Claim processor jobs in Brookline, MA

SUMMARY: Under general supervision of the Follow-up Supervisor, performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician multi-specialty practice. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Review all denied claims, correct them in the system and send correctedppealed claims asbr / written correspondence, fax or via electronic submission. Identify and analyze denials and enact corrective measures as needed to effectivelybr / communicate and resolve payer errors. Continually maintain knowledge of payer specific updates via payer's listservs, providerbr / updates, webinars, meetings and websites. Understand and maintain compliance with HIPAA guidelines when handling patient information Contact internal departments to acquire missing or erroneous information on a claimbr / resulting in adjudication delays or denials. Report to supervisor identification of denial trends resulting in revenue delays. Answers telephone inquiries from 3rd party payers; refer all unusual requests tobr / supervisor. Retrieve appropriate medical records documentation based on third party requests. Refer all accounts to supervisor for additional review if the account cannot be resolvedbr / according to normal procedures. Work with management to improve processes, increase accuracy, create efficiencies andbr / achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordancebr / with established policies, procedures, and objectives of the system andbr / affiliates. Perform other related duties as required. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Equivalent to a high school graduate. Knowledge of 3rd party billing to include ICD, CPT, HCPCS and 1500 claim forms. Demonstrated skills in critical thinking, diplomacy and relationship-building. Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings. Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies. EXPERIENCE: One to three years of relevant experience in professional billing preferred. Experience with Epic a plus. INDEPENDENT ACTION: Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action. SUPERVISORY RESPONSIBILITY: None Pay Range: $19.58-$32.31 EEO Statement: Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor. Location: Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903 Work Type: Monday-Friday 7:30-4 Work Shift: Day Daily Hours: 8 hours Driving Required: No

All Boston Mutual employees who interact with our policyholders, our producers, and our BML associates embrace the principles of our brand and service philosophy. We are all brand ambassadors. Both our words and our behaviors matter. We share a common service philosophy and pride ourselves in living the BML brand promises every day, one interaction at a time. The following statements represent what Boston Mutual stands “FOR” - it is what makes us different and better in the market we serve. We are FOR being a progressive life insurance company offering financial peace of mind to working Americans and their families. We are FOR providing practical and affordable products designed for those we serve. We are FOR making it easy to secure a level of financial protection with a portfolio of products - beginning with life insurance. We are FOR providing a personalized customer experience to our policyholders and producers. We are FOR acting in the best interests of our policyholders, producers, employees and the communities in which we live and serve - representing the goodness of mutuality in all we do. We do our best to: Demonstrate a desire to assist Listen for understanding and respond empathetically Explain things in a manner that is easy to understand Be knowledgeable students of our business Take full ownership to resolve questions and issues Be professional, polite and courteous Leave our customers and associates “better than where we found them” Statement of Position The Life Claim Examiner reports directly to the Life Claim Manager. The Life Claim Examiner is responsible for managing and processing all assigned claims with adherence to company policies and contract provisions in full accordance of the law while demonstrating the highest levels of service professionalism in all they do. The Life Claim Examiner is expected to: Manage their assigned caseload of Life insurance claims and ensures the accuracy and completeness of submitted claims. Processes assigned claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality/production standards. Review and process claims, evaluate medical records, and request additional information when needed. Obtains claim information by communicating effectively with internal/external stakeholders verbally and in written form while maintaining a professional demeanor. Interpret and evaluate policy/contract revisions. Review pending claims on a monthly basis. Perform other duties as assigned. JOB REQUIREMENTS AND QUALIFICATIONS Education: High School Diploma, GED or equivalent required. Medical terminology and/or insurance experience preferred. Experience: Claim examiner: Minimum of 1 year of business/office experience. Sr. Claim Examiner: Minimum of 2 years life/medical claims experience required. Knowledge Requirements: Strong business knowledge Excellent written/verbal communication skills. Strong organizational skills that reflect ability to perform and prioritize a high volume of task. Multitasks seamlessly with excellent attention to context, substance, and detail while meeting goals and strict deadlines. Excellent interpersonal skills and the ability to effectively build and extend relationships. Working knowledge of desktop applications such as Outlook, Word and Excel. Certifications/Licensures: N/A ADDITIONAL INFORMATION Regular Working Conditions (Desk job with occasional walking, use of computer with hand and finger motions, close and distance vision, minimal noise level and no exposure to weather conditions) Prolonged Standing Frequent Walking or Stooping Heavy Equipment or Machinery Operation Heavy Lifting Increased Noise Level Exposure to Weather Conditions Travel Required “On Call” Hours Required Other Information:

AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Claims Adjuster I - WC. The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker's compensation insurance claims through effective research, negotiation and interaction with insures, and claimants, ensuring that company resources are utilized in a cost-effective manner in the process. Responsibilities Thoroughly investigating workers' compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable workers' comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are workers' comp injury-related and in accordance with the treatment plan. Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute Answer questions regarding the status of pending claims from claimants, policyholders and medical providers. Consult with attorneys regarding litigation management, settlement strategy and claim resolution Qualifications 3+ years Workers Comp experience in New England States, preference Massachusetts or Connecticut. (NH, MA, NY, NJ, RI, or CT) Licenses in NH, VT and RI MS Office experience (Work, Excel, Outlook) Effective negotiation skills Strong verbal and written communication skills Ability to prioritize work load to meet deadlines Ability to manage multiple tasks in a fast-paced environment This is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time. #LI-GH1 #LI-HYBRID What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Not ready to apply? Connect with us for general consideration.

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: * Provides voice to voice contact within 24 hours of first report. * Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel. * Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. * Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. * Utilizes evaluation documentation tools in accordance with department guidelines. * Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. * Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. * Maintains and document claim file activities in accordance with established procedures. * Attends depositions and mediations and all other legal proceedings, as needed. * Protects organization's value by keeping information confidential. * Maintains compliance with Claim Department's Best Practices. * Provides quality customer service and ensures file quality * Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. * Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. * Participates in special projects as assigned. * Some overnight travel maybe required. * Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: * Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. * Adjuster Licensure required. * One to three years of experience processing claims; property and casualty segment preferred. * Experience with Xactware products preferred. * Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. * Proficiency with Microsoft Office products required; internet research tools preferred. * Demonstrated customer service focus / superior customer service skills. * Excellent communication skills and ability to interact on a professional level with internal and external personnel * Results driven with strong problem solving and analytical skills. * Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. * Detail-oriented and exceptionally organized * Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

Job Details Manchester, NH Fully RemoteDescription The Claims Examiner Reviews, evaluates, and processes insurance claims and makes recommendations for resolution; Examines and authorizes insurance claims investigated by insurance adjusters; Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim; Communicates with agents, claimants, and policy holders; Determines settlement according to organization practices and procedures.; Works on projects/matters of limited complexity in a support role. This position manages general liability, bodily injury, property damage, personal/advertising injury, auto and other miscellaneous claims. The Claims Examiner will analyze, investigate and resolve complex claim issues, including coverage, liability and damages. The position requires familiarity with regulatory compliance requirements and tort law. Responsibilities Ensure appropriate investigation of the underlying facts and circumstances is carried out in a timely manner, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed. Recognizing exposures and ensuring reserving is appropriate and timely. Evaluating coverage issues and risk transfer opportunities. Effectively communicate exposures both internally and externally. Overall responsibility for formulating proper resolution strategy to ensure best total outcome. Position may require periodic travel to attend meditations, trials and/or other related meetings. Perform other duties as assigned Qualifications Requirements Bachelor's degree preferred CPCU or AIC Certification (Preferred) Experience handling large complex commercial casualty claims with 2-8 years of commercial casualty claim adjusting experience handling primary and excess general liability, auto and personal injury claims. Experience in claims coverage analysis. Ability to approach every task in a meticulous and thorough manner, documenting actions and communications, prioritizing, maintaining schedules; paying attention to detail and striving for accuracy at all times; identifying and meeting all deadlines. Understanding of legal procedures, regulatory compliance and states' statutes. Strong oral and written communication skills with the ability to communicate professionally at all levels within and outside the organization. Insurance designations a plus. Strong computer skills including Microsoft Office Word, Outlook and Excel.

