Claim processor jobs in Lincoln, NE - 46 jobs

**Claims Processing - Remote** for Iowa resident candidates Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing enhancing customer satisfaction and operational excellence. _You will report to our office in Des Moines, Iowa for part of our training regimen._ **Key Responsibilities-** + _Claims Processing:_ Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies. + _Eligibility Verification:_ Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans. + _Adjudication:_ Approve, deny, or adjust claims based on payer guidelines and policy terms. + _Compliance:_ Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards. + _Documentation:_ Record claim activity, maintain audit trails, and prepare reports for management. **Required Skills & Qualifications-** + High school diploma or equivalent REQUIRED + Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers). + 2-4 years of experience in US healthcare claims processing + Familiarity with claims management software and EDI transactions. + Excellent analytical, organizational, and communication skills. + Ability to interpret insurance policies and payer guidelines. + Detail-oriented with strong problem-solving abilities. _Competencies-_ + Regulatory Knowledge - Deep understanding of US healthcare laws and payer requirements. + Accuracy & Detail Orientation - Ensures claims are processed correctly and efficiently. + Problem-Solving - Resolves claim disputes and denials effectively. **Salary and Other Compensation:** Applications will be accepted until January 30, 2025.The hourly rate for this position is between $16.00 - 17.00 per hour, depending on experience and other qualifications of the successful candidate.This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans. **Benefits:** Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:- Medical/Dental/Vision/Life Insurance- Paid holidays plus Paid Time Off- 401(k) plan and contributions- Long-term/Short-term Disability- Paid Parental Leave- Employee Stock Purchase Plan _Disclaimer:_ The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law. Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Seeking a highly skilled and experienced Commercial Auto Claims Examiner to join a team. The ideal candidate will have a strong background in handling complex commercial auto claims, including both litigated and non-litigated cases, and will be responsible for managing claims from inception to resolution. Compensation Package Salary Range: $85,000 - $105,000 annually, based on experience and qualifications. Benefits: Comprehensive health, vision, dental, life, and disability insurance. 401(k) plan with company match. Up to 11 days of vacation time, 65 days of sick pay (85-day maximum in a two-year period), seven paid holidays, and two floating holidays. Up to 20 days of paid parental leave. Potential for a discretionary bonus. 100% upfront tuition reimbursement for full-time employees. Access to a state-of-the-art, on-site gym (Omaha office), wellness programs, and low-cost downtown parking. Opportunities for professional development, networking, and volunteering. Responsibilities Handle a caseload of 135-160 commercial auto claims, including approximately 50% litigated files. Investigate, evaluate, and resolve claims, including property damage and bodily injury claims, from all over the United States. Conduct claim investigations, coverage analysis, loss assessments, and claim reserving. Manage claims from start to finish, including negotiating settlements and overseeing litigation processes. Collaborate with independent adjusters and defense counsel as needed. Maintain accurate and timely records of claims, communications, and case summaries. Ensure compliance with applicable laws and company policies. Obtain and maintain required licenses and certifications. Stay updated on insurance and claim management principles and practices. Qualifications/Requirements A Bachelor's Degree is required. Minimum of 5+ years of experience handling complex commercial auto claims. Proven experience with bodily injury claims and managing claims from start to finish. Litigation experience is required. Possession of a Texas or Florida adjuster license is highly preferred; other state licenses will also be considered. Experience in jurisdictions such as California, Texas, Florida, Georgia, and New York is highly desired. Carrier experience is strongly preferred. A stable work history is essential; candidates with frequent job changes or lack of career progression may not be considered. Strong skills in claim investigation, coverage analysis, loss assessment, claim reserving, and settlement. #LI-BC1

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment. - Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or re-adjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Family Summary/Mission Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. /Mission Reviews and adjudicates routine claims in accordance with claim processing guidelines. Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions) • Analyzes and approves routine claims that cannot be auto adjudicated. (*) • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*) • Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. • Routes and triages complex claims to Senior Claim Benefits Specialist. (*) • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*) • May facilitate training when considered topic subject matter expert. (*) • In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*) • Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*) Performance Measures Background/Experience Desired • Experience in a production environment. • Claim processing experience. Qualifications Education and Certification Requirements High School or GED equivalent. Additional Information (situational competencies, skills, work location requirements, etc.) • Ability to maintain accuracy and production standards. • Analytical skills. • Technical skills. • Oral and written communication skills. • Understanding of medical terminology. • Attention to detail and accuracy. Additional Information All your information will be kept confidential according to EEO guidelines.

