Claim processor jobs in Maryland - 125 jobs

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

Claims Processor (Must Have SAP is Required) Duration : 4 Months contract Total Hours/week : 40.00 1 st Shift Client: Medical Device Company Job Category: Customer Service Level Of Experience: Mid-Level Employment Type: Contract on W2 (Need US Citizens Or GC Holders Only) Work days/Hours: M - F 9am - 5pm Job Description: The primary responsibility of this position is the investigation, analysis, resolution, trending and corrective action of all returns from US field engineers to support CAPA related to Return Material Authorization (RMA) procedure. Specific responsibilities include maintaining return tracker and analysis to supporting the resolution to closure and verification of CAPA effectiveness. Strong communications and problem solving skills. Ability to work independently. Competent using office software including Database management, MS Word, Excel, Internet Explorer, PowerPoint, and Outlook. Experience with SAP is required. Key responsibilities include: RMA/RGA - track shipments from FSE to Decon. Escalate any FedEx issues or incorrect tracking issues Maintain and report tracker for project purposes (region, FSE) Trending to be done by Brad team Provide root cause and FSE/DSM (Field Management) Monitor SMX closure compliance by Decon Support move to new building for Service Parts Process and setup

Why You Should Work For Us: HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Essential Functions: Reviews providers' disputes and appeals for professional and hospital claims to determine resolution according to policies and procedures. Adheres to state and federal policies and procedures when adjudicating claims, including but not limited to, interest calculation and resolution timeliness Perform any projects delegated by claims supervisor Qualifications Minimum Education/ Licensures/Qualifications High School Diploma or GED 1+ year experience handling provider disputes / appeals, preferably in PPO, Self-Funded and/or HMO setting Healthcare Background Understanding of Medical Terminology Additional Information Shift: M-F 8am-5pm RTH or Temp-To-Perm (Any transition heavily depends on performance) Pay Rate: Up to 20/hour

As a Senior Claims Specialist, you will manage 3rd party claims, providing technical guidance, support analytics, and liaise with TPAs, legal, and clients in the claims review process. You will be specifically be responsible for managing and overseeing claims in captive insurance programs. Captive insurance refers to a form of self-insurance where a company creates its own insurance company to cover its risks. In this role, you will work closely with clients, insurance brokers, and underwriters to ensure timely and accurate claims handling. Your Impact: Review and assess claims submitted by clients within captive insurance programs. Investigate and gather necessary information to determine the validity of claims. Collaborate with internal teams, external vendors, and legal counsel to resolve complex claims issues. Negotiate settlements and manage claims payments in accordance with policy terms and conditions. Provide guidance and support to junior claims specialists in handling claims effectively. Monitor claims trends and provide recommendations for process improvements to enhance efficiency and customer satisfaction. Maintain accurate claims records and documentation in compliance with regulatory requirements. Successful Candidates Will Have: Bachelor's degree in Insurance, Risk Management, Business Administration, or related field. Minimum of 5 years of experience in claims management, preferably in captive insurance or a related industry. Strong knowledge of insurance policies, coverage terms, and claims handling procedures. Excellent analytical and problem-solving skills with attention to detail. Effective communication and negotiation skills to interact with various stakeholders. Ability to work independently and prioritize tasks in a fast-paced environment. Professional certifications such as CPCU, AIC, or ARM are a plus. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, the firm serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and 5,300 employees across the US and Canada. Industry recognition includes being named a Best Places to Work in Insurance for five consecutive years (2018-2022) and to the Inc. 5000 list as one of America's Fastest Growing Private Companies. Risk Strategies is committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: $64,800 - $110,000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions. The Claims Examiner Workers' Comp understands and participates in every aspect of the WC claim process. Working in a team approach, the Claims Examiner WC will make decisions concerning reserve adjustments, develop a plan of action, and determine claim resolution. The Claims Examiner WC also works with the Adjusters, WC Manager, and fellow Amergis team members. Essential Duties and Responsibilities: + Manages full cycle claim management for assigned states to resolution + Participates in conference calls with local offices, third-party administrators (TPAs), medical providers, and other Amergis employees in order to communicate status plans + Ensures legal deadlines are met + Monitors TPA's file resolution plans + Represents Amergis in depositions, mediation, and conference calls regarding assigned claim files + Provides analysis on the financial aspects of assigned claims files + Provides excellent customer service to injured workers + Prepares WC claim reports for department management team + Reviews, identifies and makes recommendations for maintaining control and/or reducing the claims experience (loss history) of the company + Authorizes or revise reserve requests + Coordinates with Benefits team during employee's absence + Coordinates with state programs and internal departments for transitional duty + Educates branch offices about all aspects of Workers' Compensation + Assists Manager in achieving overall department goals + Performs other duties as assigned/necessary Minimum Requirements: + College degree preferred; or equivalent work experience + 5 to 10 years of Workers' Compensation experience preferred + Some legal experience strongly preferred + Good organizational skills and attention to detail + Ability to work independently and cooperatively in a team environment + Ability to communicate effectively and provide excellent customer service with individuals at all levels of the organization + Computer proficiency, including Microsoft Office applications, required + Prior experience performing internet research + Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language is required At Amergis Healthcare Staffing, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits: Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical), Health Advocate Employee Assistance Program, Health Savings Account , 401(k), 401(k) Company Match, Profit Sharing, Short Term Disability, Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death and Dismemberment Insurance, Voluntary Life and Accidental Death and Dismemberment Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Accident Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance, Pet Insurance, MilkStork, Transportation Benefit, Educational Assistance Program, College Partnership Program, Paid Time Off/Company Holidays *Benefit eligibility is dependent on employment status. Amergis Healthcare Staffing is an equal opportunity/affirmative action 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. This posting will remain active on job boards for 5 days from date of posting unless there is a good faith basis to extend the posting date. Please note that this pay range represents a good faith estimate of the compensation that will be offered for this position based on the circumstances. The actual pay offered to a successful candidate will take into account a wide range of factors, including but not limited to location, experience, and other variable factors. "Pursuant to the San Francisco Fair Chance Initiative, Amergis will consider for employment qualified applicants with arrest and conviction records"

