Claims Representative II
Claim processor job in Baltimore, MD
Davies Claims North America seeks an experienced Claims Representative to manage claims related to MTA operations, including minor property damage and complex bodily injury. Reporting to the MTA Claims Supervisor, this role involves investigation, litigation management, and reserve evaluation for claims exceeding $25,000.
Key Responsibilities:
Handle a caseload of 150+ files, some with multiple claimants
Investigate claims, manage litigation, and maintain detailed documentation
Evaluate reserves and issue timely reports
Uphold company values: Dynamic, Innovative, Connected, Collaborative
Perform additional duties as assigned
Requirements:
High school diploma or equivalent
Minimum 3 years of experience in auto property damage, bodily injury, and general liability claims
Proficiency in Microsoft Office
Familiarity with Medicare reporting requirements (Section 111)
Benefits:
Medical, dental, and vision coverage
401(k) with employer match
Paid holidays and time off
Life, short-term, and long-term disability insurance
Claims Analyst
Claim processor job in Washington, DC
At least twenty-four (24) Medicaid related Claims Analyst and Claims Processors are needed for a long-term project in DC. These positions are 100% onsite and located downtown, near Farragut North Metro Station.
The Midtown Group is teaming up with a leading technology company to support a D.C. government department that offers its residents a Medicaid program. Our collective goal is to modernize and optimize DC's Medicaid program while offering outstanding customer support. Our venture is focused on improving outcomes, enhancing provider experiences, and safeguarding program integrity. For this project, our partner will provide technology, and we will provide people and expertise across several functions, including contact center operations.
Claims Analyst and Claims Processors will support D.C. medical providers who need assistance with Medicaid benefits.
These positions are in-person, located in Downtown D.C. There are no plans to move to hybrid or fully remote models. Interviews begin on Tuesday, 12/9/25, and these engagements are expected to start on 1/16/26 and may continue for up to two or three years or longer.
Key job tasks
Claims/Financial Analyst/Processors have several job responsibilities, and some of the critical ones are:
· Handle refund checks and state warrants received from healthcare providers and the State agency.
· Contact providers, verbal and in writing, to resolve check-related issues.
· Receive and respond to client inquiries.
· Responsible for handling the Accounts Receivable transfer process, setting up expenditures, setting up Accounts Receivable transactions, and placing and recoupment caps using the Medicaid system.
· Responsible for analyzing financial data to ensure accurate reporting.
· Research highly complex claims processing or financial transactions.
· Process adjustments and voids.
· Ensure SLAs are compliant with client and Midtown Group expectations
· Other duties as assigned.
Performance measurement
The Midtown Group measures performance in a number of ways, with the key ones being:
Quality Assurance assessments: may have their calls monitored and assessed at any time during a shift. We and our partner monitor and assess our CSRs regularly. CSRs are expected to maintain or exceed a QA pass rate of 90%+. Calls are considered to have failed if a CSR misses or incorrectly performs any critical element of the job. These items are well-covered in training and reinforced during pre-shift and individual coaching sessions.
Call handling metrics are a good measure of performance and the three focus areas are:
Percent of your shift that you are either on a call or available to take a call.
Length of call. We are here to provide efficient, professional assistance, so a consistent track record of very long or very short calls is generally frowned upon.
Percent of calls that you transfer. This often indicates that a CSR is unable or unwilling to assist callers.
Attendance
Minimum requirements
· High School Diploma or equivalent, 2-year post-high school Degree, or bachelor's degree.
· A minimum of two years of previous experience for a government or private sector operations center in a similar or related field.
· Two to four years of working experience in claims processing and financial analysis.
· Organization skills to balance/prioritize work with the ability to multi-task.
· Proficiency with basic help desk software, computer software and Microsoft Office applications.
· Problem-solving skills to bring inquiries to effective resolution.
· Customer service skills, with an emphasis on written and oral communication, to professionally and efficiently respond to inquiries.
Other important skills
The ability to provide operational excellence is extremely important to both the Midtown Group and our client. If you have the service gene - if helping others is in your DNA - we are happy to have you join us.
Our most effective and successful Claims/Financial Analyst/Processors exhibit the following skills:
· Conduct themselves with professionalism, empathy, patience, courtesy, and tact, at all times.
