Claim processor jobs in Grapevine, TX

PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U. S. mortgage loans and the management of investments related to the U. S. mortgage market. At Pennymac, our people are the foundation of our success and at the heart of our dynamic work culture. Together, we work towards a unified goal of helping millions of Americans achieve aspirations of homeownership through the complete mortgage journey. A Typical Day The Claims Processor will take direction from the department supervisor for post-sale functions, such as: evictions, property maintenance, conveyance of title, title delivery, and adherence to GSE servicing requirements during the REO process. As the Claims Processor, you will be responsible for filing MI, investor, and insurer claims timely and accurately, providing all back-up as requested, and the reconciliation and posting of claim proceeds. The Claims Processor will: Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including: eviction management, property inspection and maintenance, conveyance of title, title delivery, maintenance of HOA, taxes, and property insurance during the GSE REO process File claims for reimbursement of expenses Reconcile claim proceeds File supplemental claims as needed Ensure data accuracy Perform other related duties as required and assigned Demonstrate behaviors which are aligned with the organization's desired culture and values What You'll Bring High School Diploma / GED 1+ years of relevant work experience Default-related experience preferred Demonstrated aptitude for data, reporting, and working with numbers, desired Familiar with GSE and Insurer servicing guidelines Must be highly proficient in Excel and Word Why You Should Join As one of the top mortgage lenders in the country, Pennymac has helped over 4 million lifetime homeowners achieve and sustain their aspirations of home. Our vision is to be the most trusted partner for home. Together, 4,000 Pennymac team members across the country are guided by our core values: to be Accountable, Reliable and Ethical in all that we do. Pennymac is committed to conducting a business that makes positive contributions and promotes long-term sustainable growth and to fostering an equitable and inclusive environment, where all employees and customers feel valued, respected and supported. Benefits That Bring It Home: Whether you're looking for flexible benefits for today, setting up short-term goals for tomorrow, or planning for long-term success and retirement, Pennymac's benefits have you covered. Some key benefits include: Comprehensive Medical, Dental, and Vision Paid Time Off Programs including vacation, holidays, illness, and parental leave Wellness Programs, Employee Recognition Programs, and onsite gyms and cafe style dining (select locations) Retirement benefits, life insurance, 401k match, and tuition reimbursement Philanthropy Programs including matching gifts, volunteer grants, charitable grants and corporate sponsorships To learn more about our benefits visit: ********************* page. link/benefits For residents with state required benefit information, additional information can be found at: ************ pennymac. com/additional-benefits-information Compensation: Individual salary may vary based on multiple factors including specific role, geographic location / market data, and skills and experience as defined below: Lower in range - Building skills and experience in the role Mid-range - Experience and skills align with proficiency in the role Higher in range - Experience and skills add value above typical requirements of the role Some roles may be eligible for performance-based compensation and/or stock-based incentives awarded to employees based on company and individual performance. Salary $39,000 - $55,000 Work Model OFFICE

