIS employee will cultivate a collaborative workplace atmosphere, fostering trust within the team. We believe in respectful challenges, presuming best intent, and building meaningful relationships with colleagues, customers, and the communities we serve.
Joining our team means becoming part of a workplace where every individual's contributions are valued, and excellence is pursued with purpose and passion. Together, we elevate our standards, achieve ambitious results, and make a lasting impact on each other and those we serve.
Auto-ApplyTrucking Claims Specialist
Claim processor job in New York, NY
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
* Competitive compensation
* Healthcare benefits package that begins on first day of employment
* 401K retirement plan with company match
* Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
* Up to 6 weeks of parental and bonding leave
* Hybrid work schedule (3 days in the office, 2 days from home)
* Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
* Tuition reimbursement after 6 months of employment
* Numerous opportunities for continued training and career advancement
* And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
* Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
* Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
* Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
* Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
* Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
* Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
* Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Salary Range
$95,000.00-$145,000.00 USD
The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Qualifications
* Minimum of 3 years of trucking industry experience.
* Experience with bodily injury and/or cargo exposures.
* Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
* Strong analytical and negotiation skills, with the ability to manage multiple priorities.
* Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
* Possession of applicable state adjuster licenses.
* Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplyClaims Insights Analyst
Claim processor job in Trenton, NJ
NJM Insurance Group's Claims & Medical Services Analytics group is seeking a Claims Insights Analyst. The Claims Insights Analyst applies a strong understanding of data sources and associated business processes to provide management with research, analysis and insights in support of departmental strategies and goals.
This position will perform analysis on large and diverse sets of data to tell compelling stories through presentations, dashboards and visualizations to drive strategic decision making. The Claims Insights Analyst is a highly motivated, creative self-thinker and has a good sense for interpreting and communicating the “why” behind the data and application to the business.
Job Responsibilities:
Develop intelligent insights from analysis of both quantitative and qualitative data, testing hypotheses, running exploratory analysis and identifying trends in support of business strategies and goals. Translate results/findings into clear and concise presentations for management and assist in the development of plans for corrective action. Develop and enhance KPI dashboards, analytics and reports to monitor performance to create a comprehensive view of the business.
Collaborate with cross-functional business teams and Data Engineers to fully understand the meaning, business rules and structure of required data and ensure alignment and consistency of data to support the end-to-end journey. Partner with the department Business Stakeholders to identify, plan and prioritize source system improvements that facilitate data analytics.
Expand understanding/knowledge of business data sources and competitive environments. Scan the market to understand key trends impacting markets, customers, products, services and operational processes.
Comply with Data Governance standards and guidelines for data definition, quality, accuracy, completeness, availability and security to encourage data integrity and conformance.
Required Skills & Experience:
3+ years writing queries (T-SQL).
3+ years using business intelligence tools (Power BI, SSRS, SAS, Excel).
1+ years using scripting languages (Javascript, Python, R) preferred.
BS from a 4-year accredited college/university in related field (Statistics, Mathematics, Business Intelligence, Finance etc.) or equivalent experience.
Strong analytical aptitude with the ability to turn raw data into presentations containing insights and visualizations that are critical in making strategic business decisions.
Strong business and technical knowledge with the ability to balance multiple priorities in a fast-paced work environment.
Knowledge of property and casualty insurance industry data and the Guidewire product (ClaimCenter, PolicyCenter, BillingCenter, ContactCenter) suite.
Strong verbal and written communication skills.
Ability to read and understand data models.
Compensation: This role may be filled at an Associate Insights Analyst, Insights Analyst, or Senior Insights Analyst level based on skills, experience and credentials.
Associate Insights Analyst: $68,711 - $90,977
Insights Analyst: $79,129 - $120,315
Senior Insights Analyst: $98,936 - 150,540
Compensation: Salary is commensurate with experience and credentials.
Pay Range: $0-$0
Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.
Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
Auto-ApplyClaim Clerk
Claim processor job in Wall, NJ
Job Title: Claim Clerk
at CCMSI Wall Township, NJ Work Schedule: Full-time, Monday - Friday, 8:00 AM - 4:30 PM (No opportunity for remote work) Pay Rate: $18-20 per hour (37.5 hours per week - 1 hour unpaid lunch)
At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.
Reasons you should consider a career with CCMSI:
Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.
The Claim Clerk is responsible for the general clerical duties for the claim personnel and other team members as assigned. Additionally, the position is accountable for the quality of claim service as perceived by CCMSI clients and within Corporate Claim Standards.
