Complex Claims Examiner -FAIRCO
Claim processor job in New York, NY
For a description, see PDF at: ************ transre. com/wp-content/uploads/2025/10/FAIRCO-Complex-Claims-Examiner.
pdf
Claims Examiner
Claim processor job in Jersey City, NJ
With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠.
Position Summary
The Claims Division is seeking a team member to join the Shared Services Team as a Claims Examiner. Responsibilities include investigating, evaluating and resolving various types of commercial first and third party low complexity claims. This requires accurate and thorough documentation, as well as completion of resolution action plans based upon the applicable law, coverage and supporting evidence.
Responsibilities:
* Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level
* Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution
* Review and analyze supporting damage documentation
* Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions
* Establish appropriate loss and expense reserves with documented rationale
* Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines
Experience & Qualifications
* Hands-on experience and strong aptitude with Outlook, Microsoft Excel, PowerPoint, and Word
* Knowledge of ImageRight preferred
* Exceptional communication (written and verbal), influencing, evaluation, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines
* Ability to take part in active strategic discussions and leverage technical knowledge to make cost-effective decisions
* Strong time management and organizational skills; ability to adhere to both internal and external regulatory timelines
* Ability to work well independently and in a team environment
* Texas Claim Adjuster license preferred, but not required for posting. Upon employment candidate would be required to obtain Texas Claim Adjuster license within six months of hire date.
Education
* Bachelor's degree preferred
* 3-5 years' experience handling the process of commercial insurance claims
#LI-SW1
#LI-HYBRID
For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.
$71,900 - $97,110/year
* Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.
* Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits.
Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team.
14400 Arch Insurance Group Inc.
Auto-ApplyClaims Processor
Claim processor job in Commack, NY
Required Qualifications (as evidenced by an attached resume): Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience.
Preferred Qualifications:
Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel.
Brief Description of Duties:
The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties:
Duties:
Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims.
Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized.
Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc.
Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate.
Assist in the resolution of billing issues, i.e., WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error.
Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network.
Assist in the education of program guidelines and claims processes to external providers.
Assist in the maintenance of the comprehensive claims process, i.e. through input of suggestions for quality improvement or revisions to best practices.
Other duties or projects as assigned.
Special notes:
The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA.
**The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required.
For this position, we are unable to sponsor candidates for work visas.
Resume/CV and cover letter should be included with the online application.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA.
In accordance with the Title II Crime Awareness and Security Act
a
copy of our crime statistics can be viewed
here
.
Visit our WHY WORK HERE page to learn about the total rewards we offer.
SUNY Research Foundation\: A Great Place to Work.
The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting.
Auto-ApplyClaims Examiner
Claim processor job in New York, NY
Job Description
Jones Jones LLC is a trusted leader in workers' compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. Our firm values growth, integrity, and excellence across every level of our organization.
We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow within a premier workers' compensation firm.
The Firm is located at 5 Hanover Square, New York, NY and this is a hybrid position.
Essential Functions
1. Claims Adjusting Work (NYTIC / Emerald):
Perform intake and coverage verification via WCB employer coverage search
Initiate three-point contact (employer/clamant/provider) within 24 hours
Conduct compensability analysis and develop action plans
Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement
Calculate AWW and benefit rates; set and review reserves at key milestones
Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections
Route medical bills to bill review and ensure fee schedule compliance
Prepare for hearings and maintain eCase updates
Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices
2. Licensing & Compliance (Jones Jones):
Collaborate with the Compliance team on licensing forms and regulatory filings
Review TPA scorecards and ensure compliance with WCB standards
Track and invoice licensing fees and renewals
Support examiner training and respond to licensing-related inquiries
3. ADR (MRM):
Manage intake, eligibility, and notices under the collectively bargained ADR program
Coordinate and schedule mediations
Draft case summaries and settlement proposals
Ensure adherence to Medical Network protocols and document variances
Prepare and route settlement paperwork, including Section 32 agreements
Maintain dashboards of ADR cycle times and outcomes for annual reporting
Obtain loss runs from wrap-up sponsors
4. MMG
Evaluate Independent Medical Examination (IME) reports for accuracy and compliance
Assist with administrative tasks such as schedule coordination and provider panel management
Competencies
Excellent and professional verbal and written communication skills
Strong understanding of workers' compensation best practices
Exceptional organizational skills and attention to detail
Excellent time management skills with a proven ability to meet deadlines
Strong analytical and problem-solving skills
Ability to perform well in a fast-paced, dynamic environment
Ability to maintain confidentiality and exercise discretion and sound judgment
Proficient with Microsoft Office Suite or related software
Qualifications
Bachelor's degree in business administration or related field
Active Independent Adjuster License (required)
2- 5 years of claims management experience
Apply today to join a firm with over a century of success and a future focused on innovation. Jones Jones LLC is an equal employment opportunity employer.
