Company Details Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company's distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.
Company URL: *********************
The company is an equal opportunity employer.
Responsibilities
The Workers' Compensation Examiner is responsible for the analysis and management of workers' compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. This position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California.
Key functions include but are not limited to:
* Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
* Negotiates settlement of claims up to designated authority level and makes claims payments.
* Processes complex or technically difficult claims.
* Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
* Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
* Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
* Prepares necessary state filings within statutory limits.
* Actively manages the litigation process; ensures timely and cost effective claims resolution.
* Coordinates vendor referrals for additional investigation and/or litigation management.
* Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
* Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
* Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
* Frequently communicates with all appropriate parties involved with the claim.
* Refers cases as appropriate to management.
* Maintains professional client relationships.
* Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.
Qualifications
* Baccalaureate degree from an accredited college or university preferred
* Professional certification as applicable to workers' compensation required
* 1-4 years claims management experience
* In-depth knowledge of appropriate insurance principles and laws for workers' compensation
* Strong written and verbal communication skills
* Strong organizational skills
* Strong negotiation skills
* Strong analytical and interpretive skills
* PC literate
Additional Company Details
We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $70,000 - $85,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Sponsorship not Offered for this Role Responsibilities The Workers' Compensation Examiner is responsible for the analysis and management of workers' compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. This position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. Key functions include but are not limited to: - Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. - Negotiates settlement of claims up to designated authority level and makes claims payments. - Processes complex or technically difficult claims. - Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. - Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. - Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. - Prepares necessary state filings within statutory limits. - Actively manages the litigation process; ensures timely and cost effective claims resolution. - Coordinates vendor referrals for additional investigation and/or litigation management. - Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. - Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets. - Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner. - Frequently communicates with all appropriate parties involved with the claim. - Refers cases as appropriate to management. - Maintains professional client relationships. - Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.
$70k-85k yearly Auto-Apply 15d ago
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Claims Supervisor, Workers' Compensation (CA Expertise Required)
Cannon Cochran Management 4.0
Claim processor job in San Diego, CA
Workers' Compensation Claim Supervisor
Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking an experienced Workers' Compensation Claim Supervisor with deep California jurisdiction expertise to lead a team of 3-6 adjusters supporting a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch.
This is a hands-on leadership role for a supervisor who understands the full California workers' compensation lifecycle-from intake through resolution-and can coach adjusters through complex, fast-paced claims while ensuring strict compliance with regulatory and client-specific requirements. You'll guide claim strategy, mentor your team, and partner closely with clients to deliver consistent, high-quality outcomes.
Responsibilities
When we hire claim supervisors at CCMSI, we look for leaders who believe strong teams create strong outcomes-leaders who own results, develop people, and treat every claim with purpose and care.
Supervise and guide a team of 3-6 California Workers' Compensation adjusters handling cradle-to-grave claims
Ensure claims are investigated, evaluated, and resolved accurately, timely, and in compliance with California WC laws
Review claim files regularly, providing direction on complex, litigated, or high-exposure matters
Oversee reserve accuracy and compliance with client handling instructions
Participate in claim reviews, audits, and quality initiatives
Partner with internal teams, clients, and vendors to resolve issues and maintain service standards
Recruit, onboard, train, and mentor staff; conduct performance evaluations and manage development plans
Address personnel and administrative matters with professionalism and consistency
Ensure compliance with carrier/state reporting requirements
Qualifications
What You'll Bring
Required:
• 10+ years of WC claims experience (California jurisdiction)
• Proven experience adjusting CA WC claims from intake through resolution
• CA SIP designation or CAClaims Certificate (or ability to obtain within 60 days)
• Demonstrated leadership, coaching, and communication skills
Preferred:
• 3+ years of supervisory experience
• Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required.
• Experience supporting PEO and/or staffing accounts
• Proficiency in Microsoft Office and claims systems
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote
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$98k-110k yearly Auto-Apply 6d ago
Claims Examiner
Anchor General Insurance Group 4.1
Claim processor job in San Diego, CA
As an experienced claims professional, you will play a critical role by being part of our claims team that focus on delivering an empathetic voice and provide exceptional customer service by achieving a prompt, fair and equitable settlement according to fair claims handling requirements. In this role, you will investigate, evaluate and negotiate claims of varying complexity. This includes knowledge of contracts, investigation, and determination of coverage, liability, damages, and the setting of proper reserves. This may also include the ability to investigate, evaluate and negotiate bodily injury claims with both attorney represented claimants as well as claimants without attorney representation.
Duties and Responsibilities:
• Empathize and assist those that have been involved in an auto accident.
• Evaluate losses utilizing critical thinking and solid judgment to solve problems, make decisions, and resolve complex issues.
• Conduct prompt, thorough and fair investigations by obtaining relevant facts to determine coverage, origin and extent of loss.
• Monitor costs to ensure they are reasonable and customary.
