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Claim processor jobs in Cary, NC

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  • Injury Examiner

    USAA 4.7company rating

    Claim processor job in Chesapeake, VA

    Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Injury Examiner, you will be responsible to adjust complex bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy. This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week. What you'll do: Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. Serves as a resource for team members on complex claims. Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: High School Diploma or General Equivalency Diploma. 4 years auto claims and injury adjusting experience. Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations. Advanced negotiation, investigation, communication, and conflict resolution skills. Demonstrated strong time-management and decision-making skills. Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims. Ability to exercise sound financial judgment and discretion in handling insurance claims. Advanced knowledge of coverage evaluation, loss assessment, and loss reserving. Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. What sets you apart: 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage College Degree (Bachelor's or higher). Insurance Designation. Compensation range: The salary range for this position is: $85,040 - $162,550. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
    $46k-66k yearly est. Auto-Apply 1d ago
  • Claims Examiner

    Harriscomputer

    Claim processor job in North Carolina

    Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.
    $28k-46k yearly est. Auto-Apply 4d ago
  • Claims Examiner- Property Casualty

    Kinsale Management 4.0company rating

    Claim processor job in Richmond, VA

    Kinsale Insurance is an Excess & Surplus lines insurer specializing in hard-to-place, small to medium sized commercial accounts. Kinsale is eligible in all states and writes a variety of Property, Casualty and Specialty lines. Given the experience of our staff and our control over the underwriting and claims processes, Kinsale offers unmatched underwriting flexibility to brokers placing difficult E&S accounts. Kinsale will consider offering terms on a wide range of risks including accounts with new or high hazard operations and businesses that have a poor loss history or that are located in high-risk venues. We are hiring a Claims Examiner to join our Casualty Lines Division here in Richmond, VA. Responsibilities Responsible for handling a wide variety of moderate to complex Property Liability claims under the supervision of a Claims Supervisor Conducts investigation throughout all aspects of the claims process Determines liability, evaluates exposure, and negotiates claims to resolution Investigates and analyzes coverage; makes coverage determinations; drafts coverage correspondence; effectively communicates coverage determinations to policyholders and other stakeholders Maintains accurate documentation/information in claim file Handles claims in litigation filed against insureds; appoints, directs, and manages defense counsel Proactively drives litigation toward resolution Participates in and attends mediations to facilitate settlements Qualifications A minimum of 1- 2 years of experience handling property liability claims, or related industry experience Superior written and oral communication skills Strong analytical and problem-solving skills Strong organization and time management skills Exhibit skills in Microsoft Office products (Word, Outlook, Excel, Power Point) Ability to work in a collaborative environment Ability to multi-task Strong negotiation skills Proficiency in assigning and directing investigations Education and Certifications: Minimum of 2 years of professional work experience Four-year college degree At Kinsale we offer the following great benefits: Competitive salary with performance-based bonus opportunities Single and family health, dental, and vision insurance plans with a generous percentage of maximum HSA funds contributed by the company Short-term and long-term disability Life insurance Matching 401(k), fully vested from first day of contribution Generous paid time off and holidays Yearly reimbursement for educational training and development opportunities Promotion from within the company with clear goals and developed career paths Kinsale values strong financial responsibility. A credit check will be conducted as a part of the selection process for roles that require sound judgement, trustworthiness, or access to sensitive information.
    $35k-52k yearly est. 60d+ ago
  • Claim Examiner - Workers Comp (Southeast Experience Required)

    Sedgwick 4.4company rating

    Claim processor job in Raleigh, NC

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claim Examiner - Workers Comp (Southeast Experience Required) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **PRIMARY PURPOSE** **:** To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. **Experience** : Five (5) years of claims management experience or equivalent combination of education and experience required **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
    $25k-37k yearly est. 56d ago
  • Management Liability Claims Specialist