As a Senior Claims Specialist, you will manage 3rd party claims, providing technical guidance, support analytics, and liaise with TPAs, legal, and clients in the claims review process. You will be specifically be responsible for managing and overseeing claims in captive insurance programs. Captive insurance refers to a form of self-insurance where a company creates its own insurance company to cover its risks. In this role, you will work closely with clients, insurance brokers, and underwriters to ensure timely and accurate claims handling. Your Impact: Review and assess claims submitted by clients within captive insurance programs. Investigate and gather necessary information to determine the validity of claims. Collaborate with internal teams, external vendors, and legal counsel to resolve complex claims issues. Negotiate settlements and manage claims payments in accordance with policy terms and conditions. Provide guidance and support to junior claims specialists in handling claims effectively. Monitor claims trends and provide recommendations for process improvements to enhance efficiency and customer satisfaction. Maintain accurate claims records and documentation in compliance with regulatory requirements. Successful Candidates Will Have: Bachelor's degree in Insurance, Risk Management, Business Administration, or related field. Minimum of 5 years of experience in claims management, preferably in captive insurance or a related industry. Strong knowledge of insurance policies, coverage terms, and claims handling procedures. Excellent analytical and problem-solving skills with attention to detail. Effective communication and negotiation skills to interact with various stakeholders. Ability to work independently and prioritize tasks in a fast-paced environment. Professional certifications such as CPCU, AIC, or ARM are a plus. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, the firm serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and 5,300 employees across the US and Canada. Industry recognition includes being named a Best Places to Work in Insurance for five consecutive years (2018-2022) and to the Inc. 5000 list as one of America's Fastest Growing Private Companies. Risk Strategies is committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: $64,800 - $110,000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