Job Description Key Responsibilities: Customer Claims: • Manage Customer Injury and Liability Claims: Oversee the investigation, documentation, and resolution of customer claims related to personal injury, property damage, or any other incidents occurring on organization premises. • Coordinate with Insurance Providers: Liaise with insurance companies to ensure proper claims filing and coordinate the resolution of claims involving external parties. • Customer Support: Handle escalated customer claims and provide appropriate resolutions while ensuring the store's best interests are maintained. • Documentation & Compliance: Ensure that all claims are properly documented in compliance with company policies and legal requirements. Keep detailed records of each customer-related claim. • Risk Prevention: Identify trends or recurring incidents that may contribute to customer claims and work with store management to implement safety measures or preventive actions. Employee Claims: • Workers' Compensation Claims: Oversee and manage all workers' compensation claims, ensuring compliance with state and federal regulations, and ensuring employees receive appropriate benefits. • Workplace Injury Claims: Manage the investigation of employee injury claims, including gathering evidence, interviewing witnesses, and ensuring all necessary forms are completed and submitted on time. • Fleet Claims Management: Manage the investigation of employee fleet claims, support employee's injuries if any, gather witness statements • Support and Guidance: Provide support to injured employees, ensuring they are informed throughout the claims process and are aware of their rights and available benefits. • Collaboration with HR and Legal: Work with HR and legal teams to ensure employee-related claims are handled correctly and in compliance with labor laws, insurance regulations, and company policies. • Collaboration with Safety Team: Work with the Safety Team to consistently do store visits, conduct safety audits, checklists and investigations as needed. Development: • Process Improvement: Identify opportunities to improve the claims process, whether through more efficient systems, better documentation, or enhanced communication strategies. Risk Management and Reporting: • Claims Analysis and Reporting: Review and analyze the data on claims to identify trends, recurring issues, or areas for improvement. Prepare detailed reports for management regarding claim frequency, costs, and risk mitigation efforts. • Collaboration with Risk and Safety Teams: Work closely with the Risk Management and Safety teams to address underlying causes of incidents that may lead to claims and develop preventive strategies. • Compliance: Ensure that all claims are processed in line with company policies, industry standards, and legal requirements, including managing documentation for audits or regulatory reviews. • Invoices: Reconcile and verify all invoices generated from claims. • Safety Monitor Report: Complete Safety Monitor report and communicate all parties involved to resolve an issue related to an investigation. Qualifications: • Bachelor's degree in Business, Risk Management, Insurance, or a related field (or equivalent experience). • 3-5 years of experience in claims management, risk management, or a specialist role, preferably in a retail or supermarket environment. • Strong understanding of risk management principles, insurance claims processes, and workers' compensation regulations. • Strong problem-solving and analytical abilities to investigate and resolve complex claims efficiently. • Excellent communication skills, both written and verbal, with the ability to manage sensitive issues with customers and employees. • Attention to detail and ability to maintain accurate records and reports. • Proficient in Microsoft Office and experience with claims management software or risk management tools. Physical Requirements: • Ability to stand for extended periods • Ability to lift up to 50 lbs as needed Work Environment: • Fast-paced, high-volume environment • Occasional evening, weekend, or holiday work may be required • Occasional travel to different company locations Physical Demands: Some lifting, carrying, pushing, and/or pulling; some stooping, kneeling, crouching, and/or crawling; and significant fine finger dexterity. Generally, the job requires 70% sitting, 20% walking, and 10% standing. This job is performed in a generally clean and healthy office environment.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). This position enjoys a flexible, hybrid work schedule and is available in any location near a CNA office. JOB DESCRIPTION: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically, Manager or above Skills, Knowledge & Abilities Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. Demonstrated ability to develop collaborative business relationships with internal and external work partners. Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. Demonstrated investigative experience with an analytical mindset and critical thinking skills. Strong work ethic, with demonstrated time management and organizational skills. Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. Developing ability to negotiate low to moderately complex settlements. Adaptable to a changing environment. Knowledge of Microsoft Office Suite and ability to learn business-related software. Demonstrated ability to value diverse opinions and ideas Education & Experience: Bachelor's Degree or equivalent experience. Typically, a minimum four years of relevant experience, preferably in claim handling. Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. Professional designations are a plus (e.g. CPCU) #LI-LG1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. Job Description Claims Processor Type: Temporary/Contract Length: Up to 90 days (Note: Could be less or could be extended depending on weather events and amount of claims/work to be processed) Hours: Must be flexible to work 7 days a week: Monday through Friday, 7:00 a.m. to 7:00 p.m.; Saturday and Sunday, 8:00 a.m. to 5:00 p.m. Pay Rate: $15.00 per hour Location: Richardson, TX Qualifications High school/GED Additional Information Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world. We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.

The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager. Specific Duties include: Claims & Incident Management: Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to: Input and/or review all incidents reported in DPR's RMIS system. Maintain incident records in Insurance Team's document management system. Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements. Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities. Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable. Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate. Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date. Provide in-network aluminum certified repair shop information to drivers following an incident. Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement. When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form. Work with Insurance Controller on auto program claim reports Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed. Fleet Vehicle Safety & Operations Policy Management: Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training Ensure authorized driver list is kept current Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy Key Skills: Strategic thinking Ability to mentor and inspire others Integrity Team player Strong writing and communication skills Self-Starter Highly organized and responsive - ability to meet deadlines Detail Oriented Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs. Risk and dispute management - insured claims Qualifications: A minimum of five years relevant insurance industry experience Previous experience in auto claims management highly desired DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world. Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek. Explore our open opportunities at ********************

Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************

As a 100% employee-owned contractor, when you work at Sundt, you're not just hiring on at a company, you're joining a culture. Because everyone at Sundt is part owner, you'll join a team of people who are deeply invested in their work. From apprentices to managers, we're passionate about the details and deliberate in everything we do. At Sundt we focus on building long-term prosperity for our clients, communities, and employee-owners. We offer competitive pay, industry-leading benefits including a 401k and employee stock ownership plan, incentive programs for craft and administrative employees as well as training that focuses on your personal and professional growth. We're driven by skill, grit and purpose. Join us as we strive to be the most skilled builder in America. Job Summary The Paralegal / Claims Specialist supports the company's Legal and Risk Management functions by assisting attorneys and insurance professionals in the investigation, evaluation, and resolution of claims and lawsuits. The role involves direct collaboration with outside counsel, insurance adjusters, and internal Safety and Operations teams. The Paralegal/Claims Specialist will independently manage the day-to-day handling of routine litigation and claims matters, including discovery, documentation, and coordination with defense counsel. Key Responsibilities 1. Assists attorneys with trial preparation, exhibits, witness coordination, and logistics. 2. Assists company attorneys with responding to non-party subpoenas and regulatory inquiries. 3. Attends mediations, depositions, and hearings as appropriate to support counsel, our internal personnel and maintain awareness of case progress. 4. Communicates directly with claimants, witnesses, experts, and internal personnel to obtain and analyze relevant information, including managing internal electronic data preservation in coordination with IT team, and oversee transfer of preserved data for discovery. 5. Coordinates with Safety personnel regarding incident intake, documentation, and potential claims escalation. 6. Drafts and edits legal documents including correspondence, discovery requests and responses, routine pleadings, affidavits, and case summaries. 7. In conjunction with attorneys, manages litigation, including coordinating discovery and e-discovery, tracking deadlines, managing document production, approving and processing legal invoices and maintaining organized case files. 8. Maintains accurate and up-to-date records in Risk Information Management Systems {RIMS) or other claims databases. 9. Reviews and analyzes claims in coordination with legal and risk management professionals determine liability, damages, and insurance coverage. 10. Works closely with company attorneys, outside counsel, and insurance adjusters to investigate, evaluate, and resolve claims and lawsuits. Minimum Job Requirements 1. 5-10 Years of Experience 2. Bachelor's degree 3. Knowledge working for a law firm or an insurance company representing clients in responding to claims and lawsuit preferred. 4. Paralegal certification Note: is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 50Ibs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Note: Job Description is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 501bs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Equal Opportunity Employer Statement: Sundt is committed to the equal treatment of all employees, and/or applicants for employment, and prohibits discrimination based on race, religion, sex (including pregnancy), sexual orientation, gender identity, color, age, disability, national origin, covered veteran status, genetic information; or any other classification protected by applicable Federal, state, or local laws. Benefit list: Market Competitive Salary (paid weekly) Bonus Eligibility based on company, group, and individual performance Employee Stock Ownership Plan & 401K Industry Leading Health Coverage Starting Your First Day Flexible Time Off (FTO) Medical, Health Savings, and Wellness credits Flexible Spending Accounts Employee Assistance Program Workplace Wellness Programs Mental Health Program Life and Disability Insurance Employee-Owner Perks Educational Assistance Sundt Foundation - Charitable Employee-Owner's program #LI-KA1

The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. This is a hybrid position. Candidates residing within 50 miles of the following offices are quired to report onsite twice a month: Suwanee, GA; Irving, TX; Boston, MA; and Plano, TX. Please note this is subject to change. The starting salary for the role is $56,000. The actual compensation for this role will depend on the candidate's geographic location, overall experience, and skill level. Responsibilities: * Manages an inventory of claims to evaluate compensability/liability. * Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. * Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. * Assesses 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, refers claims to the subrogation group or Special Investigations Unit as appropriate. * Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. * Performs other duties as assigned. Qualifications * Proven interpersonal, analytical and negotiation abilities required. * Ability to provide information in a clear, concise manner, ability to build effective relationships. * Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred. * Licensing may be required in some states. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

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

MSIG USA continues to grow! MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., one of the world's top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business's unique risks. Summary/Job Purpose: This position is responsible to conduct thorough investigations and evaluate and negotiate complex claims including litigation and coverage issues. Accountable to ensure compliance with MSMM Claim Handling Guidelines, including reserving and payment practices, regulatory requirements and Fair Claims Practices Acts. Essential Functions: Investigates, researches and analyzes highly complex or severe claims, including coverage issues and legal issues affecting liability and damages. Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority. Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claim practices and company policy and procedures. Attends pre-trials, trials, settlement conferences and mediations on assigned cases as required Assigns the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the company's Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness. Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews. Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations. Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement. Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations. Maintains full compliance with all state licensing and continuing education requirements to ensure current and appropriate filing/standing of all adjuster licenses. Maintains regular reporting of case status, developments and direction to Home Office staff and other appropriate parties as necessary. Ensures timely and appropriate file reports and system documentation as required by company claim manuals and procedures. Participates and/or manages special projects and assignments as needed. Supervisory Responsibilities: This position has no supervisory responsibilities. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and Experience Required: Diploma/Degree & Experience High School Degree or G.E.D. is required. Bachelor's degree preferred 7+ years related experience handling complex Liability or Workers' Compensation Claims It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group! It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.