    IAT Insurance Group

    Claim processor job in Raleigh, NC

    IAT Insurance Group has an immediate opening for a Management Liability Claims Specialist that can be located in any of our IAT locations. This role works a hybrid schedule from an IAT Office. The hybrid schedule reflects our values (thinking and acting like an owner, collaboration, and teamwork) as it requires working from the office with colleagues and other disciplines Monday through Wednesday, with the option of working Thursday and Friday remotely. Responsibilities: Responsible for handling Management Liability Claims (EPL, D&O, Fiduciary and Crime) for Private and Non-Profit businesses based on Claim Guidelines Within authority limit, thoroughly analyze, investigate, negotiate and resolve all levels of severity claims Selects, directs and manages defense counsel including approval of budgets Develops litigation/file disposition strategy. Attends mediations, settlement conferences and trials Verifies/analyzes applicable coverage for the reported claims Follow operational policies and procedures, including compliance, regulatory and performance and customer service standards Prepare reports, including Large Loss Reports, to management which accurately reflects loss development, potential/actual financial exposure, coverage issues, claim and recovery strategies Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file Identifies and addresses recovery/contribution/SIU opportunities Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines. Drafts correspondence, including but not limited to, coverage letters to stakeholders as required Support business partners on an as needed basis on various claim and underwriting related issues and marketing meetings Maintains resident/nonresident adjuster licenses as required Performs other duties as assigned Qualifications: Must Have: Bachelor's Degree with 5+ years of management liability claims experience (including handling employment liability practices, directors & officers' liability and fiduciary liability coverages) or equivalent Equivalent experience is defined as 9+ years of relevant claims experience, specifically claims involving litigation. Excellent coverage analysis skills with experience in drafting coverage position correspondence Experience handling litigated files and direction of defense counsel Excellent negotiation skills Must be willing to travel, average 1 day a month Claims Licensure as required by respective state(s) Excellent oral and written communication skills Ability to organize, multi-task and prioritize work Excellent customer service and interpersonal skills Ability to analyze data, utilize sound judgment to draw conclusion and make supported decisions To qualify, applicants must be authorized to work in the United States and must not require, now or in the future, VISA sponsorship for employment purposes Preferred to Have: CPCU and other insurance related studies Our Culture IAT is the largest private, family-owned property and casualty insurer in the U.S. I nsurance A nswers T ogether is how we define IAT, in letter and in spirit. We work together to provide solutions for people and businesses. We collaborate internally and with our partners to provide the best possible insurance and surety options for our customers. At IAT, we're committed to driving and building an open and supportive culture for all. Our employees propel IAT forward - driving innovation, stable partnerships and growth. That's why we continue to build an engaging workplace culture to attract and retain the best talent. We offer comprehensive benefits like: 26 PTO Days (Entry Level) + 12 Company Holidays = 38 Paid Days Off 7% 401(k) Company Match and additional Profit Sharing Hybrid work environment Numerous training and development opportunities to assist you in furthering your career Healthcare and Wellness Programs Opportunity to earn performance-based bonuses College Loan Assistance Support Plan Educational Assistance Program Mentorship Program Dress for Your Day Policy 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. We maintain a drug-free workplace and participate in E-Verify. Compensation: Please note, that the annual gross salary range associated with this posting is $60,600 - $95,700. This range represents the anticipated low and high end of the base salary for this position. Actual salaries will vary based on factors such as a candidate's qualifications, skills, competencies, and geographical location related to this specific role. The total compensation will include a base salary, performance-based bonus opportunities, 401(K) match, profit-sharing opportunities, and more. To view details of our full benefits, please visit **************************************************
    $60.6k-95.7k yearly 60d+ ago
  • Claims Analyst/Lead Claims Analyst/Senior Claims Analyst (Full-Time)