· Communicate effectively, clearly, and professionally.
· Quickly and effectively process transactions and analyze financial data, to a high standard. Operational quality is very important to us.
· Know when and how to collaborate and escalate to quickly and effectively address and resolve issues.
· Effectively collect and handle sensitive data and personal information, as needed.
· Exercise good judgment at all times.
· Deal well with conflict, as well as complex and emotional situations.
· Be flexible, and able to work independently.
Hours, project duration, etc.
The contact center operating hours are Monday through Friday, from 8:00am to 5:00pm ET. However, schedules will be between the hours of 7:45am to 5:15pm ET, to allow for pre-shift sessions and last-minute contacts/wrap up.
The contact center is closed on Federal holidays. Candidates must be able to work 40 hours per week.
The base period for this contract is through November 2026, with two further annual option periods. So, this contract could run until November 2028.
Disability claims processor
Claim processor job in Vienna, VA
Job Description
Hybrid: Pensacola, FL, Vienna, VA, or Winchester, VA - 3x a week starting in April 2026.
Shared Services Advisor - Make a Meaningful Impact
Join a dynamic team as a Shared Services Advisor where you'll provide essential guidance and support across various shared services functions. In this pivotal role, you'll optimize operations and serve as a trusted resource for employees navigating disability claims.
Key Responsibilities:
Employee Support & Communication: Serve as the first point of contact for employees after vendor approval of disability claims. Respond to incoming calls and make outbound calls to provide accurate information and compassionate guidance.
Case Management: Skillfully manage and resolve employee-submitted cases, including those requiring complex information and detailed guidance, ensuring timely and satisfactory outcomes.
Reporting & Data Validation: Create comprehensive reports and perform meticulous validations to ensure accuracy and compliance across all processes.
System Updates: Review and update employment statuses in Oracle HCM to maintain accurate records and ensure data integrity.
Vendor & Stakeholder Collaboration: Work closely with vendors, contractors, and advisors involved in processing disability payments to ensure seamless coordination and timely resolution of issues.
What You'll Bring:
Knowledge of shared services models and operational efficiency practices
Strong problem-solving and process improvement skills
Excellent communication and advisory abilities
Understanding of compliance and regulatory standards
Join this collaborative team where your contributions will directly impact employee experience and operational excellence. The client offers professional growth opportunities in a supportive environment where your expertise will be valued.
CC Pace is an equal opportunity employer. The organization celebrates diversity and is committed to creating an inclusive environment for all employees. CC Pace does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetic information, or any other protected characteristic under federal, state, or local laws.
CC Pace is committed to employing only candidates who are legally authorized to work in the United States. To comply with the Immigration Reform and Control Act of 1986, all new employees, as a condition of employment, must complete the Employment Eligibility Verification Form I-9 and provide documentation that establishes identity and authorization to work. E-Verify will be used for employment verification as part of your onboarding process.
CC Pace values integrity throughout the hiring process. As part of standard verification procedures, candidates will be asked to provide documentation confirming employment history, education, and work authorization.
Claims Processor - Entry Level (BS Degree Required)
Claim processor job in Baltimore, MD
Claims Processor - Entry Level
Duration : 5 Months
Total Hours/week : 40.00
1
st
Shift
Client: Medical Device Company
Job Category: Customer Service
Level of Experience: Entry Level
Employment Type: Contract on W2 (Need US Citizens or GC Holders Only)
Work days/hours: M - F 8am - 5pm
Job Description:
The primary responsibility of this position is the investigation, analysis, resolution, trending and corrective action of all claims/complaints.
Specific responsibilities include maintaining claim/complaint files and supporting the resolution of claim/complaint CAPAs to closure and verification of CAPA effectiveness.
Bachelor's degree required.
Minimum of 2 years of experience in complaint investigation.
Strong communications and problem solving skills.
Ability to work independently.
Competent using office software including Database management, MS Word, Excel, Internet Explorer, PowerPoint, and Outlook.
Experience with SAP is required.
Claims Examiner
Claim processor job in Annapolis, MD
Why You Should Work For Us:
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you!