Complex Claims Examiner
Claim processor job in New York, NY
About Us
Since 1977 we have delivered first class solutions to insurers worldwide, by combining global reach with local decision making. We have built customer & broker relationships on years of trust, experience and execution. Through our people, our products and our partnerships, we deliver the capacity and expertise necessary to contribute to the sustainable growth of prosperous communities worldwide. To do so, our colleagues work with:
Integrity Work honestly, to enhance TransRe's reputation
Respect Value all colleagues. Collaborate actively.
Performance We reward excellence. Be accountable, manage risk and deliver TransRe's strengths
Entrepreneurship Seize opportunities. Innovate for and with customers.
Customer Focus Anticipate their priorities. Exceed their expectations.
We have the following job opportunity in our New York City office:
Description
We seek an experienced claims professional to join our growing FAIRCO team in our New York City office. FAIRCO is a subsidiary of TransRe Holdings, a Berkshire Hathaway company. As a member of FAIRCO, the Complex Claims Examiner will be responsible for adjusting Professional & Management Liability claims, with opportunities for experiences with other FAIRCO programs. Responsibilities will include but not be limited to:
Managing and adjusting primary and excess Professional & Management Liability claims, including private and public company, Directors and Officers, lawyers liability, accountants liability, financial institutions, cyber, employment practices and miscellaneous professional liability.
Proactively handling claims throughout the entire claim lifecycle from inception to resolution.
Analyzing policy coverage and drafting coverage analyses based on contract terms and claim details.
Evaluating liability and damages to determine the level of exposure to the insured and the policy.
Directing and closely monitoring assignments to defense counsel and experts in accordance with relevant guidelines.
Collaborating with underwriters, brokers, program partners, and insureds to ensure seamless claims resolution.
Traveling to and attending claims mediations, as required.
Developing and implementing claims handling strategies to mitigate risk and reduce claim expenses.
Requirements
The ideal candidate will possess the following knowledge, skills and abilities:
Extensive experience litigating or handling issues pertaining to complex Professional & Management Liability issues, with a focus on Directors and Officers coverage.
Experience leading mediations for Professional & Management Liability claims.
Experience evaluating coverage under various types of policies, drafting coverage correspondence, and participating in claims investigations.
Track record of effectively managing defense counsel and legal spend, assessing liability and financial exposure, and effectively negotiating cost effective, good faith claims resolutions.
Juris Doctorate preferred.
Willingness to travel up to 25% of the time for mediations, industry conferences, and client meetings.
Possession of, or willingness to obtain, a New York and other state adjuster's licenses.
Work Schedule
TransRe is supportive of an agile work schedule, which may differ based on individual roles, your local office's practices and preferences, marketplace trends, and TransRe's business objectives. This position is eligible for a hybrid work schedule with 3 days in the office per week, and 2 days remote.
Compensation
In addition to base salary, for this position, TransRe offers a comprehensive benefits package, paid time off, and incentive pay opportunity. The anticipated annual base salary range in New York for this position, exclusive of benefits, paid time off, and incentive pay opportunity is $140,000 - $180,000. This range is an estimate, and the actual base salary offered for this position will be determined based on certain factors, including the applicant's specific skill set and level of experience.
We are an Equal Opportunity Employer (EOE) and we support diversity in the workforce.
Auto-ApplyClaims Processor
Claim processor job in Commack, NY
Claims Processor Required Qualifications (as evidenced by an attached resume):Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting.
Previous medical claims processing experience.
Preferred Qualifications: Medical coding certification.
Knowledge of medical terminology, ICD-10 and CPT coding.
Experience with Electronic Medical Records (EMR).
Experience with an electronic billing system(s).
Experience with the Patient Keeper billing system.
Knowledge of IDX (scheduling system).
Familiarity with World Trade Center Health Program (WTCHP).
Familiarity with HIPAA.
Proficiency with Word and Excel.
Brief Description of Duties:The successful candidate must possess excellent organizational and communication skills.
S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision.
S/he will be responsible for assisting the Claims Manager with the following duties: Duties:Verifying accuracy, completeness and compliance with WTCHP guidelines.
Validating and releasing both internal and external claims.
Research claims for payment in the WTCHP InterChart and EMR.
Confirmed the patient was WTC-referred and services were authorized.
Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc.
Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines.
Deny claims when appropriate.
Assist in the resolution of billing issues, i.
e.
, WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error.