Established in 1991, Collabera is one of the fastest growing end-to-end information technology services and solutions companies globally. As a half a billion dollar IT company, Collabera's client-centric business model, commitment to service excellence and Global Delivery Model enables its global 2000 and leading mid-market clients to deliver successfully in an increasingly competitive marketplace. With over 8200 IT professionals globally, Collabera provides value-added onsite, offsite and offshore technology services and solutions to premier corporations. Over the past few years, Collabera has been awarded numerous accolades and Industry recognitions including. Collabera awarded Best Staffing Company to work for in 2012 by SIA. (hyperlink here) Collabera listed in GS 100 - recognized for excellence and maturity Collabera named among the Top 500 Diversity Owned Businesses Collabera listed in GS 100 & ranked among top 10 service providers Collabera was ranked: 32 in the Top 100 Large Businesses in the U.S 18 in Top 500 Diversity Owned Businesses in the U.S 3 in the Top 100 Diversity Owned Businesses in New Jersey 3 in the Top 100 Privately-held Businesses in New Jersey 66th on FinTech 100 35th among top private companies in New Jersey *********************************************** Collabera recognizes true potential of human capital and provides people the right opportunities for growth and professional excellence. Collabera offers a full range of benefits to its employees including paid vacations, holidays, personal days, Medical, Dental and Vision insurance, 401K retirement savings plan, Life Insurance, Disability Insurance. Job Description Claims Initiation Analyst II: Receives incoming calls and assists customers with questions or issues regarding potential fraudulent activity on a deposit account (checking, savings) . Takes appropriate action based on an evaluation of the customer's needs which may include, filing a new claim(s), updating and follow-up on existing claim(s), and/or reviewing appeals on denied claims. Takes personal ownership to ensure that customer requests are processed quickly and efficiently, while maintaining compliance with industry regulations and bank procedures. Responsibilities include but are not limited to: initiating claims using multiple systems and tools, providing first call resolution on inquiries, and may assist the customer in resolving disputes directly with the merchant. May debit or credit customer's accounts, as appropriate. May research and resolve other general customer account inquiries as appropriate and/or escalate issues on the customer's behalf while providing world class customer service. Understand and adhere to established service level agreements and set appropriate expectation with the clients and customers regarding the claims process. Ideal candidate will have credit card knowledge in a customer service contact center. Qualifications Critical Skills: * Claims experience (in financial industry, preferrably but not required) * Customer service experience (in a call center environment, preferred but not required) * credit card experience (preferred but not required) Additional Information Should you have any questions, please feel free to call me on ************. Email your resume to: ********************************

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. About GEICO The Government Employees Insurance Company (GEICO) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. GEICO is a wholly owned subsidiary of Berkshire Hathaway and is the third largest auto insurer in the United States. In 2023, GEICO earned premiums worth over $40 billion U.S. dollars. GEICO is going through a massive digital transformation to re-platform the Insurance industry, removing friction across Customers, Partners, Marketplace, Segments, Channels, and Experiences as we grow our reach and market share. About The Role GEICO is hiring a Innovation Analyst to join their Claims Innovation team. As an Innovation Analyst, you will support GEICO's Claims Innovation team in identifying, analyzing, and implementing opportunities to improve processes and technology. This role partners with cross-functional teams to deliver innovative solutions that enhance efficiency, accuracy, and customer experience. Responsibilities: Evaluate and analyze existing claims processes, data, and performance metrics to identify areas of opportunity for efficiency, effectiveness, or accuracy Gather and analyze data to provide insights into claims processes and performance metrics Support the development of actionable strategies and assist in implementing process and technology enhancements. Assist the Director, Claims Innovation in establishing priorities, goals, and objectives Collaborate with Operations, Product, AI/ML, and Engineering teams to define and prioritize requirements. Prepare reports and presentations summarizing findings, recommendations, and project progress. Contribute to and/or lead pilot programs, POC's, or A/B testing and reporting on performance and progress Participate in innovation workshops, ideation sessions, and design sprints. Monitor project risks, benefits, and performance metrics; escalate issues as needed. Stay informed on industry trends, emerging technologies, and best practices. About You Skills & experiences: 3+ years of experience in business process optimization, business analysis, consulting, innovation, or process engineering. Leadership experience in P&C insurance claims Bachelor's degree in Business, Finance, Economics, Statistics, or related field. Knowledge of innovation methodologies, processes, and principles Strong analytical skills and ability to interpret data for decision-making. Effective communicator with strong collaboration skills. Demonstrated ability to adapt and learn in a fast-paced environment. Commitment to diversity, equity, and inclusion. Leadership qualities: Leads from the front and isn't shy about using their voice Ability to lead and influence with empathy and humility Ability to navigate and lead through complexity Curiosity, critical thinking skills; a lifelong learner who sees situations through multiple lenses Exceptional character and an ability to instill confidence and build trust. Someone who possesses high emotional intelligence, and is an attentive, empathetic listener Location: Remote, or available office #LI-HB1 Annual Salary $82,000.00 - $172,200.00 The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations. At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