The work we do matters! Hiring Agency: Banking and Finance - Agency 19 Hiring Rate: $52.885 Job Posting: JR2026-00022441 Review Examiner (Open) Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed): 02-05-2026 Job Description: NDBF is seeking the next strong addition to our Financial Institutions Division on the Review Examiner team! This is a senior policy influencing position responsible for team supervision, regulatory process development, industry analytics, as well as consideration of the future of Nebraska's financial industries. NDBF provides an opportunity for you to make a positive difference in the growth of Nebraska communities through oversight of the financial industries in Nebraska. Interested to learn more about us and our vision for making Nebraska the most trusted financial home for people and businesses? Visit our website at About NDBF | Nebraska Banking and Finance. This position is within the Financial Institutions Division of the Department of Banking and Finance. A Review Examiner is the first point of contact with a caseload of financial institutions, directly or indirectly supervises a team of financial institution examiners and administrative professionals, analyzes reports of examination, and delivers responses and reports reflecting expertise to financial institutions, consumers, Deputy Director, and Director. NDBF offers abundant opportunities for professional growth, with direct work interest in masters programs and advanced certificates in examination related topics. We also value collective learning, combined with a flexible, supportive, and collaborative work environment. This position provides the opportunity to be a part of meaningful work and make a difference through public service. If interested in this opportunity, applicants should submit a cover letter and professional resume to the Deputy Director - Financial Institutions, in conjunction with the State of Nebraska's application process. Starting Salary: $110,000/year. Salary may be adjusted according to experience, expertise, and relevant skills. The position may be underfilled if the requirements and experience below have not been met, provided the applicant is willing to complete appropriate classes or training to meet such standards. Salary would be adjusted according to experience, expertise, and relevant skills. Underfill opportunities are subject to approval. Look what we have to offer! * 13 paid holidays * Vacation and sick leave that begin accruing immediately * Military leave * 156% (that's not a typo!) state-matched retirement * Tuition reimbursement * Employee assistance program * 79% employer paid health insurance plans * Dental and vision insurance plans * Employer-paid $20,000 life insurance policy * Public Service Loan Forgiveness Program (PSLF) through the Federal government * Wide variety and availability of career advancement as the largest and most diverse employer in the State * Opportunity to be part of meaningful work and make a difference through public service * Training and Development based on your career aspirations * Collaborate team dynamic * A safe and secure environment At the State, we stand by our core values of treating others with dignity and respect, acting ethically in all situations, and creating an environment where our customer is our top priority. Apply to join our team today! Location: This position is located at the NDBF main office at 1526 K Street, Suite 300, Lincoln, NE and onsite office presence is required. Following orientation and training periods, this position could potentially work from our Omaha office location, subject to approval. Job Duties: * Oversee the examination programs of state-chartered banks, trust companies, credit unions, digital asset depositories, crypto ATMs, and other licensed entities. * Ensure regulatory and documentation standards are met for examinations. Interact with other regulators and industry professionals on matters related to safety and soundness, compliance, and specialty examination areas such as information technology, AML/CFT, trust, capital markets, accounting, financial technology, digital assets, and data analytics. * Prepare financial analysis for upcoming examinations using various resources and identify areas of increasing risk for inclusion in examination scope. * Utilize available industry resources to collect, analyze, and interpret industry data, with the potential opportunity to deliver content in presentations to both internal and external parties. * Maintain information systems and act as an expert resource to Department staff. * Review and analyze reports of examination related to financial institutions as prepared by the examination team. Prepare formal summaries of examination findings and professional written responses addressing significant findings, plans for corrective action, and regulatory guidance. * Provide guidance, training, and supervision to financial institution examiners on matters related to regulatory oversight, examination procedures and findings, workpaper documentation standards, and preparation of reports. Complete examiner-in-charge evaluations and provide constructive feedback as necessary. Assist examiners and financial industry professionals in interpreting and applying laws, rules, regulations, policies, and regulatory guidance. * Train, mentor, and oversee administrative professionals on matters related to information reporting systems, application processing, industry communications, and other administrative duties as assigned. Complete assigned performance evaluations and provide constructive feedback as necessary. Assist administrative professionals in ensuring consistent operations of the Department. * Monitor the changing trends and overall condition of supervised financial institutions. Coordinate and participate in meetings with the Board of Directors of financial institutions and other regulators. Provide recommendations as to the extent of supervision needed and prepare supervisory documents such as Matters Requiring Board Attention, Consent Orders, Memoranda of Understanding, and Board Resolutions. Make recommendations regarding the scope and frequency of examinations and visitations. Review progress reports and all necessary follow up documentation. * Provide input and assist with the preparation of the examination schedule and monitor the successful