    MBP 4.1company rating

    Claim processor job in Raleigh, NC

    MBP is looking for Claims Analyst/Lead Claims Analyst/Senior Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Highly proficient in Oracle P6 and experienced with one or more of the following: Microsoft Project, Phoenix Project Manager, or similar. Responsibilities Main Duties: Performs review and analysis of construction claims. Assists with development of contractor claims. Develops and/or review time extension requests. Assist with development of expert reports and exhibits. Qualifications Education B.S. in Civil Engineering, Construction Management, or relevant experience which equates to this degree. P.E. license, Certified Construction Manager, Planning and Scheduling Profession, or similar, certification preferred. Skills and Abilities Experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Experience drafting expert reports and deliverables. Proficient in Oracle P6 required and experienced with Microsoft Project desired. Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration. Ability to relate technical knowledge to a non-technical audience. Proficiency in reading/understanding construction plans and specifications. Proficiency with Microsoft Office software programs including Word, Excel, and PowerPoint. Experience providing training, supervision, proposal development, and business development desired. Occasional overnight travel may be required. STATUS: Full-time BENEFITS: Competitive compensation with opportunities for semi-annual bonuses Generous Paid Time Off and holiday schedules 100% Employer paid medical, dental, vision, life, AD&D, and disability benefits (for individual) Health Savings Account with company contribution 401(k)/Roth 401(k) plan with company match Tuition Assistance and Student Loan Reimbursement Numerous Training and Professional Development opportunities Wellness Program & Fitness Program Reimbursement Applicants must be authorized to work in the U.S. without sponsorship. MBP is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Protected veterans and individuals with disabilities are encouraged to apply.
    $57k-84k yearly est. Auto-Apply 60d+ ago
  • Associate Claims Examiner - Equine

    Markel 4.8company rating

    Claim processor job in Richmond, VA

    What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills. Job Responsibilities Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Conducts, coordinates and directs investigation into loss facts and extent of damages. Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure. Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents. Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting. Required Qualifications This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred. Must have or be eligible to receive claims adjuster license. Successful completion of basic insurance courses or achievement of industry designations. Ability to be trained in insurance adjusting up to two years of claims experience. 2-4 years of experience in general liability, construction defect, or related liability lines preferred. Bachelor's degree preferred Excellent written and oral communication skills. Strong organizational and time management skills. # LI-Hybrid US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose ‘Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.
    $34k-49k yearly est. Auto-Apply 14d ago
  • Claims Analyst/Lead Claims Analyst/Senior Claims Analyst (Full-Time)

    McDonough Bolyard Peck, Inc. (Mbp

    Claim processor job in Raleigh, NC

    MBP is looking for Claims Analyst/Lead Claims Analyst/Senior Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Highly proficient in Oracle P6 and experienced with one or more of the following: Microsoft Project, Phoenix Project Manager, or similar. Responsibilities Main Duties: Performs review and analysis of construction claims. Assists with development of contractor claims. Develops and/or review time extension requests. Assist with development of expert reports and exhibits. Qualifications Education B.S. in Civil Engineering, Construction Management, or relevant experience which equates to this degree. P.E. license, Certified Construction Manager, Planning and Scheduling Profession, or similar, certification preferred. Skills and Abilities Experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Experience drafting expert reports and deliverables. Proficient in Oracle P6 required and experienced with Microsoft Project desired. Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration. Ability to relate technical knowledge to a non-technical audience. Proficiency in reading/understanding construction plans and specifications. Proficiency with Microsoft Office software programs including Word, Excel, and PowerPoint. Experience providing training, supervision, proposal development, and business development desired. Occasional overnight travel may be required. STATUS: Full-time BENEFITS: Competitive compensation with opportunities for semi-annual bonuses Generous Paid Time Off and holiday schedules 100% Employer paid medical, dental, vision, life, AD&D, and disability benefits (for individual) Health Savings Account with company contribution 401(k)/Roth 401(k) plan with company match Tuition Assistance and Student Loan Reimbursement Numerous Training and Professional Development opportunities Wellness Program & Fitness Program Reimbursement Applicants must be authorized to work in the U.S. without sponsorship. MBP is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Protected veterans and individuals with disabilities are encouraged to apply.
    $42k-73k yearly est. Auto-Apply 32d ago
  • Claims Specialist - Executive Claims Specialist - Coverage - Claims-Made