Ensure that vendors and providers are in the WTCHP network, when necessary.
Work with Claims Manager to have vendors and/or providers added to the network.
Assist in the education of program guidelines and claims processes to external providers.
Assist in the maintenance of the comprehensive claims process, i.
e.
through input of suggestions for quality improvement or revisions to best practices.
Other duties or projects as assigned.
Special notes:The Research Foundation of SUNY is a private educational corporation.
Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding.
FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA.
**The incumbent must be willing to work and travel between the Nassau and Commack clinic locations.
Occasional Evenings and Saturdays will be required.
For this position, we are unable to sponsor candidates for work visas.
Resume/CV and cover letter should be included with the online application.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA.
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here.
Visit our WHY WORK HERE page to learn about the total rewards we offer.
SUNY Research Foundation: A Great Place to Work.
The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting.
Job Number: 2504206Official Job Title: Clerical Specialist IIJob Field: Clerical/SecretarialPrimary Location: US-NY-CommackDepartment/Hiring Area: Dept of Med - WTCHPSchedule: Full-time Shift :Day Shift Shift Hours: 8:00am-4:00pm Posting Start Date: Dec 1, 2025Posting End Date: Dec 16, 2025, 4:59:00 AMSalary:$50,000-$56,000Appointment Type: RegularSalary Grade:N7 SBU Area:The Research Foundation for The State University of New York at Stony Brook
Auto-ApplyClaims Processor
Claim processor job in Commack, NY
Claims Processor Required Qualifications (as evidenced by an attached resume):Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting.
Previous medical claims processing experience.
Preferred Qualifications: Medical coding certification.
Knowledge of medical terminology, ICD-10 and CPT coding.
Experience with Electronic Medical Records (EMR).
Experience with an electronic billing system(s).
Experience with the Patient Keeper billing system.
Knowledge of IDX (scheduling system).
Familiarity with World Trade Center Health Program (WTCHP).
Familiarity with HIPAA.
Proficiency with Word and Excel.
Brief Description of Duties:The successful candidate must possess excellent organizational and communication skills.
S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision.
S/he will be responsible for assisting the Claims Manager with the following duties: Duties:Verifying accuracy, completeness and compliance with WTCHP guidelines.
Validating and releasing both internal and external claims.
Research claims for payment in the WTCHP InterChart and EMR.
Confirmed the patient was WTC-referred and services were authorized.
Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc.
Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines.
Deny claims when appropriate.
Assist in the resolution of billing issues, i.
e.
, WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error.
Ensure that vendors and providers are in the WTCHP network, when necessary.
Work with Claims Manager to have vendors and/or providers added to the network.
Assist in the education of program guidelines and claims processes to external providers.
Assist in the maintenance of the comprehensive claims process, i.
e.
through input of suggestions for quality improvement or revisions to best practices.
Other duties or projects as assigned.
Special notes:The Research Foundation of SUNY is a private educational corporation.
Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding.
FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA.
**The incumbent must be willing to work and travel between the Nassau and Commack clinic locations.
Occasional Evenings and Saturdays will be required.
For this position, we are unable to sponsor candidates for work visas.
Resume/CV and cover letter should be included with the online application.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA.
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here.
Visit our WHY WORK HERE page to learn about the total rewards we offer.
SUNY Research Foundation: A Great Place to Work.
The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting.
Job Number: 2504206Official Job Title: Clerical Specialist IIJob Field: Clerical/SecretarialPrimary Location: US-NY-CommackDepartment/Hiring Area: Dept of Med - WTCHPSchedule: Full-time Shift :Day Shift Shift Hours: 8:00am-4:00pm Posting Start Date: Dec 1, 2025Posting End Date: Dec 16, 2025, 4:59:00 AMSalary:$50,000-$56,000Appointment Type: RegularSalary Grade:N7 SBU Area:The Research Foundation for The State University of New York at Stony Brook
Auto-ApplyTrucking Claims Specialist
Claim processor job in New York, NY
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
* Competitive compensation
* Healthcare benefits package that begins on first day of employment
* 401K retirement plan with company match
* Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
* Up to 6 weeks of parental and bonding leave
* Hybrid work schedule (3 days in the office, 2 days from home)
* Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
* Tuition reimbursement after 6 months of employment
* Numerous opportunities for continued training and career advancement
* And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
* Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
* Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
* Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
* Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
* Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
* Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
* Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Salary Range
$95,000.00-$145,000.00 USD
The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Qualifications
* Minimum of 3 years of trucking industry experience.
* Experience with bodily injury and/or cargo exposures.
* Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
* Strong analytical and negotiation skills, with the ability to manage multiple priorities.
* Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
* Possession of applicable state adjuster licenses.
* Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplyCommercial Auto Bodily Injury Claims Examiner
Claim processor job in New York, NY
Job DescriptionOur client is actively seeking a seasoned Commercial Auto Bodily Injury Claims Adjuster to join their growing NYC team. This person will be responsible for managing a portfolio of moderate to complex claims involving commercial auto exposures, often including litigated files. From first notice to final resolution, you'll drive the claims process with precision, ensuring timely outcomes and outstanding service. Key Responsibilities:
Conduct thorough investigations and evaluations of commercial auto bodily injury claims, exercising sound judgment within designated authority limits to ensure prompt and fair resolution.
Manage a caseload consisting of 100 - 110 Commercial Auto files with bodily injury exposures.
Collaborate with claimants, legal representatives, and other stakeholders to negotiate settlements, issue payments, and bring claims to closure effectively.
Maintain accurate documentation and prepare detailed claim status reports to support transparency and compliance throughout the claims lifecycle.
Requirements:
5 to 7+ years of experience handling Litigated Commercial Auto Bodily Injury claims.
Strong analytical thinking and attention to detail to assess coverage, liability, and damages accurately.
Excellent negotiation and communication skills, with the ability to manage complex interactions confidently.
Proficiency in modern claims management software and related technologies.
Active adjusters license, highly preferred.
Salary & Benefits:
Competitive base salary ranging from $95,000 to $110,000, depending on experience.
Comprehensive benefits package, including health, dental, and vision insurance.
Generous PTO and paid holidays.
Clear pathways for career advancement.
401(k) plan with competitive employer matching.
Associate Claims Examiner
Claim processor job in Red Bank, NJ
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it.
The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills.
Associate Claims Examiner will be responsible for the resolution of claims with the Prompt Resolution Team (PRT) of lower complexity and exposure. This position will have decision-making authority in the amount of $25,000 and work under the general direction of their manager. The ACE position supports all product lines in Casualty with particular emphasis on Binding and Commercial Wholesale Primary and Small Commercial Programs.
Job Responsibilities
Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
Conducts, coordinates and directs investigation into loss facts and extent of damages.
Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents.
Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting.
Required Qualifications
Must have or be eligible to receive claims adjuster license.
Successful completion of basic insurance courses or achievement of industry designations.
Ability to be trained in insurance adjusting up to two years of claims experience.
2-4 years of experience in general liability, construction defect, or related liability lines preferred.
Bachelor's degree preferred
Excellent written and oral communication skills.
Strong organizational and time management skills.
#
LI-Hybrid
US Work Authorization
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Pay information:
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $25 - $38.25 with a 10% bonus potential.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
Are you ready to play your part?
Choose ‘Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Auto-ApplyClaims Specialist - EPL
Claim processor job in Red Bank, NJ
This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.
About the Team
AXIS is a leading provider of specialty insurance and global reinsurance. The Employment Practices Liability team is an engaging team handling excess and primary claims for various AXIS policy forms. The strength of our team is grounded in our people and culture, encouraging collaboration, growth, and diversity.
How does this role contribute to our collective success?
The selected individual will collaborate with a team to investigate, analyze, and evaluate Third Party Liability claims, ensuring proper coverage determinations. Expertise will be developed in Employment Practices Liability while engaging with complex insureds on significant and dynamic disputes. This role offers meaningful opportunities to contribute to impactful case resolutions within specialized insurance sectors. The selected individual will also have exposure to Fiduciary Liability claims.
What Will You Do In This Role?
* Serving as a Claims Specialist focused on Employment Practices Liability Claims within AXIS' North America Claim team.
* Determining the appropriate valuation of complex claims, recommending settlement strategies, adhering to company policies, and collaborating with insureds, brokers, and partners effectively.
* Traveling to participate in mediations, observe trials, and strengthen relationships with vital AXIS partners.
* Escalating coverage concerns to internal teams and collaborating with external coverage attorneys when specific assignments necessitate their involvement.
* Developing claims and litigation strategies, delegating tasks, and overseeing the work of external legal advisors effectively.
* Assisting with underwriting inquiries while analyzing claim trends, conducting data analysis, and performing comprehensive risk assessments to support decision-making processes.
* Keeping precise records of claim activities and promptly updating systems with all relevant details ensuring accuracy and efficiency.
About You
We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals.
What We're Looking For
* Seek candidates who bring unique perspectives and diverse skills to the team.
* Contribute actively to the success of a growing and dynamic team by bringing energy and a positive attitude.
* Hold a Juris Doctorate.
* Operate efficiently in settings with high visibility, shifting deadlines, and evolving expectations while staying focused and achieving outcomes.
