Claim processor jobs in Lawrence, MA - 91 jobs

AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Senior Claims Examiner - WC. The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker's compensation insurance claims through effective research, negotiation and interaction with insures, and claimants, ensuring that company resources are utilized in a cost-effective manner in the process. The adjuster reports to a WC Supervisor. Responsibilities * Thoroughly investigating workers' compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable workers' comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. * Reviewing and analyzing medical bills to confirm charges and treatment are workers' comp injury-related and in accordance with the treatment plan. * Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute * Answer questions regarding the status of pending claims from claimants, policyholders and medical providers. * Consult with attorneys regarding litigation management, settlement strategy and claim resolution. Qualifications * 3-5 years experience as a Workers Comp adjuster * MS Office experience (Work, Excel, Outlook) * Effective negotiation skills * Strong verbal and written communication skills * Ability to prioritize work load to meet deadlines * Ability to manage multiple tasks in a fast-paced environment The expected salary range for this role is $87,600-95,000.00 Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs. Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district. Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more! Qualifications We are located in Boston, but you can work from your home in this telecommuting position. You will be responsible for the fair and accurate disposition of the Company's most complex casualty claims through investigation, evaluation, and settlement or recommendation within the authority level granted by the Territorial Claim Manager. Duties Interprets and determines policy coverages under the personal lines and commercial lines classifications Investigates, analyzes, and evaluates liability and damages Develops and maintains case files that document all actions Establishes adequate and timely reserves in accordance with company guidelines Provides equitable evaluations and settlements through negotiations Directs and monitors defense counsel in the handling of cases in litigation, through conclusion by trial or settlement Identifies, investigates, and refers potential fraudulent claims to SIU Answers questions and resolves problems within established levels of authority Provides excellent customer service Assists in training and provides a resource to adjusters Performs other activities as required Qualifications College degree or commensurate casualty claims experience required 5+ years of experience handling MA auto bodily injury claims required Significant mediation and litigation experience required

The Claims Examiner Reviews, evaluates, and processes insurance claims and makes recommendations for resolution; Examines and authorizes insurance claims investigated by insurance adjusters; Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim; Communicates with agents, claimants, and policy holders; Determines settlement according to organization practices and procedures.; Works on projects/matters of limited complexity in a support role. This position manages general liability, bodily injury, property damage, personal/advertising injury, auto and other miscellaneous claims. The Claims Examiner will analyze, investigate and resolve complex claim issues, including coverage, liability and damages. The position requires familiarity with regulatory compliance requirements and tort law. Responsibilities Ensure appropriate investigation of the underlying facts and circumstances is carried out in a timely manner, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed. Recognizing exposures and ensuring reserving is appropriate and timely. Evaluating coverage issues and risk transfer opportunities. Effectively communicate exposures both internally and externally. Overall responsibility for formulating proper resolution strategy to ensure best total outcome. Position may require periodic travel to attend meditations, trials and/or other related meetings. Perform other duties as assigned Qualifications Requirements Bachelor's degree preferred CPCU or AIC Certification (Preferred) Experience handling large complex commercial casualty claims with 2-8 years of commercial casualty claim adjusting experience handling primary and excess general liability, auto and personal injury claims. Experience in claims coverage analysis. Ability to approach every task in a meticulous and thorough manner, documenting actions and communications, prioritizing, maintaining schedules; paying attention to detail and striving for accuracy at all times; identifying and meeting all deadlines. Understanding of legal procedures, regulatory compliance and states' statutes. Strong oral and written communication skills with the ability to communicate professionally at all levels within and outside the organization. Insurance designations a plus. Strong computer skills including Microsoft Office Word, Outlook and Excel.

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. What you will do Responsible for reviewing receipt submissions for required information. Outreach to providers, pharmacies, and members to obtain additional information as needed. Reviewing settlement documentation to determine whether a receipt is reimbursable. Keying in the necessary information to create a claim. Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor. Maintain the expected turnaround time for processing receipts. Performing other clerical tasks, as required. Demonstrates a commitment to service by consistent attendance and punctuality. Skills and Abilities Proficient in MS Office. Excellent critical thinking and decision-making skills. Good administrative and organizational skills. Excellent written and verbal communication skills with ability to adapt communication style depending on audience. Meticulous attention to detail. Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation. Ability to work independently and as part of a team. Education Qualifications H.S. Diploma or General Education Degree (GED) required Experience Qualifications 0-2 years experience as a Claims Processor or in a related role required The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation. #LI-BB1 #LI-HYBRID Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.