    James River Holdings 4.7company rating

    Claim processor job in Richmond, VA

    Under minimal supervision, the Claims Specialist/Executive Claims Specialist manages a caseload of high complexity commercial insurance claims focused on Allied Health (assisted living and skilled nursing facilities). The Claims Specialist will review claims to analyze land determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty. Duties and Responsibilities Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service Perform coverage, liability, and damage analysis on all claims assignments Investigate allegations, determine facts based on evidence and interviews Draft disclaimers and reservation of rights letters when coverage issues arise Assign limited investigations and appraisals to independent licensed professionals Manage a caseload of high complexity claims with delegated authority Manage litigated files Negotiate settlements, mitigate losses, and control expenses Participate in and attend mediations to facilitate settlements Maintain accurate documentation in claim files Maintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokers Act as a consultant providing technical expertise within specialty area to internal stakeholders Provide technical guidance, assistance and training as needed for less experienced Claims professionals Maintain a passing quality assurance score on all audits and QAs Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity Handle claims in accordance with established James River Claims Best Practices Other duties as required by management Knowledge, Skills and Abilities Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL) Expert level of expertise in claim handling and suit management Expert knowledge of P&C insurance industry Expert ability to effectively assess risk Proficiency in MS Office (Word, Excel, Outlook) Excellent written and verbal communication skills Advanced analytical and organizational skills Advanced negotiation skills Ability to work independently and take initiative Ability to exercise sound judgement in making critical decisions Research, analysis and problem-solving skills Ability to work in a team environment and accept feedback from Claims management Ability to build effective relationships with business partners Ability to organize complex information and pay close attention to detail Ability to anticipate customer needs and take initiative to meet those needs Ability to train and provide technical guidance to less experienced Claims professionals Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter Experience and Education Claims Specialist High school diploma required Bachelor's Degree preferred Advanced Degree or Juris Doctorate Degree preferred Minimum of seven years of experience handling primary and excess claims-made and occurrence liability policies and claims. Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills Adjuster license and/or certifications desired preferred Executive Claims Specialist High school diploma required Bachelor's Degree preferred Advanced Degree or Juris Doctorate Degree preferred Minimum of ten years of experience handling primary and excess claims-made and occurrence liability policies and claims. Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL) Project management and process implementation experience preferred #LI-KS1 #LI-Remote
    $49k-89k yearly est. 17d ago
  • Claims Processing Expert

    The Strickland Group 3.7company rating

    Claim processor job in Raleigh, NC

    Join Our Dynamic Insurance Team - Unlock Your Potential! Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for our next leaders-those who want to build a career or an impactful part-time income stream. Is This You? ✔ Willing to work hard and commit for long-term success? ✔ Ready to invest in yourself and your business? ✔ Self-motivated and disciplined, even when no one is watching? ✔ Coachable and eager to learn? ✔ Interested in a business that is both recession- and pandemic-proof? If you answered YES to any of these, keep reading! Why Choose Us? 💼 Work from anywhere - full-time or part-time, set your own schedule. 💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month. 📈 No cold calling - You'll only assist individuals who have already requested help. ❌ No sales quotas, no pressure, no pushy tactics. 🧑 🏫 World-class training & mentorship - Learn directly from top agents. 🎯 Daily pay from the insurance carriers you work with. 🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Ownership opportunities - Build your own agency (if desired). 🏥 Health insurance available for qualified agents. 🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom. 👉 Apply today and start your journey in financial services! ( Results may vary. Your success depends on effort, skill, and commitment to training and sales systems. )
    $27k-34k yearly est. Auto-Apply 40d ago
  • Claims Investigator - Experienced

    Command Investigations

    Claim processor job in Raleigh, NC

    Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR zXwwJNzVpn
    $41k-57k yearly est. 15d ago
  • Property and Casualty Claims Specialist

    Metis 4.3company rating

    Claim processor job in Roanoke, VA

    Job Description METIS | Location: Roanoke, VA | Full-Time Are you seeking a professional career in Roanoke? Do you like solving problems, analyzing details, and helping people? At Metis, we take a unique approach to commercial insurance through administering self-insurance Risk Pools. If you are looking for a change and a challenge, we're looking for a dedicated Property and Casualty Claims Specialist to join our growing team. What You'll Do: Manage and resolve property and casualty and/or general liability claims Assess and evaluate claims, conduct investigations, and ensure documentation is collected Build relationships with members and help claimants navigate the claims process What You Bring: Bachelor's Degree or higher - required 7+ years of experience in property and casualty claims handling Strong knowledge of policy analysis and associated legal issues A team player with excellent communication and a customer focused mindset *Please be sure to fully complete and upload the attached “Application for Employment” form along with your electronic application. Incomplete submissions may not be considered. What We Offer: Competitive compensation and performance bonuses Individual dental, life, short-term & long-term disability insurance at no cost Medical insurance with wellness incentives Health Savings Account with annual company contribution 401(k) with 200% company match up to 6% of salary Generous paid time off, including vacation, sick leave, and 11 paid holidays Support for continuing education and professional growth A beautiful campus with a collaborative, supportive, wellness-focused culture including onsite gym and café
    $48k-86k yearly est. 27d ago
  • Liability Insurance Manager