* Demonstrate organizational abilities and solve problems effectively.
* Exhibit outstanding skill in verbal communication and written expression.
* Showcase skill as a litigator or litigation manager, well-versed in dispute resolution.
* Write coverage letters independently with precision and attention to detail, ensuring accuracy in all aspects of the work.
Role Factors
Travel is associated with this role. The role requires you to be in office 3 days per week and adhere to AXIS licensing requirements.
What We Offer
For this position, we currently expect to offer a base salary in the range of $85,000 - $145,000. Your salary offer will be based on an assessment of a variety of factors including your specific experience and work location.
In addition, you will be offered competitive target incentive compensation, with awards based on overall corporate and individual performance. On top of this, you will be eligible for a comprehensive and competitive benefits package which includes medical plans for you and your family, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and much more.
Where this role is based in the United States of America, this role is Exempt for FLSA purposes.
About Axis
This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.
AXIS Persona
AXIS Capital seeks professionals who thrive in a dynamic, high-performing environment grounded in humility and mutual respect. We employ those who exemplify our core values of People, Excellence, Decisiveness, and Stronger Together.
We are a team characterized by integrity and self-discipline, striving for continuous improvement and driven to achieve ambitious results. Our focus is on hiring, developing, retaining, and rewarding individuals who excel in:
Purposeful Action: Delivering top-tier work with a data-driven approach and operating at AXIS speed.
Collaborative Decision-Making: Valuing input from all relevant groups and being open to debate. Able to leave their ego at the door and be committed to achieving results through teamwork, fully supporting decisions once made.
Measuring Outcomes: Consistently evaluating performance against established expectations.
The AXIS employee will cultivate a collaborative workplace atmosphere, fostering trust within the team. We believe in respectful challenges, presuming best intent, and building meaningful relationships with colleagues, customers, and the communities we serve.
Joining our team means becoming part of a workplace where every individual's contributions are valued, and excellence is pursued with purpose and passion. Together, we elevate our standards, achieve ambitious results, and make a lasting impact on each other and those we serve.
Auto-ApplyClaims Specialist
Claim processor job in New York, NY
Why Shiftsmart
We're building the Amazon of labor. We're a labor platform pairing end-to-end workforce management technology with a rapidly growing global network of 5M flexible workers to create scalable labor solutions for the largest companies and government agencies in the world like Circle K, Pepsi, Walmart, Starbucks and more. Our unique business model fractionalizes jobs down to shifts and makes it easy for workers to work across multiple companies through a digital marketplace. We're one of the fastest-growing startups in the country. We've grown 2-3x each year since we started, paid over $130M in wages to hourly workers, and raised $120M+ from top-tier investors including D1 Capital & Imaginary Ventures…
and we're only getting started.
Mission:
The mission of the Privacy and Compliance function is to ensure Shiftsmart processes and policies adhere to relevant legal and regulatory requirements and ensure positive & safe experiences for both users, clients, and company. You will be directly contributing in helping create and maintain a resource for both customers and users to assist with any privacy or legal related requests.
This role is based in New York City (HQ) with typically 4+ days in office
Outcomes:
This role will handle a diverse array of incidents and issues, but should always focus on solving for clarity, thoroughness, and risk mitigation.This position will evolve over time but some of your early responsibilities will include:
Gather, organize, and analyze information related to incidents and escalated complaints.
Support the creation of comprehensive written investigative reports based on gathered data.
Perform initial analysis of all escalated incidents and complaints, considering factors such as location, type of task, and the nature of the issue.
Coordinate closely with the Customer, Support, and Operations teams to compile relevant data, records, and other evidence necessary for investigative reports.
Maintain a robust tracking system to monitor the outcomes of all escalations and investigated cases.
Meet response time SLAs for communicating with partners, law enforcement contacts, and customer contacts.
Competencies:
Experience: You have 1-2 years of experience in employee relations, as a claims analyst, or in an investigatory role with the potential, motivation and ambition to grow and thrive in a fast-paced environment.
Communication: You have excellent communication skills and enjoy helping people feel heard, know how to ask the important questions, and analyze the relevant information into a report
Results driven: Takes pride in & has a track record of hitting or exceeding targets; persists in accomplishing objectives despite obstacles or setbacks. You thrive in an environment where success is measured in metrics and improvement
Collaboration: Ability to work closely with all areas of the company to be a problem solver. This role will handle a diverse array of incidents and issues, but should always focus on solving for clarity, thoroughness, and risk mitigation.
Highly organized: You plan, organize and execute in a highly structured way & relish bringing formality to ambiguity, ruthlessly prioritize, and feel organization is second nature to you.