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

Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $18.22 - $27.36/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program. Job Description At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto. That's where you come in. We're looking for an Arbitrator I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details! Benefits We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies. We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans. How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program. 10 days of free child or senior care through your complimentary Care.com membership. Generous 401(k) retirement plans with up to 6% company match. Employee discounts on hundreds of items, from cars to computers to continuing education. Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance. Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so. We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well. Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines. Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making. Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases. Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution. Uses appropriate levels/limits of financial approval authority to resolve cases. Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information. Prepares and facilitates communication for resolution via telephone, email, and in-person discussion. Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold. Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements. Engages with supervisor/manager to determine if escalation is required. Performs other duties as assigned. Who You Are You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications: Minimum A high school diploma or GED and less than 2 years of related experience. Accuracy and attention to detail. Organizational and time management skills. The ability to adapt in a fluid and changing environment. Preferred 1+ years of automotive or body shop experience. Claims adjuster experience. Cox is a great place to be, wouldn't you agree? Apply today! At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits. What You'll Do From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include: Drug Testing To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited. Benefits Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.

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? LOCATION REQUIREMENT: This field position services Insureds/Agents in the Maryland area. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. * You will be issued a company vehicle for this position.* 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. 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 *********************************************************

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 Hybrid role reporting to White Marsh, MD. 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 * Requires regular and consistent attendance * Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program ("IIPP") * Additional projects and 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-Hybrid

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

Job Description Job Title: Claims Specialist Reporting to: Director of Project Management Company: Tate About Us At Tate, we are passionate about everything we do. As an independent brand operating within Kingspan Group, a global plc group of companies, Tate has been recognized worldwide as an industry leader in the development and manufacture of data center infrastructure solutions and commercial office raised access floors, for over 60 years. With revenues of over $420m and growing, Tate plays a pivotal role in offering expertise in cutting edge design engineering to craft solutions, by working collaboratively with clients as a trusted partner. Tate continues to grow and expand, operating multiple manufacturing and commercial sites across the US, Europe, the Middle East, Asia, and Australia. We are excited about our fresh, dynamic, and inclusive team of experts working on new innovations and forward-thinking designs, as we remain a market leading player within our industry. We continue to invest heavily in the best available manufacturing tools and equipment needed to adhere to Tate's world class standards and in keeping with our Planet Passionate sustainability strategy, our focus is on having minimal climate impact. We are excited to potentially welcome you as part of our team as we continue to grow on a worldwide scale. About the Role We are seeking a highly organized and customer-focused Claims Specialist to manage and resolve customer claims with precision and empathy. In this role, you will serve as the primary point of contact for customers, ensuring claims are logged, tracked, and resolved efficiently while collaborating across Manufacturing, Finance, and Customer Service teams. The ideal candidate will use strong analytical, project management, and communication skills to drive root cause analysis, implement corrective actions, and enhance the overall customer experience. What You'll Do Log, track, and manage customer claims in Salesforce from initiation to resolution. Communicate empathetically with customers, providing timely updates throughout the claims process. Collaborate with Manufacturing, Finance, and other internal teams to investigate claims and implement resolutions. Facilitate cross-functional meetings and follow up on corrective actions to ensure accountability. Identify trends in claims, perform root cause analysis, and recommend process improvements. Provide regular reports on claim volume, resolution times, root causes, and customer impact. Additional Expectations Maintain accurate and thorough documentation of all claims, communications, and outcomes. Escalate complex issues appropriately and ensure follow-through on resolutions. Uphold a high standard of service excellence in every customer interaction. Support continuous improvement initiatives by analyzing data and providing actionable insights. Manage multiple priorities effectively while maintaining attention to detail and quality. What You'll Bring Bachelor's degree in business, Project Management, or a related field. 3+ years of experience in customer service, claims resolution, or project coordination. Proficiency in Salesforce, Excel, and data analysis tools. Excellent communication, problem-solving, and organizational skills. Ability to drive cross-functional collaboration and manage multiple priorities. Preferred: experience in manufacturing or B2B environments, familiarity with root cause analysis frameworks (e.g., 5 Whys, Fishbone), exposure to corrective action planning, and project management certification (CAPM or PMP). What You'll Get Pay range: $70,000 USD to $85,000 USD. This role is eligible for a discretionary bonus. Career Scope and Advancement: As we grow, new positions and career opportunities arise, offering accelerated paths for the right candidates, locally and globally. World of Wellness Philosophy: We empower you to take charge of your health and well-being. You'll have access to a wide range of medical, dental, and vision benefits, along with personalized guidance from a “Health Advocate.” We also offer other supplemental options, including 401k, legal, disability, and theft insurance, to ensure your financial wellness. Corporate Social Responsibility: Through Planet Passionate we are determined to reduce our manufacturing carbon (CO2e) emissions to as close to zero as technically possible, together with halving carbon intensity in our primary supply chain. We are very involved in our community, and you will have ample opportunities to support us in creating a better world. Skills Development: Given the dynamic pace of our business and a strong collaborative environment, your new role will be diverse and multifaceted - allowing you to be more versatile and develop a broader skill set. Mentorship and development: At Tate, we don't believe in hierarchy; we work together as one team for one common goal. You will have access and exposure to our senior leaders and experts for learning in your role, and additional mentorship for the future. Culture: We have a great team of culture, highly collaborative, supportive, and social skills. Together we innovate, collaborate, take ownership, and strive for excellence. Stay connected with us on LinkedIn for insights into life at Tate. Join us in our mission to make a difference through exceptional solutions. Tate Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to legally protected characteristics. We are committed to providing reasonable accommodations to qualified individuals with disabilities. Employment may be contingent upon completion of post-offer requirements in accordance with applicable law.