Under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts. This is a hybrid position. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Westborough, MA; Boston, MA; Suwanee, GA; Hoffman Estates, IL; Plano, TX. Please note this is subject to change. Responsibilities: * Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly. * Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources. * Manages an inventory of property/casualty and disability claims (e.g. workers` compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits. * Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols. * Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action. * Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources. * Updates files and provides comprehensive reports as required. * Work on resolution in early life of a claim to avoid attorney representation. * High volume of incoming claims. * Time management skills are in need. Qualifications * Effective interpersonal, analytical and negotiation abilities required * Ability to provide information in a clear, concise manner with an appropriate level of detail * Demonstrated ability to build and maintain effective relationships * Demonstrated success in a professional environment; success in a customer service/retail environment preferred * Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent * Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory * Licensing may be required in some states 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

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. 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. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

About the role. The Senior Claim Analyst is a key member of the Claims team reporting to a Casualty Manager and may be based remotely out of their home, or in regional PURE office. The primary goal of this position is to deliver flawless service to our members and independent agency partners. This person will handle first and third party claims in a quality manner and meet our high standards of accuracy, efficiency, quality customer service and regulatory compliance. What you'll do. Claims handling: Make appropriate coverage determinations, reserve and resolve claims within prescribed authority levels, handle status updates with agents and members, all with a focus on timeliness. Resolve claims and respond to inquiries involving members, agents, vendors (independent adjusters/appraisers, salvage rental car agencies), defense and plaintiff attorneys. Process transactions in claim and policy administration system, input claim data for reporting. Vendor Management: Manage vendor resources, activities, budgets, and expenses. Collaboration: Review reporting results with underwriting and senior management. Contribute as subject matter expert facilitating internal training of colleagues on topics of special interest or need in consultation with manager and Claims Department Leadership. Support both internal and external business partners as casualty Subject Matter Expert in dealing with cross functional teams (UW, Sales, RM) and agency partners regarding technical/functional business requirements and business development. What we're looking for. Technical Experience: 8+ years' of direct Property and Casualty Insurance experience. 5+ years' experience in handling both Auto & General Liability litigated files, complex first and third party bodily injury and complex coverage claims. Proven ability to handle complex first and third party Auto and GL bodily injury and coverage claims including, but not limited to, exposures of $250K plus. Experience handling litigated files as well as files that involve arbitration and mediation, including in person attendance at legal proceedings as required. Experience within the high net worth industry a plus. Working knowledge of excel, word, and email applications. Education/Continuous Education requirements: A Bachelor's degree is preferred. Demonstrated commitment to continuous learning and professional development including completion of one or more advanced educational or industry designations such as JD, MBA, CPCU, AIC, or CCLA. Competencies: Excellent interpersonal, listening, written, and oral communication skills. Highly detailed and organized, capable of prioritizing multiple tasks and assuring consistently high levels of accuracy. Demonstrate integrity, exhibit team spirit and enthusiasm, and establish trust and credibility. Agile learner who can quickly absorb information and apply it to current business situations. The base salary for this role can range from $95,000 to $110,000 based on a full-time work schedule. An individual's ultimate compensation will vary depending on job-related skills and experience, geographic location, alignment with market data, and equity among other team members with comparable experience Want to Learn More? [Our Values] [Our Benefits] [Our Community Impact] [Our Leadership]