If you're looking for a meaningful career, you'll find it here at Webster. Founded in 1935, our focus has always been to put people first--doing whatever we can to help individuals, families, businesses and our colleagues achieve their financial goals. As a leading commercial bank, we remain passionate about serving our clients and supporting our communities. Integrity, Collaboration, Accountability, Agility, Respect, Excellence are Webster's values, these set us apart as a bank and as an employer. Come join our team where you can expand your career potential, benefit from our robust development opportunities, and enjoy meaningful work! A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. What you will do Responsible for reviewing receipt submissions for required information. Outreach to providers, pharmacies, and members to obtain additional information as needed. Reviewing settlement documentation to determine whether a receipt is reimbursable. Keying in the necessary information to create a claim. Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor. Maintain the expected turnaround time for processing receipts. Performing other clerical tasks, as required. Demonstrates a commitment to service by consistent attendance and punctuality. Skills and Abilities Proficient in MS Office. Excellent critical thinking and decision-making skills. Good administrative and organizational skills. Excellent written and verbal communication skills with ability to adapt communication style depending on audience. Meticulous attention to detail. Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation. Ability to work independently and as part of a team. Education Qualifications H.S. Diploma or General Education Degree (GED) required Experience Qualifications 0-2 years experience as a Claims Processor or in a related role required The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation. #LI-BB1 #LI-HYBRID Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.

The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. Responsibilities: Manages an inventory of claims to evaluate compensability/liability. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Performs other duties as assigned. Qualifications BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). Knowledge of claims investigation techniques, medical terminology and legal aspects of claims. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Responsible for extracting knowledge and insights from data in order to investigate business/operational problems through a range of data preparation, modeling, analysis, and/or visualization techniques. Essential Functions * Collects, monitors and analyzes Medicare Advantage and D-SNP Claims reporting to ensure timeliness, accuracy and compliance internally to support decisions on day-to-day operations, strategic planning, and/or specific business performance issues. * Reviews, tracks, and communicates key performance indicators (KPIs) related to regulatory compliance, timeliness, and accuracy. * Performs data validation of source-to-target data for data visuals and dashboards. * Creates and updates claim reports. * Collates, models, interprets, and analyzes data. * Identifies trends and explains variances and trends in data, recommends actions, and escalates to leaders as appropriate. * Identifies and documents enhancements to modeling techniques. * Completes thorough quality assurance procedures, ensuring accuracy, reliability, trustworthiness, and validity of work. * Provides audit support, both internal and external, which includes supporting the monthly Claims Compliance Monitoring and Organization Determination, Appeals, and Grievances (ODAG/ODR) reporting processes for all Medicare Advantage and D-SNP contracts. * Works closely with internal departments, including but not limited to Enrollment, Customer Service, Reimbursement Strategy, Benefits, Product, Configuration, IT, and Digital Services to ensure seamless coordination and integration for claims data analysis. * Collaborate with vendor partners to monitor and analyze claims reporting. * Identifies operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member and provider satisfaction. * Assist with the implementation and management of new medical health plan products or changes to existing plans. * Support the creation and maintenance of medical health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements. * Performs other duties as assigned * Complies with all policies and standards Qualifications Education * Bachelor's Degree required; experience can be substituted for degree Experience * At least 2-3years of medical claims processing and/or data analysis within the health insurance or healthcare industry experience required * Medicare experience required. * Massachusetts Medicaid experience required. Knowledge, Skills, and Abilities * Healthcare knowledge, particularly as it pertains to medical claims processing data, is preferred but not required. * Working knowledge of relational databases, SQL, Power BI, data visualization, and business intelligence tools such as Tableau. * Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred. * Project management skills and/or experience are a plus. * Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint. Additional Job Details (if applicable) Working Conditions * This is a remote role that can be done from most US states * This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 5:00 pm Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