Independent: Able to function with a high-level of autonomy once given a playbook.
Compensation philosophy
To provide greater transparency we share base salary ranges, which are based on role and level benchmarked against similar stage, high growth companies. Offers are determined based on multiple factors including skills, work experience, and relevant credentials.
In addition to competitive salaries and meaningful equity we offer the following benefits:
Comprehensive healthcare coverage: We cover 100% of employee premiums for medical, dental, and vision care (60-75% for dependents)
401(k) match program: We match 100% on the first 3% of your contributions and 50% on the next 2% for a maximum match of 4%
Generous, fully paid parental and family leave policies
Pre-tax commuter benefits
Collaborative office with fully stocked kitchen @ 1 World Trade in Manhattan
Equal opportunity employer
Shiftsmart is committed to creating a diverse environment and is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Operating Principles @ Shiftsmart
Inspired by Leadership Principles @ Amazon
Execution Is Binary
We #GetShiftDone. We take immense pride in both the quality of our work and our relentless determination to deliver on our commitments. If we say we are going to do something, we do it.
We own the outcome with an unstoppable mindset through the finish line and are impatient to move the ball forward. This means we work really hard, execute with urgency, and ruthlessly challenge timelines for anything important. As a result, we do not defer responsibility to other teams or individuals. Instead, we take the problem as far as we can and only when needed ask others for help.
Each time a crisis or opportunity emerges we take the hill as one team, because we are allergic to the words
“it can't be done”
.
Missionaries, Not Mercenaries
We before me. We believe in our mission to build a better world for workers. We understand why our work matters and take seriously how it impacts our customers and our partners. This belief permeates everything we do from the strategic to the mundane.
We are energetic, ambitious, and want to win. We constantly raise the standards for ourselves and everyone around us. We show up for our customers, our partners, and most importantly our teammates, and make every effort to build lasting relationships with each of them.
We do not measure success based on our titles or the size of our empires. This also means we put the needs of the business before the details of our job descriptions. Rather than fight for a bigger piece of the pie, we fight to grow the entire thing and recognize this is how to grow our careers too.
Inputs > Outcomes
We work really hard. Fundamentally changing how labor works is not easy. It often requires long days, late nights, and weekends to deliver on our commitments. We lean into this challenge.
We focus on the process. We think in terms of value chains and appreciate that a bad process with a good outcome is simply dumb luck.
We lead with data. We use facts, not fiction, to build narratives and make decisions. To do this we prepare written memos in advance and resist the urge to engage in endless water cooler what ifs, because we value the time and attention of our teammates.
We hire and develop the best. When we decide to hire a new team member, we do so because we believe they will increase the talent density on our team. We view ourselves as leverage maximizers rather than inconvenience reducers and strive to increase the output of everyone we interact with.
Honesty Over Harmony
We share the truth even when it is painful. We do not, however, share the truth callously to hurt people's feelings or make them look bad. We also assume positive intent. If someone is not delivering in a way that we need, we ask them and tell them before assuming the worst.
We embrace mutual feedback. As people leaders we care more about our team's growth and success than how much others like us. As individuals we seek, accept, and apply feedback. We do not give or take feedback personally because we understand it enables us to learn and grow.
We tell the truth to ourselves. We reject a pollyannaish view of our world. Instead if something isn't going well that we are responsible for, we call it out. And when someone calls out their own truth that may be less optimal, we don't punish them for it.
We have the meeting in the meeting. If something is broken or we disagree, we call it out and say something in the moment even if it feels uncomfortable to do so. This means that if something is broken, we do not just accept it and complain later.
Invent & Iterate
We are ********************* categorically reject the phrase
“that is how it's always been done”
, and constantly discover new and better ways to do more with less. This means we are resourceful and often do things that don't scale, only to create ways to scale them later. We're builders.
We think BIG. At every level of the company, we embrace big, hairy, audacious, and transformative goals. We fear lack of progress and incremental thinking more than failing to deliver or falling short of an audacious goal. We believe courage means to try without fear and learn without ego.
We do not let perfect get in the way of better. When faced with the choice we prioritize delivering something, even if imperfect, over endless debate and alignment. We embrace good mistakes.
Auto-ApplyClaims Specialist
Claim processor job in New York, NY
SourceProSearch is seeking a Claims Specialist with 1-2 years of experience to work in our New York office. The ideal candidate should be comfortable with technology and platforms. This position requires at least 2 days per week in the office.
Job Responsibilities:
Format documents and communications for clients.
Liaise between third-party vendors and the firm.
Review documents (release/document verification) for production to defense counsel for quality control.
Calendaring and entry of case info into the database.
Perform intake and initial filtering of client inquiries.
Preparation of submissions involving large volumes of individual claims.
Run and analyze client data reports.
Organize documents and communications with clients.
Ensure that case documents accurately reflect a client's individual information.
Keep track of communications or developments relating to client cases and deadlines that may be applicable to individual clients.
Prepare and send client communications.
Communicate with clients telephonically, on occasion.
Work with attorneys to plan data gathering and settlement update workflows.
Analyze and summarize client inquiries to identify trends and patterns requiring further action.
Assist with the development of processes and technological systems for addressing large volumes of client interactions.
Skills/Requirements:
Proficient in the use of Microsoft Word and Excel.
Familiarity with Filesite preferred.
Familiarity with client management systems or databases preferred.
Strong technical skills and ability to quickly learn new litigation support software.
Strong written and oral communication skills and strong interpersonal skills.
Must possess great attention to detail.
Must possess analytical and critical thinking skills.
Strong organizational and time-management skills.
Ability to work independently while understanding the importance of teamwork.
Ability to manage workload consisting of multiple tasks.
The work shift for this position is 9:30 am-5:30 pm, five days a week, but the applicant must be willing and available to work overtime, both evening and weekends, when necessary.
****************************
Complex Claims Specialist - Cyber, Technology, Media & Crime
Claim processor job in New York, NY
Job Type:
Permanent
Build a brilliant future with Hiscox
Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist!
Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations:
West Hartford, CT (preferred)
Atlanta, GA
Boston, MA
Chicago, IL
Los Angeles, CA
Manhattan, NY
About the Hiscox Claims team:
The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners.
The role:
The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible.
What you'll be doing as the Complex Claims Specialist:
Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to:
Reviewing and analyzing claim documentation and legal filings
Drafting coverage analyses for tech E&O, first and third party cyber claims
Strategizing and maximizing early resolution opportunities
Monitoring litigation and managing local defense and breach counsel
Attending mediations and/or settlement conferences, either in person or by phone as appropriate
Smartly managing and tracking third-party vendor and service provider spend
Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
Liaising directly on daily basis with insureds and brokers
Maintaining timely and accurate file documentation/information in our claims management system
Our must-haves:
5+ years of professional lines claims handling experience
A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience
A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Advanced knowledge of coverage within the team's specialty or focus
Advanced knowledge of litigation process and negotiation skills
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred
What Hiscox USA Offers
Competitive salary and bonus (based on personal & company performance)
Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care)
Company paid group term life, short-term disability and long-term disability coverage
401(k) with competitive company matching
24 Paid time off days with 2 Hiscox Days
10 Paid Holidays plus 1 paid floating holiday
Ability to purchase 5 additional PTO days
Paid parental leave
4 week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox USA
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range $140,000 - $155,000 (Boston, Manhattan, West Hartford)
Salary range $125,000-$135,000 (Chicago, Atlanta)
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.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-AJ1
Work with amazing people and be part of a unique culture
Auto-ApplyTransactional Risk Claims Specialist
Claim processor job in New York, NY
Who are we? Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
* Classification: Exempt/Full-time
* Reports to: Head of Claims for Transactional Risk
* Travel: 0-15%
* Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team.
The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
* Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
* Assist with entering claim data into operational systems.
* Assist with quality control and performance management, to ensure high-quality claim handling.
* Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
* Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
* Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
* Perform other duties as assigned.
Key requirements
* Bachelor's degree required and law degree preferred.
* Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
* Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
* Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
* Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
* Ability to manage multiple competing priorities.
* Ability to adapt to evolving regulatory and legal environments.
* Complete assigned tasks correctly, on time and able to learn quickly.
* Self-motivated and demonstrating attention to detail.
* Be able to work independently for extended periods.
* Excellent written and verbal communication skills as well as general business understanding.
* Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
* If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
* Our successes have all come from someone brave enough to try something new
* We support each other in the small everyday moments and the bigger challenges
* We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
* Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
Auto-ApplyTransactional Risk Claims Specialist
Claim processor job in New York, NY
Who are we?
Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
Classification: Exempt/Full-time
Reports to: Head of Claims for Transactional Risk
Travel: 0-15%
Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team.
The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
Assist with entering claim data into operational systems.
Assist with quality control and performance management, to ensure high-quality claim handling.
Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
Perform other duties as assigned.
Key requirements
Bachelor's degree required and law degree preferred.
Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
Ability to manage multiple competing priorities.
Ability to adapt to evolving regulatory and legal environments.
Complete assigned tasks correctly, on time and able to learn quickly.
Self-motivated and demonstrating attention to detail.
Be able to work independently for extended periods.