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 1 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in South Eastern MA. The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory. Experienced candidates will also be considered. **What Will You Do?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic. + Verbal and written communication skills -Intermediate. + Attention to detail ensuring accuracy - Basic. + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic. + Analytical Thinking - Basic. + Judgment/ Decision Making - Basic. + Valid passport. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. + Valid driver's license. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time._** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits. This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and research, as necessary on all new and revised coding logic, related Medicare/Medicaid policies for review/approval through the Payment Integrity governance process. **Supervision Exercised:** + No, this position does not have direct reports. **Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration requirements for Optum CES and Zelis edits. + Quarterly and Annual review and research, as necessary on all new CPT and HCPCS codes for coding logic, related Medicare/Medicaid policies to make recommend reimbursement determinations. + Analyze, measure, manage, and report outcome results on edits implemented. + Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to industry standard coding regulations, and make recommendations based on new/revised coding edits for presentation to Payment Integrity committee meetings. + Analyze, measure, manage, and report outcome results on edits implemented. + Use and maintain the rules and policies specific to CES and Zelis. + Query and analyze claims to address any negative editing impacts and create new opportunities for savings based on provider billing trends + Liaison between business partners and vendors; bringing and interpreting business requests, providing solutioning options and documentation, developing new policies based on State and Federal requirements, host meetings, and managing projects to completion + Define business requests received, narrow the scope of the request based on business needs and requirements, provider resolution option based on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System) with BPaaS vendor and other PI partners, perform user acceptance testing, and analyze post production reports for issues + Support collaboration between PI/Claims and other internal stakeholders related to the identification and implementation of cost-savings initiatives specific to edits. **Working Conditions:** + Standard office conditions. Remote opportunity. **Other:** + Standard office equipment + None/stationary **Required Education (must have):** + Bachelor's Degree or Equivalent experience Ideal Candidate to have the one or all of the required certification OR willing to get certified within 1 year of employment - + Certified Professional Coder (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters Degree **Required Experience (must have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims Editing System (CES), Zelis, Lyric or other editing tools + Extensive knowledge and experience in Healthcare Revenue Integrity, Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills & Abilities (must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare) + Medical Coding, Compliance, Payment Integrity and Analytics + Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies (i.e . Center for Medicare & Medicaid Services (CMS) & MA Medicaid, Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) both practitioner and facility, modifier to procedure validation, and other CMS and American Medical Association (AMA) guidelines, etc.) + Advanced experience of medical terminology and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims' processing policies, coding principals and payment methodologies + Ability to work cross functionally to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives + Ability to plan, organize, and manage own work; set priorities and measure performance against established benchmarks + Ability to communicate and work effectively at multiple levels within the company + Customer service orientation; positive outlook, self-motivated and able to motivate others + Strong work ethic; able to solve problems and overcome challenges **Required Language (must have):** + English **Compensation Range/Target: $64,000 - $96,000** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. EEO is The Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-AR1 #Li-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Van Pool Transportation LLCHeadquartered in Massachusetts, Beacon Mobility is a growing family of companies committed to serving the diverse needs of our customers. Experienced, compassionate, and inspired, we take pride in our ability to create customized, mobility-based solutions that empower people to get where they need to go. Our purpose is simple - MOBILITY WITHOUT LIMITS: Transporting people to live, learn, and achieve. We provide those we serve with the opportunities, resources, and support to confidently move ahead. Description Headquartered in Massachusetts, Beacon Mobility is a growing family of companies committed to serving the diverse needs of our customers. Experienced, compassionate, and inspired, we take pride in our ability to create customized, mobility-based solutions that empower people to get where they need to go. Our purpose is simple - MOBILITY WITHOUT