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? 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. This position services a territory in Southeastern, South Shore and Cape Cod areas of Massachusetts . The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory. What Will You Do? * Handles 1st party property claims of moderate severity and complexity as assigned. * Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. * Broad scale use of innovative technologies. * Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. * Establishes timely and accurate claim and expense reserves. * Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. * Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. * Writes denial letters, Reservation of Rights and other complex correspondence. * Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. * Meets all quality standards and expectations in accordance with the Knowledge Guides. * Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. * Manages file inventory to ensure timely resolution of cases. * Handles files in compliance with state regulations, where applicable. * Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. * Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. * Identifies and refers claims with Major Case Unit exposure to the manager. * Performs administrative functions such as expense accounts, time off reporting, etc. as required. * Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. * May provides mentoring and coaching to less experienced claim professionals. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. * Must secure and maintain company credit card required. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. * This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * General knowledge of estimating system Xactimate. * Two or more years of previous outside property claim handling experience. * Interpersonal and customer service skills - Advanced. * Organizational and time management skills- Advanced. * Ability to work independently - Intermediate. * Judgment, analytical and decision making skills - Intermediate. * Negotiation skills - Intermediate. * Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate. * Investigative skills - Intermediate. * Ability to analyze and determine coverage - Intermediate. * Analyze, and evaluate damages -Intermediate. * Resolve claims within settlement authority - Intermediate. * Valid passport. What is a Must Have? * High School Diploma or GED. * One year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program. * Valid driver's license. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Ask Yourself This... Are you someone who thrives working in a fast-paced environment? Do you enjoy providing support to others? Then join us as a Claim Representative in Burlington, MA! What You'll Do This fast-paced, highly rewarding entry-level position is all about helping people with a focus on customer service, and is the first point of contact when a worker is injured at work. The Claim Representative handles the claim process from beginning to end; working closely with injured workers, employers, doctors, insurance companies, as well as co-workers in other departments within the company. The Claim Representative manages the claim process and treatment plans, with the goal of getting an injured worker back on the job as soon as possible. This position offers a hybrid working schedule after an initial training period. We're looking for someone that: has a college degree, has experience in a call center or customer service environment, can organize and prioritize workflows and meet company/industry deadlines, is self-motivated and once trained, able to work with little direction, and has or is willing to pursue a professional insurance designation. At A.I.M. Mutual Insurance Companies, we are committed to building a diverse and inclusive workplace, and we believe that all people are capable of great things. So, if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway! Who We Are At A.I.M. Mutual Insurance Companies, we are committed to setting the standard in service excellence. We are guided by our founding principles to help employers effectively manage their workers' compensation program, providing quality services to injured workers and creating safe workplaces. We are one of the largest regional workers' compensation specialists, and we credit our staff for putting their service-oriented work ethic and workers' compensation insurance knowledge into practice, every day, in all they do. What we do ... We provide a workers' compensation experience that ensures peace of mind for all. Why we do it ... To protect and support the well-being of all New England workers and their families. How we do it ... Listening with empathy Acting with compassion Doing the right thing Succeeding through collaboration We proudly offer robust compensation and benefits packages, including: 35-hour work week Summer hours June through September Competitive pay, with opportunities to advance Medical, dental, vision plans and pet insurance Employer-sponsored retirement plan with matching employer contribution Tuition reimbursement Company-paid life and disability insurance Paid time off and generous holiday time A.I.M. Mutual has also earned the 2024 Best Place for Working Parents business designation. At. A.I.M. Mutual, we recognize the importance of having a highly experienced staff to meet day-to-day customer needs. Come be a part of a great team of people that strives to surpass customer expectations every day. Working for A.I.M. Mutual is not just a job, it's a career. Thank you for your interest in joining the A.I.M. Mutual Insurance team!

This position is responsible for assisting the Claims Department with servicing and processing of policyholder claims. The purpose of this position is to provide clerical support to help ensure claims resolve accurately and timely. Responsibilities Demonstrate customer service skills and managing FNOL intake Managing a high volume of incoming calls Scanning and indexing claim file documentation Ability to multitask in a fast-paced environment Ability to learn basic insurance fundamentals Other related duties as assigned by supervisor Requirements High school diploma or GED required General clerical skills Professional telephone manner Excellent interpersonal and organizational skills Proficient in a PC Windows environment Demonstrate experience in Microsoft Excel Accuracy in spelling and grammar Ability to work together in a team setting on shared tasks Experience working in a paperless environment preferred Benefits At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness. Why Concord Group Insurance Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont. At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do. Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve. Compensation We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities. Equal Employment Opportunity The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state, or local law. The Concord Group participates in E-Verify.