• Keep the insured and others informed about the claim status with timely and accurate written/verbal communications to resolve claims efficiently and effectively.
• Confirm or deny coverage of the claim based on the facts and the policy terms and conditions.
• Negotiate the settlement of claims, based on experience, under varying levels of oversight from supervisor and management according to authority levels and file complexity. Maintain a diary system for file review and document files to reflect status of work being performed on the file.
• Document and communicate all claims activities timely and effectively and in a manner which supports the outcome of the claims file.
• Answer phone calls and respond to emails and voicemails in a timely manner.
• Other duties as assigned.
This is an on-site position. However, a hybrid schedule may be offered after a probationary period of 6 to 12 months, depending on experience and performance.
Qualifications
To be successful, an individual must have a disciplined approach to all job-related activities. A solid foundation of personal organization, sound decision making, analytical skills, customer service skills, and a clear understanding of team commitment are required. This individual should demonstrate the ability to communicate in a clear manner, possess excellent interpersonal skills and must also demonstrate confidence in their decision-making ability.
Exercise sound financial judgment and discretion in handling insurance claims.
Knowledge of automobile claims: coverage evaluation, claims investigation, loss assessment, evaluation, reserves, insurance regulations, negotiation, and settlement.
Knowledge of investigation management, including but not limited to taking and using recorded statements, determining coverage and application of coverage to claims, negotiation, and resolution of claims.
Knowledge of California-specific adjusting, including California insurance claims regulatory compliance, relevant case law, and Californiaclaims legal framework.
Arizona, Texas, Washington, and Oregon claim knowledge as a plus.
Self-directed individual who works well with minimal supervision.
Must have strong analytical skills necessary to make decisions, resolve issues inherent in handling claims effectively by dealing with situations at various levels of intensity and reach a resolution.
Must be able to interpret insurance policies and various contracts, perform analytical research, and make sound decisions using good judgment.
Ability to effectively operate a computer and have working knowledge of MS Office applications.
Ability to multitask.
Ability to adapt quickly in a fast-paced environment and strong attention to detail.
An effective listener with the ability to manage, analyze, and execute directions.
Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of co-workers, supervisors, managers, internal customers, external customers, vendors, and other insurance professionals.
A Texas All Claims Insurance License may be required, depending on company forecasts.
Education or Experience
Preferred: 2 or more years of experience in automobile claims handling.
Preferred: College degree.
Required: Able to meet minimum efficiency standards for customary business applications such as Word, Excel, Google Sheets, and Teams.
$55k-77k yearly est. 16d ago
Claims Processor PACE
Neighborhood Healthcare 4.0
Claim processor job in Escondido, CA
About Us Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.
Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.
As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 90k people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.
ROLE OVERVIEW and PURPOSE
The PACE ClaimsProcessor will review, analyze, and adjudicate all contracted claims for PACE participants to ensure timely and accurate payments are distributed. This position will use technology and data to identify and resolve root causes for claims and payment errors. Additionally, this role will work collaboratively with our third-party administrator (TPA), contracted providers, specialists, participants, and other departments to ensure timely resolution of invoices and claims.
RESPONSIBILITIES
* Conducts claim audits daily to cross-references provider contracts and assure payment accuracy on all claims received, suspended, approved, denied, posted, and paid
* Adjudicates and processes claims to ensure claims are allowable and have proper authorizations, including correct payment amounts, contract alignment, and current Medicare rates
* Analyzes payment ACH requests from our TPA to ensure claims are paid timely and accurately according to contractual agreements
* Processes monthly eligibility for PACE enrolled participants with Centers for Medicare & Medicaid Services (CMS) and Department of Health Care Services (DHCS)
* Researches and responds to customer inquiries, concerns or requests for EOP's throughout the life of a claim in a timely manner to ensure customer satisfaction and retention
* Understands and interprets Medicare and Medi-Cal fee schedules
* Works collaboratively with TPA to ensure risk adjustments, encounter data submissions, and accounts receivables are completed in a timely manner
* Assists in maintaining and developing claim policies and procedures
* Works closely with PACE Accounting to ensure data accuracy for financial reporting
* Maintains professional working relationships with all levels of staff, clients, and the public
* Participates in accomplishing department goals and objectives
* Operates to instill confidence in our care and in our facilities for patients, fellow employees, and other stakeholders
* Impacts patient experience by demonstrating courteous and helpful behavior and a commitment to accuracy
* Contributes to the success of the organization by participating in quality improvement activities
EDUCATION/EXPERIENCE
* High school diploma/GED required
* One-year medical billing or medical claims experience required; two years' experience preferred
* One-year electronic medical records system experience required; PACE preferred
* CPT, HCPCS and ICD-10 and revenue code experience preferred
* Experience with eligibility verification preferred
* Experience with revenue cycle processes in the healthcare setting required; examining/processing Medicare and Medicaid claims preferred
ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities)
* Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
* Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
* Knowledgeable about third-party administrator systems
* Knowledgeable about and experience with using Microsoft Office Applications
* Knowledgeable about and experience with principles and practices of the health care industry and familiarity with Medi-Cal and Medicare payers
* Knowledgeable about and experience with medical office procedures and billing insurance carriers.