LIMITS: Transporting people to live, learn, and achieve. We provide those we serve with the opportunities, resources, and support to confidently move ahead. We support safe, compassionate, and inclusive environments that provide our communities with the mobility solutions they need to flourish and succeed. Providing support to 13,000 employees through more than 500 contracts, we collectively deliver Paratransit and School Bus services with a fleet of 13,000+ vehicles at 200+ locations from New England to New Mexico. Reporting to the Director of Claims, the Region Claims Analyst provides oversight and controls to reporting and management of crash and injury events across all locations within a region. This position is responsible for utilizing company defined reporting processes, KPI's and predictive analytics tools to ensure appropriate shareholders are aware of the opportunities to improve or sustain results. The role will require highly effective communication, motivation and project management skills while delivering analytical support to operations, safety and claims leadership. Support to locations will require compliance with applicable company practices, governmental reporting regulations, and contractual requirements. The candidate for this role requires successful experience in managing complex data systems. Our ideal candidate will be flexible and result-oriented with a track record of continually inspiring shareholders buy in. Achieving that end will also require the ability to proactively analyze current processes/procedures and appropriately challenge colleagues and leadership as needed to build continued process improvement and reliable safety practices. Primary Responsibilities: Reporting process oversight - Support and oversee timely crash and injury event reporting: Training safety directors on intake process/portal Communicating outlier reporting to safety directors for correction or process modelling Propose resource or process modification to drive accuracy and efficiency Ensure event coding accuracy - Review and correct event coding and details to achieve: Timely actionable performance metrics Efficient claims mitigation Efficient recovery opportunities Claims administration support/oversight - maintain command of claims within prescribed values to: Drive employee injury and return to work awareness - who, what needed, when Ensure TPA and operations awareness of critical elements and drive claims closure Ensure TPA and operations awareness of physical damage/subrogation events and values Significant Event & Crisis Support - Provides immediate and ongoing support to regional operations staff with crash/injury crisis response and investigations. Provide crisis response support with deploying investigators and conducting an initial review of the loss prior to Sedgwick submission/intervention. Communicate potential indicators which affect values (i.e.: venue, questionable damage, questionable video, questionable liability). Communicate significant events claims progression (i.e.: safety, operations, external counsel, executive team). Interdepartmental Communication - Establishes and maintains effective business relationships with internal teams, TPA's, and underwriters/brokers. Qualification Requirements: Bachelor's degree in business administration or risk management; or evidence of equivalent experience specifically around critical thinking, leading investigations and verbal & written communication skill development Broad understanding of safety policies and transportation best practices Excellent written and verbal communication skills. Ability to travel up to 25% of the time within the assigned Region, with periodic outside of the assigned region travel (as needed) Preferred qualifications: Demonstrate competency in the areas of research methodologies, project management and contract administration Advanced knowledge of Microsoft Office software (Word, Excel, Outlook, PowerPoint, etc.) and transportation related software and telematics Terms of acceptance: Upon acceptance of an offer of employment, employee will perform services for Beacon Mobility that may require Beacon Mobility to disclose confidential and proprietary information ("Confidential Information") to Employee. (Confidential Information is information and data of any kind concerning any matters affecting or relating to Beacon mobility, the business or operations of Beacon Mobility, and/or the products, drawings, plans, processes, or other data of Beacon Mobility not generally known or available outside of the company.) Employee will hold the Confidential Information received from Beacon Mobility in strict confidence and will exercise a reasonable degree of care to prevent disclosure to others and will not disclose or divulge either directly or indirectly the Confidential Information to others unless first authorized to do so in writing by Beacon Mobility management. All provisions of this agreement will be applicable only to the extent that they do not violate any applicable law and are intended to be limited to the extent necessary so that they will not render this agreement invalid, illegal or unenforceable. If any provision of this agreement or any application thereof will be held to be invalid, illegal or unenforceable, the validity, legality and enforceability of other provisions of this agreement or of any other application of such provision will in no way be affected thereby. Beacon Mobility is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Beacon Mobility makes hiring decisions based solely on qualifications, merit, and business needs at the time.