Essential Functions:
Reviews providers' disputes and appeals for professional and hospital claims to determine resolution according to policies and procedures.
Adheres to state and federal policies and procedures when adjudicating claims, including but not limited to, interest calculation and resolution timeliness
Perform any projects delegated by claims supervisor
Qualifications
Minimum Education/ Licensures/Qualifications
High School Diploma or GED
1+ year experience handling provider disputes / appeals, preferably in PPO, Self-Funded and/or HMO setting
Healthcare Background
Understanding of Medical Terminology
Additional Information
Shift: M-F 8am-5pm
RTH or Temp-To-Perm (Any transition heavily depends on performance)
Pay Rate: Up to 20/hour
Epic Resolute PB Claims Analyst
Claim processor job in Arlington, VA
Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Resolute PB Claims Analyst you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery.
Work you'll do/Responsibilities
As a Project Delivery Senior Analyst (PDSA) at Deloitte, you will work within an engagement team and be responsible for supporting the overall project goals and objectives. In this role, you will interact with stakeholders and cross-functional teams. It is expected that you will be able to perform independent tasks as well as provide technical guidance to team members, as needed.
* Work with the implementation team to plan and complete build, implement end-to-end Epic.
* Work command center shifts to investigate during go-live, document, and resolve break-fix tickets.
* Conduct and document root cause analysis and complete any assigned system maintenance.
* Assist in low level design, operational discussions, build, test, and migrate Epic build, provide go-live support following migration of new build.
* Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management.
The Team
Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation.
AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.
Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.
Qualifications
Required
* Current Epic Certification in Epic Professional Billing
* 3+ years' experience in Epic Professional Billing
* Experience in Epic implementation or enhancement processes
* Experience in application design, workflows, build, troubleshooting, testing, and support.
* Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience
* Limited immigration sponsorship may be available.
* Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
Preferred
* Hospital or Clinic operations experience
* Additional Epic Certifications
* ITIL process knowledge
* Analytical/ Decision Making Responsibilities
* Analytical ability to manage multiple projects and prioritize tasks into manageable work products
* Can operate independently or with minimum supervision
* Excellent Written and Communication Skills
* Ability to deliver technical demonstrations
Additional Requirements
Information for applicants with a need for accommodation: ************************************************************************************************************
Recruiting tips
From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters.
Benefits
At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you.
Our people and culture
Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work.
Our purpose
Deloitte's purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more.
Professional development
From entry-level employees to senior leaders, we believe there's always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.
As used in this posting, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see ********************************* for a detailed description of the legal structure of Deloitte LLP and its subsidiaries.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.
Requisition code: 316852
Job ID 316852
Stop Loss & Health Claim Analyst
Claim processor job in Baltimore, MD
Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.
Job Description:
The Opportunity:
This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim.
The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources.
How you will contribute:
* Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
* The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions
* Maintain claim block and meet departmental production and quality metrics
* An awareness of industry claim practices
* Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records
* Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc.
* Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process
* Establish cooperative and productive relationships with professional resources
What you will bring with you:
* Bachelor's degree preferred
* A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing
* Demonstrated ability to work as part of a cohesive team
* Strong written and verbal communication skills
* Knowledge of Stop Loss Claims and Stop Loss industry preferred
* Demonstrated success in negotiation, persuasion, and solutions-based underwriting
* Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
* Overall knowledge of health care industry
* Proficiency using the Microsoft Office suite of products
* Ability to travel
Salary Range: $54,900 - $82,400
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Job Category:
Claims - Life & Disability
Posting End Date:
30/01/2026
Auto-ApplyClaims Initiation Analyst
Claim processor job in Cockeysville, MD
Established in 1991, Collabera is one of the fastest growing end-to-end information technology services and solutions companies globally. As a half a billion dollar IT company, Collabera's client-centric business model, commitment to service excellence and Global Delivery Model enables its global 2000 and leading mid-market clients to deliver successfully in an increasingly competitive marketplace.
With over 8200 IT professionals globally, Collabera provides value-added onsite, offsite and offshore technology services and solutions to premier corporations. Over the past few years, Collabera has been awarded numerous accolades and Industry recognitions including.
Collabera awarded Best Staffing Company to work for in 2012 by SIA. (hyperlink here)
Collabera listed in GS 100 - recognized for excellence and maturity
Collabera named among the Top 500 Diversity Owned Businesses
Collabera listed in GS 100 & ranked among top 10 service providers
Collabera was ranked:
32 in the Top 100 Large Businesses in the U.S
18 in Top 500 Diversity Owned Businesses in the U.S
3 in the Top 100 Diversity Owned Businesses in New Jersey
3 in the Top 100 Privately-held Businesses in New Jersey
66th on FinTech 100
35th among top private companies in New Jersey
***********************************************
Collabera recognizes true potential of human capital and provides people the right opportunities for growth and professional excellence. Collabera offers a full range of benefits to its employees including paid vacations, holidays, personal days, Medical, Dental and Vision insurance, 401K retirement savings plan, Life Insurance, Disability Insurance.
Job Description
Claims Initiation Analyst II: Receives incoming calls and assists customers with questions or issues regarding potential fraudulent activity on a deposit account (checking, savings) . Takes appropriate action based on an evaluation of the customer's needs which may include, filing a new claim(s), updating and follow-up on existing claim(s), and/or reviewing appeals on denied claims. Takes personal ownership to ensure that customer requests are processed quickly and efficiently, while maintaining compliance with industry regulations and bank procedures. Responsibilities include but are not limited to: initiating claims using multiple systems and tools, providing first call resolution on inquiries, and may assist the customer in resolving disputes directly with the merchant. May debit or credit customer's accounts, as appropriate. May research and resolve other general customer account inquiries as appropriate and/or escalate issues on the customer's behalf while providing world class customer service. Understand and adhere to established service level agreements and set appropriate expectation with the clients and customers regarding the claims process.
Ideal candidate will have credit card knowledge in a customer service contact center.
Qualifications
Critical Skills:
* Claims experience (in financial industry, preferrably but not required)
* Customer service experience (in a call center environment, preferred but not required)
* credit card experience (preferred but not required)
Additional Information
Should you have any questions, please feel free to call me on ************.
Email your resume to: ********************************
Easy ApplyClaims Examiner - Auto/Bodily Injury
Claim processor job in Alexandria, VA
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Claims Examiner - Auto/Bodily Injury
**PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
+ Responsible for litigation process on litigated claims.
+ Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
+ Reports large claims to excess carrier(s).
+ Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
+ Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
+ Communicates claim action/processing with insured, client, and agent or broker when appropriate.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.
**Experience**
Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
**Skills & Knowledge**
+ In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
+ Knowledge of medical terminology for claim evaluation and Medicare compliance
+ Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
+ Strong oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Strong organizational skills
+ Strong interpersonal skills
+ Good negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Service Expectations
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical:** Computer keyboarding, travel as required
**Auditory/Visual:** Hearing, vision and talking
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Senior Claims Analyst
Claim processor job in Washington, DC
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
Experienced Outside Property Claim Representative
Claim processor job in Washington, DC
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$67,000.00 - $110,600.00
**Target Openings**
1
**What Is the Opportunity?**
This position could be eligible for a sign on bonus.
LOCATION REQUIREMENT: This position services Insureds/Agents in and around 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 ******************************************************** .
Claims Analyst I
Claim processor job in Washington, DC
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.
Auto-ApplyClaims Analyst - Construction Project
Claim processor job in Baltimore, MD
The Claims Analyst will perform a variety of "changes and claims" related contract administration tasks. An ideal candidate requires experience in transit projects through design, construction and commissioning phases. The Claims Analyst will be responsible for coordinating and reviewing claims / changes and engaging, strategizing, and working with various Program / Project teams to undertake the merit assessment, mitigation, and resolution of claims. The role requires commercial claim knowledge, and preferably also technical understanding, of multiple subject areas related to implementation of a large transit infrastructure projects.
Responsibilities
Maintain claims and early warnings' register.
Review alleged claims.
Carry out initial triage and risk assessment of claims.
Review project correspondence, and track and report on project claims.
Interface with the contractor and other stakeholders, as required, to gather additional details etc.
Attend various technical and commercial project working group meetings.
Requirements
Required Skills:
Critical thinking skills sufficient to apply analytical techniques to assess claims.
The ability to liaise effectively and to work closely with various multi-disciplinary technical and project controls teams
Proficiency with Microsoft Office Suite, particularly Excel.
Strong organization, time management, and prioritization skills with proven ability to balance competing tasks and meet deadlines.
Self-directed, detail-oriented, excellent at meeting deadlines with well-developed time management skills.
Excellent communication (both written and verbal), teamwork, and interpersonal skills.
Required Qualifications:
Bachelor's degree in engineering, business or other relevant degree.
1 - 4 years of relevant experience
Position Location
Field: Hybrid - 2 or 3 days in program office
Claims Analyst/Forensic Scheduler
Claim processor job in Baltimore, MD
Do you thrive on uncovering the story behind project delays and turning data into defensible insights? Join PEMCCO as a Claims Analyst/Forensic Scheduler, where you'll perform detailed schedule and delay analyses to assess time and cost impacts on construction projects. In this role, you'll support dispute resolution and litigation preparation by developing clear, evidence-based findings and narrative documentation that stand up to scrutiny.
PEMCCO, Inc. is an Information Technology and Information Management (IT/IM) services firm. We assist our customers in maximizing existing and emerging technologies to achieve their desired business productivity objectives. Living the Culture and Making It Happen is the motto we live by. We Live the Culture by carrying out the tenets of our Core Values of Loyalty, Integrity, and Commitment to our Customers and Employees every day. We Make It Happen by following Smart Organization Healthy Organization (SOHO) principles for internal and external communications and the successful execution of projects.
Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
Essential Functions
* Reconstruct as‑built schedules from field data, daily reports, and contractor updates.
* Perform critical path delay analysis, disruption quantification, and time‑impact modeling.
* Prepare expert‑level claims narratives with exhibits, graphics, and correlation charts.
* Support negotiations, mediations, and expert testimony preparation.
* Interface with project management, legal counsel, and technical advisors.
* Maintain a documentation library compliant with DGS and COMAR record‑keeping requirements.
Competencies
* Mastery of forensic scheduling, claims causation, and delay quantification.
* Excellent analytical, research, and report‑writing skills.
* Familiarity with contract law, AIA, and MD GMP provisions, and time‑extension protocols.
Required Qualifications
* Bachelor's degree in Engineering, Construction, or related field.
* 10+ years of schedule or claims analysis experience, including public capital programs.
* Must pass client background screening and security clearance.
Preferred Qualifications
* AACE CFCC or PSP certification.
* Experience in forensic schedule analysis for DGS, MDOT, or SHA.
Benefits
* 15 days of Paid Time Off
* 11 Paid Holidays
* Medical, Dental, and Vision
* Voluntary Short-Term Disability, Life Insurance, Accident, Critical Illness, Hospital Indemnity, Whole Life Plus, Identity Theft, and Law Assure
* 401(k)
* Employee Assistance Program (EAP)
Compensation
* $145 - $175 hourly, depending on experience, ability, and capability.
The role requires full-time, on-site presence in Baltimore, MD. Candidates must be able to reliably commute; relocation expenses are not provided.
PEMCCO, Inc. is an equal-opportunity employer. The Company does not discriminate based on race, color, sex, sexual orientation, gender identity or expression, religion, national origin, age, disability, genetic information, military or veteran status, pregnancy, childbirth, and related medical conditions, or any other characteristics protected by applicable federal, state, or local law.
Claims Analyst/Forensic Scheduler
Claim processor job in Baltimore, MD
Do you thrive on uncovering the story behind project delays and turning data into defensible insights? Join PEMCCO as a Claims Analyst/Forensic Scheduler, where you'll perform detailed schedule and delay analyses to assess time and cost impacts on construction projects. In this role, you'll support dispute resolution and litigation preparation by developing clear, evidence-based findings and narrative documentation that stand up to scrutiny.
PEMCCO, Inc. is an Information Technology and Information Management (IT/IM) services firm. We assist our customers in maximizing existing and emerging technologies to achieve their desired business productivity objectives. Living the Culture and Making It Happen is the motto we live by. We Live the Culture by carrying out the tenets of our Core Values of Loyalty, Integrity, and Commitment to our Customers and Employees every day. We Make It Happen by following Smart Organization Healthy Organization (SOHO) principles for internal and external communications and the successful execution of projects.
Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
Essential Functions
Reconstruct as‑built schedules from field data, daily reports, and contractor updates.
Perform critical path delay analysis, disruption quantification, and time‑impact modeling.
Prepare expert‑level claims narratives with exhibits, graphics, and correlation charts.
Support negotiations, mediations, and expert testimony preparation.
Interface with project management, legal counsel, and technical advisors.
Maintain a documentation library compliant with DGS and COMAR record‑keeping requirements.
Competencies
Mastery of forensic scheduling, claims causation, and delay quantification.
Excellent analytical, research, and report‑writing skills.
Familiarity with contract law, AIA, and MD GMP provisions, and time‑extension protocols.
Required Qualifications
Bachelor's degree in Engineering, Construction, or related field.
10+ years of schedule or claims analysis experience, including public capital programs.
Must pass client background screening and security clearance.
Preferred Qualifications
AACE CFCC or PSP certification.
Experience in forensic schedule analysis for DGS, MDOT, or SHA.
Benefits
15 days of Paid Time Off
11 Paid Holidays
Medical, Dental, and Vision
Voluntary Short-Term Disability, Life Insurance, Accident, Critical Illness, Hospital Indemnity, Whole Life Plus, Identity Theft, and Law Assure
401(k)
Employee Assistance Program (EAP)
Compensation
• $145 - $175 hourly, depending on experience, ability, and capability.
The role requires full-time, on-site presence in Baltimore, MD. Candidates must be able to reliably commute; relocation expenses are not provided.
PEMCCO, Inc. is an equal-opportunity employer. The Company does not discriminate based on race, color, sex, sexual orientation, gender identity or expression, religion, national origin, age, disability, genetic information, military or veteran status, pregnancy, childbirth, and related medical conditions, or any other characteristics protected by applicable federal, state, or local law.
Claim Representative, Workers' Compensation RTW - Hunt Valley, MD
Claim processor job in Huntingtown, MD
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.
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
What Is the Opportunity?
This role is eligible for a sign on bonus
Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery The injured worker is working modified duty and receiving ongoing medical treatment. The injured worker as returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. With close to moderate supervision, may handle claims of greater complexity where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and there has been a change in the current position. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.
What Will You Do?
Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability
Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions.
Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment.in collaboration with internal nurse resources where appropriate.
Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Prepare necessary letters and state filings within statutory limits.
Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud.Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.
Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction.
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.
Perform other duties as assigned.
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
2 years Workers Compensation claim handling experience.
Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology.
Ability to effectively present file resolution to internal and/or external stakeholders.
Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
Principles of Investigation: Intermediate investigative skills including the ability to take statements.
Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
WC Technical:
Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims.
Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
Intermediate knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Customer Service:
Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
Teamwork:
Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
Planning & Organizing:
Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
Maintain Continuing Education requirements as required or as mandated by state regulations.
What is a Must Have?
High School Diploma or GED.
1 year Workers Compensation claim handling experience or successful completion of the WC trainee program.
Claims Specialist
Claim processor job in Baltimore, MD
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.
This is a Hybrid role reporting to White Marsh, MD.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Receives claims, confirms policy coverage and acknowledgment of the claim
Determines validity and compensability of the claim
Establishes reserves and authorizes payments within reserving authority limits
Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision
Communicates claim status with the customer, claimant and client
Adheres to client and carrier guidelines and participates in claims review as needed
Assists other claims professionals with more complex or problematic claims as necessary
Requires regular and consistent attendance
Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”)
Additional projects and duties as assigned
KNOWLEDGE & SKILLS:
Excellent written and verbal communication skills
Ability to learn rapidly to develop knowledge and understanding of claims practice
Ability to identify, analyze and solve problems
Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
Strong interpersonal, time management and organizational skills
Ability to meet or exceed performance competencies
Ability to work both independently and within a team environment
EDUCATION & EXPERIENCE:
Bachelor's degree or a combination of education and related experience
Minimum of 1 year of industry experience and claims management preferred
State Certification as an Experienced Examiner
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $51,807 - $83,551
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Hybrid
Chinese Triage Examiner
Claim processor job in Bethesda, MD
The National Solutions Sector is currently looking experienced **_Chinese Triage_** **_E_** **_xaminers_** 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 onlyand 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.