* Ability to successfully manage multiple tasks simultaneously
* Excellent planning and organizational ability
* Ability to work as part of a team as well as independently
* Ability to work with highly confidential information in a professional and ethical manner
Physical Requirements
* Ability to lift/carry 25 lbs./weight
* Ability to stand or sit for long periods of time
Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!
Pay range: $24.95 - $34.93/hr hourly, depending on experience/qualifications.
$25-34.9 hourly 14d ago
Supervisor Claims
Insurance Company of The West
Claim processor job in San Diego, CA
Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!
PURPOSE OF THE JOB
The purpose of this job is to ensure efficient, effective activity within technical units assigned to produce professional and optimal claim results through aggressive claim management. This position exists to oversee, lead, and guide a unit of Claims staff while working in compliance with Company philosophies, practices, and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Establishes and maintains a high degree of the Company's philosophy and technical practices throughout the claims operation.
Conducts periodic audits of staff assignments to ensure operational workflow.
Collaborates in the preparation and delivery of Workers' Compensation education and training programs.
Manages control and direction of reported claims within the authority level established by management.
Participates in different Department projects as assigned by upper Management.
Approves, reserves and makes payments within designated limitations of authority.
Approves reserves and payments within designated limitations of authority.
Executes claims with a reserve authority of no greater than $175,000.
Recommends claim settlements on those exceeding authority, to ensure reserve adequacy on each claim within the unit.
Develops, coaches, leads and mentors a team of claims personnel to ensure claims are processed promptly, professionally and economically.
Communicates Mission, Values and other organization operating principles to staff.
Establishes and maintains the overall work cadence and ensures performance and outcomes strive for excellence in delivery and customer experience. Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition and retention.
Establishes hiring criteria, on-boarding and training requirements for incoming staff.
Oversees the performance management and development process for the department and performs performance management duties, development planning and coaching for direct reports.
Ensures adherence to all Company policies and procedures and compliance responsibilities.
SUPERVISORY RESPONSIBILITIES
Directly supervises a unit of employees within the Claims team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures.
EDUCATION AND EXPERIENCE
High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum 4-6 years of related examining experience required.
CERTIFICATES, LICENSES, REGISTRATIONS
IEA Certificate, WCCP Accreditation preferred.
KNOWLEDGE AND SKILLS
Strong understanding of Workers' Compensation claims principles and application. Strong foundation of business acumen. Basic understanding of personnel and performance strategies. Excellent verbal and written communication skills, time management, and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Ability to effectively present information to top management and/or public groups Ability to apply principles of logic to a wide range of intellectual and practical problems.
PHYSICAL REQUIREMENTS
Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
WORK ENVIRONMENT
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
We are currently not offering employment sponsorship for this opportunity
#LI-ET1 #LI-Hybrid
The current range for this position is
$90,559.93 - $152,723.07
This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
WHY JOIN ICW GROUP?
Challenging work and the ability to make a difference
You will have a voice and feel a sense of belonging
We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
Bonus potential for all positions
Paid Time Off
Paid holidays throughout the calendar year
Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.
___________________
Job Category
Claims
$90.6k-152.7k yearly Auto-Apply 12d ago
Field Property Claim Representative
The Travelers Companies 4.4
Claim processor job in San Diego, CA
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$67,000.00 - $110,600.00
Target Openings
1
What Is the Opportunity?
This role is eligible for a sign on bonus.
LOCATION REQUIREMENT: This position services Insureds/Agents in the San Diego county. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Ideal locations include Downtown, Santee, El Cajon, La Mesa, Lemon Grove, Chula Vista, Bonita, National City, La Jolla, Poway, and surrounding areas.
Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
What Will You Do?
* Handles 1st party property claims of moderate severity and complexity as assigned.
* Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates.
* Broad scale use of innovative technologies.
* Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate.
* Establishes timely and accurate claim and expense reserves.
* Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
* Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits.
* Writes denial letters, Reservation of Rights and other complex correspondence.
* Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
* Meets all quality standards and expectations in accordance with the Knowledge Guides.
* Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
* Manages file inventory to ensure timely resolution of cases.
* Handles files in compliance with state regulations, where applicable.
* Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
* Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
* Identifies and refers claims with Major Case Unit exposure to the manager.
* Performs administrative functions such as expense accounts, time off reporting, etc. as required.
* Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
* May provides mentoring and coaching to less experienced claim professionals.
* May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
* CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states.
* Must secure and maintain company credit card required.
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work.
* This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position.
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's Degree.
* General knowledge of estimating system Xactimate.
* Customer Service experience -.