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.

The Total Loss Unit within our Claims Organization is responsible for identifying, negotiating and settling total losses with both insureds and claimants. The Total Loss Claim Representative processes payments and is responsible for the documentation of assigned claims as well as coordinate disposition of the total loss salvage vehicle. He/she is responsible for controlling total loss expenses and salvage recoveries on all total losses assigned. Responsibilities: * Negotiates and communicates all total loss and diminished value settlements per company and state guidelines. Multi jurisdictions, including MA, NH, CT, NY, and others as required * Understands the total loss evaluation methodology processes with the ability to effectively communicate these to vehicle owners. * Has a basic understanding of vehicle financing / leasing. * Reviews damage estimates to confirm vehicles are total losses. * Documents all settlements and actions in the claim file system. * Works directly with salvage vendor to move vehicles and obtains salvage bids where necessary * Negotiates and settles claims within his/her individual authority. Submits claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate. * Escalates claims to supervisor that are not moving in a positive direction. * Maintains an effective diary system on pending files. Prioritize and handle multiple tasks simultaneously. * Quickly adjusts to fluctuating workload and responsibilities. * Keeps involved parties and agents updated on the status of the claim and emerging issues. * Ensures that service, loss and expense control are maintained at all times. * Adheres to privacy guidelines, law and regulations pertaining to claims handling. * Prepares payments to vehicle owners, banks and lease companies. * This role will report in person to our Boston office, located directly across from South Station. Qualifications: * Property and casualty claims handling experience desired * Ability to work independently and in a team environment * Excellent oral and written communication skills * Excellent organizational skills * Solid problem solving skills * Proficient in Word, Excel, MS Outlook Salary Range: The pay range for this position is $50,000 to $73,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. Benefits & Perks: * Paid time off * Free onsite gym at our Boston location * Tuition reimbursement * Low cost and excellent health insurance coverage options that start on Day 1 (medical, dental, vision) * Robust health and wellness programs * Auto and home insurance discounts * Matching donation opportunities * Annual 401(k) employer contribution * Various Paid Family leave options including Paid Parental Leave * Resources to promote professional development * Convenient locations and pre-tax commuter benefits The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent". #LI-DNI

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

The Claims Analyst reviews, processes and analyzes healthcare claims to determine their validity and accuracy. They assess damages, verify policy coverage and ensure compliance with regulations and company procedures. Effective communication, problem-solving and attention to detail are crucial for this role. ESSENTIAL RESPONSIBILITIES: Reviews submitted claims for accuracy, completeness and adherence to policy terms and legal requirements. Analyzes claim data to identify trends, patterns, and potential irregularities. Communicates with stakeholders to gather information, explain decisions, and resolve issues. Investigates potential fraudulent claims and gathering supporting evidence. Makes informed decisions on claim validity and determining appropriate compensation. Maintains accurate and detailed records of claims processing and outcomes. Ensures adherence to relevant regulations and company policies. Performs other duties as required. JOB SPECIFICATIONS: High School Diploma. Associate's Degree preferred. 1-3 years of experience in data analysis in a customer service environment within healthcare insurance industry preferred. Experience analyzing data, identifying discrepancies and making informed decisions. Able to clearly explain complex information, both verbally and in writing. Able to identify and resolving issues related to claims processing. Strong attention to detail to ensure accuracy in claim review and data entry. Knowledge of Insurance/Healthcare, including understanding policy terms, coverage, and relevant regulations. Exceptional customer service skills. COVID vaccine preferred