**About Leidos**
Leidos is an industry and technology leader serving government and commercial customers with smarter, more efficient digital and mission innovations. Headquartered in Reston, Virginia, with 47,000 global employees, Leidos reported annual revenues of approximately $16.7 billion for the fiscal year ended January 3, 2025. For more information, visit ************** .
**Pay and Benefits**
Pay and benefits are fundamental to any career decision. That's why we craft compensation packages that reflect the importance of the work we do for our customers. Employment benefits include competitive compensation, Health and Wellness programs, Income Protection, Paid Leave and Retirement. More details are available at **************/careers/pay-benefits .
**Securing Your Data**
Beware of fake employment opportunities using Leidos' name. Leidos will never ask you to provide payment-related information during any part of the employment application process (i.e., ask you for money), nor will Leidos ever advance money as part of the hiring process (i.e., send you a check or money order before doing any work). Further, Leidos will only communicate with you through emails that are generated by the Leidos.com automated system - never from free commercial services (e.g., Gmail, Yahoo, Hotmail) or via WhatsApp, Telegram, etc. If you received an email purporting to be from Leidos that asks for payment-related information or any other personal information (e.g., about you or your previous employer), and you are concerned about its legitimacy, please make us aware immediately by emailing us at ***************************** .
If you believe you are the victim of a scam, contact your local law enforcement and report the incident to the U.S. Federal Trade Commission (******************************* .
**Commitment to Non-Discrimination**
All qualified applicants will receive consideration for employment without regard to sex, race, ethnicity, age, national origin, citizenship, religion, physical or mental disability, medical condition, genetic information, pregnancy, family structure, marital status, ancestry, domestic partner status, sexual orientation, gender identity or expression, veteran or military status, or any other basis prohibited by law. Leidos will also consider for employment qualified applicants with criminal histories consistent with relevant laws.
REQNUMBER: R-00165386
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. Leidos will consider qualified applicants with criminal histories for employment in accordance with relevant Laws. Leidos is an equal opportunity employer/disability/vet.
Easy ApplyClaims - Field Claims Representative
Claim processor job in Towson, MD
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
The Field Claims department is currently seeking Field Claims Representatives to service the territory surrounding: Towson Maryland. 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:
Salary: The pay range for this position is $60,500 - $83,600 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:
Salary: The pay range for this position is $68,200- $99,000 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.
Claims Analyst
Claim processor job in Washington, DC
Job Description
Role: Claims Analyst
Status: Full-time
Mission: To allow frail elderly people to age in the location of their choosing and continue to lead connected, meaningful lives
JOB SUMMARY
The Claims Analyst reviews, processes and analyzes healthcare claims to determine their validity and accuracy. They assess damages, verify policy coverage and ensure compliance with regulations and company procedures. Effective communication, problem-solving and attention to detail are crucial for this role.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Reviews submitted claims for accuracy, completeness and adherence to policy terms and legal requirements.
Analyzes claim data to identify trends, patterns, and potential irregularities.
Communicates with stakeholders to gather information, explain decisions, and resolve issues.
Investigates potential fraudulent claims and gathering supporting evidence.
Makes informed decisions on claim validity and determining appropriate compensation.
Maintains accurate and detailed records of claims processing and outcomes.
Ensures adherence to relevant regulations and company policies.
Develop and maintain positive relationships with the network of providers through ongoing
communication and by providing feedback
Performs other duties as required.
QUALIFICATIONS
Education and Experience:
High School Diploma. Associate's Degree preferred.
1-3 years of experience in data analysis in a customer service environment within the healthcare insurance industry preferred.
Experience analyzing data, identifying discrepancies and making informed decisions.
Skills and Competencies:
Able to clearly explain complex information, both verbally and in writing.
Able to identify and resolve issues related to claims processing.
Strong attention to detail to ensure accuracy in claim review and data entry.
Knowledge of Insurance/Healthcare, including understanding policy terms, coverage, and relevant regulations.
Exceptional customer service skills.
Learn more at:
edenbridgepace.com/dc