* Interpersonal and customer service skills - Advanced.
* Organizational and time management skills- Advanced.
* Ability to work independently - Intermediate.
* Judgment, analytical and decision making skills - Intermediate.
* Negotiation skills - Intermediate.
* Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate.
* Investigative skills - Intermediate.
* Ability to analyze and determine coverage - Intermediate.
* Analyze, and evaluate damages -Intermediate.
* Resolve claims within settlement authority - Intermediate.
* Valid passport.
What is a Must Have?
* High School Diploma or GED.
* One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program.
* Valid driver's license.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
$67k-110.6k yearly 1d ago
Claims Innovation - Senior Analyst - Casualty or Commercial PD
Geico Insurance 4.1
Claim processor job in Poway, CA
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
About GEICO
The Government Employees Insurance Company (GEICO) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. GEICO is a wholly owned subsidiary of Berkshire Hathaway and is the third largest auto insurer in the United States. In 2023, GEICO earned premiums worth over $40 billion U.S. dollars.
GEICO is going through a massive digital transformation to re-platform the Insurance industry, removing friction across Customers, Partners, Marketplace, Segments, Channels, and Experiences as we grow our reach and market share.
About The Role
GEICO is hiring a Innovation Analyst to join their Claims Innovation team. As an Innovation Analyst, you will support GEICO's Claims Innovation team in identifying, analyzing, and implementing opportunities to improve processes and technology. This role partners with cross-functional teams to deliver innovative solutions that enhance efficiency, accuracy, and customer experience.
Responsibilities:
* Evaluate and analyze existing claims processes, data, and performance metrics to identify areas of opportunity for efficiency, effectiveness, or accuracy
* Gather and analyze data to provide insights into claims processes and performance metrics
* Support the development of actionable strategies and assist in implementing process and technology enhancements.
* Assist the Director, Claims Innovation in establishing priorities, goals, and objectives
* Collaborate with Operations, Product, AI/ML, and Engineering teams to define and prioritize requirements.
* Prepare reports and presentations summarizing findings, recommendations, and project progress.
* Contribute to and/or lead pilot programs, POC's, or A/B testing and reporting on performance and progress
* Participate in innovation workshops, ideation sessions, and design sprints.
* Monitor project risks, benefits, and performance metrics; escalate issues as needed.
* Stay informed on industry trends, emerging technologies, and best practices.
About You
Skills & experiences:
* 3+ years of experience in business process optimization, business analysis, consulting, innovation, or process engineering.
* Leadership experience in P&C insurance claims
* Bachelor's degree in Business, Finance, Economics, Statistics, or related field.
* Knowledge of innovation methodologies, processes, and principles
* Strong analytical skills and ability to interpret data for decision-making.
* Effective communicator with strong collaboration skills.
* Demonstrated ability to adapt and learn in a fast-paced environment.
* Commitment to diversity, equity, and inclusion.
Leadership qualities:
* Leads from the front and isn't shy about using their voice
* Ability to lead and influence with empathy and humility
* Ability to navigate and lead through complexity
* Curiosity, critical thinking skills; a lifelong learner who sees situations through multiple lenses
* Exceptional character and an ability to instill confidence and build trust. Someone who possesses high emotional intelligence, and is an attentive, empathetic listener
Location:
Remote, or available office
#LI-HB1
Annual Salary
$82,000.00 - $172,200.00
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
* Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
* Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
* Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
* Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$82k-172.2k yearly Auto-Apply 13d ago
Claims Examiner
Imagine Staffing Technology 4.1
Claim processor job in San Diego, CA
Job DescriptionJob ProfileJob TitleWorkers Compensation Claims Examiner (1360552) LocationRemote/Hybrid in San Diego CAHire TypeContingentHourlyopenWork ModelMonday - FridayContact Phone(443)-345-3305 Contact Emailsean@marykraft.com Nature & Scope:Positional Overview
Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices, service expectations, and specific client requirements. The examiner will also identify subrogation opportunities and negotiate settlements to achieve cost-effective resolutions.Role & Responsibility:Tasks That Will Lead To Your Success
Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
Manage claims through well-developed action plans, ensuring timely and appropriate resolutions.
Negotiate settlement of claims within designated authority limits.
Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness.
Prepare necessary state filings within statutory limits.
Oversee the litigation process to ensure timely and cost-effective resolution of claims.
Coordinate vendor referrals for additional investigation or litigation management.
Implement cost-containment strategies, including partnerships with vendors, to reduce overall claim costs.
Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
Report claims to excess carriers and respond to their inquiries in a timely and professional manner.
Maintain communication with claimants and clients, fostering professional relationships.
Ensure claims files are properly documented, with accurate coding.
Refer complex cases to supervisors or management as needed.
Skills & Experience:Qualifications That Will Help You Thrive
Bachelor's degree from an accredited college or university preferred.
Professional certifications relevant to workers' compensation claims are preferred.