completion of all deadlines and requirements. * Coordinate and complete regulatory investigations, as necessary. * Evaluate, research, and recommend action regarding consumer inquiries and complaints. * Evaluate training needs for administrative professionals and financial institution examiners, and coordinate resources to maintain sufficient knowledge and expertise among Department staff. * Interpret policy, write policy recommendations, research trends, and practices as required to accomplish NDBF goals and maintain examination standards as set by the Conference of State Bank Supervisors and federal regulatory agencies. * Evaluate applications or requests for approval submitted for financial institution licenses, charters, operating locations, changes in control, mergers, dividends, and other areas requiring approval. Effectively communicate with financial industry professionals and their legal counsel regarding additional information needed, application status, and the determination, once complete. Prepare summary memoranda and make recommendations to the Deputy Director and Director based on detailed and informed analysis. * Present general regulatory issues to small and large groups representing NDBF in speaking engagements, as assigned. * Attend continuing education events, as assigned. * Complete all other duties as assigned and necessary to support the NDBF vision and mission. Requirements / Qualifications Minimum Qualifications: To qualify for this Review Examiner position, the candidate must possess a sound knowledge of general financial institution operations and examination principles, with five years regulatory experience within the last 10 years, including serving as Examiner-in-Charge of safety and soundness financial institution examinations. The candidate must have earned a bachelor's or graduate degree from an accredited college or university related to business, finance, accounting, fintech, economics, analytics, or similar field. A minimum of six semester hours in accounting is required. Preferred: Regulatory experience of a caseload of financial institutions in a similar role of Review Examiner, Case Manager, Managing Examiner, or comparable role. Other: The chosen candidate will be expected to achieve and maintain professional certification opportunities as they arise. Continuing education requirements will be assigned. Supervisory experience is helpful, but not required. Occasional travel is required, including some overnight travel. A valid driver's license or the ability to provide independent authorized transportation, and evidence of vehicle insurance is required. Regular and reliable attendance required. Knowledge, Skills and Abilities Strong ability to define problems, collect, and analyze data, draw valid conclusions, prepare reports, and monitor financial trends and performance. Must be able to communicate effectively with teammates, industry professionals, other regulators, and the public, both orally and in writing, to present analyses, conclusions, and opinions clearly, concisely, and professionally. Must have excellent review, analysis, and editing abilities. Strong computer skills including proficiency with Microsoft applications and ability to learn various examination and database software programs. Willing to learn new processes and skillfully adapt to change quickly. Must be motivated to set and achieve individual and group goals, work with limited supervision, and be a positive team player. Must be able to travel occasionally. Possess the highest integrity, strong leadership and conflict management skills, and personal accountability and ethics. If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: ************************** Benefits We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation. Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: ************************************************** Equal Opportunity Statement The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Specialist, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$117,000 - $125,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Applied Underwriters, Inc., a global risk services company, is seeking to hire an experienced Claims Examiner to join our large loss claims team. In this role, you will use your strong communication, investigation, and negotiation skills to successfully manage a diverse caseload of commercial general liability claims. This person must appreciate the sensitive nature of complex, litigated liability claims and have extensive knowledge on policy interpretation and negligence standards. At Applied Underwriters, employees have been at the heart of our success story for more than 30 years. Headquartered in Omaha, NE, our company thrives on innovation and empowers our employees to shape the future of global risk services. Join a team where your ideas are valued and your talents are nurtured with formal, paid training and mentorship. Experience a workplace culture that celebrates initiative, recognizes results, and provides outstanding benefits that allow you to focus on achieving your full potential. Requirements: Juris Doctorate At least two years experience working in an insurance defense capacity or as a Commercial Claims Examiner. Personal injury attorneys encouraged to apply. Proficient in the use of software programs, including Microsoft Word, Excel, and Outlook. Our Benefits Include: 100% employer-paid medical, dental, and vision insurance for employees 401(k) plan with 100% immediate vesting and a 4% company match Paid time off (PTO) and paid holidays On-site pharmacy, Promesa, provides convenient prescription delivery directly to you Life, disability, critical illness and accident insurance Employee Assistance Program (EAP) Pre-tax Flexible Spending Accounts for health, dependent care, and commuter-related expenses Tuition reimbursement Fitness reimbursement and various additional quality-of-life benefits Applied Underwriters is a global risk services firm helping business and people manage uncertainty through its business services, insurance, and reinsurance solutions. As a company, we truly operate differently within our business sector. Applied Underwriters has one of the highest customer retention rates in the industry - a success directly attributed to our employees and their high level of commitment, hard work, and ambition.