    Duke University 4.6company rating

    Claim processor job in Durham, NC

    At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Generous PTO and Excellent Medical Benefits General Description of the Job Class At the direction of the Assistant Vice President, Risk Management, the Insurance Manager will provide general support to the DUHS Clinical Risk Management Department. * Provide administrative direction and support to the professional liability insurance program for Duke University Health System and affiliated organizations. This support includes: * Identification of both insurable and non insurable risk * Advising department leadership and other internal clients of potential exposures * Proposing risk reduction strategies * Proposing risk financing mechanisms, including potential insurance coverage or financial transfer of risk * Maintain familiarity with insurance markets and stability Duties and Responsibilities of this Level * Research, evaluate, and make recommendations regarding current and state of the art trends in risk financing, loss control and claims management strategies. * Assist with professional liability insurance coverage program development, including working with brokers at all levels to obtain coverage, renew coverage, and revise coverage as needed. * Provide consultation and technical advice on professional liability insurance issues relating to new programs, contracts, and affiliation agreements. * Working with Corporate Finance, maintain and continually revise as needed the financial and operational records that support the insurance, risk management, and legal operations affecting professional liability exposures. * Responsible for data management including statistical trending of losses, analysis of patterns, and analysis of incurred costs. * Responsible for data collection, verification, and transmission of exposure data to actuary, auditors and brokers, and others as required. * Review and maintain insurance policies, analyzes existing policies for coverage, endorsements and exclusions, anticipates and deals with policy expirations and renewals. * Coordinate coverage with DU Corporate Risk Management in areas where exposures and responsibilities overlap. Develop and prepare insurance program presentations as needed. * Participate in setting, documentation and ongoing evaluation of reserves. * Develop ongoing analysis of current losses as they might or will impact breach of reinsurance. Assures appropriate notifications are transmitted. * Supervise insurance support staff and oversee the documentation of provider claims histories, insurance verifications, and maintaining records of off-site and expert witness activities. * All other duties incidental to the work described herein. Required Qualifications at this Level Education: Work normally requires a Bachelor's degree in Insurance, Risk Management, Business Administration, Hospital Administration, Law or a closely related field. Experience: Work requires a minimum of five years of progressively responsible experience in third-party insurance, risk financing or captive insurance management. Prior experience must include contract and insurance policy review and projection/management of financial reserves. Degrees, Licensure, and/or Certification: Associate in Risk Management (ARM), or Certified Property and Casualty Underwriter (CPCU) designation preferred. Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Nearest Major Market: Durham Nearest Secondary Market: Raleigh
    $32k-58k yearly est. 31d ago
  • Inventory Claim Specialist

    Kioti Tractor

    Claim processor job in Wendell, NC

    Job Description Inventory Claims Coordinator Department: Warehouse Operations - 171032 Reports to: Inventory Supervisor Full-time Status: Hourly, Non-Exempt Management Level: Non-Management JOB SUMMARY The Inventory Claims Coordinator serves as a support element and liaison for all distribution centers and the dealer network. This person will be cross trained and gain exposure to many functions including claims processing, inventory investigations, dealer network relationship building and recording claim data. KEY RESPONSIBILITIES OF JOB The Inventory Claims Coordinator key responsibilities are outlined below: Claims: Resolve and process claim disputes Technical drawing look-up Inventory background investigations Credit and Debit process on claim investigations Issuing and monitoring call tags Resolve and process freight claim disputes and tracking reimbursement if applicable Inventory Management Provide inventory control reporting and vendor reports Track claim data and communicate common themes for mitigation Directly or indirectly locate misplaced parts to help satisfy sale to customer/dealer Help maintain or relay proper product identification and location accuracy and ability to transfer product to correct location if needed Other Responsibilities Determine and record data for KPI's Promote dealer satisfaction utilizing customer service skills EDUCATIONAL AND PHYSICAL REQUIREMENTS High school diploma or GED equivalent required with minimum of 3 years' related experience Associate or Bachelor degree with a minimum of 1 year experience 1-5 Years of related customer service or inventory experience. Must be a team player with strong interpersonal communication skills Good time-management skills and attention to detail Outstanding written and oral communication skills with the ability to effectively present information Proficiency in Microsoft programs, including Excel, a plus SAP experience preferred SalesForce experience preferred
    $31k-55k yearly est. 6d ago
  • Auto Claims Representative