Lockton is currently seeking a Clinical Claims Specialist within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims, reduce the cost of risk while improving the health of our employer client's employee health plan. * Provide explanation of disease states and associated costs to internal and external stakeholders. * Provide cost-of-care estimates used in the risk assessment of stop loss underwriting. * Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals. * Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims. * Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction. * Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan. * Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance. * Manage and organize task lists and open items and cases. * Attend team clinical rounds to discuss cases and strategy solutions.

Are you keen to work somewhere that's stimulating and friendly, with loads of opportunities for growth and plenty of freedom to make a real impact? This could be the place for you! We are looking for a Claims Specialist III (CS3) to join us at INSHUR! We're based in Dallas, TX , with offices in New York City and Westlake, CA ️ and our company embraces a hybrid working model, allowing you to thrive in both collaborative office settings and the comfort of your own home . You'll have the opportunity to work remotely while also connecting with your colleagues at our Dallas office 3 days a week initially and reducing to 1 day a week following your orientation, typically 90 days, fostering a dynamic and supportive environment. Supported by (and reporting to) Claims Manager and Team Leaders, you'll be joining a friendly team of 29 specialists who believe in delivering great customer service at scale. We value high performance and care deeply about making INSHUR a place where everyone is building something special, that we can all be proud of, while enjoying the ride. What you'll do As our Claim Specialist III (CS3) you will be responsible for handling and resolving commercial auto claims across the United States. The claims that are assigned to you will involve coverage investigations, liability negotiations, third-party bodily injury, and depending on your experience litigation. You will be responsible for setting and maintaining reserves, assigning defense counsel, negotiating settlements with attorneys, issuing payments, and interpreting policy contracts. While we prioritise aptitude and passion over a strict checklist of requirements, we've outlined a core set of skills we believe will lead to success in this role. To make things clear, we've categorised them into "essentials to thrive in the role" and "additional skills that could set you apart" We'd love to hear from you if you have …these essentials to thrive in the role; * Experience handling third-party bodily injury claims in a personal auto or commercial auto space at a recognized insurance carrier * Have already secured an insurance license in Texas. * Ability to secure a license in California and New York within 60 days. * Enjoy working in a fast-paced environment. * Understand that customer satisfaction and retention is driven by handling claims well. * Are passionate about building a successful career in Claims. * Helped resolve customer concerns in your most recent role. * Understand the value of contributing to a team's shared success. * Ability to work from our office in Irving, TX 3 days a week during your first 2 weeks and then 2 days a week for 90 days. After successful completion of trial period, this will reduce to 1 day a week. … these additional skills that could set you apart * A bachelor's degree is strongly preferred. You'll love it here if you: Thrive navigating ambiguity and finding clarity in uncertain situations. Take pride in being accountable and owning your responsibilities. Enjoy in a fast-paced environment where change happens quickly. Are solutions-focused and driven to overcome challenges. Embrace resilience and adapt to setbacks with a positive attitude. Are intellectually curious, constantly seeking to learn, explore new ideas, and not afraid to question and improve your understanding. You may not enjoy working here if: Prefer a more structured, slow-moving environment. Feel most comfortable when tasks and processes are clearly defined from the start. Struggle with handling multiple challenges at once or adapting to frequent changes. Tend to stick strictly to your defined role and avoid contributing outside of your responsibilities. What to expect from the process: Screen & Intro: 20-minute call with the Talent Team to discuss the role and your experience. First Interview: 60-minute onsite interview with a Claims Manager or Team Lead and People Partner to delve into the role, including technical questions and an opportunity for you to ask questions. What we offer We offer all our employees a competitive salary and stock options. We've also built a benefits package that invests in our people's long-term personal and professional growth and wellbeing. Here's a sample of what this includes: 25 days of holiday (+5 days after 5 years), 5 sick days and 8 federal holidays Medical, dental and vision health insurance plans ️ Life insurance, short-term, and long-term disability benefits 13 weeks fully paid parental leave for all new parents, regardless of your gender 401(k) with 4% company match Commuter Benefits Flexible working hours to fit your lifestyle $650 annual training allowance & learning opportunities ️ $50 monthly wellbeing and home setup allowance 24/7 Employee Assistance Program and mental health benefits It goes without saying that we provide everyone with a laptop, monitor, top of the range kit, and any software you need. About Us INSHUR is on a mission to be the leader in insurance solutions for the on-demand economy, making coverage fair and accessible for drivers. Cutting edge technology & deep insurance know-how underpins our revolutionary offering for on-demand drivers, keeping premiums affordable and delivering results for partners. With a focus on embedded insurance solutions, and complementary technology integrations for digital platform providers such as Uber, Amazon, Bolt, FREENOW and OLA, we've been helping drivers stay on the road since 2016 through our data, technology and in-house insurance expertise. Backed by some of the most forward thinking VC's including Viola Growth, JVP, Munich Re, Viola Fintech, MTech Capital, Antler, and MS&AD, we have secured over $113.5 million in funding as well as the acquisition of American Business Insurance in 2023. We have exciting plans to continue growing our portfolio and product lines and expand to new territories in the future. As a global team of around 220 people based across the US, UK, and the Netherlands, we value: Generosity, inclusivity, open-mindedness, and diversity Delivering great results and learning in the open Freedom to make long-term, high-impact decisions The wellbeing of our teammates and the people around us And… Enjoying the ride! Equal opportunities At INSHUR, we believe that having a diverse team where everyone can bring their authentic selves to work is key to our success. We're passionate about creating equal opportunities and making the tech industry a better place for all and we don't discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, marital status, disability, or age. As at Aug 2025, our team consists of 46% women, 31% from BAME or BIPOC backgrounds, and 12% LGBTQ+ . We proudly represent 30+ nationalities and span multiple generations, including Baby Boomers, Gen X, Millennials, and Gen Z. We're proud to have been recognised for Diversity and Inclusion by the British Insurance Awards . We recognise that some companies often hire people similar to the existing team-something we've worked hard to overcome. We follow a structured hiring process and ensure our interview teams are trained to foster inclusivity and equity. While this position is advertised as full-time, we're flexible on specific arrangements and happy to discuss options like part-time, job-sharing, or other flexible work setups for the right candidate. ️ If you need any adjustments during the interview process, please let us know, and we'll do our best to accommodate your needs.