Join us as a Claims Analyst IV to take on key responsibilities within a world-class claims function. Make your mark in Claims As a Claim Analyst IV, you will be responsible for handling all aspects of lawyers professional liability claims from inception through conclusion brought against insureds. The responsibilities for this role include making coverage determinations, investigating losses, evaluating, and projecting potential exposures, setting judgmental reserves, developing and implementing resolution strategies, managing outside law firms, working with underwriting on policy terms, trends and promoting client relationships. How you will create an impact Focused on Lawyers Professional Liability, you will be responsible for a portfolio of claims from coverage inquiry through legal liability assessment and quantum analysis, to timely and accurate resolution. Your goal will be timely, accurate and customer-focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense - you will actively promote and demonstrate the principles of ‘Treating Customers Fairly' in claims handling. You will communicate regularly with internal and external stakeholders in your role as a Lawyers Professional Liability claims expert and thought leader. As a valued member of the team, you will work closely with our underwriting partners to provide feedback on claim exposures and trends to inform decisions on the portfolio. You will also contribute to continuous improvement in Claims by ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all key internal and external stakeholders. What you'll need to succeed Experience handling third-party liability claims, litigation or other related experience. Lawyers professional liability claim and/or litigation experience preferred. Experience with professional liability or other financial lines insurance policies. Bachelor's Degree or equivalent required. Multi-state adjuster licenses and/or JD preferred. Experience in negotiation, mediation, arbitration and ADR skills in third party claims. Policy language skills enabling accurate and consistent policy wording interpretation. The ability to influence claims and non-claims stakeholders by effectively directing claims strategy. Ready to take your career to the next level? We would love to hear from you. For positions based in New York, the base salary range is $70,000-$95,000 and the position is eligible for a bonus in accordance with the terms of the applicable incentive plan. In addition, we're proud to offer a range of competitive benefits, a summary of which can be viewed here: 2025 Benefits Summary. #claims #claimsmanagement #arbitration #litigation #negotiation #complexclaims #financiallines #investigations #LI-NH1 At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike. Enjoy benefits that take care of what matters At AIG, our people are our greatest asset. We know how important it is to protect and invest in what's most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security-as well as your professional development-to bring peace of mind to you and your family. Reimagining insurance to make a bigger difference to the world American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world's most far-reaching property casualty networks. It is an exciting time to join us - across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become. Welcome to a culture of inclusion We're committed to creating a culture that truly respects and celebrates each other's talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG's greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations. AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories. AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to *********************. Functional Area: CL - ClaimsAIG Claims, Inc.

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Waltham, MA. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $25.00 an hour and up Sign-On Bonus: $5,000 for employees starting before January 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion

Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character. We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world? Learn more about our unique culture and history. Job Opportunity: Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss Senior Claims Auditor with knowledge of employer group health insurance, managed care, and direct medical claims products. This position will work with our Third-Party Administrator's (TPA's) daily with interaction with several other areas in our Medical Stop-Loss Division. The position is preferably located in our Indianapolis or Plymouth Meeting, PA office. We are open to candidates who could work from out Atlanta or Boston office as well. Duties & Responsibilities: Audit specific and aggregate claims for assigned complex blocks of business Audit and process claim reimbursements Verify claims are paid in accordance with the plan document and reimbursable under the Stop Loss policy Verify participant and dependent eligibility Maintain and exceed targeted claims accuracy standards Maintain accurate and detailed information for each file Conduct implementation calls for newly sold groups Review and approve plan documents and plan amendments Initiate and further cost containment opportunities Audit program business claims across several lines within our Accident & Health Division Assist management with implementation calls for new business sold Set and adjust reserves Qualifications, Skills, and Experience: Minimum of 5+ years' experience examining and auditing medical stop loss claims Proficient with Microsoft Office Suite, especially Excel Knowledge of group insurance, managed care, and direct medical claims products Demonstrate excellent mathematical, communication and customer service skills Excellent problem-solving and critical-thinking skills Detail/results-oriented Strong analytical skills Excellent customer service Knowledge of COB, Medicare, HIPAA, CPT, ICD9/ICD10, and interpretation of employer group health plan benefits Ability to work independently with minimal supervision while meeting or exceeding established turn-around-time, production, and accuracy standards BHSI Offers: A competitive package and exciting growth opportunities for career-oriented teammates A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework Benefits that support your life and well-being, which include: Comprehensive Health, Dental and Vision benefits Disability Insurance (both short-term and long-term) Life Insurance (for you and your family) Accidental Death & Dismemberment Insurance (for you and your family) Flexible Spending Accounts Health Reimbursement Account Employee Assistance Program Retirement Savings 401(k) Plan with Company Match Generous holiday and Paid Time Off Tuition Reimbursement Paid Parental Leave NOTE: This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization. The base salary range for this position is from $70,000 - $80,000 along with annual bonus eligibility; a candidate's actual salary is commensurate with experience as determined by their relevant skills, experience, and geographical location. We value our teammates - both their capabilities and character - as demonstrated by our amazing culture.