Five (5) years of claims management experience or an equivalent combination of education and experience required.
Minimum of 3 years of California workers' compensation claims handling experience is mandatory.
Self-Insurance Plan (SIP) certification is preferred but not mandatory.
Expertise in insurance principles and laws, claim and disability duration, and medical management practices.
Strong knowledge of Social Security, Medicare application procedures, and recovery processes.
Excellent communication skills, both oral and written, including presentation abilities.
Proficiency in Microsoft Office and general PC literacy.
Strong analytical, interpretive, and problem-solving skills.
Strong organizational skills and the ability to manage multiple priorities effectively.
Excellent negotiation skills.
Ability to work collaboratively in a team environment and meet or exceed service expectations.
$26k-32k yearly est. 17d ago
Supervisor, Liability Claims
Alliant 4.1
Claim processor job in San Diego, CA
SUMMARY Responsible for managing, reporting and monitoring liability claims files. Provides coverage/policy interpretation for liability claims, as well as guidance on liability coverage and claims issues. Provides proactive oversight, guidance, and professional development to a team of liability Claims Adjusters.
ESSENTIAL DUTIES AND RESPONSIBILITIES Partners proactively with management to inform, analyze, educate and mitigate potential future liability claims; identifies high frequency and/or severity trends for immediate action;
Resolves complex exposure claims, using high service oriented file handling working closely with clients to resolve conflicts, settle disputes, resolve grievances;
Presents potentially problematic and high value cases to management for review and settlement boundary approval;
Manages and maintains information regarding claims and requests for documents from employees and others, and monitors claims;
Maintains claims information for regular quarterly review, and carrier notifications. Files all notices and reports of claims to all carriers;
Reviews/acts on reported litigated claims; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties;
Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization;
Proactively addresses cases involving a legal inquiry or dispute and develops a strategy to bring a case to satisfactory resolution;
Supervises staff including; motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate;
Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information);
Other duties as assigned.
QUALIFICATIONS
EDUCATION / EXPERIENCEBachelor's Degree or equivalent combination of education and experience
Eight (8) or more years related work experience
Valid Insurance License
SKILLSExcellent verbal and written communication skills
Good leadership, problem solving, and time management skills
Good planning, organizational, and prioritization skills
Ability and motivation to work independently
Ability to interface with executive - internally and externally
Proficient in Microsoft Office products
Frequent travel required (35%+)#LI-DM1
$77k-114k yearly est. 20d ago
Supervisor Claims
ICW Group 4.8
Claim processor job in San Diego, CA
Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!
PURPOSE OF THE JOB
The purpose of this job is to ensure efficient, effective activity within technical units assigned to produce professional and optimal claim results through aggressive claim management. This position exists to oversee, lead, and guide a unit of Claims staff while working in compliance with Company philosophies, practices, and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Establishes and maintains a high degree of the Company's philosophy and technical practices throughout the claims operation.
* Conducts periodic audits of staff assignments to ensure operational workflow.
* Collaborates in the preparation and delivery of Workers' Compensation education and training programs.
* Manages control and direction of reported claims within the authority level established by management.
* Participates in different Department projects as assigned by upper Management.
Approves, reserves and makes payments within designated limitations of authority.
* Approves reserves and payments within designated limitations of authority.
* Executes claims with a reserve authority of no greater than $175,000.
* Recommends claim settlements on those exceeding authority, to ensure reserve adequacy on each claim within the unit.
Develops, coaches, leads and mentors a team of claims personnel to ensure claims are processed promptly, professionally and economically.
* Communicates Mission, Values and other organization operating principles to staff.
* Establishes and maintains the overall work cadence and ensures performance and outcomes strive for excellence in delivery and customer experience. Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition and retention.
* Establishes hiring criteria, on-boarding and training requirements for incoming staff.
* Oversees the performance management and development process for the department and performs performance management duties, development planning and coaching for direct reports.
* Ensures adherence to all Company policies and procedures and compliance responsibilities.
SUPERVISORY RESPONSIBILITIES
Directly supervises a unit of employees within the Claims team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures.
EDUCATION AND EXPERIENCE
High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum 4-6 years of related examining experience required.
CERTIFICATES, LICENSES, REGISTRATIONS
IEA Certificate, WCCP Accreditation preferred.
KNOWLEDGE AND SKILLS
Strong understanding of Workers' Compensation claims principles and application. Strong foundation of business acumen. Basic understanding of personnel and performance strategies. Excellent verbal and written communication skills, time management, and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Ability to effectively present information to top management and/or public groups Ability to apply principles of logic to a wide range of intellectual and practical problems.
PHYSICAL REQUIREMENTS
Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
WORK ENVIRONMENT
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
We are currently not offering employment sponsorship for this opportunity
#LI-ET1 #LI-Hybrid
The current range for this position is
$90,559.93 - $152,723.07
This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
WHY JOIN ICW GROUP?