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $20/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

Experienced Claims Representative - Workers' Compensation We are seeking a seasoned workers' compensation professional to work with clients to control costs and exposure and help injured workers get back to work. In this position, you will handle workers' compensation claims involving litigated, loss time and complicated medical claims. This position offers a hybrid/home-based work opportunity. The successful candidate must reside in the state of SD, KS, NE, MO, or IA to be considered. A minimum of three years of progressive workers' compensation claims handling experience to include handling litigated claims and files with larger losses is required Experience in the Midwest jurisdictions is preferred Proven decision making and problem-solving skills Excellent verbal and written communication skills Must be proficient in Microsoft Word and Excel In our 30+-year history, we've soared to great heights, reimagined ourselves, and gained a profound awareness of the value we bring as experienced workers' compensation insurance providers. Today our reputation has grown as the region's leading workers' compensation insurance writer. While our product is insurance, what we truly sell is safer workplaces, help for companies looking to protect their employees, and support for people at their most vulnerable. We offer a competitive wage and benefits package including medical, dental and vision coverage, paid holidays, paid parental leave PTO, 401K, and much more! At RAS, we believe in an inclusive work environment, where employees are welcomed, valued, respected, and heard to ensure that individuals bring their best selves to work. RAS provides equal opportunities to all qualified candidates without regard to race, color, religion, sexual orientation, gender identity or expression, age, disability status, veteran status, national origin, or any other status protected under federal, state or local law.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Title: Claims analyst Duration: 12 months Job Description: Family Summary/Mission Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/Mission Reviews and adjudicates routine claims in accordance with claim processing guidelines. Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions) • Analyzes and approves routine claims that cannot be auto adjudicated. (*) • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. (*) • Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. • Routes and triages complex claims to Senior Claim Benefits Specialist. (*) • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. (*) • May facilitate training when considered topic subject matter expert. (*) • In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). (*) • Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). (*) Performance Measures Background/Experience Desired • Experience in a production environment. • Claim processing experience. Qualifications Education and Certification Requirements High School or GED equivalent. Additional Information (situational competencies, skills, work location requirements, etc.) • Ability to maintain accuracy and production standards. • Analytical skills. • Technical skills. • Oral and written communication skills. • Understanding of medical terminology. • Attention to detail and accuracy. Additional Information All your information will be kept confidential according to EEO guidelines.