Who are we: Toyota Insurance is a brand name of Toyota Insurance Management Solutions USA, LLC (TIMS). We are an independent agency specializing in property and casualty insurance for Toyota vehicle owners. We offer insurance through our trusted carrier partners to provide coverage for your Toyota vehicle, home and other assets. Our mission is to improve the Toyota ownership experience by improving the insurance experience. Job Overview: We are seeking a detail-oriented and proactive Auto Claims Specialist to join our team and support the auto property damage claims process. This role combines technical expertise in auto damage assessment with advocacy and coordination between internal and external stakeholders to ensure timely, accurate, and fair resolution. The ideal candidate will possess strong analytical skills, attention to detail, and excellent communication abilities with the desire to grow within the claims and insurance operations field. Job Responsibilities: Claims Intake & Documentation: Receive initial auto claim and damage information from internal teams or external parties. Collect, review, and validate all relevant supporting documentation such as police reports, First Notice of Loss (FNOL), recorded statements, and any other applicable claims information for accuracy and completeness. Accurately enter claims and damage data into the claims management system (Nexure). Must have a solid understanding of rideshare insurance policies, including how coverage exclusions apply and impact claims. File Management & Reporting: Organize and maintain secure auto claim files and records in compliance with company and regulatory standards. Submit loss notices and report claims promptly to insurance carriers. Prepare and submit any additional applicable claims or inquiries as required. Damage Review & Estimation: Review and document auto damages thoroughly. Analyze and validate repair estimates for vehicle damages. Coordinate with repair shops to discuss damages and confirm accuracy of estimates. Repair Process Oversight: Examine and evaluate repair processes and timelines. Monitor repairs through completion, ensuring quality and adherence to agreed timelines. Communication & Collaboration: Serve as the primary liaison between internal departments, vendors, external stakeholders, attorneys, and carriers. Provide clear and timely updates to all parties involved in the claim process. Claims Evaluation & Escalation: Review claim settlement recommendations for accuracy and fairness. Collaborate with senior claims analyst on complex or high-risk claims and escalate as necessary. Required Education and Experience: Licensed as an Adjuster in the State of Texas. 3 to 5 years of experience in auto insurance claims, auto claims adjusting, advocacy and/or auto claims estimation. Strong knowledge of insurance policies, auto repair processes and claims regulations. Knowledge of and experience in auto claims involving public or livery passenger conveyance policy exclusions and endorsements. Excellent organizational, time management skills, and communication skills. Strong understanding of the complete auto claims process, from initial intake to final resolution. Ability to work independently with minimal supervision. Preferred Skills: Strong analytical and problem-solving abilities. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and claims management systems. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Insurance agency, brokerage, or agent knowledge and/or experience is a plus. Strong attention to detail and organizational skills. Core Competencies: Analytical Thinking: Ability to interpret complex data, identify trends, and make informed decisions to resolve claims efficiently. Attention to Detail: Ensures accuracy in documentation, compliance with regulatory requirements, and thorough investigation of claims. Problem-Solving: Skilled in evaluating claim scenarios and developing effective solutions to minimize risk and optimize outcomes. Communication Skills: Strong written and verbal communication for interacting with internal teams, external partners, and clients. Work Environment and Physical Demands: Ability to work within a Team environment under tight schedules. Willingness to work evenings or weekends, as dictated by the needs of the business. Compensation: Base Salary: $46,000-$60,000 based on skills and experience Onsite-Plano office What are the Perks? Medical, Dental & Vision Insurance Paid Time Off, Paid Holidays and Sick Days 401(k) Match FSA and HSA Pet Insurance Life Insurance Degree of Travel: None Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Work Authorization: Applicants must be authorized to work for any employer in the U.S. This position does not offer sponsorship or the transfer of sponsorship of employment Visa. Learn More: Visit our website Toyota Insurance: *********************************** to learn more about our company culture and career opportunities. FLSA Job Status: ☒ Exempt ☐Non-Exempt All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. An Equal Opportunity Employer: Female / Minority / Disability / Protected Veteran / Sexual Orientation / Gender Identity EEOC is The Law' Information: ******************************************************************************

For More Open Positions Visit us at: ********************************** Our Mission WOONGJIN, Inc. is a rapidly growing team who provides a range of unique, exceptional, and enhanced services to our clients. We have a strong moral code that includes the service of goodness without expectations of reward. We are motivated by the sense of responsibility and servant leadership. Benefits Medical Insurance Vision Insurance Dental Insurance 401(k) Paid Sick hours Job Description Process carrier claim payments (AR) accurately on or before deadlines according to company policy. Collaborate with our Recovery Team to report claim approvals and pending payments. Review essential claim documentation to confirm payment accuracy (AP). Communicate with carriers/3PL's to confirm payment details. Audit/Manage contracts and tariffs in regards to process payments in the system. Dispute invalid claim resolutions to overturn declination and negotiate claim settlements Investigate and diagnose potential errors preventing payment processing Facilitate Legal reviews to review and execute settlement agreements from carriers/3PL's. Work within company guidelines to analyze contractual agreements of the customer, shipper, consignee or carrier and then assess the physical damage reports and the cargo claims findings Track and submit approval requests for aging claim offsets against carrier invoices. Perform ad-hoc reporting or other job-related duties, as required Contract period: 3 months + Extend Salary: $24 - $26/hr. Qualifications Required proficiency in Microsoft Excel, including but not limited to, advanced reporting functions and formatting, VLOOKUP, and pivot tables 3-5 years of Accounting/Finance experience preferred 1+ years of freight claims processing Excellent verbal and written communication skills Strong critical thinking and creative problem solving skills Flexibility to work in a fast-paced, team-oriented environment Superior attention to detail, organization, cross-group collaboration, and project management skills Additional Information All your information will be kept confidential according to EEO guidelines. *** NO C2C ***

Claims Specialist Program Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance! Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes. The details When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault. You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case. You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual. Qualifications What you've got You have 0-2 years of professional experience. A strong academic record with a cumulative 3.0 GPA preferred You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism. You possess strong negotiation and analytical skills. You are detail-oriented and thrive in a fast-paced work environment. You must have permanent work authorization in the United States. What we offer Competitive compensation package Pension and 401(k) savings plans Comprehensive health and wellness plans Dental, Vision, and Disability insurance Flexible work arrangements Individualized career mobility and development plans Tuition reimbursement Employee Resource Groups Paid leave; maternity and paternity leaves Commuter benefits, employee discounts, and more Learn more about benefits at ************************** A little about us As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow. We were recognized as a ‘2018 Great Place to Work' by Great Place to Work US, and were named by Forbes as one of the best employers in the country for new graduates and women-as well as for diversity. Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information, or on any basis prohibited by federal, state, or local law. We can recommend jobs specifically for you! Click here to get started.

Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com. About You: You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small & big wins. INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with. You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas. You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren't just the individuals using your product. They are the driving factor in your motivation to make a change. Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear. You thrive in a Team Environment. Collaboration is key in innovation and creating change. These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life. If this sounds like you, we would love to connect to speak further about career opportunities at Lantern. Please apply to our role & someone from our Talent Acquisition Team will reach out to help you navigate our interview process. Job Overview Our Reimbursement Specialists are a central points of contact for our provider network. The primary responsibility of the role is to deliver effective, accurate payment and communication to our providers. The day-to-day responsibilities of our Reimbursement Specialists include payment processing, researching, accurate billing/payment disbursement, and ensuring payment data accuracy and integrity. The desired candidate is articulate, empathetic, pragmatic, self-starting and ambitious. In addition, our Reimbursement Specialists are horizontal thinkers, analytical, organized and detail oriented. Key Responsibilities: Processes provider payments in accordance with company policies and procedures. Serves as primary contact to Finance Department regarding payment, determinations and payment processing activities. Assist in the final determination on claim disposition and payment determination. Serves as liaison to internal departments regarding provider related inquiries on claims related content. Processes adjustments or provider disputes providing timely follow-up. Coordinates research and responds to system inquiries from providers regarding payment, reimbursement determination, provider contact information and claims billing procedures. Communicates with supervisor on a daily and/or weekly basis regarding any outstanding claims issues related to system, authorizations, reimbursement/payment errors or internal approvals. Works with provider contracting staff when new/modified reimbursement contracts are needed Performs pre-adjudication claims reviews to ensure proper terms and schedules were used. Initiate necessary actions regarding pending claims or payment documentation. Follow up on open items reports to timely and accurate resolution. Respond proactively to provider issues and concerns and give feedback to management. Provide feedback to the manager regarding proper claims billing procedures in accordance with company policy and procedures. Assist in training new Payment Specialists. Initiate change requests to resolve system issues impacting claims/payment processing or issue resolution Runs and analyzes daily activity reports. Analyze, develop and deliver claims resolutions quickly and accurately according to company policies and procedures. Requirements: Minimum Bachelor's degree in healthcare, business, marketing or related field; or HS Diploma (or GED) and 4 years' applicable experience Minimum 2 years of experience in previous claims, health insurance or healthcare practice Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) preferred Knowledge of commonly used medical data resources preferred Knowledge of payor contracts and interpretation Knowledge of general office operations and/or experience with standard medical insurance claim forms preferred Strong communication (verbal, written and listening), teamwork, negotiation and organizational skills Ability to commit to providing a level of customer service within established standards Ability to provide attention to detail to ensure accuracy including mathematical calculations Ability to organize workload to meet deadlines and participate in department/team meetings Ability to analyze data and arrive at a logical conclusion Ability to identify issues and determine appropriate course of action for resolution Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software Ability to work with accuracy in a fast-paced environment Ability to work independently and handle PHI and confidential information Ability to process detailed verbal and written instructions Benefits Medical Insurance Dental Insurance Vision Insurance Short & Long Term Disability Life Insurance 401k with company match Paid Time Off Paid Parental Leave Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

Job Description Imagine being part of a fun and energetic environment where your problem-solving skills are not only valued but celebrated. You will work onsite alongside like-minded professionals, fostering a culture of collaboration and high performance. Embrace your potential in a forward-thinking atmosphere dedicated to customer-centricity and integrity, ensuring every claim is handled with empathy and expertise. If you thrive in an environment that motivates you to think abundantly and push the boundaries of what's possible, then this is the role for you. You can get great benefits such as Medical, Dental, Vision, 401(k), Life Insurance, Health Savings Account, Flexible Spending Account. Commitment to Training & Development, Competitive Salary, and Paid Time Off. Don't miss out on the chance to make a meaningful impact-apply today! What's your day like? As an Auto Liability PD Claims Specialist at Lonestar, you'll engage in a variety of fulfilling tasks each day. Starting your week on a Monday, you can expect to manage a portfolio of auto liability claims, conducting thorough investigations into incidents while ensuring compliance with industry regulations. Your day will involve reviewing documentation, communicating with policyholders, and collaborating with internal teams to resolve claims efficiently. You'll expertly analyze loss details, assess damages, and negotiate settlements in a timely manner. Daily interactions will include empathetic communication with customers, guiding them through the claims process, and providing updates on their cases. Your work schedule will be Monday through Friday, from either 8:00 AM to 5:00 PM or 8:30 AM to 5:30 PM, allowing for a balanced work-life harmony as you contribute to our high-performance culture. Are you the Auto Liability PD Claims Specialist we're looking for? To thrive as an Auto Liability PD Claims Specialist at Lonestar, you'll need a unique blend of skills and expertise. With a minimum of three years' experience in auto liability and property damage claims, you'll leverage your technical knowledge to effectively determine the course of action on each assigned file. Strong analytical skills are essential for conducting thorough investigations and maintaining accurate documentation of coverage, liability, and applicable damages. Exceptional communication skills-both verbal and written-will enable you to work seamlessly with internal teams and external customers, ensuring a collaborative approach to establishing facts and developing evidence. Organizational capabilities will help you prioritize multiple claims, keeping up with current assignments for prompt resolution. A Texas Licensed Adjuster certification is required, and familiarity with unfair claim practices is vital. Experience in automated claims processing is preferred, and being bilingual in Spanish is a valuable asset in fostering strong customer relationships. Your professionalism will be crucial in handling vendor interactions while maintaining Lonestar's reputation for quality service. Knowledge and skills required for the position are: Review and determine course of action on each file assigned utilizing technical knowledge and experience for the purpose of supporting final disposition of a loss. Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage liability status and damages that are applicable for each claim. Honor/decline/negotiate first and third-party liability claims upon completion of coverage/policy investigation and analysis of damages and liability. Work directly with internal and external customers to develop evidence and establish facts on assigned claims. Organize plan and prioritize work activities to keep up with current assignments and to ensure prompt conclusion of claims. Prepare and present claim evaluations for the appropriate settlement authority. Notify the Underwriting Department of any adverse information uncovered in the course of the investigation. Familiarity with unfair claim practices in states where doing business. Conduct business with vendors in a professional manner while maintaining a reasonable expense factor and upholding the company's reputation for quality service. Provide customer service both to internal and external customers. Handle other duties as assigned. QUALIFICATIONS REQUIRED: Minimum of 3 years previous auto liability/PD claims handling experience is required! Non-Standard insurance experience is preferred but not required. Texas Licensed Adjuster - All Lines is required (Multi-State licensing is preferred). Excellent analytical organizational interpersonal and communication (verbal and written and phone) skills. Strong skills in the areas of verbal and written communication with an ability to develop and maintain positive customer experience and management and third-party customer relationships. Experience in an automated claims processing work environment Knowledge of fraud reduction practices General working knowledge of policies file procedures state rules and regulations. Ability to pass written examinations where required by state statutes to become a licensed Claims Adjuster. Bi-lingual in Spanish is a plus! In-Office Position (not available for hybrid or remote). Are you ready for an exciting opportunity? If you think this job is a fit for what you are looking for, great! We're excited to meet you! Job Posted by ApplicantPro