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Worcester, Massachusetts. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $57,750 - $79,800 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $65,100 - $94,500 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.

Working as part of the Claims Department, the Litigated Claims Specialist lends expertise in the laws, regulations, and jurisdictional statutes to identify or resolve disputed claims, assuring effective reimbursement. What You'll Do Investigate/rectify partial payments from claims in litigation Secure payment on outstanding invoices Investigate claim that are in litigation Assess current and ongoing risk of continued medications service in relation to ongoing litigation Research and act upon information obtained Interact and communicate daily with other departments Communicate with external sources such as attorneys and adjusters Obtain medical documentation to facilitate/warrant collections Analyze information and data for resolution Participate and develop special processes/procedures to better the Litigated Claims Team Special projects as designated by manager What You'll Need to Succeed 2+ years Workers Compensation knowledge Bachelor's Degree or equivalent related experience Familiar with medical terminology Knowledge of databases and MS Office (Excel & Word) Knowledge of IWP reimbursement process and procedures Make A Difference With IWP Injured Workers Pharmacy (IWP) is proud to be THE Patient Advocate Pharmacy, helping injured workers around the country access their prescription medications with ease. As a specialized workers' compensation home delivery pharmacy, we collaborate with the legal, medical, and insurance communities to help injured workers return to a productive life. At IWP we believe in our service, but it's the people who make it a great place to work. We value our employees and strive for a culture of teambuilding, open mindedness, and fun. If that sounds like something you'd like to be part of, we'd love to hear from you! Your compensation will include a competitive salary, generous benefits, and opportunities for growth and development. IWP is an Equal Opportunity Employer. IWP does not discriminate on the basis of race, creed, color, religion, national origin, sex, sexual orientation, gender identity, age, physical or mental disability, or any other basis covered by appropriate law. All employment decisions are made on the basis of qualifications, merit, and business need. IWP is committed to providing reasonable accommodations for qualified individuals with physical and mental disabilities in our job application procedures. If you need assistance or an accommodation due to a disability, you may contact us at humanresources@IWPharmacy.com We will make a determination on your request for reasonable accommodation on a case-by-case basis. We are dedicated to attracting and retaining top talent with competitive and fair compensation. The salary range for this role is $23/hr - $25/hr.

Job Description The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Job Type: Permanent Build a brilliant future with Hiscox Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist! Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations: West Hartford, CT (preferred) Atlanta, GA Boston, MA Chicago, IL Los Angeles, CA Manhattan, NY About the Hiscox Claims team: The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners. The Role: The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible. What you'll be doing as the Complex Claims Specialist: Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to: Reviewing and analyzing claim documentation and legal filings Drafting coverage analyses for tech E&O, first and third party cyber claims Strategizing and maximizing early resolution opportunities Monitoring litigation and managing local defense and breach counsel Attending mediations and/or settlement conferences, either in person or by phone as appropriate Smartly managing and tracking third-party vendor and service provider spend Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager Liaising directly on daily basis with insureds and brokers Maintaining timely and accurate file documentation/information in our claims management system Our Must-Haves: 5+ years of professional lines claims handling experience A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred What Hiscox USA Offers: Competitive salary and bonus (based on personal & company performance) Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care) Company paid group term life, short-term disability and long-term disability coverage 401(k) with competitive company matching 24 Paid time off days with 2 Hiscox Days 10 Paid Holidays plus 1 paid floating holiday Ability to purchase 5 additional PTO days Paid parental leave 4 week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox USA: Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary Range: $125,000- $160,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-RM1 Work with amazing people and be part of a unique culture