The work we do matters! Hiring Agency: Banking and Finance - Agency 19 Hiring Rate: $52.885 Job Posting: JR2026-00022441 Review Examiner (Open) Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed): 02-05-2026 Job Description: NDBF is seeking the next strong addition to our Financial Institutions Division on the Review Examiner team! This is a senior policy influencing position responsible for team supervision, regulatory process development, industry analytics, as well as consideration of the future of Nebraska's financial industries. NDBF provides an opportunity for you to make a positive difference in the growth of Nebraska communities through oversight of the financial industries in Nebraska. Interested to learn more about us and our vision for making Nebraska the most trusted financial home for people and businesses? Visit our website at About NDBF | Nebraska Banking and Finance. This position is within the Financial Institutions Division of the Department of Banking and Finance. A Review Examiner is the first point of contact with a caseload of financial institutions, directly or indirectly supervises a team of financial institution examiners and administrative professionals, analyzes reports of examination, and delivers responses and reports reflecting expertise to financial institutions, consumers, Deputy Director, and Director. NDBF offers abundant opportunities for professional growth, with direct work interest in masters programs and advanced certificates in examination related topics. We also value collective learning, combined with a flexible, supportive, and collaborative work environment. This position provides the opportunity to be a part of meaningful work and make a difference through public service. If interested in this opportunity, applicants should submit a cover letter and professional resume to the Deputy Director - Financial Institutions, in conjunction with the State of Nebraska's application process. Starting Salary: $110,000/year. Salary may be adjusted according to experience, expertise, and relevant skills. The position may be underfilled if the requirements and experience below have not been met, provided the applicant is willing to complete appropriate classes or training to meet such standards. Salary would be adjusted according to experience, expertise, and relevant skills. Underfill opportunities are subject to approval. Look what we have to offer! • 13 paid holidays • Vacation and sick leave that begin accruing immediately • Military leave • 156% (that's not a typo!) state-matched retirement • Tuition reimbursement • Employee assistance program • 79% employer paid health insurance plans • Dental and vision insurance plans • Employer-paid $20,000 life insurance policy • Public Service Loan Forgiveness Program (PSLF) through the Federal government • Wide variety and availability of career advancement as the largest and most diverse employer in the State • Opportunity to be part of meaningful work and make a difference through public service • Training and Development based on your career aspirations • Collaborate team dynamic • A safe and secure environment At the State, we stand by our core values of treating others with dignity and respect, acting ethically in all situations, and creating an environment where our customer is our top priority. Apply to join our team today! Location: This position is located at the NDBF main office at 1526 K Street, Suite 300, Lincoln, NE and onsite office presence is required. Following orientation and training periods, this position could potentially work from our Omaha office location, subject to approval. Job Duties: Oversee the examination programs of state-chartered banks, trust companies, credit unions, digital asset depositories, crypto ATMs, and other licensed entities. Ensure regulatory and documentation standards are met for examinations. Interact with other regulators and industry professionals on matters related to safety and soundness, compliance, and specialty examination areas such as information technology, AML/CFT, trust, capital markets, accounting, financial technology, digital assets, and data analytics. Prepare financial analysis for upcoming examinations using various resources and identify areas of increasing risk for inclusion in examination scope. Utilize available industry resources to collect, analyze, and interpret industry data, with the potential opportunity to deliver content in presentations to both internal and external parties. Maintain information systems and act as an expert resource to Department staff. Review and analyze reports of examination related to financial institutions as prepared by the examination team. Prepare formal summaries of examination findings and professional written responses addressing significant findings, plans for corrective action, and regulatory guidance. Provide guidance, training, and supervision to financial institution examiners on matters related to regulatory oversight, examination procedures and findings, workpaper documentation standards, and preparation of reports. Complete examiner-in-charge evaluations and provide constructive feedback as necessary. Assist examiners and financial industry professionals in interpreting and applying laws, rules, regulations, policies, and regulatory guidance. Train, mentor, and oversee administrative professionals on matters related to information reporting systems, application processing, industry communications, and other administrative duties as assigned. Complete assigned performance evaluations and provide constructive feedback as necessary. Assist administrative professionals in ensuring consistent operations of the Department. Monitor the changing trends and overall condition of supervised financial institutions. Coordinate and participate in meetings with the Board of Directors of financial institutions and other regulators. Provide recommendations as to the extent of supervision needed and prepare supervisory documents such as Matters Requiring Board Attention, Consent Orders, Memoranda of Understanding, and Board Resolutions. Make recommendations regarding the scope and frequency of examinations and visitations. Review progress reports and all necessary follow up documentation. Provide input and assist with the preparation of the examination schedule and monitor the successful completion of all deadlines and requirements. Coordinate and complete regulatory investigations, as