JOB ID 22741 - Healthcare Claims Specialist Applicants cannot reside in CA, CO, DE, IL, MA, MI, NJ, NY, OR, WA Pay: $18.00 per hour Type: Contract to hire Schedule: M-F, 8:00 AM to 5:00 PM EST Job description: Generate and prepare insurance claims accurately based on provider documentation and billing notes, ensuring compliance with payer requirements. Verify claim details, including CPT and ICD-10 coding, patient demographics, insurance eligibility, and authorization/referral requirements prior to submission. Apply internal billing rules and payer-specific guidelines to minimize errors and reduce claim denials. Collaborate with coders and billing staff to resolve documentation issues and meet productivity and accuracy benchmarks. Maintain HIPAA compliance and organizational standards while working remotely in a dedicated workspace with reliable high-speed internet (25 Mbps download / 10 Mbps upload). Nice to have: Experience with speciality practice Certification or coursework in medical billing, coding, or healthcare admin. Familiar with medical terminology, insurance billing practices, and revenue cycle processes. Basic understanding of CPT, ICD-10, and HCPCS coding. Requirements: Must have (2) years of recent experience in a healthcare administrative support, billing experience strongly preferred. Must be MS Office proficient and computer proficient to navigate EMRs. Must have a private, designated workspace (HIPAA compliant). Must submit speed test: 25 Mbps download speed/10 Mbps upload speed. High school diploma or equivalent Background check required Drug screening required

MSIG USA continues to grow! MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., one of the world's top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business's unique risks. Summary/Job Purpose: This position is responsible to conduct thorough investigations and evaluate and negotiate complex claims including litigation and coverage issues. Accountable to ensure compliance with MSMM Claim Handling Guidelines, including reserving and payment practices, regulatory requirements and Fair Claims Practices Acts. Essential Functions: Investigates, researches and analyzes highly complex or severe claims, including coverage issues and legal issues affecting liability and damages. Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority. Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claim practices and company policy and procedures. Attends pre-trials, trials, settlement conferences and mediations on assigned cases as required Assigns the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the company's Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness. Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews. Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations. Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement. Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations. Maintains full compliance with all state licensing and continuing education requirements to ensure current and appropriate filing/standing of all adjuster licenses. Maintains regular reporting of case status, developments and direction to Home Office staff and other appropriate parties as necessary. Ensures timely and appropriate file reports and system documentation as required by company claim manuals and procedures. Participates and/or manages special projects and assignments as needed. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and Experience Required: High School Degree or G.E.D. is required. Bachelor's degree preferred 7+ years related experience handling complex Liability or Workers' Compensation Claims It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group! It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.