* Challenging work and the ability to make a difference
* You will have a voice and feel a sense of belonging
* We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
* Bonus potential for all positions
* Paid Time Off
* Paid holidays throughout the calendar year
* Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.
___________________
Job Category
Claims
$90.6k-152.7k yearly Auto-Apply 10d ago
Supervisor, Liability Claims
Alliant Insurance Services 4.7
Claim processor job in San Diego, CA
SUMMARY Responsible for managing, reporting and monitoring liability claims files. Provides coverage/policy interpretation for liability claims, as well as guidance on liability coverage and claims issues. Provides proactive oversight, guidance, and professional development to a team of liability Claims Adjusters.
ESSENTIAL DUTIES AND RESPONSIBILITIES Partners proactively with management to inform, analyze, educate and mitigate potential future liability claims; identifies high frequency and/or severity trends for immediate action;
Resolves complex exposure claims, using high service oriented file handling working closely with clients to resolve conflicts, settle disputes, resolve grievances;
Presents potentially problematic and high value cases to management for review and settlement boundary approval;
Manages and maintains information regarding claims and requests for documents from employees and others, and monitors claims;
Maintains claims information for regular quarterly review, and carrier notifications. Files all notices and reports of claims to all carriers;
Reviews/acts on reported litigated claims; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties;
Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization;
Proactively addresses cases involving a legal inquiry or dispute and develops a strategy to bring a case to satisfactory resolution;
Supervises staff including; motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate;
Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information);
Other duties as assigned.
QUALIFICATIONS
EDUCATION / EXPERIENCEBachelor's Degree or equivalent combination of education and experience
Eight (8) or more years related work experience
Valid Insurance License
SKILLSExcellent verbal and written communication skills
Good leadership, problem solving, and time management skills
Good planning, organizational, and prioritization skills
Ability and motivation to work independently
Ability to interface with executive - internally and externally
Proficient in Microsoft Office products
Frequent travel required (35%+)#LI-DM1
$83k-111k yearly est. 21d ago
Claims Investigator - Experienced
Command Investigations
Claim processor job in San Diego, CA
CLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are highly needed.
Must have reliable transportation, along with own digital recorder and camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
W/C and P&C investigations
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
$43k-59k yearly est. Auto-Apply 60d+ ago
Worker Compensation Adjuster -Glendale, CA
Avonrisk
Claim processor job in San Diego, CA
Job DescriptionWorker Compensation Claims Adjuster Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Glendale, CA We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations.
Our Mission:
To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives.
Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes.
Our Goal:
To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients.
Your Impact:
Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance
Ensure all claims are handled in accordance with relevant statutes and company guidelines
Address personnel issues promptly and decisively, keeping management informed of corrective action
Foster a collaborative and productive team environment focused on excellence in claim resolution
Our Offer:
Competitive salary and benefits package, including medical, dental, vision, and 401(k)
Opportunity for professional growth and advancement in a dynamic organization
Collaborative work environment with a team dedicated to workers' compensation excellence
Interested? Get in Touch:
To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following:
Apply to this posting
Call me directly at ************
Email ************************
We look forward to hearing from you!
“Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.”
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$53k-72k yearly est. Easy Apply 6d ago
Field Property Claim Representative
Travelers 4.8
Claim processor job in San Diego, CA
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$67,000.00 - $110,600.00Target Openings1What Is the Opportunity?This role is eligible for a sign on bonus.
LOCATION REQUIREMENT: This position services Insureds/Agents in the San Diego county. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Ideal locations include Downtown, Santee, El Cajon, La Mesa, Lemon Grove, Chula Vista, Bonita, National City, La Jolla, Poway, and surrounding areas.
Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.What Will You Do?
Handles 1st party property claims of moderate severity and complexity as assigned.
Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates.
Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves.
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with the Knowledge Guides.
Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations, where applicable.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
Identifies and refers claims with Major Case Unit exposure to the manager.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
May provides mentoring and coaching to less experienced claim professionals.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states.
Must secure and maintain company credit card required.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work.
This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's Degree.
General knowledge of estimating system Xactimate.
Customer Service experience -.
Interpersonal and customer service skills - Advanced.
Organizational and time management skills- Advanced.
Ability to work independently - Intermediate.
Judgment, analytical and decision making skills - Intermediate.
Negotiation skills - Intermediate.
Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate.
Investigative skills - Intermediate.
Ability to analyze and determine coverage - Intermediate.
Analyze, and evaluate damages -Intermediate.
Resolve claims within settlement authority - Intermediate.
Valid passport.
What is a Must Have?
High School Diploma or GED.
One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program.
Valid driver's license.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Company Details Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Client Segments: Small Business, Mid-Larger Businesses and Programs (Groups & Association Members). The company's distribution partners (agents & brokers) number 400 locations throughout the state. Preferred serves 11,000 policyholders and provides medical claims handling and claims management for policyholders as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.