necessary. Evaluate, research, and recommend action regarding consumer inquiries and complaints. Evaluate training needs for administrative professionals and financial institution examiners, and coordinate resources to maintain sufficient knowledge and expertise among Department staff. Interpret policy, write policy recommendations, research trends, and practices as required to accomplish NDBF goals and maintain examination standards as set by the Conference of State Bank Supervisors and federal regulatory agencies. Evaluate applications or requests for approval submitted for financial institution licenses, charters, operating locations, changes in control, mergers, dividends, and other areas requiring approval. Effectively communicate with financial industry professionals and their legal counsel regarding additional information needed, application status, and the determination, once complete. Prepare summary memoranda and make recommendations to the Deputy Director and Director based on detailed and informed analysis. Present general regulatory issues to small and large groups representing NDBF in speaking engagements, as assigned. Attend continuing education events, as assigned. Complete all other duties as assigned and necessary to support the NDBF vision and mission. Requirements / Qualifications Minimum Qualifications: To qualify for this Review Examiner position, the candidate must possess a sound knowledge of general financial institution operations and examination principles, with five years regulatory experience within the last 10 years, including serving as Examiner-in-Charge of safety and soundness financial institution examinations. The candidate must have earned a bachelor's or graduate degree from an accredited college or university related to business, finance, accounting, fintech, economics, analytics, or similar field. A minimum of six semester hours in accounting is required. Preferred: Regulatory experience of a caseload of financial institutions in a similar role of Review Examiner, Case Manager, Managing Examiner, or comparable role. Other: The chosen candidate will be expected to achieve and maintain professional certification opportunities as they arise. Continuing education requirements will be assigned. Supervisory experience is helpful, but not required. Occasional travel is required, including some overnight travel. A valid driver's license or the ability to provide independent authorized transportation, and evidence of vehicle insurance is required. Regular and reliable attendance required. Knowledge, Skills and Abilities Strong ability to define problems, collect, and analyze data, draw valid conclusions, prepare reports, and monitor financial trends and performance. Must be able to communicate effectively with teammates, industry professionals, other regulators, and the public, both orally and in writing, to present analyses, conclusions, and opinions clearly, concisely, and professionally. Must have excellent review, analysis, and editing abilities. Strong computer skills including proficiency with Microsoft applications and ability to learn various examination and database software programs. Willing to learn new processes and skillfully adapt to change quickly. Must be motivated to set and achieve individual and group goals, work with limited supervision, and be a positive team player. Must be able to travel occasionally. Possess the highest integrity, strong leadership and conflict management skills, and personal accountability and ethics. If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: ************************** Benefits We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation. Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: ************************************************** Equal Opportunity Statement The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Liability Claims Examiner - General Liability Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult general liability and auto liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Assesses liability and resolves claims within evaluation. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + 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 for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of General Liability claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in_ _this job posting only, the range of starting pay for this role is $75,000 - $95,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ \#Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Complex Claims Specialist - Workers' Compensation (Remote) Seeking an experienced Complex Claims Specialist with a strong background in handling complex Workers' Compensation claims. This role involves managing a caseload of high-severity claims, including catastrophic injuries, across multiple jurisdictions. The ideal candidate will possess extensive knowledge of Workers' Compensation regulations, laws, and best practices. This is a 100% remote position with occasional travel required for mediations, training, and departmental meetings. Compensation Package Salary Range: $100,000 - $125,000 (depending on experience) Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities As a Complex Claims Specialist, your key responsibilities will include: Investigating coverage, determining compensability, and managing high-exposure Workers' Compensation claims involving catastrophic injuries and complex cases. Establishing and updating reserves throughout the claim lifecycle to reflect exposure, with documented rationale. Resolving claims within authority limits and making case value recommendations to senior leadership for cases exceeding authority. Collaborating with outside defense counsel to manage litigated files in accordance with established guidelines. Partnering with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills. Ensuring compliance with state and federal Workers' Compensation regulations. Providing exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors. Developing creative resolution strategies for complex cases, utilizing internal and external resources effectively. Documenting claim files in accordance with company and regulatory guidelines. Identifying subrogation potential and red flags requiring Special Investigations Unit (SIU) involvement. Training new team members and acting as a technical resource for less experienced claims representatives. Maintaining continuing education requirements. Qualifications/Requirements Knowledge and Experience: Active adjuster license required. Minimum of 10 years of experience handling complex Workers' Compensation claims. Multi-state experience in jurisdictions such as California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions is required). Proficiency in structured settlements and Medicare Set-Asides. Strong negotiation, analytical, organizational, and time management skills. Ability to work independently in a fast-paced, virtual office environment. Advanced verbal and written communication skills for interacting with internal and external stakeholders. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to prioritize tasks effectively under pressure. Education: Bachelor's degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion. #LI-BC1