    Auto-Owners Insurance 4.3company rating

    Claim processor job in Raleigh, NC

    Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to: Investigate, evaluate, and settle entry-level insurance claims Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products Learn and comply with Company claim handling procedures Develop entry-level claim negotiation and settlement skills Build skills to effectively serve the needs of agents, insureds, and others Meet and communicate with claimants, legal counsel, and third-parties Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements Desired Skills & Experience Bachelor's degree or direct equivalent experience with property/casualty claims handling Ability to organize data, multi-task and make decisions independently Above average communication skills (written and verbal) Ability to write reports and compose correspondence Ability to resolve complex issues Ability to maintain confidentially and data security Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Continually develop product knowledge through participation in approved educational programs Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-AT1 #LI-Hybrid
    $30k-39k yearly est. Auto-Apply 11d ago
  • Medical Coding Appeals Analyst

    Elevance Health

    Claim processor job in Norfolk, VA

    Sign On Bonus: $1,000 **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law This position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. + Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. + Translates medical policies into reimbursement rules. + Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. + Coordinates research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre-adjudication claims reviews to ensure proper coding was used. + Prepares correspondence to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when new/modified reimbursement contracts are needed. **Minimum Requirements:** Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. **Preferred Skills, Capabilities and Experience:** + CEMC, RHIT, CCS, CCS-P certifications preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $31k-49k yearly est. 60d+ ago
  • Claims Specialist

    Capsigna

    Claim processor job in Charlotte, NC

    Responsibilities: Processing fast paced inbound customer service calls. Taking inbound calls from clients Providers, Consumers and Insurance companies regarding medical billing. Resubmitting claims, and answering questions regarding benefits Demonstrates excellent customer service skills with the ability to take ownership in assisting, researching and resolving customer issues. Performs other duties as assigned. Requirements Previous Call Center or Customer Service experience preferred. Ability to develop rapport and demonstrate a caring attitude. Clear, distinct oral and written communication skills. Must be detail oriented.
    $30k-54k yearly est. 60d+ ago
  • Claims Representative II

    Berkley 4.3company rating

    Claim processor job in North Carolina

    Company Details With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results. All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P. For further information about Key Risk please visit *************** The company is an equal opportunity employer. Responsibilities Key Risk is looking for a Claims Representative who enjoys analysis and management of workers compensation claims. Key functions include but are not limited to the following: Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Negotiate settlement of claims up to designated authority level and makes claims payments. Calculates and assigns timely an appropriate reserve to claims and continues to manage reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. Prepares necessary state filings within statutory limits. Actively manages the litigation process; ensures timely and cost-effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. Frequently communicates with all appropriate parties involved with the claim. Maintains professional client relationships. Actively executes appropriate claims activities to ensure consistent delivery of quality claims services. Qualifications BA/BS Degree 2-3 years of workers compensation claims experience Adjuster license strongly desired or ability to obtain license within six months Knowledge of appropriate insurance principles and laws of workers' compensation, preferably jurisdiction specific. Strong verbal and written communication Strong interpersonal, time management and organizational skills. Strong negotiation skills. Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail. Ability to perform with a sense of urgency. Ability to work both independently and within a team environment. Ability to travel for business purposes, approximately less than 10%. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
    $41k-56k yearly est. Auto-Apply 3d ago
  • Experienced Outside Property Claim Representative

    Travelers Insurance Company 4.4company rating

    Claim processor job in Ashburn, VA

    **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** $67,000.00 - $110,600.00 **Target Openings** 1 **What Is the Opportunity?** This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Chantilly, Fairfax, Manassas, Springfield areas.. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. 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. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (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 with multiple constituents, i.e.; contractors or insured's representatives 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 provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. + 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. + On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). 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. + General knowledge of estimating system Xactimate preferred. + Two or more years of previous outside property claim handling experience preferred. + Interpersonal and customer service skills - Advanced + Organizational and time management skills- Advanced + Ability to work independently - Intermediate + Judgment, analytical and decision making skills - Intermediate + Negotiation skills - Intermediate + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate + Investigative skills - Intermediate + Ability to analyze and determine coverage - Intermediate + Analyze, and evaluate damages -Intermediate + Resolve claims within settlement authority - Intermediate + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED required. + A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. + Valid driver's license required. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We 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 ******************************************************** .
    $30k-46k yearly est. 53d ago
  • Claims Specialist

    PRG 4.4company rating

    Claim processor job in Charlotte, NC

    Project Resources Group (PRG) is seeking a Claims Recovery Specialist for our Charlotte, NC office. Be part of our expanding team focused on recovering third-party property and utility damage claims, primarily in a B2B setting. We're looking for motivated, detail-oriented professionals with strong negotiation skills. Experience in collections or insurance adjusting is highly relevant and transferable. We offer a competitive base salary plus commission. Key Responsibilities Resolve and negotiate claims recovery of repair and replacement costs on third-party cable/fiber and utility damages across multiple state lines, via phone, email, and letters. Work directly with liable parties' insurance providers to defend and negotiate claims settlements. Collaborate with claims departments and management of liable parties, from small businesses to large corporations to municipalities. Learn, understand, and be able to utilize state dig laws and statutes, 811 excavator requirements, NESC standards, CGA guidelines, etc. Develop a professional working relationship with damaging parties, on-site field investigators, management, and other personnel. Conduct 40-50 inbound/outbound calls daily, approximately 2-2.5 hours of total talk time throughout the day. Enter notes and documentation throughout the recovery process into the company's proprietary Claims Database Tool. Use a calendar and diary system to coordinate handling claims to be worked twice weekly. Follow advanced claim handling procedures as detailed by the OPD Claims Manager. Use photographs, narratives, job costs, site sketches, locate tickets, and other components on-site field investigators provide to visualize and understand the damage scene to defend liability accurately. Participate in weekly department meetings to discuss individual and team recovery tactics, strategies, and goals. Maintain a working knowledge of the entire PRG claims recovery process. Preferred Qualifications Strong proficiency in Microsoft Word, Outlook, and Excel. Tech-savvy with the ability to quickly adapt to new software and systems. Excellent written and verbal communication skills, with an emphasis on professional phone and email correspondence. Familiarity with the construction, cable, or utility locate industries is advantageous. Understanding of B2B construction, claims management, recovery, or insurance claim negotiation and settlement processes is preferred. Ideally, 3-5 years of experience in claims, recovery, and/or the insurance industry. College education is preferred. Bilingual in Spanish is a plus. Compensation and BenefitsWe offer a competitive hourly pay ($19-$23/hour based on experience), plus the potential to earn substantial commissions up to $4,000-$10,000 monthly based on performance. Along with a comprehensive benefits package, including: Medical, dental, and vision coverage for employees and dependents 401(k) retirement plan, with company match after 1 year Short-term disability coverage after 1 year Paid time off and holidays Additional perks such as company-paid life insurance, and other supplemental insurances available About PRG Since 2001, PRG has been a leader in construction management and outside plant damage recovery for the telecommunications and utility industries. With 20+ offices and 800+ employees nationwide, we deliver industry-leading solutions with speed, accuracy, and expertise. Equal Opportunity EmployerPRG is proud to be an Equal Opportunity Employer. PRG does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state, or local law and ordinances.#INDCS
    $19-23 hourly Auto-Apply 60d+ ago

Learn more about claim processor jobs

How much does a claim processor earn in Cary, NC?

The average claim processor in Cary, NC earns between $23,000 and $59,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average claim processor salary in Cary, NC

$37,000

What are the biggest employers of Claim Processors in Cary, NC?

The biggest employers of Claim Processors in Cary, NC are:
  1. Sedgwick LLP
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