Responsibilities
Match mail for assigned accounts.
Follow up on bills.
File claim mail and related documents.
Set up designated claim files and complete all set up instructions, as requested.
Back-Up for Receptionist
Summarize correspondence and medical records in the claim log notes as wells as file it in the appropriate claim, as directed by claim staff.
Retrieve closed files and re-file in storage.
Maintain claim files in storage.
Photocopy claim documents, as needed.
Return provider calls or other calls, as directed.
Provide support to claim staff on client specific teams.
Compliance with service commitments as established by the team.
Performs other duties as assigned.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
High School diploma or equivalent required.
Computer Skills
Proficient in Microsoft Office
Certificates, Licenses, Registrations
None required
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity
Work requires the ability to sit or stand up to 7.5 or more hours at a time
Work requires sufficient auditory and visual acuity to interact with others
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.
Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.
#CCMSIWallTownship #Hiring #JoinOurTeam #ClaimsClerk #InsuranceJobs #EntryLevelJobs #InOffice #JobOpportunity #NewJerseyJobs #GreatPlaceToWork #IND456 #LI-InOffice #EmployeeOwned #AdminJobs #CCMSICareers #CareerGrowth #CareerPath
Auto-ApplyTrucking Claims Specialist
Claim processor job in New York, NY
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
Competitive compensation
Healthcare benefits package that begins on first day of employment
401K retirement plan with company match
Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
Up to 6 weeks of parental and bonding leave
Hybrid work schedule (3 days in the office, 2 days from home)
Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
Tuition reimbursement after 6 months of employment
Numerous opportunities for continued training and career advancement
And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Salary Range
$95,000.00-$145,000.00 USD
The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Qualifications
Minimum of 3 years of trucking industry experience.
Experience with bodily injury and/or cargo exposures.
Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
Strong analytical and negotiation skills, with the ability to manage multiple priorities.
Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
Possession of applicable state adjuster licenses.
Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplyLarge Loss Claims Specialist, Major Case Casualty
Claim processor job in New York, NY
Our Claims team sets us apart. Our experienced Claims professionals use their specialized expertise to handle even the most complex claims seamlessly. How do you make a good thing better? You focus on excellence and creating a culture of continuous improvement.
You create an environment that fosters collaboration, customer service and colleague development.
And you build a team of passionate and innovative claims experts who see success as a reason to roll up their sleeves and drive for improvement.
As a Large Loss Claims Specialist on the Major Case Casualty team, you will play a key role in managing and resolving some of AXA XL's most significant excess casualty and multinational casualty claims.
You will work closely with your manager, fellow Claims Specialists, the Global Casualty Practice Leader and both in-house and external counsel to move claims toward resolution, while also regularly collaborating with clients, brokers and the Underwriting team.
Your primary focus will be to achieve the best possible outcomes for AXA XL and its clients by proactively resolving and settling claims.
You will be responsible for analyzing complex coverage issues, gathering and organizing relevant information, ensuring reserves are adequate, mitigating risk exposure, managing litigation, and developing effective resolution strategies.
You will be performing complex work under limited supervision.
As such, we will expect you to exercise sound judgment and decision making in accordance with specified policies and guidelines.
You should possess a high level of procedural and/or technical knowledge that has been developed through extensive experience.
What you'll be doing What will your essential responsibilities include? Technical claims management: Oversee technical aspects of claims, evaluate applicable AXA XL coverage, draft coverage position letters, analyze contracts, and effectuate risk transfer.
Reserving and disposition: Ensure timely and adequate reserving, properly dispose of high exposure and complex claims, monitor reserving activity, and make timely adjustments to reserves as required.
Loss investigation and claim management: Conduct loss investigations on all assigned claims, determine potential recoveries, maintain accountability for claims until settlement/closure, and adhere to agreed time and budget constraints.
Documentation and communication: Maintain an accurate written record of relevant activities, ensure adherence to claims procedural and documentation standards, and provide accurate and timely claims status updates to internal and external customers.
Relationship building and reporting: Regularly update the Claims Manager, build relationships with internal local and global AXA XL departments, and provide summaries and statistical reports as required.
Customer focus and development: Anticipate and meet all internal and external customer needs, coach or train less experienced claim representatives, and maintain market awareness to maximize personal development.
Claim file management: Ensure accurate, timely and complete claim files, including all relevant documents and correspondence, and maintain records in compliance with AXA XL's documentation standards.