Responsibilities
The Associate Claims Examiner (ACE) utilizes general understanding of department's operation and objectives. They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation.
The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player. This position requires particular attention to detail, and is often task-oriented.
This position will require 120 hours of classroom training at Supervisor's direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification.
Key functions include but are not limited to:
* Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.
* Issue Benefit Notices as required with regards to the start, changing and ending of benefits.
* Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity.
* Transmit Second Report of Information (SROI) to the State of California as required.
* Gather and document information from medical providers on disability status of claimants.
* Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made.
* Refers cases as appropriate to management by setting an activity for review.
* Maintains professional client relationships.
* Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim.
* Coordinate and process void, stop pay, and reissue Indemnity payments.
* Offer and, if accepted, enroll claimants in our EFT program.
* Attend Examiner Certification training as directed by Supervisor.
* Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements.
* Assist technical and operations with other duties as needed and as time allows.
Qualifications
* Bachelor degree from an accredited college or university preferred
* 2+ years of related administrative office work experience.
* Strong written and verbal communication skills, attention to detail and deadline structures.
* Ability to work both independently and collaboratively with all levels of staff.
* Proficient with MS Office software and PC applications and systems.
* Baccalaureate degree from an accredited college or university preferred
* Knowledge of workers' compensation principles and policies equivalent preferred.
Additional Company Details
We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $60,000-65,000 annually • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Sponsorship not Offered for this Role Responsibilities The Associate Claims Examiner (ACE) utilizes general understanding of department's operation and objectives. They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player. This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor's direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification. Key functions include but are not limited to: - Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods. - Issue Benefit Notices as required with regards to the start, changing and ending of benefits. - Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity. - Transmit Second Report of Information (SROI) to the State of California as required. - Gather and document information from medical providers on disability status of claimants. - Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made. - Refers cases as appropriate to management by setting an activity for review. - Maintains professional client relationships. - Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim. - Coordinate and process void, stop pay, and reissue Indemnity payments. - Offer and, if accepted, enroll claimants in our EFT program. - Attend Examiner Certification training as directed by Supervisor. - Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements. - Assist technical and operations with other duties as needed and as time allows.
$60k-65k yearly Auto-Apply 6d ago
Claims Supervisor, Workers' Compensation (CA Expertise Required)
Cannon Cochran Management 4.0
Claim processor job in San Diego, CA
Workers' Compensation Claim Supervisor
Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 adjusters
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking a Workers' Compensation Claim Supervisor with California jurisdiction expertise to remotely lead a team of adjusters out of our Las Vegas, NV branch. This role is critical in ensuring claims are handled accurately, efficiently, and in compliance with client and regulatory requirements. You'll provide clear guidance and direction throughout the lifecycle of each claim, while mentoring and developing your team for long-term success.
Responsibilities
• Oversee proper handling of WC claims to protect the interests of the adjuster, client, and carrier
• Review claim files regularly and provide direction on complex or litigated matters
• Assist with reserve accuracy and compliance with client handling instructions
• Participate in claim reviews and ensure adherence to jurisdictional laws and best practices
• Recruit, train, and mentor staff; conduct performance reviews and manage PIPs
• Address personnel issues and manage administrative responsibilities
• Ensure compliance with carrier/state reporting requirements
Qualifications
What You'll Bring
Required:
• 10+ years of WC claims experience (California jurisdiction)
• Prior experience adjusting WC claims from start to resolution
• CA SIP designation or CAClaims Certificate (or ability to obtain within 60 days)
• Strong leadership, communication, and organizational skills
Preferred:
• 3+ years of supervisory experience
• Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required.
• Proficiency in Microsoft Office and claims systems
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote
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$98k-110k yearly Auto-Apply 6d ago
Claims Processor PACE
Neighborhood Healthcare 4.0
Claim processor job in Escondido, CA
Job Description
About Us
Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.
Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.
As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 90k people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.
ROLE OVERVIEW and PURPOSE
The PACE ClaimsProcessor will review, analyze, and adjudicate all contracted claims for PACE participants to ensure timely and accurate payments are distributed. This position will use technology and data to identify and resolve root causes for claims and payment errors. Additionally, this role will work collaboratively with our third-party administrator (TPA), contracted providers, specialists, participants, and other departments to ensure timely resolution of invoices and claims.