Experienced Claims Representative - Workers' Compensation We are seeking a seasoned workers' compensation professional to work with clients to control costs and exposure and help injured workers get back to work. In this position, you will handle workers' compensation claims involving litigated, loss time and complicated medical claims. This position offers a hybrid/ home-based work opportunity . The successful candidate must reside in the state of SD, KS, NE, MO, or IA to be considered. A minimum of three years of progressive workers' compensation claims handling experience to include handling litigated claims and files with larger losses is required Experience in the Midwest jurisdictions is preferred Proven decision making and problem-solving skills Excellent verbal and written communication skills Must be proficient in Microsoft Word and Excel In our 30+-year history, we've soared to great heights, reimagined ourselves, and gained a profound awareness of the value we bring as experienced workers' compensation insurance providers. Today our reputation has grown as the region's leading workers' compensation insurance writer . While our product is insurance, what we truly sell is safer workplaces, help for companies looking to protect their employees, and support for people at their most vulnerable. We offer a competitive wage and benefits package including medical, dental and vision coverage, paid holidays, paid parental leave PTO, 401K, and much more! At RAS, we believe in an inclusive work environment, where employees are welcomed, valued, respected, and heard to ensure that individuals bring their best selves to work. RAS provides equal opportunities to all qualified candidates without regard to race, color, religion, sexual orientation, gender identity or expression, age, disability status, veteran status, national origin, or any other status protected under federal, state or local law.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment. * Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or re-adjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Liability Claims Examiner - General Liability Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE: To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Analyzes and processes complex or technically difficult general liability and auto liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. * Assesses liability and resolves claims within evaluation. * Negotiates settlement of claims within designated authority. * Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. * Prepares necessary state fillings within statutory limits. * 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 for our clients. * Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. * Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. * Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. * Ensures claim files are properly documented and claims coding is correct. * Refers cases as appropriate to supervisor and management. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of General Liability claims management experience or equivalent combination of education and experience required. Skills & Knowledge * Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Good interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Service Expectations TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000 - $95,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Seeking a highly skilled and experienced Complex Claims Specialist to join a team. This role involves managing complex litigated commercial auto and heavy equipment bodily injury claims, including liability disputes, fatality claims, and complicated injury cases. The ideal candidate will have a strong background in handling commercial auto claims, litigation experience, and a proven ability to manage claims from inception to resolution. Compensation Package Salary Range: $100,000 - $145,000 per year Employment Type: Permanent Comprehensive benefits package Responsibilities Manage a caseload of 110-150 complex litigated claims, with 90% being litigated files. Handle claims involving commercial auto and heavy equipment, such as 18-wheelers, garbage trucks, dump trucks, and commercial buses. Investigate and resolve liability disputes, fatality claims, and complicated bodily injury claims. Oversee claims from all over the United States, ensuring timely and accurate resolution. Collaborate with legal teams and other stakeholders to manage litigation processes effectively. Qualifications/Requirements Minimum of 5+ years of experience handling complex commercial auto claims. Proven expertise in managing bodily injury claims. Litigation experience is required. Experience handling claims from start to finish, including investigation, evaluation, and resolution. Familiarity with jurisdictions such as Texas, Florida, California, Georgia, and New York is highly desired. Possession of a valid home state adjuster license (Texas and Florida licenses are preferred). Bachelor's Degree is required; Juris Doctor (JD) preferred but not mandatory. A stable work history with demonstrated career progression. Prior experience with insurance carriers is highly desirable. Strong analytical, negotiation, and communication skills. #LI-BC1

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims in a call center environment. * Respond to inbound calls to provide support for provider claims adjudication activities including responding to provider to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or re-adjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.