Claim processor jobs in Cleveland, OH

SummaCare - 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days * Hybrid after training As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits. Summary: Accurately and efficiently handles claims in accordance with regulatory and contractual guidelines. Reviews claims related to coordination of benefits, medical coding, and authorization allocation while ensuring compliance with established policies. Applies cost-containment strategies in collaboration with vendor partners to minimize claim expenses while adhering to plan-specific processing rules. are essential for success in this position. 1. Formal Education Required: a. High School Diploma or equivalent 2. Experience & Training Required: a. One (1) year experience to include any combination of the following: i. Health insurance claims processing ii. Health claims data entry including Document Management Services (DMS) iii. Customer service experience in a managed care environment iv. Physician or hospital billing v. Patient accounts Essential Functions: 1. Requires close attention to detail with independent judgment, decision making and problem solving skills necessary to complete the task being performed 2. Organizes reference materials for easy access; manages time to accurately complete tasks within time frames in a fast paced environment 3. Processes all types of claims, promptly and accurately, as assigned via the document management system, and ensures self-funded service standards, prompt pay standards, and regulatory requirements are met. 4. Maintains a working knowledge of the claims processing system, imaging system, key-stroke emulation system, code editing application, claims processing policies & procedures, and unique benefits/processing rules for self-funded, Medicare, MEWA, Marketplace and fully-insured plans. 5. Escalates questions or concerns to their mentor for evaluation and potential referral to the Claims Management staff for action plan and resolution 6. Meets or exceeds claims production and quality standards as established/communicated by Claims Management staff 7. Coordinates information and resolves service forms and other assignments promptly, in accordance with experience/capabilities. Handles special projects within timeframes established/assigned by supervisor 3. Other Skills, Competencies and Qualifications: a. Strong independent judgment and decision-making skills b. MS-windows based computer environment c. Medical terminology, CPT, HCPCs and ICD-10 knowledge d. Familiar with professional (CMS1500) and institutional (UB-04) claim types 4. Level of Physical Demands: a. Sit for prolonged periods of time b. Bend, stop and stretch c. Lift up to 20 pounds d. Manual dexterity to operate computer, phone and standard office machines Equal Opportunity Employer/Veterans/Disabled $19.23/hr - $23.08/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. * Basic Life and Accidental Death & Dismemberment (AD&D) * Supplemental Life and AD&D * Dependent Life Insurance * Short-Term and Long-Term Disability * Accident Insurance, Hospital Indemnity, and Critical Illness * Retirement Savings Plan * Flexible Spending Accounts - Healthcare and Dependent Care * Employee Assistance Program (EAP) * Identity Theft Protection * Pet Insurance * Education Assistance * Daily Pay

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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 Claims Examiner - Auto/Bodily Injury **PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. + Responsible for litigation process on litigated claims. + Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. + Reports large claims to excess carrier(s). + Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. **Skills & Knowledge** + In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **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**

Job Description McGregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home. We are seeking a highly motivated and dedicated Junior Claims Analyst to join our team at PACE. As a Junior Claims Analyst, you will be responsible for supporting the administration and operation of the McGregor PACE health plan. This role contributes to the efficiency of claims processing by reviewing documentation, analyzing claim details, and assisting with daily tasks. Location: THIS IS A HYBRID ROLE Pay Range - $22.00-$24.00 Responsibilities: Prepare all claims appeals for review by the Director of Health Plan Operations. Code the IBNR (Incurred but Not Reported) report by identifying the appropriate accounts within the Monthly Paid Claims report Monitor enrollments and disenrollments using the Daily Transaction Reply Report (DTRR) and communicate results for follow-up. Update the rosters folder on SharePoint with participant subsidy letters. Review the claims listed on the Pend reports to see if they meet contracted terms and release for payment when verified. Verify that the End-Stage Renal Disease (ESRD) payments reported on the Monthly Membership Report (MMR) align with the total number of participants receiving these services. Communicate discrepancies as needed. Research external providers' inquiries regarding accuracy and status of payments. Prepare the weekly authorization manifest and submit it to our third-party claims administrator. Process, review, and summarize scheduled claim detail reports as well as ad-hoc requests. Complete other duties assigned by the Senior Claims Analyst or Director of Health Plan Operations. Minimum Qualifications: High School diploma (required). Strong verbal and written communication skills (required). Excellent customer service and organizational skills (required). Proficiency in Windows, Word, Excel, and PowerPoint (required). Reliable transportation (required). Preferred Qualifications: Associate's degree (preferred). Healthcare and/or industry experience (preferred). Strong analytical and problem-solving skills (preferred). A keen eye for detail when reviewing documentation and ensuring accuracy in claims processing systems (preferred).

Job Details Wooster, OH Millersburg, OH; Newark, OH; Orrville, OH; Uniontown, OHDescription The Claims Specialist is responsible for providing prompt, effective assistance to clients and third parties reporting and settling claims with our agency. They also act as a liaison between the agency and carriers and assist others in the agency with service regarding claims activity. ESSENTIAL JOB RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty adequately. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reports loss/claim information to the appropriate carrier the same day it is received. Gives prompt and courteous service on a same-day basis to all clients. Takes first reports of claims. Organizes claim information on forms and submits claim to appropriate carrier. Sets expectations of the claim process including time frames, deductibles, restoration companies and adjustors. Follows up with insurance companies for the timely and accurate settlement of losses. Responds to customers' inquiries and questions regarding the status of loss within 24 hours of inquiry. Follows all systems, procedures, and insurance company regulations. Authorizes claim payments within agency authority. Coordinates, as necessary, any activities between clients and claim adjusters. Complete weekly and monthly reports of claims notifications and updates. Notifies risk advisor and/or management of severe losses over $100,000. Provides updates to management and or appropriate risk advisor/customer service for clients with severe or frequent losses. Deals promptly and with full integrity with all carrier claims personnel, responding within 24 hours to any request for action or information Qualifications REQUIREMENTS: Knowledge, Skills, and Ability Extensive knowledge of claims procedures and insurance coverage Ability to satisfy the needs of the customer, both internal and external, needs little assistance from others in this endeavor Strong negotiating, decision-making, and relationship building skills Excellent customer service and teamwork skills Ability to interact with employees, customers and vendor companies Working knowledge of computer software packages including Microsoft Word, Excel and Outlook programs Ability to use general office equipment, including a computer, calculator, typewriter, fax machine, copier and telephone Ability to learn and perform new duties and responsibilities Education or Experience High school diploma. Bachelor's degree preferred. Must be willing to work toward industry designations Requires current driver's license Working Environment/ Physical Activities General office work environment. Requires regular use of arms, hands, and fingers. Frequently required to sit for extended periods of time, reach with arm and hands, stand, walk, stoop, talk and hear. Required to lift and/or move up to 10 pounds. Ability to work during regular business hours (8:00am-5:00pm), if required. Travel as needed. HIPAA Compliance This position may have access to Protected Health Information (PHI) and Electronic Protected Health Information (ePHI). An employee will be responsible for following the guidelines of the HIPAA Confidentiality Agreement. Note: This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with this job. The employee is expected to perform those duties listed as well as other related duties directed by management.

About Us We're not like other insurance companies. From our specialty products to our business model, our culture to our results - we're different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn't just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us. RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar - a testament to our culture and validation of our reputation as an excellent underwriting company. Principal Duties & Responsibilities * Proactively handle Personal Umbrella Liability claims (auto, premises and personal liability) with a detailed focus on claim investigation, evaluation, and monitoring of primary carrier activity to achieve optimum results. * Effectively investigate and analyze complex coverage issues and write coverage letters as appropriate. * Complete timely and thorough investigations into liability and damages for early exposure recognition. * Focus on claims resolution with timely and effective liability investigations and damage evaluations and reserve setting. * Handle claims in accordance with RLI's Best Practices. Education & Experience * Typically requires a bachelor's degree and 6+ years of relevant legal or technical claims experience. * Experience handling large exposure third-party liability claims on a primary/excess basis is preferable. * Significant experience in effective handling of policy limit demands in states such as Florida, Texas and California. * Must be able to excel in a fast-paced environment with little supervision. * Effectively work with primary carriers and defense counsel and understand umbrella/excess handling and management of outside counsel. * Ideal candidate will have superior working knowledge of Florida, California, New York and Texas case law, statutes and procedures impacting the handling and value of liability claims. Knowledge, Skills, & Competencies * Ability to use analytical methods in complex claim processes to find workable solutions. * Ability to generate innovative solutions within the claims department. * Ability to communicate findings and recommendations to internal and external contacts on claim matters. Compensation Overview The base salary range for the position is listed below. Please note that the base salary is only one component of our robust total rewards package at RLI. The salary offered will take into account a number of factors including, but not limited to, geographic location, experience, scope & responsibilities of the role, qualifications/credentials, talent availability & specialization, as well as business needs. The below range may be modified in the future. Base Pay Range $108,348.00 - $157,917.00 Total Rewards At RLI, we're all owners. We hire the best and the brightest employees and allow them to share in the company's success through our Total Rewards. With the Employee Stock Ownership plan at its core, the Total Rewards program includes all compensation, benefits and perks that come with being an RLI employee. Financial Incentives * Annual bonus plans * Employee stock ownership plan (ESOP) * 401(k) - automatic 3% company contribution * Annual 401k and ESOP profit-sharing contributions (Up to 15% of eligible earnings) Work & Life * Paid time off (PTO) and holidays * Paid volunteer time off (VTO) to support our communities * Parental and family care leave * Flexible & hybrid work arrangements * Fitness center discounts and free virtual fitness platform * Employee assistance program Health & Wellness * Comprehensive medical, dental and vision benefits * Flexible spending and health savings accounts * 2x base salary for group life and AD&D insurance * Voluntary life, critical illness, & accident insurance for purchase * Short-term and long-term disability benefits Personal & Professional Growth RLI encourages its employees to pursue professional development work in insurance and job-related areas. We make a commitment to employees to provide educational opportunities that help them enhance their skills and further their career advancement. RLI fosters a true learning culture and encourages professional growth through insurance courses, in-house training and other educational programs. RLI covers the cost for most programs and employees typically earn a bonus upon successful completion of approved courses and certifications. Our personal and professional growth benefits include: * Training & certification opportunities * Tuition reimbursement * Education bonuses Diversity & Inclusion Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers. We actively support, and participate in, initiatives led by the American Property Casualty Insurance Association that aim to increase diversity in the insurance industry. Cultivating an exceptional and diverse workforce to deliver excellent customer service reinforces our culture and is a key to achieving superior business results. RLI is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.

Seeking experienced Full-Time to Part-Time Private Investigators to conduct SURVEILLANCE as it relates to the investigation of suspect insurance claims. We are seeking individuals who possess proven investigative skill sets within the industry. Honesty, integrity, self-reliance, resourcefulness, independence, discipline, and a calm intensity are a few characteristics of our Investigators and staff. Investigators with Scene Investigation and Recorded Statement experience are encouraged to apply. 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 ****************** Requirements: 1+ years of experience as an Surveillance Investigator Must be licensed as a Private Investigator in your state (if required) Flexibility to work varied/irregular hours and days including weekends and holidays Valid state issued driver's license The Surveillance Investigator should demonstrate proficiency in the following areas: Obtaining quality surveillance video evidence Writing accurate and detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations 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 offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. 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-DNI

A Third-Party Claims Supervisor is responsible for overseeing a team of claim representatives and claim specialists who manage claims made by individuals or entities against our clients. The core objective is to ensure that claims are handled accurately, efficiently, and in compliance with all relevant laws, regulations, and company policies, while also providing excellent customer service and team leadership. ESSENTIAL DUTIES & RESPONSIBILITIES: Includes, but is not limited to, the following: Team Supervision and Management: Supervise and manage a team of claims adjusters/specialists, including hiring, training, mentorship, coaching plans and performance evaluations. Claims Oversight: Oversee the start-to-end claims process, including intake, investigation, evaluation, negotiation, and settlement of claims. Quality Assurance & Compliance: Conduct regular quality audits of staff work to ensure compliance with company policies, procedures, and all applicable state and federal regulations. Complex Claim Resolution: Act as an escalation point for complex or contentious claims, assisting staff with coverage investigations, liability analysis, and settlement negotiations. Workflow & Efficiency: Monitor team workloads, manage diaries, and implement process improvements to optimize performance, productivity, and customer satisfaction. Communication & Reporting: Serve as a liaison between the company, clients, claimants, attorneys, and other third parties. Prepare and present reports on claim metrics, trends, and operational performance to management. Reserve Management: Ensure the appropriate and timely establishment and adjustment of claim reserves to reflect potential exposure. Litigation Support: Coordinate with the client, legal counsel and third-party administrators (TPAs) on litigated claims. Fraud Detection and Prevention: Monitor claims to identify potential fraud, referring suspicious activities to appropriate authorities and/or management. Data Analysis and Trend Identification: Analyze claims data and statistics to identify patterns, trends, and areas for process improvements or risk management strategies for clients and internal departments. Vendor and Service Partner Management: Manage relationships with external service providers such as independent adjusters, appraisers, and contractors, ensuring quality and cost-effectiveness of their services. Client Relationship Management (for TPAs): Serve as a primary point of contact for self-insured clients, providing detailed reports, participating in client reviews, and ensuring service level agreements (SLAs) are met. Mentorship and Professional Development: Create professional development plans for employees, provide ongoing technical advice and guidance to staff, and assist with their performance evaluations, promotion, retention, and termination activities. License Tracking and Record Keeping: Maintain an accurate and up-to-date database or system of all required department, facility, or individual employee licenses, permits, and certifications. This includes tracking expiration dates, status, and related documentation. Maintaining Licensing: Maintain insurance adjuster licensing as required in all states. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. EDUCATION and/or EXPERIENCE: High School Diploma/GED: This is the basic minimum requirement for entry-level claims roles. Associate's or Bachelor's Degree: Most employers prefer candidates with a degree in Business Administration, Finance, Risk Management, Insurance, or a related field. Prior Claims Experience: A minimum of 2-5 years of technical experience in claims processing or adjusting is typically required. This experience should ideally involve handling complex or litigated claims, coverage investigations, and liability analysis. Supervisory/Leadership Experience: Previous experience in a supervisory, team lead, or mentorship role is highly preferred, demonstrating an ability to guide and manage a team. Industry-Specific Knowledge: Strong knowledge of specific claim types (e.g., general liability, commercial auto, property and casualty) and related regulations is essential. LICENSING: Ability to obtain and maintain insurance adjuster licensing as required in all states. ORAL COMMUNICATION SKILLS: Active Listening: This is arguably the most important skill. It involves fully concentrating on what is being said, understanding the message, and paying attention to non-verbal cues. This helps in collecting accurate information, showing empathy, and ensuring all parties feel heard. Clarity and Conciseness: The ability to convey complex information, such as insurance policies or claim decisions, in simple, straightforward language is crucial. Avoiding industry jargon and getting straight to the point prevents misunderstandings and saves time for all involved. Empathy and Emotional Intelligence: Claims often involve sensitive situations or frustrated individuals. Displaying empathy-acknowledging and sharing the feelings of others without necessarily agreeing with their position-helps de-escalate conflict and builds rapport. Tone, Volume, and Pacing: How you speak is as important as the words you use. A calm, confident, and respectful tone helps build credibility and ensures the message is received as intended, especially during difficult conversations. Pacing your speech to avoid talking too quickly also helps the listener process information. Confidence: Speaking with assurance demonstrates professionalism and competence. This doesn't mean being overbearing, but rather being prepared and assertive, which helps gain the trust of clients, team members, and management. Audience Awareness and Adaptability: Different situations and people require different communication styles. A conversation with a C-level executive might be formal and data-focused, while a discussion with a frustrated claimant might require a more patient and empathetic approach. Negotiation and Conflict Resolution: A claims supervisor frequently engages in negotiations and manages disagreements. Strong oral skills enable effective persuasion, working toward agreements, and resolving divergent interests in a constructive manner. Non-Verbal Communication: Body language, facial expressions, and eye contact play a significant role in communication. Maintaining appropriate eye contact and an open posture conveys engagement and honesty, while a lack of eye contact can imply disinterest or untrustworthiness. Giving and Receiving Feedback: Both providing constructive feedback to team members and accepting criticism from superiors or clients are vital. This fosters a culture of continuous improvement and open dialogue within the department. PREFERRED KNOWLEDGE, COMPENTENCIES & SKILLS: Leadership and Management: The ability to motivate, train, and mentor a team effectively, manage performance, and resolve conflicts. Analytical and Problem-Solving Skills: Essential for evaluating complex claims, identifying discrepancies, and making sound, data-driven decisions. Communication Skills: Excellent verbal and written communication skills are crucial for interacting with claimants, clients, legal counsel, and senior management. Attention to Detail: Meticulousness in reviewing documents, policy language, and regulations is vital to prevent errors and ensure compliance. Negotiation Skills: Strong ability to negotiate settlements effectively with various parties, including attorneys. Technical Proficiency: Competency with claims management software/systems (e.g., Guidewire, Duck Creek), Microsoft Office Suite (especially Excel for data analysis), and data analysis tools. Regulatory Knowledge: In-depth understanding of relevant state and federal insurance regulations and compliance standards. Deep Industry Knowledge: Comprehensive understanding of the insurance industry, including property & casualty, general liability, commercial auto, and workers' compensation lines of business. Claims Management Methodologies: Knowledge of best practices for claims investigation, evaluation, negotiation, subrogation, and resolution processes, including fraud detection techniques. MATHEMATICAL SKILLS: Basic Arithmetic and Calculation: The ability to perform fundamental operations (addition, subtraction, multiplication, division) quickly and accurately is essential for calculating damages, reviewing invoices, verifying expenses, and processing payments. Estimation: Using available data to estimate the potential future cost of a claim (setting reserves). Projections: Forecasting potential claim outcomes based on historical data and current trends. Metrics Review: Analyzing performance metrics, such as claim frequency, severity, closure rates, and loss ratios. Statistical Comprehension: Understanding basic statistics used in reports (e.g., averages, medians, percentages) to make informed decisions. Attention to Detail and Accuracy: Ensuring all calculations are performed without error is critical. A simple mistake in a calculation can lead to underpayment of a claimant, resulting in litigation, or overpayment of a claim, leading to financial loss for the company. Physical Demands and Working Conditions The worker is subject to inside environmental conditions: Protection from weather conditions but not necessarily from temperature changes. The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.. Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. Talking: Expressing or exchanging ideas by means of the spoken word; those activities where detailed or important spoken instructions must be conveyed clearly and understandably both in person and over telephone. Hearing: Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound. Repetitive motions: Making substantial movements (motions) of the wrists, hands, and/or fingers. WORK SCHEDULE Flexible work arrangements available, two business days remote work after training completion. Standard schedule: Monday through Friday, 8:00AM - 5:00PM.

McGregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home. We are seeking a highly motivated and dedicated Junior Claims Analyst to join our team at PACE. As a Junior Claims Analyst, you will be responsible for supporting the administration and operation of the McGregor PACE health plan. This role contributes to the efficiency of claims processing by reviewing documentation, analyzing claim details, and assisting with daily tasks. Responsibilities: Prepare all claims appeals for review by the Director of Health Plan Operations. Code the IBNR (Incurred but Not Reported) report by identifying the appropriate accounts within the Monthly Paid Claims report Monitor enrollments and disenrollments using the Daily Transaction Reply Report (DTRR) and communicate results for follow-up. Update the rosters folder on SharePoint with participant subsidy letters. Review the claims listed on the Pend reports to see if they meet contracted terms and release for payment when verified. Verify that the End-Stage Renal Disease (ESRD) payments reported on the Monthly Membership Report (MMR) align with the total number of participants receiving these services. Communicate discrepancies as needed. Research external providers' inquiries regarding accuracy and status of payments. Prepare the weekly authorization manifest and submit it to our third-party claims administrator. Process, review, and summarize scheduled claim detail reports as well as ad-hoc requests. Complete other duties assigned by the Senior Claims Analyst or Director of Health Plan Operations. Minimum Qualifications: High School diploma (required). Strong verbal and written communication skills (required). Excellent customer service and organizational skills (required). Proficiency in Windows, Word, Excel, and PowerPoint (required). Reliable transportation (required). Preferred Qualifications: Associate's degree (preferred). Healthcare and/or industry experience (preferred). Strong analytical and problem-solving skills (preferred). A keen eye for detail when reviewing documentation and ensuring accuracy in claims processing systems (preferred).

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$65,300.00 - $107,600.00Target Openings1What Is the Opportunity?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 *********************************************************

The Claim Representative Trainee reports directly to the Auto Physical Damage Manger. This position is responsible for first learning the proper philosophy and methodology for claims investigation, adjustment and successful resolution and then applying those principles to independently handle first party auto claims and auto third party claims in accordance with company standards. The Trainee will be required to demonstrate progressive development in the training process. This process includes, but is not limited to, assigned courses of study, seminars and on-the-job instruction. Proper application of training to work product is mandatory. Completion of training program is required to attain Claim Representative position. Salary Grade (7) 43,817 - 54,771 - 65,725 ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Communicate and work effectively with team members to insure that the level of service provided to customers meets or exceeds their expectations. Analyze first notice of loss to determine nature of loss, coverage provided and scope of damages. Conduct investigation of all aspects of reported claims. Secure and/or file all supporting documentation and verify it for accuracy, relationship and completeness. Establish accurate and timely reserves. Seek technical assistance in handling claims outside delegated authority. Maintain an active diary and monitor it to achieve timely development of file and timely disposition of claim. Promptly and properly document all developments in file. Exercise good judgment in reaching final disposition of claim by evaluation of the nature of loss, coverage provided and applicable limits, liability and damage. Effectively negotiate settlements when appropriate. Recognize and pursue subrogation when applicable. Adhere to all statutory regulations and unfair claims practices acts. Manager or Assistant Vice President may assign other duties as deemed necessary. Successfully complete training program. SUPERVISORY RESPONSIBILITIES None QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE College degree or equivalent experience Excellent verbal and written communication skills Strong interpersonal skills Superior organizational skills Efficient time management skills Proven negotiation skills LANGUAGE SKILLS Excellent verbal and written communication skills. The individual must be able to effectively and clearly communicate with agents, insureds, departmental and Company personnel via telephone, fax, e-mail, one-on-one dialogue and small group presentations in a professional manner. REASONING ABILITY The position requires the individual to apply common sense, understanding, reasoning and sound educated judgement coupled with sound Claims training and experience to properly evaluate and analyze claims for recommended action within assigned authority levels. CERTIFICATES, LICENSES, REGISTRATIONS AINS, AIC, CIC, CRM or CPCU considered, but not required. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees are required to sit at a workstation to perform various PC functions. Additionally, the employee is required to devote substantial time to telephone communication. While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. Employees may be required to travel from time to time. This may require extended periods of time sitting in a vehicle. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Claim Representative Trainee is responsible for the proper handling of claims. Each Claim Representative Trainee will be assigned a specific work cubicle station and/or other individual work areas. The workstation will be located adjacent to other similar workstations. The workstation has the necessary equipment to perform the position duties including personal computer, telephone, file space, and needed work table space. The environment is reasonably quiet with needed interaction between other team members, Manager, and other company staff. Moderate noise level from telephone calls is expected.

Job Details MIDVIEW CROSSING - Elyria, OH Full Time DayDescription Independent Management Services is a full-service property management and marketing firm, specializing in the revitalization of under-managed multifamily housing developments. Since our founding in 1989, we have expanded our nationwide presence to include over 100 sustainable communities in 11 states focusing exclusively in the affordable and workforce housing sectors. However, our total breath of experience also includes market rate and commercial property management. We offer competitive salaries commensurate with experience and a comprehensive benefit package. We intend to build a team of individuals, who are self-motivated, willing to learn and grow with our firm. We progressively uphold a professional management team to serve our clients, enhancing our management skills and capabilities. Your progress, training, experience, motivation, attitude, and goals may create many possibilities for career opportunities with our company. If you have superior attention to detail with outstanding communications skills and enjoy a challenging fast pace environment, join our team now! Responsibilities: Occupancy, marketing, leasing, and resident verification procedures. Collect information from residents for eligibility screening, rent calculation, and income verification. Initial and annual recertification of income for residents. Complete unit inspections prior to move in/out and ensure units are ready for occupancy within deadlines. Receive and resolve resident requests and concerns. Foster positive working relationships with residents while always maintaining a professional demeanor. Administrative support tasks such as filing, typing, answering telephones, and data entry. Reports directly to the Site Manager. Job Qualifications: Sales-minded individual with attention to detail and strong verbal/written communication skills. Excellent follow-up skills via telephone or email correspondence. Experience with Tax Credit Compliance, EIV, and HUD Section 8 subsidy programs. Knowledge of REAC and MOR compliance. Proficiency with Paycom software and Microsoft Office suite preferred. Experience with RealPage OneSite preferred. Demonstrated track record regarding work attendance and reporting to work timely. Must adhere to Federal Fair Housing Laws. Qualifications We offer a competitive salary plus benefits including: Employer paid health and dental insurance (100% employee only) with affordable dependent and family coverage. Voluntary insurance options: Vision, Life, Accident Injury, Long-Term Disability, and Identity Theft. 401(k) with above-average employer matching contribution. Generous paid time off package. Training and employee development program. Among many other employee benefits.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Confident Staff Solutions is a leading staffing agency in the healthcare industry, specializing in providing top talent to healthcare organizations across the country. Our team is dedicated to helping healthcare facilities improve patient outcomes and achieve their goals by connecting them with highly skilled and qualified professionals. Overview: We are offering a HEDIS course to individuals looking to start working as a HEDIS Abstractor. Once the course is completed, we will connect you with hiring recruiters looking to hire for the upcoming HEDIS season. HEDIS Course: Includes - Medical Terminology - Introduction to HEDIS - HEDIS Measures (CBP, LSC, CDC, BPM, CIS, IMA, CCS, PPC, etc) - Interview Tips Self-Paced Course https://courses.medicalabstractortemps.com/courses/navigating-hedis-2026

Job Description Seeking experienced Full-Time to Part-Time Private Investigators to conduct SURVEILLANCE as it relates to the investigation of suspect insurance claims. We are seeking individuals who possess proven investigative skill sets within the industry. Honesty, integrity, self-reliance, resourcefulness, independence, discipline, and a calm intensity are a few characteristics of our Investigators and staff. Investigators with Scene Investigation and Recorded Statement experience are encouraged to apply. 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 ****************** Requirements: 1+ years of experience as an Surveillance Investigator Must be licensed as a Private Investigator in your state (if required) Flexibility to work varied/irregular hours and days including weekends and holidays Valid state issued driver's license The Surveillance Investigator should demonstrate proficiency in the following areas: Obtaining quality surveillance video evidence Writing accurate and detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations 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 Powered by JazzHR 7Z549djTZy

Job Description A Third-Party Claims Supervisor is responsible for overseeing a team of claim representatives and claim specialists who manage claims made by individuals or entities against our clients. The core objective is to ensure that claims are handled accurately, efficiently, and in compliance with all relevant laws, regulations, and company policies, while also providing excellent customer service and team leadership. ESSENTIAL DUTIES & RESPONSIBILITIES: Includes, but is not limited to, the following: Team Supervision and Management: Supervise and manage a team of claims adjusters/specialists, including hiring, training, mentorship, coaching plans and performance evaluations. Claims Oversight: Oversee the start-to-end claims process, including intake, investigation, evaluation, negotiation, and settlement of claims. Quality Assurance & Compliance: Conduct regular quality audits of staff work to ensure compliance with company policies, procedures, and all applicable state and federal regulations. Complex Claim Resolution: Act as an escalation point for complex or contentious claims, assisting staff with coverage investigations, liability analysis, and settlement negotiations. Workflow & Efficiency: Monitor team workloads, manage diaries, and implement process improvements to optimize performance, productivity, and customer satisfaction. Communication & Reporting: Serve as a liaison between the company, clients, claimants, attorneys, and other third parties. Prepare and present reports on claim metrics, trends, and operational performance to management. Reserve Management: Ensure the appropriate and timely establishment and adjustment of claim reserves to reflect potential exposure. Litigation Support: Coordinate with the client, legal counsel and third-party administrators (TPAs) on litigated claims. Fraud Detection and Prevention: Monitor claims to identify potential fraud, referring suspicious activities to appropriate authorities and/or management. Data Analysis and Trend Identification: Analyze claims data and statistics to identify patterns, trends, and areas for process improvements or risk management strategies for clients and internal departments. Vendor and Service Partner Management: Manage relationships with external service providers such as independent adjusters, appraisers, and contractors, ensuring quality and cost-effectiveness of their services. Client Relationship Management (for TPAs): Serve as a primary point of contact for self-insured clients, providing detailed reports, participating in client reviews, and ensuring service level agreements (SLAs) are met. Mentorship and Professional Development: Create professional development plans for employees, provide ongoing technical advice and guidance to staff, and assist with their performance evaluations, promotion, retention, and termination activities. License Tracking and Record Keeping: Maintain an accurate and up-to-date database or system of all required department, facility, or individual employee licenses, permits, and certifications. This includes tracking expiration dates, status, and related documentation. Maintaining Licensing: Maintain insurance adjuster licensing as required in all states. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. EDUCATION and/or EXPERIENCE: High School Diploma/GED: This is the basic minimum requirement for entry-level claims roles. Associate's or Bachelor's Degree: Most employers prefer candidates with a degree in Business Administration, Finance, Risk Management, Insurance, or a related field. Prior Claims Experience: A minimum of 2-5 years of technical experience in claims processing or adjusting is typically required. This experience should ideally involve handling complex or litigated claims, coverage investigations, and liability analysis. Supervisory/Leadership Experience: Previous experience in a supervisory, team lead, or mentorship role is highly preferred, demonstrating an ability to guide and manage a team. Industry-Specific Knowledge: Strong knowledge of specific claim types (e.g., general liability, commercial auto, property and casualty) and related regulations is essential. LICENSING: Ability to obtain and maintain insurance adjuster licensing as required in all states. ORAL COMMUNICATION SKILLS: Active Listening: This is arguably the most important skill. It involves fully concentrating on what is being said, understanding the message, and paying attention to non-verbal cues. This helps in collecting accurate information, showing empathy, and ensuring all parties feel heard. Clarity and Conciseness: The ability to convey complex information, such as insurance policies or claim decisions, in simple, straightforward language is crucial. Avoiding industry jargon and getting straight to the point prevents misunderstandings and saves time for all involved. Empathy and Emotional Intelligence: Claims often involve sensitive situations or frustrated individuals. Displaying empathy-acknowledging and sharing the feelings of others without necessarily agreeing with their position-helps de-escalate conflict and builds rapport. Tone, Volume, and Pacing: How you speak is as important as the words you use. A calm, confident, and respectful tone helps build credibility and ensures the message is received as intended, especially during difficult conversations. Pacing your speech to avoid talking too quickly also helps the listener process information. Confidence: Speaking with assurance demonstrates professionalism and competence. This doesn't mean being overbearing, but rather being prepared and assertive, which helps gain the trust of clients, team members, and management. Audience Awareness and Adaptability: Different situations and people require different communication styles. A conversation with a C-level executive might be formal and data-focused, while a discussion with a frustrated claimant might require a more patient and empathetic approach. Negotiation and Conflict Resolution: A claims supervisor frequently engages in negotiations and manages disagreements. Strong oral skills enable effective persuasion, working toward agreements, and resolving divergent interests in a constructive manner. Non-Verbal Communication: Body language, facial expressions, and eye contact play a significant role in communication. Maintaining appropriate eye contact and an open posture conveys engagement and honesty, while a lack of eye contact can imply disinterest or untrustworthiness. Giving and Receiving Feedback: Both providing constructive feedback to team members and accepting criticism from superiors or clients are vital. This fosters a culture of continuous improvement and open dialogue within the department. PREFERRED KNOWLEDGE, COMPENTENCIES & SKILLS: Leadership and Management: The ability to motivate, train, and mentor a team effectively, manage performance, and resolve conflicts. Analytical and Problem-Solving Skills: Essential for evaluating complex claims, identifying discrepancies, and making sound, data-driven decisions. Communication Skills: Excellent verbal and written communication skills are crucial for interacting with claimants, clients, legal counsel, and senior management. Attention to Detail: Meticulousness in reviewing documents, policy language, and regulations is vital to prevent errors and ensure compliance. Negotiation Skills: Strong ability to negotiate settlements effectively with various parties, including attorneys. Technical Proficiency: Competency with claims management software/systems (e.g., Guidewire, Duck Creek), Microsoft Office Suite (especially Excel for data analysis), and data analysis tools. Regulatory Knowledge: In-depth understanding of relevant state and federal insurance regulations and compliance standards. Deep Industry Knowledge: Comprehensive understanding of the insurance industry, including property & casualty, general liability, commercial auto, and workers' compensation lines of business. Claims Management Methodologies: Knowledge of best practices for claims investigation, evaluation, negotiation, subrogation, and resolution processes, including fraud detection techniques. MATHEMATICAL SKILLS: Basic Arithmetic and Calculation: The ability to perform fundamental operations (addition, subtraction, multiplication, division) quickly and accurately is essential for calculating damages, reviewing invoices, verifying expenses, and processing payments. Estimation: Using available data to estimate the potential future cost of a claim (setting reserves). Projections: Forecasting potential claim outcomes based on historical data and current trends. Metrics Review: Analyzing performance metrics, such as claim frequency, severity, closure rates, and loss ratios. Statistical Comprehension: Understanding basic statistics used in reports (e.g., averages, medians, percentages) to make informed decisions. Attention to Detail and Accuracy: Ensuring all calculations are performed without error is critical. A simple mistake in a calculation can lead to underpayment of a claimant, resulting in litigation, or overpayment of a claim, leading to financial loss for the company. Physical Demands and Working Conditions The worker is subject to inside environmental conditions: Protection from weather conditions but not necessarily from temperature changes. The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.. Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. Talking: Expressing or exchanging ideas by means of the spoken word; those activities where detailed or important spoken instructions must be conveyed clearly and understandably both in person and over telephone. Hearing: Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound. Repetitive motions: Making substantial movements (motions) of the wrists, hands, and/or fingers. WORK SCHEDULE Flexible work arrangements available, two business days remote work after training completion. Standard schedule: Monday through Friday, 8:00AM - 5:00PM.

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 Claims Representative ESSENTIAL FUNCTIONS and RESPONSIBILITIES Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution. Identifies and pursues subrogation opportunities; secures and disposes of salvage. Communicates claim action/processing with insured, client, and agent or broker when appropriate. Maintains professional client relations. Performs coverage, liability, and damage analysis on all claims assignments. 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. Secure and maintain the State adjusting licenses as required for the position. Experience Three (3) years of personal line or commercial line property claims management experience or equivalent combination of education and experience required to include knowledge of construction basics. Property estimating software experience a plus. Skills & Knowledge Familiarity with personal and commercial lines policies and endorsements Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims. Knowledge of total loss processing, State salvage forms and title requirements. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $50,000 - $55,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. 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-DNP #LI-Hybrid#IN-DNI