Expense management and Best Practices: Adhere to and manage expense budgets and ensure adherence to AXA XL Best Practices in all claims-handling activities.
You will report to the Practice Leader, Head of Major Case Casualty, Americas.
What you'll bring We're looking for someone who has these abilities and skills: Advanced excess casualty and/or multinational casualty claims experience: Experience managing high exposure and complex claims.
Demonstrated experience negotiating and settling complex claim files.
Expert knowledge of coverage across multiple jurisdictions.
Additionally, advanced experience analyzing coverage and writing coverage position letters, oftentimes without the assistance of coverage counsel.
Excellent communication: Both verbal and written communication, presentation and negotiation skills.
Able to communicate and negotiate effectively with internal and external stakeholders at various levels of sophistication.
Collaborative approach: Develop productive working relationships with insured, brokers, claim handlers, underwriters and legal counsel.
Seek input from others as needed to achieve the best result possible.
Capable of working and collaborating with a virtual team.
Ethical: Handle responsibilities with integrity and the highest standards of professionalism.
Passion for results: Approach tasks proactively and anticipate needs.
Think quickly and prioritize multiple work streams without sacrificing quality.
Act with a sense of urgency.
Intellectual curiosity: Willing to ask questions and explore new ideas.
Eager to learn and focused on continuously improving technical skills.
Education: Bachelor's degree required Who we are AXA XL, the P&C and specialty risk division of AXA, is known for solving complex risks.
For mid-sized companies, multinationals and even some inspirational individuals we don't just provide re/insurance, we reinvent it.
How? By combining a comprehensive and efficient capital platform, data-driven insights, leading technology, and the best talent in an agile and inclusive workspace, empowered to deliver top client service across all our lines of business − property, casualty, professional, financial lines and specialty.
With an innovative and flexible approach to risk solutions, we partner with those who move the world forward.
Learn more at axaxl.
com What we offer Inclusion AXA XL is committed to equal employment opportunity and will consider applicants regardless of gender, sexual orientation, age, ethnicity and origins, marital status, religion, disability, or any other protected characteristic.
At AXA XL, we know that an inclusive culture and enables business growth and is critical to our success.
That's why we have made a strategic commitment to attract, develop, advance and retain the most inclusive workforce possible, and create a culture where everyone can bring their full selves to work and reach their highest potential.
It's about helping one another - and our business - to move forward and succeed.
Five Business Resource Groups focused on gender, LGBTQ+, ethnicity and origins, disability and inclusion with 20 Chapters around the globe.
Robust support for Flexible Working Arrangements Enhanced family-friendly leave benefits Named to the Diversity Best Practices Index Signatory to the UK Women in Finance Charter Learn more at Inclusion & Diversity at AXA XL | AXA XL.
AXA XL is an Equal Opportunity Employer.
Total Rewards AXA XL's Reward program is designed to take care of what matters most to you, covering the full picture of your health, wellbeing, lifestyle and financial security.
It provides competitive compensation and personalized, inclusive benefits that evolve as you do.
We're committed to rewarding your contribution for the long term, so you can be your best self today and look forward to the future with confidence.
Sustainability At AXA XL, Sustainability is integral to our business strategy.
In an ever-changing world, AXA XL protects what matters most for our clients and communities.
We know that sustainability is at the root of a more resilient future.
Our 2023-26 Sustainability strategy, called "Roots of resilience", focuses on protecting natural ecosystems, addressing climate change, and embedding sustainable practices across our operations.
Our Pillars: Valuing nature: How we impact nature affects how nature impacts us.
Resilient ecosystems - the foundation of a sustainable planet and society - are essential to our future.
We're committed to protecting and restoring nature - from mangrove forests to the bees in our backyard - by increasing biodiversity awareness and inspiring clients and colleagues to put nature at the heart of their plans.
Addressing climate change: The effects of a changing climate are far-reaching and significant.
Unpredictable weather, increasing temperatures, and rising sea levels cause both social inequalities and environmental disruption.
We're building a net zero strategy, developing insurance products and services, and mobilizing to advance thought leadership and investment in societal-led solutions.
Integrating ESG: All companies have a role to play in building a more resilient future.
Incorporating ESG considerations into our internal processes and practices builds resilience from the roots of our business.
We're training our colleagues, engaging our external partners, and evolving our sustainability governance and reporting.