Excellent written and verbal communication skills as well as general business understanding.
Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
Our successes have all come from someone brave enough to try something new
We support each other in the small everyday moments and the bigger challenges
We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
*Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
Auto-ApplyClaims Specialist
Claim processor job in New York, NY
We are seeking a highly skilled and detail-oriented Claims Specialist with expertise in handling No-Fault, Worker's Compensation and all other medical insurance claims. The ideal candidate must have 3+ years experience and will have a thorough understanding of regulatory requirements and processes associated with these types of claims, along with excellent communication and problem-solving skills. Must be available for employment Monday-Friday for 9a-5p employment.
Responsibilities:
Manage and process No-Fault insurance claims, including reviewing claim submission, verifying coverage, and ensuring compliance with regulatory guidelines.
Handle Worker's Compensation claims from initial filling through resolution, including investigating incidents, gathering relevant documentation, and coordinating with legal counsel as needed.
Conduct through investigation into claim validity, including medical records, and other relevant documentation.
Communicate effectively with claimants, insurance adjuster, and other stakeholders to facilitate the claims process and resolve issues in a timely manner.
Maintain accurate and up-to-date claim files and documentation, ensuring compliance with internal policies and regulatory requirements.
Obtain and verify insurance information for patients, including primary and secondary coverage, policy numbers, group numbers, and policy holder information.
Liase with insurance companies and third-party payers to confirm coverage details, policy benefits, and pre-authorization requirements.
Collaborate with medicalbillingteam to ensure accurate timely submission of claims and pre-authorizations.
Resolve insurance related issues and discrepancies, including denials and rejections, through effective communication and follow-up with insurance carriers.
Educate patients on insurance benefits, coverage limitations, and financial responsibilities, providing assistance with insurance inquiries and concerns.
Verify patient insurance coverage and eligibility.
Assist patients with insurance-related inquiries, explaining coverage details, copays, deductibles, and out-of-pocket expenses.
Prepare and submit insurance claims and billing statements.
Maintain confidentiality of patient information and ensure compliance with HIPAA regulations in all administrative activities.
Qualifications:
3+ years experience with medical insurance claims
Thorough understanding of regulatory requirements and processes
Excellent communication and problem-solving skills
Insurance Claims Specialist
Claim processor job in Ronkonkoma, NY
Job Description
The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.
DUTIES AND KEY RESPONSIBILITIES:
Claims Management and Oversight
Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
Respond to inquiries and concerns regarding new and existing claims
Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
Compliance and Reporting
Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
Monitor claim trends and identify risk mitigation opportunities.
Financial Coordination and Invoicing
Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
Work with finance team to place and monitor appropriate reserves and allocate funds.
Data Analytics and Reporting
Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
Collaboration and Communication
Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
Provide regular updates to management on claims status, strategic initiatives, and risk trends.
Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.
QUALIFICATIONS:
3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
Associate's degree required.
Excellent customer service skills
Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
Exceptional interpersonal, verbal, and written communication skills
Proven customer relationship and conflict resolution skills
Ability to develop and maintain strong working relationships with internal and external parties
Strong attention to detail and accuracy in data entry and record keeping
Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.
Professional Liability Claim Manager
Claim processor job in New York, NY
Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims.
JD preferred with good interpersonal skills.
Call for additional details.
Claims Specialist
Claim processor job in Newark, NJ
Job Title: Remote Claims Specialist
Hourly Pay: $22 -$27/hour
We are looking for a skilled Claims Specialist to join our work-from-home team. In this role, you will assist in processing and reviewing insurance claims, ensuring all necessary information is gathered, and helping resolve claims efficiently. If you have strong attention to detail and enjoy supporting customers through the claims process, this is a great opportunity for you.
Key Responsibilities:
Assist in processing insurance claims, ensuring accuracy and timely resolution
Review claims documentation, including reports, medical records, and other evidence
Communicate with claimants, insurance adjusters, and third parties to gather information
Help resolve disputes or issues with claims and escalate when necessary
Maintain detailed records of claims progress and updates
Ensure compliance with industry regulations and internal policies
Provide excellent customer service and answer inquiries related to claims
Qualifications:
Experience in insurance, claims handling, or a related field
Strong attention to detail and organizational skills
Excellent communication and customer service abilities
Ability to handle multiple claims and prioritize effectively in a remote environment
Familiarity with insurance policies and claims procedures is a plus
Must have reliable internet and a quiet, dedicated workspace
Perks & Benefits:
100% remote work flexibility
Competitive hourly pay: $22 - $27
Paid training and professional development opportunities
Flexible work hours, including evening and weekend options
Opportunities for career growth in the insurance industry
A supportive and team-oriented work environment