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: Towson, Maryland. 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 $60,500 - $83,600 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 $68,200 - $99,000 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.

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. **Essential Job Duties:** + Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim's aged inventory by verifying various aspects of the system and claim + Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies + Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections + Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable **Job Requirements:** + Minimum of three (3) years of experience processing and auditing Medicare and Medicaid professional, institutional, and dental health insurance claims + Experience working with CMS and Medicaid healthcare claims highly preferred + Demonstrated skills within Microsoft Office Applications, including Excel **Benefits of Working at WelbeHealth:** Apply your claims expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for. + Medical insurance coverage (Medical, Dental, Vision) starting day one of employment + Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time + Advancement opportunities - We've got a track record of hiring and promoting from within, meaning you can create your own path! + And additional benefits Salary/Wage base range for this role is $68,640 - $77,519 / year + Bonus. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications. Compensation $68,640-$77,519 USD **COVID-19 Vaccination Policy** At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. **Our Commitment to Diversity, Equity and Inclusion** At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. **Beware of Scams** Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to ****************************

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **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:** $21.53 **Pay Range Maximum:** $32.30 _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: J273827

The Claims Analyst will perform a variety of "changes and claims" related contract administration tasks. An ideal candidate requires experience in transit projects through design, construction and commissioning phases. The Claims Analyst will be responsible for coordinating and reviewing claims / changes and engaging, strategizing, and working with various Program / Project teams to undertake the merit assessment, mitigation, and resolution of claims. The role requires commercial claim knowledge, and preferably also technical understanding, of multiple subject areas related to implementation of a large transit infrastructure projects. Responsibilities Maintain claims and early warnings' register. Review alleged claims. Carry out initial triage and risk assessment of claims. Review project correspondence, and track and report on project claims. Interface with the contractor and other stakeholders, as required, to gather additional details etc. Attend various technical and commercial project working group meetings. Requirements Required Skills: Critical thinking skills sufficient to apply analytical techniques to assess claims. The ability to liaise effectively and to work closely with various multi-disciplinary technical and project controls teams Proficiency with Microsoft Office Suite, particularly Excel. Strong organization, time management, and prioritization skills with proven ability to balance competing tasks and meet deadlines. Self-directed, detail-oriented, excellent at meeting deadlines with well-developed time management skills. Excellent communication (both written and verbal), teamwork, and interpersonal skills. Required Qualifications: Bachelor's degree in engineering, business or other relevant degree. 1 - 4 years of relevant experience Position Location Field: Hybrid - 2 or 3 days in program office