AXA Hearts in Action: We have established volunteering and charitable giving programs to help colleagues support causes that matter most to them, known as AXA XL's "Hearts in Action" programs.
These include our Matching Gifts program, Volunteering Leave, and our annual volunteering day - the Global Day of Giving.
For more information, please see Sustainability at AXA XL.
Applicants for this role must be legally authorized to work in the United States without sponsorship now or in the future.
The U.
S.
base salary range for this position is USD $144,500-$227,500.
Actual pay will be determined based upon the individual's skills, experience and location.
We strive for market alignment and internal equity with our colleagues' pay.
At AXA XL, we know how important physical, mental, and financial health are to our employees, which is why we are proud to offer benefits such as a competitive retirement savings plan, health and wellness programs, and many other benefits.
We also believe in fostering our colleagues' development and offer a wide range of learning opportunities for colleagues to hone their professional skills and to position themselves for the next step of their careers.
For more details about AXA XL's benefits offerings, please visit US Benefits at a Glance 2025.
Trucking Claims Specialist
Claim processor job in New York, NY
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
Competitive compensation
Healthcare benefits package that begins on first day of employment
401K retirement plan with company match
Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
Up to 6 weeks of parental and bonding leave
Hybrid work schedule (3 days in the office, 2 days from home)
Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
Tuition reimbursement after 6 months of employment
Numerous opportunities for continued training and career advancement
And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Salary Range
$95,000.00-$145,000.00 USD
The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Qualifications
Minimum of 3 years of trucking industry experience.
Experience with bodily injury and/or cargo exposures.
Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
Strong analytical and negotiation skills, with the ability to manage multiple priorities.
Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
Possession of applicable state adjuster licenses.
Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplySr. Claims Analyst, Environmental Casualty
Claim processor job in New York, NY
Sr. Claims Analyst, Environmental Casualty - (25000048) Description Location: New York, NY, New Jersey, Farmington, CT, or other Allied World office locations. Job Summary:Investigate, evaluate, and resolve claims asserted against the Company's environmental policies.
Engage in collaborative projects in support of other areas of the company, including underwriting, finance and accounting, actuarial, operations, and technology.
Provide superior service to all customers, whether internal or external.
Job Responsibilities:· Efficiently manage a vigorous load of claims involving a broad spectrum of accounts and coverages.
Promptly analyze coverage, draft accurate and timely coverage positions, and manage litigation by effectively interacting with insureds, brokers, defense counsel, underwriters and other parties as required.
Establish timely and appropriate reserves and regularly report claim developments and trends to claims and underwriting management.
Represent Company in the resolution of claims and participate in legal proceedings, including mediations.
· Work with other areas of the Company including underwriting, finance and accounting, actuarial, operations and technology on projects as requested.
Prepare claim summaries and other reports as necessary for management.
Prepare Executive Claim reports and present on a quarterly basis to senior executives.
· Meet with existing or prospective clients and brokers.
Attend relevant industry conferences/meetings.
Qualifications CompensationThe below annualized base pay range is a broad range based on analysis of similar positions in the market.
The actual base pay for the position may be above or below he listed range and determined by a number of considerations, including but now limited to complexity, location, and scope of the role, along with experience, skills, education, training, and other conditions of employment.
Base salary represents one compensation of Allied World comprehensive total reward package, which may also include annual incentive compensation rewards.
The salary range is flexible and will be determined according to the candidate's experience.
$105,000 - $113,000Qualifications:· Minimum of 2 years' experience handling claims.
· Four-year college degree is required.
Knowledge of claims, legal and coverage issues in all U.
S.
jurisdictions.
Excellent negotiation and communication skills.
Strong technical skills and writing experience.
Proficient with Microsoft Office products, internet research.
Ability to accurately and timely analyze coverage, draft coverage position letters and interact and collaborate with counsel regarding litigation and coverage strategies, negotiate and resolve claims and otherwise act within the scope of delegated authority.
Compliance with multi-state adjuster licensing requirements.
Some travel required.
About FairfaxFairfax is a holding company which, through its subsidiaries, is engaged in property and casualty insurance and reinsurance and investment management.
About Allied WorldAllied World Assurance Company Holdings, Ltd, through its subsidiaries, is a global provider of insurance and reinsurance solutions.
We operate under the brand Allied World and have supported clients, cedents and trading partners with thoughtful service and meaningful coverages since 2001.
We are a subsidiary of Fairfax Financial Holdings, Limited and benefit from a strong capital base and a worldwide network of affiliated entities that allow us to think and respond in non-traditional ways.