RESPONSIBILITIES
Conducts claim audits daily to cross-references provider contracts and assure payment accuracy on all claims received, suspended, approved, denied, posted, and paid
Adjudicates and processes claims to ensure claims are allowable and have proper authorizations, including correct payment amounts, contract alignment, and current Medicare rates
Analyzes payment ACH requests from our TPA to ensure claims are paid timely and accurately according to contractual agreements
Processes monthly eligibility for PACE enrolled participants with Centers for Medicare & Medicaid Services (CMS) and Department of Health Care Services (DHCS)
Researches and responds to customer inquiries, concerns or requests for EOP's throughout the life of a claim in a timely manner to ensure customer satisfaction and retention
Understands and interprets Medicare and Medi-Cal fee schedules
Works collaboratively with TPA to ensure risk adjustments, encounter data submissions, and accounts receivables are completed in a timely manner
Assists in maintaining and developing claim policies and procedures
Works closely with PACE Accounting to ensure data accuracy for financial reporting
Maintains professional working relationships with all levels of staff, clients, and the public
Participates in accomplishing department goals and objectives
Operates to instill confidence in our care and in our facilities for patients, fellow employees, and other stakeholders
Impacts patient experience by demonstrating courteous and helpful behavior and a commitment to accuracy
Contributes to the success of the organization by participating in quality improvement activities
EDUCATION/EXPERIENCE
High school diploma/GED required
One-year medical billing or medical claims experience required; two years' experience preferred
One-year electronic medical records system experience required; PACE preferred
CPT, HCPCS and ICD-10 and revenue code experience preferred
Experience with eligibility verification preferred
Experience with revenue cycle processes in the healthcare setting required; examining/processing Medicare and Medicaid claims preferred
ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities)
Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
Knowledgeable about third-party administrator systems
Knowledgeable about and experience with using Microsoft Office Applications
Knowledgeable about and experience with principles and practices of the health care industry and familiarity with Medi-Cal and Medicare payers
Knowledgeable about and experience with medical office procedures and billing insurance carriers.
Ability to successfully manage multiple tasks simultaneously
Excellent planning and organizational ability
Ability to work as part of a team as well as independently
Ability to work with highly confidential information in a professional and ethical manner
Physical Requirements
Ability to lift/carry 25 lbs./weight
Ability to stand or sit for long periods of time
Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!
Pay range: $24.95 - $34.93/hr hourly, depending on experience/qualifications.
$25-34.9 hourly 15d ago
Claims Investigator - Experienced
Command Investigations
Claim processor job in San Diego, CA
Job DescriptionCLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are highly needed.
Must have reliable transportation, along with own digital recorder and camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
W/C and P&C investigations
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
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$43k-59k yearly est. 26d ago
Complex Commercial Construction Defect Claim Representative
The Travelers Companies 4.4
Claim processor job in San Diego, CA
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$94,400.00 - $155,800.00
Target Openings
1
What Is the Opportunity?
This role is eligible for a sign-on bonus of up to $20,000.
This position is hybrid (3 days in office, 2 days remote).
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.
What Will You Do?
* Directly handles assigned severity claims.
* Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
* Consults with Manager on use of Claim Coverage Counsel as needed.
* Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
* Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
* Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
* Maintains claim files and documents claim file activities in accordance with established procedures.
* Utilizes evaluation documentation tools in accordance with department guidelines.
* Proactively creates Claim File Analysis (CFA) by adhering to quality standards.
* Utilizes diary management system to ensure that all claims are handled timely.
* At required time intervals, evaluate liability & damages exposure.
* Establishes and maintains proper indemnity and expense reserves.
* Recommends appropriate cases for discussion at roundtable.
* Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
* Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
* Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance.
* Develops and employ creative resolution strategies.
* Responsible for prompt and proper disposition of all claims within delegated authority.
* Negotiates disposition of claims with insureds and claimants or their legal representatives.
* Recognizes and implements alternate means of resolution.
* Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
* Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy,
* Tracks and controls legal expenses to assure cost-effective resolution.
* Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's Degree.
* 5 years equivalent business experience.
* Advanced level knowledge and skill in claim and litigation.
* Basic working level knowledge and skill in various business line products.
* Strong negotiation and customer service skills.
* Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
* Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims.
* Able to make independent decisions on most assigned cases without involvement of supervisor.
* Openness to the ideas and expertise of others actively solicits input and shares ideas.
* Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
* Demonstrated coaching, influence and persuasion skills.
* Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
* Can adapt to and support cultural change.
* Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
* Analytical Thinking - Advanced.
* Judgment/Decision Making - Advanced.
* Communication - Advanced.
* Negotiation - Advanced.
* Insurance Contract.
* Knowledge - Advanced.
* Principles of Investigation - Advanced.
* Value Determination - Advanced.
* Settlement Techniques - Advanced.
* Legal Knowledge - Advanced.
* Medical Knowledge - Intermediate.
What is a Must Have?
* High School Degree or GED.
* 3 years of liability claim handling experience and/or comparable litigation claim experience.
* In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
* Generally, license(s) are required to be obtained within three months of starting the job.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
How much does a claim processor earn in La Mesa, CA?
The average claim processor in La Mesa, CA earns between $26,000 and $73,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.
Average claim processor salary in La Mesa, CA
$44,000
What are the biggest employers of Claim Processors in La Mesa, CA?
The biggest employers of Claim Processors in La Mesa, CA are: