Claim processor jobs in Germantown, MD - 124 jobs

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.

**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?** LOCATION REQUIREMENT: This field position services Insureds/Agents in the Maryland area. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. *You will be issued a company vehicle for this position.* 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. **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. + General knowledge of estimating system Xactimate. + Two or more years of previous outside property claim handling experience. + 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. **What is a Must Have?** + High School Diploma or GED. + One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. + Valid driver's license. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. About GEICO The Government Employees Insurance Company (GEICO) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. GEICO is a wholly owned subsidiary of Berkshire Hathaway and is the third largest auto insurer in the United States. In 2023, GEICO earned premiums worth over $40 billion U.S. dollars. GEICO is going through a massive digital transformation to re-platform the Insurance industry, removing friction across Customers, Partners, Marketplace, Segments, Channels, and Experiences as we grow our reach and market share. About The Role GEICO is hiring a Innovation Analyst to join their Claims Innovation team. As an Innovation Analyst, you will support GEICO's Claims Innovation team in identifying, analyzing, and implementing opportunities to improve processes and technology. This role partners with cross-functional teams to deliver innovative solutions that enhance efficiency, accuracy, and customer experience. Responsibilities: Evaluate and analyze existing claims processes, data, and performance metrics to identify areas of opportunity for efficiency, effectiveness, or accuracy Gather and analyze data to provide insights into claims processes and performance metrics Support the development of actionable strategies and assist in implementing process and technology enhancements. Assist the Director, Claims Innovation in establishing priorities, goals, and objectives Collaborate with Operations, Product, AI/ML, and Engineering teams to define and prioritize requirements. Prepare reports and presentations summarizing findings, recommendations, and project progress. Contribute to and/or lead pilot programs, POC's, or A/B testing and reporting on performance and progress Participate in innovation workshops, ideation sessions, and design sprints. Monitor project risks, benefits, and performance metrics; escalate issues as needed. Stay informed on industry trends, emerging technologies, and best practices. About You Skills & experiences: 3+ years of experience in business process optimization, business analysis, consulting, innovation, or process engineering. Leadership experience in P&C insurance claims Bachelor's degree in Business, Finance, Economics, Statistics, or related field. Knowledge of innovation methodologies, processes, and principles Strong analytical skills and ability to interpret data for decision-making. Effective communicator with strong collaboration skills. Demonstrated ability to adapt and learn in a fast-paced environment. Commitment to diversity, equity, and inclusion. Leadership qualities: Leads from the front and isn't shy about using their voice Ability to lead and influence with empathy and humility Ability to navigate and lead through complexity Curiosity, critical thinking skills; a lifelong learner who sees situations through multiple lenses Exceptional character and an ability to instill confidence and build trust. Someone who possesses high emotional intelligence, and is an attentive, empathetic listener Location: Remote, or available office #LI-HB1 Annual Salary $82,000.00 - $172,200.00 The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations. At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