Our generous benefits package includes Health, Dental and Disability Insurance, a company match 401k plan, and Group Term Life Insurance.
Allied World is an Equal Opportunity Employer.
All qualified applicants will be considered for employment without consideration of any disability, veteran status or any other characteristic protected by law.
To learn more, visit awac.
com, or follow us on Facebook at facebook.
com/alliedworld and LinkedIn at linkedin.
com/company/allied-world.
Primary Location: US-NY-New YorkOther Locations: US-CT-Farmington, US-NJ-IselinWork Locations: New York 199 Water Street New York 10038Job: ClaimsEmployee Status:RegularJob Type:StandardJob Posting: Oct 31, 2025, 8:02:59 AMMaximum Salary113,000.
00Pay BasisYearly
Auto-ApplyAdjudicator, Provider Claims
Claim processor job in New York, NY
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
* Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
* Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
* Assists in reviews of state and federal complaints related to claims.
* Collaborates with other internal departments to determine appropriate resolution of claims issues.
* Researches claims tracers, adjustments, and resubmissions of claims.
* Adjudicates or readjudicates high volumes of claims in a timely manner.
* Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
* Meets claims department quality and production standards.
* Supports claims department initiatives to improve overall claims function efficiency.
* Completes basic claims projects as assigned.
Required Qualifications
* At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
* Research and data analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Customer service experience.
* Effective verbal and written communication skills.
* Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.16 - $38.37 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Employment Practice Liability (EPL) Claims Specialist
Claim processor job in New York, NY
Seeking an experienced and detail-oriented EPLI Claims Specialist to join a dynamic team.
Compensation
$150,000 - $160,000/year (based on experience) + bonus opportunities
Competitive benefits package, paid time off, professional development opportunities, etc.
Responsibilities
Investigate and manage EPLI claims from initiation to resolution.
Analyze and interpret Employment Practice Liability insurance policies, coverage, and exclusions.
Conduct detailed investigations, including document reviews, interviews, and collaborating with legal counsel.
Assess the validity of claims and determine appropriate reserves.
Negotiate settlements with claimants, attorneys, and other involved parties.
Prepare detailed reports and documentation on claim activity and outcomes.
Requirements
Bachelor's degree in a related field or equivalent work experience.
Juris Doctorate preferred
Minimum of 5 years of experience in handling Employment Practice Liability claims
Strong knowledge of EPL insurance products, policies, and legal frameworks.
Ability to work independently and manage complex claims efficiently.
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
#LI-MW1
Ocean Marine Claim Specialist
Claim processor job in New York, NY
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.
At CNA, we provide insurance solutions to a wide range of businesses. Our Marine Claims Team handles all lines of ocean and some inland marine claims. We are seeking a motivated claim professional to join us primarily handling Hull, P&I, and Marine Liability claims. There will also be the opportunity to handle Ocean Cargo and Motor Truck Cargo claims. Under general management direction, the individual contributor will analyze, coordinate and resolve litigated and non-litigated claims within an established authority level.
JOB DESCRIPTION:
Essential Duties & Responsibilities
* Interprets policy coverages, and determines if coverages apply to claims submitted, escalating issues as needed.
* Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
* Coordinates and performs investigations and evaluates claims and lawsuits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU.
* Utilizes negotiation skills to develop settlement packages.
* Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
* Partners with attorneys, account representatives, agents, underwriters, and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
* Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
* Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
* May provide guidance and assistance to other claims staff and functional areas.
* Keeps current on state/territory regulations and issues as well as industry activity and trends.
* Some travel may be required as needed for mediations, settlement conferences, team activities and/or trials.
* May perform additional duties as assigned.
Reporting Relationship
* Manager.
Skills, Knowledge & Abilities
* Solid knowledge of marine or commercial liability claims, and insurance industry theory and practices.
* Demonstrated technical expertise and product specific knowledge.
* Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners.
* Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
* Strong analytical and problem solving skills enabling viable alternative solutions.
* Ability to exercise independent judgement, and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
* Solid knowledge of Microsoft Office Suite, as well as other business-related software.
* Ability to adapt to change and value diverse opinions and ideas.
* Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports.
* Ability to handle claims with a proactive long-term view of business goals and objectives.
Education & Experience
* Bachelor's degree or equivalent experience. Professional designations preferred.
* Typically a minimum three to five years claims experience.
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 ***************************.
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