Join Plymouth Rock Assurance, a dynamic leader in the insurance industry, as an Adverse Subrogation Claims Representative. We are seeking a seasoned professional to independently investigate, pursue, and recover monies from parties responsible for losses sustained by our insureds. As part of our team, you'll play a pivotal role in facilitating prompt collection and maximizing recovery. Your responsibilities will include assessing liability, negotiating settlements, and enhancing our processes with your expertise. Responsibilities: * Analyze investigations to make liability assessments, including reviewing first and third-party statements, witness testimonies, scene photos, and other relevant data. * Evaluate proximate cause, negligence, and damages to adjust reserves accordingly. * Negotiate and settle claims within your authority, seeking guidance from supervisors when necessary. * Maintain an effective follow-up system on pending files and prioritize tasks efficiently. * Act as an intermediary between the company, preferred vendors, customers, insureds, and claimants. * Utilize Adverse Stream system for case management and maintain an active diary management system. * Respond to and draft arbitration contentions, with a willingness to become certified as an arbitrator. * Adhere to privacy guidelines, laws, and regulations pertaining to claims handling. * Scrub adverse carrier proofs to secure optimal settlements, collaborating with appraisal staff or Hyper Quest as needed. Qualifications: * Proficiency in Microsoft Office Suite products and computer skills. * 3 to 5+ years of experience handling auto comparative negligence claims. * Working knowledge of the inter-company arbitration process is advantageous. * Certification from Arbitration Forums is a plus. * Bachelor's degree or equivalent combination of education and experience. * Ability to obtain state licenses when required. * Pursuing an insurance designation is beneficial but not mandatory. * Strong customer service, organizational, verbal, and written communication skills Perks and Benefits * 4 weeks accrued paid time off + 9 paid national holidays per year * Free onsite gym at our Boston Location * Tuition Reimbursement * Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) * Robust health and wellness program and fitness reimbursements * Auto and home insurance discounts * Matching gift opportunities * Annual 401(k) Employer Contribution (up to 7.5% of your base salary) * Various Paid Family leave options including Paid Parental Leave * Resources to promote Professional Development (LinkedIn Learning and licensure assistance) * Convenient location directly across from South Station and Pre-Tax Commuter Benefits Salary Range: The pay range for this position is $50,000 to $74,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. About the Company The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent".

Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character. We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world? Learn more about our unique culture and history. Job Opportunity: Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss Senior Claims Auditor with knowledge of employer group health insurance, managed care, and direct medical claims products. This position will work with our Third-Party Administrator's (TPA's) daily with interaction with several other areas in our Medical Stop-Loss Division. The position is preferably located in our Indianapolis or Plymouth Meeting, PA office. We are open to candidates who could work from out Atlanta or Boston office as well. Duties & Responsibilities: Audit specific and aggregate claims for assigned complex blocks of business Audit and process claim reimbursements Verify claims are paid in accordance with the plan document and reimbursable under the Stop Loss policy Verify participant and dependent eligibility Maintain and exceed targeted claims accuracy standards Maintain accurate and detailed information for each file Conduct implementation calls for newly sold groups Review and approve plan documents and plan amendments Initiate and further cost containment opportunities Audit program business claims across several lines within our Accident & Health Division Assist management with implementation calls for new business sold Set and adjust reserves Qualifications, Skills, and Experience: Minimum of 5+ years' experience examining and auditing medical stop loss claims Proficient with Microsoft Office Suite, especially Excel Knowledge of group insurance, managed care, and direct medical claims products Demonstrate excellent mathematical, communication and customer service skills Excellent problem-solving and critical-thinking skills Detail/results-oriented Strong analytical skills Excellent customer service Knowledge of COB, Medicare, HIPAA, CPT, ICD9/ICD10, and interpretation of employer group health plan benefits Ability to work independently with minimal supervision while meeting or exceeding established turn-around-time, production, and accuracy standards BHSI Offers: A competitive package and exciting growth opportunities for career-oriented teammates A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework Benefits that support your life and well-being, which include: Comprehensive Health, Dental and Vision benefits Disability Insurance (both short-term and long-term) Life Insurance (for you and your family) Accidental Death & Dismemberment Insurance (for you and your family) Flexible Spending Accounts Health Reimbursement Account Employee Assistance Program Retirement Savings 401(k) Plan with Company Match Generous holiday and Paid Time Off Tuition Reimbursement Paid Parental Leave NOTE: This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization. The base salary range for this position is from $70,000 - $80,000 along with annual bonus eligibility; a candidate's actual salary is commensurate with experience as determined by their relevant skills, experience, and geographical location. We value our teammates - both their capabilities and character - as demonstrated by our amazing culture.