Division or Field Office: Claims II Division Property Damage Dept Work from: Home in Maryland Salary Range: $79,191.00 - $126,500.00 * salary range is for this level and may vary based on actual level of role hired for * This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you're not just part of a Fortune 500 company; you're also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including: * Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. * Low contributions to medical and prescription premiums. We currently pay up to 97% of employees' monthly premium costs. * Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. * 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. * Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. * Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year. Position Summary Exercises independent discretion or judgment in the handling of assigned property claims. Serves as a consultant to claims adjusters in their handling of property losses. * This is a remote, work from home position * A company car will be provided * The candidate will ideally live in and service the DC, Southern MD & Eastern Shore territory Duties and Responsibilities * Establishes immediate contact with Policyholders and claimants. * Conducts extensive investigations into causes and origins of all major property claims. Interviews insureds, claimants and others as required. Inspects property damage, reviews information to prepare estimates, evaluates and makes recommendations regarding coverage of claims, determines liability and total value of claims and negotiates settlements. Sets and maintains adequate reserves. * Exercises discretion and independent judgment in evaluating property damage in order to determine the extent of damage. Determines liability and total value of claim, develops estimate and obtains an agreed scope of work and cost of repair with contractor and/or Policyholder. * Determines value as they apply to the coverage. * Determines steps necessary to initiate investigation of a property loss. Uses outside experts and attorneys as required. * Documents claim files and submits final report to file for closure. * Assigns and supervises the handling of property losses by independent adjusters when necessary. Advises claims adjusters regarding handling of claims. * Conducts related training of field office claims personnel in the branch and at the Home Office. * Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department. * Establishes and maintains relationships with local, state and regional organizations and agencies which are involved in related activities. * Acts as coordinator of the Catastrophe Team activities at catastrophe site. The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear. Capabilities * Values Diversity * Self-Development * Nimble Learning * Collaborates * Information Management Skills * Customer Focus * Cultivates Innovation * Job-Specific Knowledge * Instills Trust * Optimizes Work Processes (IC) * Ensures Accountability * Decision Quality Qualifications Minimum Educational and Experience Requirements * High School Diploma or GED and five years of claims handling experience (up to two years of equivalent may be substituted); or * Bachelor's Degree and three years of claims handling experience, (up to two years of equivalent experience may be substituted.) Additional Experience * Working knowledge of Windows software required. * The position requires the incumbent to serve on Catastrophe Team, which may include travel on short notice to other locations for periods in excess of two consecutive weeks. * Position requires the incumbent to provide 24-hour availability for emergency claims service. Designations and/or Licenses * Successful completion of Introduction to Claims (AIC 30) and AIC 35 preferred. * Appropriate license as required by state. * Valid driver's license and good driving record required. Physical Requirements * Use of Personal Protective Equipment (PPE) is required for this role. * Ability to move over 50 lbs using lifting aide equipment; Often (20-50%) * Climbing/accessing heights; Moderate (30-40%) * Driving; Frequent (50-80%) * Lifting/Moving 0-20 lbs; Often (20-50%) * Lifting/Moving 20-50 lbs; Often (20-50%) * Manual Keying/Data Entry/inputting information/computer use; Often (20-50%) * Pushing/Pulling/moving objects, equipment with wheels; Occasional (

Owner's project management firm is seeking an experienced SENIOR CLAIMS ANALYST for work on construction claims. Candidates qualifications must include demonstrated experience with: Furnishes reports with supporting information necessary to resolve disputes or defend against the claims, Prepares and assembles appeal files, Participates in meetings or negotiations with claimants, Appears in legal proceedings, Prepares cost estimates for use in claims negotiations, Prepares risk assessments/analysis relative to claim exposures, Prepares findings of fact and other documentation required by the CO. Provides litigation support to include court boards, timelines, diagrams, static and electronic illustrations and three dimensional models. Candidates should have demonstrated ability to work cooperatively and productively as a member of a project or claims defense team. Candidates must have 15 years experience and a Bachelor's Degree in Engineering, or Construction/Project Management. CCM and either P.E. or CPA necessary though all three are preferred. Submit resumes and project list in MS Word or PDF format: Please No Calls

JOB TITLE: Claims Analyst This position is responsible for assisting with following up on administrative appeals and documentation submitted to health insurers and governmental payers; working well with attorneys and paralegals; maintaining the workload. DUTIES AND RESPONSIBILITIES: Works within the client's Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue. Determines action required to resolve the underpayment and initiate that action, including submitting appeals and reconsideration requests. Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal's/attorney's pursuit for additional reimbursement Quickly and efficiently prepares, reviews, and submits well-written claims correspondence and related documents to insurers Is skilled, aggressive, cordial, and professional on the telephone to follow up on submitted appeals. Performs other related duties as assigned by management. QUALIFICATIONS: Bachelor's Degree (BA/BS) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience. Other skills required : BA/BS with a GPA of 3.0 or higher. Interest in healthcare and healthcare law. Able to navigate through various computer systems and applications to find information about insurance claims. Ability to prioritize and multi-task. Excellent written and verbal communication skills. Proficiency in Microsoft Office, including Word and Excel. Excellent organizational and time management skills. High attention to detail. Clear, concise, and logical writing style. COMPETENCIES: Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures. Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals. Business Necessity - The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. External Working Relationships - Develops and maintains courteous and effective working relationships with clients, vendors and/or any other representatives of external organizations. Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Great Waters Federal is part of the Seneca Nation Group (SNG) portfolio of companies. SNG is Seneca Holdings' federal government contracting business that meets mission-critical needs of federal civilian, defense, and intelligence community customers. Our portfolio comprises multiple subsidiaries that participate in the Small Business Administration 8(a) program. To learn more about SNG, visit the website and follow us on LinkedIn. Our team of talented individuals is what makes us successful. To support our team, we provide a balanced mix of benefits and programs. Your total rewards package includes competitive pay, benefits, and perks, flexible work-life balance, professional development opportunities, and performance and recognition programs. We offer a comprehensive benefits package that includes medical, dental, vision, life, and disability, voluntary benefit programs (critical illness, hospital, and accident), health savings and flexible spending accounts, and retirement 401K plan. One of our fundamental principles is to offer competitive health and welfare benefits to our team members, providing coverage and care for you and your family. Full-time employees working at least 30 hours a week on a regular basis are eligible to participate in our benefits and paid leave programs. We pride ourselves on our collaborative work environment and culture, which embraces our mission of providing financial and non-financial benefits back to the members of the Seneca Nation. Great Waters Federal is seeking a Junior Travel Claims Analyst to support one of our government customers. Roles and Responsibilities include, but are not limited to: Receiving, reviewing, and authorizing travel requests Reviewing and processing travel vouchers Ensuring travelers' compliance with the Federal Travel Regulation and the agency's travel policy in all transactions Supporting travelers who are making and booking their own travel arrangements Providing customer support by phone, email and through an automated help desk system Tracking workload volume and supporting performance metrics reporting Basic Qualifications: Bachelor's degree OR HS diploma plus two years of relevant work experience (e.g., federal claims process, federal travel, or finance compliance) Excellent customer service and attention to detail Strong written and verbal communication skills Demonstrated ability to manage multiple tasks and priorities in a fast-paced environment while consistently meeting deadlines Desired Skills: Experience coordinating travel from pre-travel authorization through voucher approval Familiarity with the Federal Travel Regulation Equal Opportunity Statement: Seneca Holdings provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex/gender, sexual orientation, national origin, age, disability, marital status, genetic information and/or predisposing genetic characteristics, victim of domestic violence status, veteran status, or other protected class status. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training. The Company also prohibits retaliation against any employee who exercises his or her rights under applicable anti-discrimination laws. Notwithstanding the foregoing, the Company does give hiring preference to Seneca or Native individuals. Veterans with expertise in these areas are highly encouraged to apply.

**Claims Processing - Remote** for Iowa resident candidates Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing enhancing customer satisfaction and operational excellence. _You will report to our office in Des Moines, Iowa for part of our training regimen._ **Key Responsibilities-** + _Claims Processing:_ Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies. + _Eligibility Verification:_ Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans. + _Adjudication:_ Approve, deny, or adjust claims based on payer guidelines and policy terms. + _Compliance:_ Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards. + _Documentation:_ Record claim activity, maintain audit trails, and prepare reports for management. **Required Skills & Qualifications-** + High school diploma or equivalent REQUIRED + Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers). + 2-4 years of experience in US healthcare claims processing + Familiarity with claims management software and EDI transactions. + Excellent analytical, organizational, and communication skills. + Ability to interpret insurance policies and payer guidelines. + Detail-oriented with strong problem-solving abilities. _Competencies-_ + Regulatory Knowledge - Deep understanding of US healthcare laws and payer requirements. + Accuracy & Detail Orientation - Ensures claims are processed correctly and efficiently. + Problem-Solving - Resolves claim disputes and denials effectively. **Salary and Other Compensation:** Applications will be accepted until January 30, 2025.The hourly rate for this position is between $16.00 - 17.00 per hour, depending on experience and other qualifications of the successful candidate.This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans. **Benefits:** Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:- Medical/Dental/Vision/Life Insurance- Paid holidays plus Paid Time Off- 401(k) plan and contributions- Long-term/Short-term Disability- Paid Parental Leave- Employee Stock Purchase Plan _Disclaimer:_ The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law. Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.88 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. 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. 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 This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington DC. 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. Additional Qualifications/Responsibilities 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.

The National Solutions Sector is currently looking experienced Chinese Triage Examiners in various languages to perform media exploitation (MEDEX) and triage in support a customer in the National Capital Region (NCR). Triage Examiners should be experienced in general linguist operations and Document and Media Exploitation (DOMEX) operations, and are expected to leverage language and analytical skills, as well as advanced computer systems aptitude in addressing triage examination projects. Triage Examiners will perform eDiscovery examinations of electronic media for content of interest using a suite of forensic examination tools and will identify and prioritize items of importance for further processing, in accordance with customer standard operating procedures. Examiners will also be expected to communicate effectively and provide ad-hoc notification to superiors on task progress and significant findings, and to produce a report of their findings for further dissemination to customer(s). Required Language: Chinese Locations: The NMEC-LEaRN program is located at the customer site in Bethesda, MD, and we also offer the option to work from different locations (JIRC sites). The primary responsibilities of the Triage Examiners are: Perform data discovery on large datasets of foreign language material and identify essential elements of information. Convert, reformat, parse, and otherwise exploit media files using customer tools to ensure compatibility and readability for translation systems. Prepare files and metadata for transfer to translation systems, including review of foreign-language data. Produce report of findings and disseminate to customer, analysts, and liaison officers. Prepare accurate written gists, translations, and/or transcriptions of general and technical material. Candidate must have operational experience within the Chinese language. Basic Qualifications Must have the sufficient language skills, analytic skills, and technical aptitude to gain proficiency with job-required tools and processes (On-the-job training may be provided as needed to address customer-specific needs, with ongoing evaluations throughout train-up period). Native-level proficiency in English. Two years of overall experience in Chinese linguist operations (i.e. translation, language analysis), and two years of experience performing media examination for Document and Media Exploitation projects. Willingness to perform occasional shift work to meet mission demands. Achieve a minimum score of a 3/3 in Reading and Listening in Chinese and 3+/3+ for Reading and Listening in English. BA degree and/or 4 years prior relevant experience in lieu of degree, or Masters with 2 years of prior relevant experience. Ability to compose summarizations of highly technical and complex subjects that are both succinct and accessible to a general reader. Outcomes-based problem solving of ill-defined and abstract problems. Ability to maintain project momentum while working independently with limited oversight over a long period of time. Ability to quickly scan and process a large amount of material in a foreign language for essential elements of information. Ability to comprehend customer prioritization requirements and apply them to files under review, as well as apply personal judgment when assessing the potential value of files and information. Demonstrated history of working on screening or translation projects and in maintaining the integrity and meaning of the translated material. Demonstrated ability to communicate in a professional manner (email, spoken, & reports). Ability to make sound decisions and handle stress, while meeting deadlines and performing in a high-paced environment. Familiarity with report writing styles for DOD and IC consumers. Possess a working proficiency in standard computer systems and office programs, with additional experience in media examination tools. Ability to use or train to proficiency on customer specific software programs and tools. Clearance Must currently possess at least an active TS/SCI clearance. Current or recent SCI-level access is a significant advantage and preferred. Must be able to pass a polygraph and Subject Interview. Preferred Qualifications Native-level proficiency in foreign language Graduate of the Defense Language Institute Chinese Course. An advanced degree in one of the following fields: Engineering, Computer Science, Chemistry, Physics, Legal, Medical, Banking and Financing, Foreign Military, Forensics Familiarity with Digital Forensics/eDiscovery/Document and Media Exploitation (DOMEX) processes and specialized tools (i.e. FTK, en Case, or similar). Past performance as a media examiner in support of DOD or IC customers. If you're looking for comfort, keep scrolling. At Leidos, we outthink, outbuild, and outpace the status quo - because the mission demands it. We're not hiring followers. We're recruiting the ones who disrupt, provoke, and refuse to fail. Step 10 is ancient history. We're already at step 30 - and moving faster than anyone else dares. Original Posting:August 26, 2025 For U.S. Positions: While subject to change based on business needs, Leidos reasonably anticipates that this job requisition will remain open for at least 3 days with an anticipated close date of no earlier than 3 days after the original posting date as listed above. Pay Range:Pay Range $73,450.00 - $132,775.00 The Leidos pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.

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 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$67,000.00 - $110,600.00Target Openings1What Is the Opportunity?Come learn more about this role at our Open House Event on 1/14! Click here to register - ************************************************************************************** This position could be eligible for a sign on bonus. LOCATION REQUIREMENT: This position services Insureds/Agents in and around Washington DC. 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 *********************************************************

Administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and ensures proper and timely closing of files. Makes decisions on claims within delegated limited authority. College degree or the equivalent of education and experience. Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Demonstrates a thorough working knowledge of claim processing and claim policies and procedures. Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions Demonstrates effective and diplomatic oral and written communication skills. Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others. Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level. Must possess a valid driver's license. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license. #LI-ET1 Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. Identifies wage loss expenses and wage exposures on medical claims. Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients. Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined. Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction. With the team managers guidance, provides input on the completion of status reports, initiate's activity checks and/or widow's statement of dependency forms. Completes all reporting forms and file documentation. Adheres to client and carrier guidelines and prepares written updates for supervisor to review. Performs other related duties as required or requested.

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.

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 Specialist, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice 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. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **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_ **_$117,000 - $125,000_** _. 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. 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**

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Northern Virginia and Washington DC. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $66,000 - $91,200 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $74,400 - $108,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

Company Details Berkley Mid-Atlantic Insurance Group is a member of W. R. Berkley Corporation, one of the largest commercial lines property casualty insurance holding companies in the United States. With the resources of a large Fortune 500 corporation and the ability to operate with the closeness and flexibility of a small company, we exclusively work with select independent agents to ensure the future of business. Company URL: *********************** The company is an equal opportunity employer. Responsibilities As a Workers' Compensation Claims Representative, you will play a critical role in maintaining these standards by providing quality claim handling and superior service to our customers, while also engaging in indemnity and expense management. Success in this position will be driven by combining your experience in Workers' Compensation claims management with excellent communication and critical reasoning. Investigate, evaluate, reserve, negotiate and resolve Workers Compensation claims in multiple jurisdictions and in accordance with Best Practices. Promptly manage claims by completing essential functions including contacts, investigations, damages development, evaluation, reserving, and disposition. Regularly handle claims involving complex coverage issues and severe injuries. Develop action plans and handle the claims from assignment to early conclusion. Review incoming mail daily, responding as needed to bring the claim to a prompt fair conclusion and seeking supervision as needed. Work closely with medical management as needed Prepare large loss reports as needed to include updated action plan and recommended reserves. Maintain a current diary on outstanding claims. Provide direction and guidance to defense attorneys and other experts while controlling expenses. Meet or exceed specific objectives for service, quality, and reserving standards and other measurable performance items. Perform other duties as assigned by the Claims Management. Qualifications 5+ years of experience in a workers' compensation claims position CPCU, SCLA or AIC designation is a plus. Working knowledge of current state and local workers' compensation laws preferred Experience in handling multiple jurisdictions is a plus Proven ability to identify and address coverage issues, complete investigations to determine exposure, set timely reserves, and develop detailed action plans. Excellent communication and negotiation skills. Computer proficiency and working knowledge of Microsoft Office products. Experience with Guidewire claims management system is a plus. 4-year college degree or equivalent work experience required. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. 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

Description of services: Audit a portion, as mutually agreed between the parties, of the combined financially stratified/attribute claim sample of medical and dental claims processed by medical care administrators. During the identified audit period (i.e., audits performed in 2024 will review claims processed through January 1, 2023 - through December 31, 2023, etc.). The audits will be conducted virtually with each administrator. Tasks, Activities and Deliverables The claims audit elements include review and validation: The claimant was eligible for benefits on the date(s) of service based on data in the administrator's eligibility files, The provider's network participation was correctly determined based on the date of service, Claims requiring utilization review approval were reviewed and processed in accordance with utilization review decisions, Deductibles, coinsurance and other appropriate cost-sharing features of the benefit plan were considered and correctly applied, The claim data was entered into the claim system correctly, and whether a paper claim was keyed or scanned, Appropriate checks were made to ensure that there was no other coverage available to the claimant or, if there was other coverage, payments were coordinated correctly, The "reasonable and customary" or provider discount features of the plan were correctly applied, including unbundling for physician services, Appropriate edits were made to ensure that the claim was not paid twice, The procedure(s) billed and paid were, in fact, covered by the plan and do not appear to be fraudulent billings by the provider, The mathematics and computations were correct, Any pre-authorization limits were appropriately applied, The paper claim form was completed appropriately and signed by the appropriate parties, The administrator adhered to its own internal policies and procedures when processing the claim, Appropriate approvals were applied to high dollar claims (pre- and post-payment), and Sufficient documentation was included in the file to support the adjudication of the claim. Education and Experience Bachelor's degree in accounting, finance, or a related field such as health information management. At least three years of experience as a claims auditor or similar role in the health care industry. Skills Strong analytical and problem-solving skills Excellent attention to detail Ability to communicate complex information effectively and clearly Good understanding of insurance policies and regulations Proficiency in using computer software such as Microsoft Office Suite Personal Attributes Ability to work independently and in a team environment. High level of integrity and ethical behavior. Strong organizational and time-management skills. Flexible and adaptable to change.

Greyling Insurance Brokerage & Risk Consulting, a division of EPIC, is a specialty insurance brokerage and risk consulting firm focused on construction and design professionals. What differentiates us is our construction industry expertise. Our leaders have prior experience as practicing construction lawyers (in-house and outside), engineers, consultants, and underwriters - giving us a unique and unmatched insight into how A/E firms operate, deliver projects, and manage risks. With respect to insurance, we place many of our largest clients who qualify in highly profitable group captive programs that have saved millions, and we do so for more A/E firms than all other insurance brokers combined. We've been so successful, that now we're looking to grow our team! JOB OVERVIEW: The Certificate Specialist (an entry level role) supports the broker teams with certificates of insurance (COIs) for their accounts. Will work with a team of 8+ members issuing COIs. Additionally, team members will have a book of assigned accounts to oversee the servicing of all aspects of COIs, along with client satisfaction regarding COIs. LOCATION - Hybrid is preferred, 3 days a week, in one of the following offices: Alpharetta GA, Chicago IL, Arlington VA, or St Louis MO. May be open to remote for qualified candidates. MUST be willing to work Mon- Fri 10am-6pm EST or some variation of later hours. WHAT YOU'LL DO: A detailed list of job duties includes (but is not limited to): * Service clients daily COI needs * Work in a collaborative environment with your book of accounts and team accounts * Assist with special projects, renewals, and client requests * Review insurance requirements and contracts and apply to COIs * Coordinate with broker teams on specific requirements/requests * Communicating with clients and developing healthy business relationships * Maintaining client expectation of 24-hour turnaround time, and communication when the TAT is not possible * Assist with special projects, renewals, and client requests * Perform other COI or team related duties that may be assigned from time to time * Ability to work 10am - 6pm EST (or some variation of later hours) WHAT YOU'LL BRING: * Exceptional time management skills * Strong verbal and written communication skills * Service oriented with great attention to detail * Interpersonal skills - enjoy working with people, internal and external * Strong analytical skills * Ability to learn new systems and software - and jump between them throughout your day * Willingness to learn and take direction from others * Ability to work independently and meet deadlines COMPENSATION: The base pay offered will be determined based on your experience, skills, training, certifications and education, while also considering internal equity and market data. WHY EPIC: EPIC has over 60 offices and 3,000 employees nationwide - and we're growing! It's a great time to join the team and be a part of this growth. We offer: * Generous Paid Time off * Managed PTO for salaried/exempt employees (personal time off without accruals or caps); 22 PTO days starting out for hourly/non-exempt employees; 12 company-observed paid holidays; 4 early-close days * Generous leave time options: Paid parental leave, pregnancy disability and bonding leave, and organ donor/bone marrow donor leave * Generous employee referral bonus program of $1,500 per hired referral * Employee recognition programs for demonstrating EPIC's values plus additional employee recognition awards and programs (and trips!) * Employee Resource Groups: Women's Coalition, EPIC Veterans Group * Professional growth & development: Mentorship Program, Tuition Reimbursement Program, Leadership Development * Unique benefits such as Pet Insurance, Identity Theft & Fraud Protection Coverage, Legal Planning, Family Planning, and Menopause & Midlife Support * Additional benefits include (but are not limited to): 401(k) matching, medical insurance, dental insurance, vision insurance, and wellness & employee assistance programs * 50/50 Work Culture: EPIC fosters a 50/50 culture between producers and the rest of the business, supporting collaboration, teamwork, and an inclusive work environment. It takes both production and service to be EPIC! * EPIC Gives Back - Some of our charitable efforts include Donation Connection, Employee Assistance Fund, and People First Foundation * We're in the top 10 of property/casualty agencies according to "Insurance Journal" To learn more about EPIC, visit our Careers Page: ************************************************ EPIC embraces diversity in all its various forms-whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. California Applicants - View your privacy rights at: ******************************************************************************************* Massachusetts G.L.c. 149 section 19B (b) requires the following statement: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. #LI-SP2 #LI-Hybrid